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Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis (Vickers 2018)

A landmark paper in 2012 demonstrated that, based on the largest dataset of high quality randomised trials, acupuncture was significantly superior both to usual care and sham, for patients with chronic headache, back/neck pain and osteoarthritis. This was where it was first properly confirmed that acupuncture was not just acting as a rather good placebo. In this update the dataset now amounts to 39 trials and over 20,000 patients. New analysis shows in addition that the acupuncture effects largely persist after the end of the treatment course: only about 15 per cent is lost after 12 months. (Note: a consistent criticism by NICE has been that there was no evidence of longer-term effects. This is now seen not to be the case and patients can be reassured that the benefits are unlikely to disappear as soon as they stop treatment): https://www.ncbi.nlm.nih.gov/pubmed/29198932

A UK version of this can be found on the website of the NHS’s research arm, as they funded some of the studies (MacPherson 2017) https://www.ncbi.nlm.nih.gov/pubmed/28121095. Another recent overview (Yin 2017) confirms that there is increasing evidence for the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches. Additional data support its use as an adjunct or alternative to opioids, and in perioperative settings: acupuncture is incrementally being introduced into orthodox pain medicine practices: https://www.ncbi.nlm.nih.gov/pubmed/?term=Acupuncture+for+chronic+pain%3A+an+update+and+critical+overview

Away from the rather artificial environment of specially constructed trials, and review of those trials, it is also instructive to look at treatments in their usual setting, ie observational studies. The largest of these on chronic pain conditions, mainly back pain (45 per cent), headache (36 per cent) and osteoarthritis (12 per cent), was for acupuncture covered by the German state health insurance scheme, with 450,000 patients and 8,700 medical acupuncturists. Acupuncture proved a highly popular treatment option and 76 per cent of the patients had a good response, 16 per cent minimal and 4 per cent unchanged. Results indicate that acupuncture provided by qualified therapists is safe, and patients benefit from the treatment.

Osteoarthritis

The most up-to-date, highest quality evidence, based on very large numbers of trials and patients, is in the Vickers 2018 paper listed under chronic pain: acupuncture is better than sham or usual care: https://www.ncbi.nlm.nih.gov/pubmed/29198932

A recent systematic review specifically focused on acupuncture for chronic knee pain (Zhang et al 2017) concluded that acupuncture provided significant benefits and was as safe as the control groups: https://www.ncbi.nlm.nih.gov/pubmed/29117967

 

Infertility

Assisted conception (IVF and ICSI)
Acupuncture just at embryo transfer could provide significant IVF-related stress reduction even if it is insufficient to improve birth outcomes but more sessions, over an extended time period, may be required for optimal effect, and this has not yet been explored adequately in research trials Hullender Rubin 2018): https://www.ncbi.nlm.nih.gov/pubmed/29440044

Natural fertility: female

The vast bulk of research has been concerned with acupuncture as an adjunct to IVF and related techniques, with little devoted to natural fertility, even though it has been used for this in East Asian countries for centuries. There is preliminary evidence that it may help with menstrual and ovulatory problems in women who are having trouble getting pregnant, but much more research is needed to confirm this. There has been some focus on polycystic ovarian syndrome, with three recent reviews. They point to possible benefits for ovulation, menstruation and pregnancy rates, with regulation of reproductive hormones, but the evidence is limited and low quality (Jo 2017): https://www.ncbi.nlm.nih.gov/pubmed/28591042; (Lim 2016): https://www.ncbi.nlm.nih.gov/pubmed/27136291; (Wu 2016): https://www.ncbi.nlm.nih.gov/pubmed/26984837

In the last two years (too recent to have appeared in the reviews) at least six randomised trials of acupuncture for PCOS-related infertility, all from China, have been published in western databases. Five of them point to beneficial effects, generally compared to the drug clomiphene. The largest of them found differently, but its treatment regime, design and analysis have been criticised by many researchers, some of whom even re-analysed the data and came up with entirely different results. It can only be said that the case is still to be proven, though there is strong experimental evidence that acupuncture can influence reproductive functioning through a number of different mechanisms

Mental Health
Anxiety

The British Acupuncture Council (BAcC) has been working with the charity Anxiety UK to gather generalised anxiety outcomes data from patients having a course of six acupuncture treatments as in usual practice. Preliminary results on 30 patients indicate that the effectiveness is at least as good as that seen with psychological therapies such as CBT.

