Chronic Pain

2021 Journal of Clinical Pharmacy and Therapeutics

Acupuncture appears to have an effect on diabetic peripheral neuropathy, effectively improving nerve conduction and clinical symptoms.

Acupuncture appears to have an effect on DPN, effectively improving nerve conduction and clinical symptoms. Although the methodological quality of the included studies was generally very low and defects were frequent, our study highlights areas where improvement in methodology is required. There is a need for further study of the pathogenesis of DPN, and for developing a unified standard for methods of acupuncture treatment, acupoint selection, and adverse reactions reporting. Traditional Chinese medical practices such as acupuncture should adopt an evidence-based approach to provide greater confidence in their use.

Acupuncture treatment of diabetic peripheral neuropathy: An overview of systematic reviews Yu B, Li M, Huang H, Ma S, Huang K, Zhong Z, Yu S, Zhang L.

2020 Current Rheumatology Reports

The majority of studies concluded the superiority of short-term analgesic effects over various controls and suggested that acupuncture may be efficacious for chronic musculoskeletal pain.

We examined 16 review articles and 11 randomized controlled trials published in the last 5 years on the clinical efficacy of acupuncture in adults with CMP conditions. The available evidence suggests that acupuncture does have short-term pain relief benefits for patients with symptomatic knee osteoarthritis and chronic low back pain and is a safe and reasonable referral option. Acupuncture may also have a beneficial role for fibromyalgia. However, the available evidence does not support the use of acupuncture for treating hip osteoarthritis and rheumatoid arthritis.

Acupuncture and Chronic Musculoskeletal Pain Zhang, Y., Wang, C.

2020 Pain Research & Management

The use of various treatments of traditional Chinese medicine can significantly improve the level of the total effective rate and reduce the occurrence of recurrence rate in the later stage of osteoarthritis treatment.

These effects are mediated by a combination of several mechanisms. This method of treatment with TCM can reduce pain, improve their ability to move, and improve their living standards by reducing the level of VAS, WOMAC, SSTCM, SS, and Lequesne and increasing the level of Lysholm. TCM therapy can reduce inflammation and exert anti-inflammatory effects by reducing the levels of IL-1, IL-6, TNF-α, MMP-3, ESR, and CRP and increasing TGF-β. TCM therapy can increase BGP, FGF-2, IGF-1, and OPG and reduce BMP-7 and RANKL levels to improve bone metabolism in order to achieve the balance of bone metabolism. The TCM therapy can also reduce the levels of VEGF and Ang I, reduce cartilage injury, and restore vascular endothelial function. The effect of TCM therapy can also increase the level of SOD and reduce the existence of reactive oxygen species. The net analysis of ACU and index showed that ACU at local acupoints such as Yinlingxue, Xuehai, and Yanglingquan can reduce inflammatory indexes, reduce cartilage damage, balance bone metabolism, reduce WOMAC, and improve TER. The network analysis chart of TCMs and index showed that TCMs can effectively reduce WOMAC through the inhibition of IL-1 and MMP-3 and improve the effect of TER and so on. However, our findings must be handled with care because of the small size and low quality of the clinical trial samples cited. Other rigorous and large-scale RCTs are needed to confirm these results.

Evaluation of the Therapeutic Effect of Traditional Chinese Medicine on Osteoarthritis: A Systematic Review and Meta-Analysis Lin Wang, Xiao-Fei Zhang, Xue Zhang, Dong-Yan Guo, Yu-Wei Duan, Zhi-Chao Wang, Li-Shan Pei, Han Ru, Jiang-Xue Cheng, Ya-Jun Shi, Jun-Bo Zou

2020 Evidence-Based Complementary and Alternative Medicine

In the treatment of chronic pain with depression, acupuncture could not only achieve better clinical efficacy, but also have higher safety compared with conventional mediation therapy.

Acupuncture has a promising application prospect due to its unique advantages for the treatment of chronic pain with depression comorbidity, which can be used in patients suffering from some certain chronic pain with depression comorbidity with poorer response to the conventional medication or suffering from serious side effects.

