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Acupuncture effective for chronic pain conditions
Clinical Question
Is acupuncture effective for the treatment of chronic pain?
Bottom line
Acupuncture, with its meridians, chi, and other concepts that do not seem to line up with anything physiologic, is vexing to most of us who trained in Western medicine. However, this meta-analysis, based on data from almost 21,000 patients, found it to be more effective than no treatment and, to a lesser extent, more effective than sham acupuncture. Given this evidence of benefit and our limited options for chronic pain treatments that don't harm more than help, acupuncture should be added to our armamentarium. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
To conduct this meta-analysis, the authors identified 44 randomized studies that evaluated the use of acupuncture to treat specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain lasting at least 4 weeks. The researchers only included studies for which treatment allocation was unambiguously concealed. Amazingly, they were able to get raw patient data to combine in their meta-analyses for 20,827 patients from 39 trials. For each chronic pain condition, acupuncture was superior to no-acupuncture control, with a moderate effect size (0.5). Acupuncture was still more effective than sham acupuncture, though the average effect size was small (0.2). Treatment effects persisted over time with only a small decrease. There was significant heterogeneity among the studies, which the authors attribute to differences in the control groups. There was limited evidence of publication bias, meaning that small studies showing no benefit may not have been published. This meta-analysis is an update of a previous meta-analysis that identified slightly better effects (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1357513).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
J’ai plusieurs patients avec des douleurs chroniques, avec cet article je peux être un plus confiant à recommander l’acupuncture comme traitement additionnel.
With this finding, it is worth considering adding acupuncture as a non pharmacologic treatment for chronic pain. Would this treatment modality impact use of opoid for chronic pain management?
Time to accept and move on already
That is a very important analysis and conclusion. We should start lobbying provincial governments, therefore to include acupunctur for specific conditions into a provincial health plans.
I run a pain clinic. I reviewed the charts of 235 consecutive patients. Using nerve blocks, manipulation, prolotherapy, and a mannitol containing cream I have developed, the average pain score when they first joined my practice was 7.6/10 and at their last visit it was 2.3/10 with 89% having pain relief. I believe these techniques are better than acupuncture to relieve musculoskeletal and neuropathic pain. In the last year, not once did I have to prescribe anything stronger than a Tramacet.
I have seen few article about acupuncture over years, all medical article show no evidence of benefit,
Most of chronic back and neck patients already acupuncture and other Rx.
I had neurologist who went to acupuncturist had no result.
My answer to my patients who question is in medical literature we have not identify any benefit My preferred choice is home exercises to be done 4 time /days on regular bases most of patient are happy after 6 months
see my above comment
Finally, some sense. We do not have the answer to chronic pain. The placebo response is powerful and should be utilized.
Garbage in, garbage out. As more studies are added to these acupuncture reviews, effect size keeps shrinking; prior probability of acupuncture working based on basic science is essentially nil; results are consistent with publication bias, statistical finagling, and placebo effects.
Good poem