An international collaboration which included some of the UK’s leading acupuncture researchers, has provided definitive evidence that acupuncture is effective for chronic pain. The collaboration gathered individual patient data for nearly 18 000 patients who took part in 29 high-quality, randomised, controlled trials of acupuncture for four chronic pain conditions: back and neck pain, shoulder pain, headache and osteoarthritis.
For each of the four conditions, true acupuncture was superior to control, and significantly more effective than usual care alone. The researchers conclude that this study provides the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain. The significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture. They hope that their findings will inform policy-making aswell as encourage clinicians to recommend acupuncture as a safe and effective treatment.
(Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis. Archives of Internal Medicine, 10 September 2012.)
Most research compiled here, concerns the clinical efficacy of acupuncture, so here I have included an economic assessment for a change. UK researchers have undertaken a systematic review of the cost-effectiveness of acupuncture for chronic pain. They looked among other things at eight economic evaluations and one cost-effectiveness analysis, covering the treatment of lower back pain, neck pain, period pain, migraines, arthritis and headaches.
Correlations were uncovered between the clinical benefits of acupuncture and medical cost savings. The UK National Institute for Health and Clinical Excellence, is normally willing to pay for treatments shown to cost up to £20 000 to £30 000 per quality life adjusted year gained; the figures for acupuncture were shown to range from only £2 500 to £15 000. Given policy-makers’ needs to base treatment access on economic as well as clinical factors, the researchers were able to conclude that acupuncture appears to be a cost-effective intervention for some chronic pain conditions.
(Costs and Consequences of Acupuncture as a Treatment for Chronic Pain: A Systematic Review of Economic Evaluations Conducted Alongside Randomised Controlled Trials. Complementary Therapies in Medicine, October 2012.)
A randomised controlled trial conducted in Italy, has found that acupuncture is as good as standard drug treatment for helping the pain of acute herpes zoster (shingles).
A total of 102 patients were randomised to receive either acupuncture or standard drug treatment (comprising as many as several drugs, as required), for four weeks. The acupuncture was administered twice per week. Both treatments were judged to be effective with no significant differences between the two groups as measured by response rates and pain scores. The authors conclude that given the reduced likelihood of cumulative drug toxicity in patients receiving acupuncture, this option is promising for future treatment of acute shingles pain.
(Acupuncture for the Treatment of Severe Acute Pain in Herpes Zoster: Results of a Nested, Open-label, Randomised Trial in the VZV Pain Study. BMC Complementary & Altern Medicine, June 2011.)
American researchers have evaluated the usefulness of acupuncture for postoperative pain. They conducted a systematic review of the evidence, including fifteen randomised controlled trials of acupuncture versus a sham control, and found that at 8 hours and 72 hours after surgery, the acupuncture groups were using significantly less opioid painkillers (eg. codeine and morphine). Furthermore, acupuncture treatment was associated with fewer opioid-related side-effects, such as nausea, sedation, dizziness, itching and urinary retention.
The authors conclude that their review suggests the perioperative administration of acupuncture may be a useful adjunct for postoperative analgesia. Further large, well-designed studies are required to confirm those findings and to answer questions regarding the most efficacious type of acupuncture and optimal timing of administration.
(Acupuncture and Related Techniques for Postoperative Pain: A Systematic Review of Randomised Controlled Trials. British Journal of Anaesthesia, August 2008.)
An audit of acupuncture for pain across almost 6000 patients who received the treatment at a specialist pain clinic in Spain over a nine year period, revealed an average success rate of 79.7%. For the audit, “success” was defined as an improvement of at least 50% in five factors: pain intensity, pain frequency, consumption of painkillers, level of incapacity, and sleep disturbance. The highest success rate (93%) was achieved in patients with headaches. The authors conclude acupuncture is effective, carries with it no severe adverse events, and considerably reduces the consumption of analgesic and anti-inflammatory drugs.
(Effectiveness of acupuncture and related techniques in treating non-oncological pain in primary healthcare-an audit. Acupuncture in Medicine, June 2007.)