Effect of Acupuncture on Chronic Pain with Depression: A Systematic Review Bin Yan, Shibai Zhu, Yu Wang, Gula Da, Guoqing Tian,

2019 Evidence-Based Complementary and Alternative Medicine

We found good evidence that receiving acupuncture for chronic pain is better than not receiving treatment or being placed on a waiting list and reasonable evidence that it is better than conventional or usual care.

In general, our analysis demonstrated good evidence that receiving acupuncture is better than not receiving treatment or being put on a waiting list in terms of pain control. When it was compared to conventional or usual care, acupuncture presented slightly (reasonable) better outcomes. Limited evidence was found in placebo treatments that involve the expectation of needling (real or fake). However, conclusions about the effectiveness of acupuncture in treating chronic pain are still limited due to the low quality of the studies published.

Classic Chinese Acupuncture versus Different Types of Control Groups for the Treatment of Chronic Pain: Review of Randomized Controlled Trials (2000-2018) Yan-Jiao Chen, Gabriel Shimizu Bassi, Yong-Qing Yang

2019 Acupuncture in Medicine

Acupuncture, regardless of the trial design, showed a positive effect on pain-related outcome measures for participants with diabetic peripheral neuropathy.

Acupuncture, regardless of the trial design, showed a positive effect on pain-related outcome measures for participants with DPN. However, a meta-analysis could not be performed owing to the highly heterogeneous outcome measures and limited number of high-quality RCTs available. Findings from this review showed that acupuncture improves symptoms despite the variations in acupuncture dosage, and provides beneficial effects in comparison with vitamin B therapies and no treatment. However, owing to problems with control group suitability and blinding, strong non-specific effects cannot be ruled out.

Acupuncture for the treatment of lower limb diabetic peripheral neuropathy: a systematic review Nash J, Armour M, Penkala S.

2017 Programme Grants for Applied Research

The programme of research found that acupuncture was more effective than usual care and sham acupuncture for chronic pain, that it was one of the more clinically effective physical therapies for osteoarthritis and that it showed benefits in the treatment of depression.

We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.

Acupuncture for chronic pain and depression in primary care: a programme of research MacPherson H, Vickers A, Bland M, et al.

2017 The Journal of Pain

Acupuncture has a clinically relevant effect on chronic pain that persists over time. Referral for acupuncture treatment is a reasonable option for chronic pain patients.

We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to sham as well as no acupuncture control for each pain condition (all P < .001) with differences between groups close to .5 SDs compared with no acupuncture control and close to .2 SDs compared with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year.

Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.

Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis Vickers, Andrew J. et al.

2017 The Journal of Alternative and Complementary Medicine

The majority of randomised controlled trials showed benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell's palsy, and carpal tunnel syndrome.

Fifteen studies were included: 13 original RCTs, a long-term follow-up, and a re-analysis of a prior RCT. The selected RCTs studied acupuncture for neuropathy caused by diabetes, Bell's palsy, carpal tunnel syndrome, human immunodeficiency virus (HIV), and idiopathic conditions.

Acupuncture is probably effective in the treatment of HIV-related neuropathy, and there is insufficient evidence for its benefits in idiopathic neuropathy. Acupuncture appears to improve nerve conduction study parameters in both sensory and motor nerves.

Acupuncture is beneficial in some peripheral neuropathies, but more rigorously designed studies using sham-acupuncture control are needed to characterize its effect and optimal use better.

Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis Alexandra Dimitrova, Charles Murchison, and Barry Oken.

2017 Pain Physician

The existing evidence suggests that most acupuncture therapies, including acupuncture combined with other therapies, are effective in decreasing pain and in improving physical function.

Thirty-three trials with 1,692 patients were included. Patients were allocated to 22 kinds of interventions, of which dry needling and manual acupuncture was the most frequently investigated intervention. Compared with placebo-sham acupuncture, scraping combined with warming acupuncture and moxibustion was found to be more effective for decreasing pain intensity; miniscalpel-needle was more effective for increasing the PPT; trigger points injection with bupivacaine was associated with the highest risk of adverse event; and only EA showed a significant difference in the ROM.

