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Review
, 172 (19), 1444-53

Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis

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Review

Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis

Andrew J Vickers et al. Arch Intern Med.

Abstract

Background: Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

Methods: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

Results: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

Conclusions: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. 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.

Conflict of interest statement

Conflicts of Interest

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram
Figure 2
Figure 2
Forest plots for the comparison of acupuncture with no acupuncture control.
Figure 3
Figure 3
Forest plots for the comparison of true and sham acupuncture.

Comment in

  • Needling the status quo.
    Avins AL. Avins AL. Arch Intern Med. 2012 Oct 22;172(19):1454-5. doi: 10.1001/archinternmed.2012.4198. Arch Intern Med. 2012. PMID: 22965282 No abstract available.
  • Acupuncture's elephant in the room.
    Barrett S, London WM. Barrett S, et al. JAMA Intern Med. 2013 Apr 22;173(8):712-3. doi: 10.1001/jamainternmed.2013.3743. JAMA Intern Med. 2013. PMID: 23609576 No abstract available.
  • Complexity of sham acupuncture.
    Huang W, Kutner N, Bliwise D. Huang W, et al. JAMA Intern Med. 2013 Apr 22;173(8):713. doi: 10.1001/jamainternmed.2013.3782. JAMA Intern Med. 2013. PMID: 23609577 No abstract available.
  • Placing acupuncture in perspective.
    Ziegelstein RC. Ziegelstein RC. JAMA Intern Med. 2013 Apr 22;173(8):713-4. doi: 10.1001/jamainternmed.2013.3785. JAMA Intern Med. 2013. PMID: 23609578 No abstract available.
  • In reply.
    Vickers AJ; Acupuncture Trialists' Collaboration. Vickers AJ, et al. JAMA Intern Med. 2013 Apr 22;173(8):714. doi: 10.1001/jamainternmed.2013.242. JAMA Intern Med. 2013. PMID: 23609579 No abstract available.
  • Acupuncture is superior to sham for painful conditions.
    White A, Foell J. White A, et al. Evid Based Med. 2013 Dec;18(6):e56. doi: 10.1136/eb-2013-101303. Epub 2013 May 1. Evid Based Med. 2013. PMID: 23635845 No abstract available.
  • Acupuncture for chronic pain.
    Vickers AJ, Linde K. Vickers AJ, et al. JAMA. 2014 Mar 5;311(9):955-6. doi: 10.1001/jama.2013.285478. JAMA. 2014. PMID: 24595780 Free PMC article.

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