There has been surprisingly little research on generalised or chronic anxiety; much more for situational anxiety, for example pre-operative, exam-related or associated with stressful work. The results have been consistently positive, with fewer side effects than conventional treatment, though the nature and quality of the studies is very variable according to recent reviews (Amorim 2018): https://www.ncbi.nlm.nih.gov/pubmed/29705474; Goyata (2016): https://www.ncbi.nlm.nih.gov/pubmed/27355312, as well as older ones (Pilkington 2007).

Situational anxiety trials have often used auriculotherapy for its convenience and effectiveness, such as this recent example with hospital nurses suffering high levels of stress (Kurebayashi 2017). Three different methods of stimulating the ear points were used alongside a control. Needle stimulation was most effective and reduced anxiety levels significantly more than for the control group: https://www.ncbi.nlm.nih.gov/pubmed/28403335

Insomnia

In a randomised trial for insomnia with 224 participants acupuncture treatment was better than waiting list (no acupuncture) in reducing insomnia and also anxiety/depressive symptoms and fatigue. The improvements were maintained at 13 weeks after treatment (Chung 2018): https://www.ncbi.nlm.nih.gov/pubmed/29229613

Another recent RCT on primary insomnia compared acupuncture against sham acupuncture. Seventy-two patients were asked to wear sleep monitors and complete questionnaires every two weeks for a total of eight weeks. Compared with pre-treatment baseline, patients in both groups had varying degrees of improvements in their sleep conditions with significant change in all indicators in the acupuncture group. The Insomnia Severity Index improved significantly more in the acupuncture group compared to the sham, as did other measures of sleep quality and also psychological health (Yin 2017): https://www.ncbi.nlm.nih.gov/pubmed/28899535

Digestive System

Dyspepsia
The most recent systematic review (16 trials, 1436 participants) was also positive for acupuncture: significantly better than sham and medications (Pang 2016): https://www.ncbi.nlm.nih.gov/pubmed/28119758.

source:​ https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/6558-research-digest.html

 

Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis (Vickers 2018)

A landmark paper in 2012 demonstrated that, based on the largest dataset of high quality randomised trials, acupuncture was significantly superior both to usual care and sham, for patients with chronic headache, back/neck pain and osteoarthritis. This was where it was first properly confirmed that acupuncture was not just acting as a rather good placebo. In this update the dataset now amounts to 39 trials and over 20,000 patients. New analysis shows in addition that the acupuncture effects largely persist after the end of the treatment course: only about 15 per cent is lost after 12 months. (Note: a consistent criticism by NICE has been that there was no evidence of longer-term effects. This is now seen not to be the case and patients can be reassured that the benefits are unlikely to disappear as soon as they stop treatment): https://www.ncbi
.nlm.nih.gov/pubmed/29198932

A UK version of this can be found on the website of the NHS’s research arm, as they funded some of the studies (MacPherson 2017) https://www.ncbi.nlm
.nih.gov/pubmed/28121095
. Another recent overview (Yin 2017) confirms that there is increasing evidence for the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches. Additional data support its use as an adjunct or alternative to opioids, and in perioperative settings: acupuncture is incrementally being introduced into orthodox pain medicine practices: https://www.ncbi.
nlm.nih.gov/pubmed/?term=Acupuncture+for
+chronic+pain%3A+an+
update+and+critical+overview

Away from the rather artificial environment of specially constructed trials, and review of those trials, it is also instructive to look at treatments in their usual setting, ie observational studies. The largest of these on chronic pain conditions, mainly back pain (45 per cent), headache (36 per cent) and osteoarthritis (12 per cent), was for acupuncture covered by the German state health insurance scheme, with 450,000 patients and 8,700 medical acupuncturists. Acupuncture proved a highly popular treatment option and 76 per cent of the patients had a good response, 16 per cent minimal and 4 per cent unchanged. Results indicate that acupuncture provided by qualified therapists is safe, and patients benefit from the treatment.