Acupuncture for Myofascial Pain Syndrome: A Network Meta-Analysis of 33 Randomized Controlled Trials Li X, Wang R, Xing X, Shi X, Tian J, Zhang J, Ge L, Zhang J, Li L, Yang K.

2017 Chinese Medicine

Cupping therapy and acupuncture are potentially safe, and they have similar effectiveness in relieving pain.

Regardless the potential bias and limitations of this review, all of the included studies showed that cupping therapy had similar therapeutic effects with acupuncture in treating pain-related conditions (such as cervical pain, back pain, osteoarthritis, and acute soft tissue injury).

For pain-related conditions, cupping therapy and acupuncture have different choice of acupoints. Based on our review, acupuncture often use two basic acupoints which are tenderness point (Ashi) and the meridians passing through the pain area; while for cupping therapy, wet cupping uses special acupoints (such as Haoyi for cervical spondylopathy) for local pain, and flash cupping combined with moving cupping often use the meridians passing through the pain area for widespread pain.

Considering the similar therapeutic effects of these two therapies, clinical practitioners may consider to choose any of them, based on their own clinical experience and the preference of patients.

Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis Zhang, YJ., Cao, HJ., Li, XL. et al.

2017 Pain

Patients with chronic pain can generally be reassured that treatment effects persist after a course of treatment with acupuncture.

The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months, suggesting approximately a 50% diminution at 12 months.

The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.

The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain MacPherson, H; Vertosick, E.A; Foster, N.E; Lewith, G; Linde, K; Sherman, K.J; Witt, C.M; Vickers, A.J

2016 Scientific Reports

Our meta-analysis found that, overall, acupuncture was superior to sham acupuncture in terms of pain relief and disability reduction for patients with musculoskeletal disorders.

Consistent with our current report, some previous systematic reviews have also found real acupuncture to be superior to sham acupuncture for neck pain, low back pain, osteoarthritis and myofascial pain. Two newly published meta-analyses found that real acupuncture had a more favorable effect than sham acupuncture for low back pain. Our finding that real acupuncture was more effective than sham acupuncture for neck pain and low back pain was also verified by a more recent systematic review.

Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials Yuan QL, Wang P, Liu L, et al.

2016 PLOS One

Certain modes of acupuncture improved postoperative pain on the first day after surgery and reduced opioid use. Our findings support the use of acupuncture as adjuvant therapy in treating postoperative pain.

Our study found that acupuncture and related techniques one day following surgery significantly reduced postoperative pain and the use of opioids. Unlike Sun et al, we also performed subgroup analysis and found that conventional acupuncture and transcutaneous electric acupoint stimulation (TEAS) may be more efficacious than electroacupuncture as adjuvant therapy to manage postoperative pain. Additional well designed studies are required to further explore the role of acupuncture and related methods in treating postoperative pain.

The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis Wu M-S, Chen K-H, Chen I-F, Huang SK, Tzeng P-C, Yeh M-L, et al.

2015 Neurology

The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy.

The majority of RCTs reviewed showed clear benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell’s palsy and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy and there is insufficient evidence for its benefits in idiopathic neuropathy. Meta-analyses of all diabetic neuropathy and bell’s palsy data using a summary estimate random effects model showed combined Odds Ratio (OR) of 4.23, p<0.001 favoring acupuncture over control for pain outcomes. The majority of trials demonstrate a positive effect of acupuncture over control condition in the treatment of neuropathy. Further more rigorously designed studies are needed to better characterize this effect.

Effects of Acupuncture on Neuropathic Pain: A Systematic Review and Meta-analysis Alexandra Dimitrova, Charles Murchison, Barry Oken

2013 Cochrane Database of Systematic Reviews

Compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia.

There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.

Acupuncture for treating fibromyalgia Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G.