The Cochrane Reviews of Acupuncture Doris Hubbs, MD, FACP April
26, 2013
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No financial conflicts of interest No intention of discussion
off-label use I would like to recognize and thank several important
people
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Systematic reviews of primary research in human health care
Internationally recognized as the highest standard in
evidenced-based health care
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Eight Cochrane reviews evaluating effectiveness of acupuncture
for pain Four reviews concluded that acupuncture is effective for:
migraines neck disorders tension HAs peripheral joint OA
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To investigate whether acupuncture is a) more effective than no
treatment b) more effective than sham (placebo) acupuncture c) as
effective as other interventions in reducing HA frequency in
migraine pts.
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Selection criteria: Randomized trials with observation period
of at least 8 weeks, comparing clinical effects of acupuncture
treatment with: No treatment or routine care only Sham acupuncture
Another intervention for migraine
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22 trials with 4419 participants met the inclusion criteria.
There is consistent evidence that acupuncture provides additional
benefit to routine care for migraine Acupuncture is at least as
effective as (possibly more) prophylactic drug tx And has fewer
adverse effects.
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To investigate whether acupuncture is a) more effective than no
tx or routine care only b) more effective than sham acupuncture c)
as effective as other interventions in reducing HA frequency in
patients with chronic tension HA
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11 trials with 2317 participants met inclusion criteria 2 large
trials showed statistically significant benefits of acupuncture
over control for response, number of HA days, and pain intensity
for the length of f/u (3 months)
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5 trials comparing acupuncture with sham tx showed small but
statistically significant benefits of acupuncture over sham
treatment
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Acupuncture can be a valuable non- pharmacological treatment in
patients with frequent episodic or chronic tension-type
headaches
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Neck pain is one of the three most frequently reported
complaints of the musculoskeletal system.
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Objective: To determine the effects of acupuncture for
individuals with neck pain. RCTs or quasi-RCTs included. 10 trials
using acupuncture for chronic neck pain.
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No trials examined the effects of acupuncture for acute or
subacute pain Methodological quality had a mean of 2.3/5 on the
Jadad Scale. For chronic mechanical neck pain, there was moderate
evidence that acupuncture was more effective than sham controls,
massage, or a wait-list control.
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Peripheral joint osteoarthritis is a major cause of pain and
disability. Objective: To assess the effects of acupuncture for
treating peripheral joint osteoarthritis
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Inclusion criteria: RCTs comparing acupuncture with sham,
another active tx, or a waiting list control group in people with
OA of the knee, hip, or hand.
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16 trials involving 3498 people were included: 12 RCTs with
only OA knee 3 trials with only OA hip 1 trial with OA of the hip
and/or knee
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Sham-controlled trials showed statistically significant
benefits; However, did not meet pre-defined thresholds for clinical
relevance Waiting list-controlled trials suggested statistically
significant and clinically relevant benefits of acupuncture for
pain from peripheral joint OA
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4 reviews concluded that acupuncture is effective for
migraines, neck disorders, tension HAs, and peripheral joint OA 3
reviews were inconclusive for shoulder pain, lateral elbow pain,
and LBP One review failed to demonstrate the effectiveness of
acupuncture for RA
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Acupuncture for conditions other than pain: Asthma, glaucoma,
depression, schizophrenia, irritable bowel syndrome, nausea due to
CHT or post-op, Bells palsy, RLS, epilepsy, vascular dementia,
stroke, insomnia, cocaine dependence, conception, induction of
labor, uterine fibroids
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Cost Difficult to find a credible placebo Unable to keep
practitioners blinded Many different acupuncture methods
Controlling the skill of the practitioner Guerra de Hoyos et al.,
Medical Acupuncture: A Journal for Physicians By Physicians, Vol.
14, #2, 2001
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Acupuncture for Chronic Pain (back, neck, OA, headache,
shoulder) Individual Patient Data Meta-analysis Systematic review
of 29 RTCs with total of 17,922 patients.
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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.
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Acupuncture has been shown in RCTs to be safe and effective for
certain types of pain, include HA, neck pain, OA pain Many
financial and technical difficulties limit the availability of
acupuncture RCTs More studies are needed to better understand the
benefits of acupuncture.