Osteoarthritis

The most up-to-date, highest quality evidence, based on very large numbers of trials and patients, is in the Vickers 2018 paper listed under chronic pain: acupuncture is better than sham or usual care: https://www.ncbi.
nlm.nih.gov
/pubmed/29198932

A recent systematic review specifically focused on acupuncture for chronic knee pain (Zhang et al 2017) concluded that acupuncture provided significant benefits and was as safe as the control groups: https://www.ncbi.nlm.nih.
gov/pubmed/29117967

Infertility

Assisted conception (IVF and ICSI)
Acupuncture just at embryo transfer could provide significant IVF-related stress reduction even if it is insufficient to improve birth outcomes but more sessions, over an extended time period, may be required for optimal effect, and this has not yet been explored adequately in research trials Hullender Rubin 2018): https://www.ncbi.nlm.nih].gov
/pubmed/29440044

Natural fertility: female

The vast bulk of research has been concerned with acupuncture as an adjunct to IVF and related techniques, with little devoted to natural fertility, even though it has been used for this in East Asian countries for centuries. There is preliminary evidence that it may help with menstrual and ovulatory problems in women who are having trouble getting pregnant, but much more research is needed to confirm this. There has been some focus on polycystic ovarian syndrome, with three recent reviews. They point to possible benefits for ovulation, menstruation and pregnancy rates, with regulation of reproductive hormones, but the evidence is limited and low quality (Jo 2017): https://www.ncbi.
nlm.nih.gov/pubmed/28591042
; (Lim 2016): https://www.ncbi.nlm.
nih.gov/pubmed/27136291
; (Wu 2016): https://www.ncbi.nlm.
nih.gov/pubmed/26984837

In the last two years (too recent to have appeared in the reviews) at least six randomised trials of acupuncture for PCOS-related infertility, all from China, have been published in western databases. Five of them point to beneficial effects, generally compared to the drug clomiphene. The largest of them found differently, but its treatment regime, design and analysis have been criticised by many researchers, some of whom even re-analysed the data and came up with entirely different results. It can only be said that the case is still to be proven, though there is strong experimental evidence that acupuncture can influence reproductive functioning through a number of different mechanisms

Mental Health
Anxiety

The British Acupuncture Council (BAcC) has been working with the charity Anxiety UK to gather generalised anxiety outcomes data from patients having a course of six acupuncture treatments as in usual practice. Preliminary results on 30 patients indicate that the effectiveness is at least as good as that seen with psychological therapies such as CBT.

There has been surprisingly little research on generalised or chronic anxiety; much more for situational anxiety, for example pre-operative, exam-related or associated with stressful work. The results have been consistently positive, with fewer side effects than conventional treatment, though the nature and quality of the studies is very variable according to recent reviews (Amorim 2018): https://www.ncbi.nlm.nih
.gov/pubmed/29705474
; Goyata (2016): https://www.ncbi.nlm.nih.
gov/pubmed/27355312
, as well as older ones (Pilkington 2007).

Situational anxiety trials have often used auriculotherapy for its convenience and effectiveness, such as this recent example with hospital nurses suffering high levels of stress (Kurebayashi 2017). Three different methods of stimulating the ear points were used alongside a control. Needle stimulation was most effective and reduced anxiety levels significantly more than for the control group: https://www.ncbi.nlm.nih
.gov/pubmed/28403335

Insomnia

In a randomised trial for insomnia with 224 participants acupuncture treatment was better than waiting list (no acupuncture) in reducing insomnia and also anxiety/depressive symptoms and fatigue. The improvements were maintained at 13 weeks after treatment (Chung 2018): https://www.ncbi.nlm.nih.
gov/pubmed/29229613

Another recent RCT on primary insomnia compared acupuncture against sham acupuncture. Seventy-two patients were asked to wear sleep monitors and complete questionnaires every two weeks for a total of eight weeks. Compared with pre-treatment baseline, patients in both groups had varying degrees of improvements in their sleep conditions with significant change in all indicators in the acupuncture group. The Insomnia Severity Index improved significantly more in the acupuncture group compared to the sham, as did other measures of sleep quality and also psychological health (Yin 2017): https://www.ncbi.nlm.nih
.gov/pubmed/28899535

Digestive System

Dyspepsia
The most recent systematic review (16 trials, 1436 participants) was also positive for acupuncture: significantly better than sham and medications (Pang 2016): https://www.ncbi.nlm.nih
.gov/pubmed/28119758
.

source:​ https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/6558-research-digest.html

 

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