Acupuncture May Be Helpful for Chronic Pain: A Meta-Analysis

A recent NCCAM-funded study, employing individual patient data meta-analyses and published in the Archives of Internal Medicine, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. In addition, results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects. A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling.

Although millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than an elaborate placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.

Researchers from the Acupuncture Trialists’ Collaboration, a group that was established to synthesize data from high-quality randomized trials on acupuncture for chronic pain, conducted an analysis of individual patient data from 29 high-quality randomized controlled trials, including a total of 17,922 people. These trials investigated the use of acupuncture for back and neck pain, osteoarthritis, shoulder pain, or chronic headache.

For all pain types studied, the researchers found modest but statistically significant differences between acupuncture versus simulated acupuncture approaches (i.e., specific effects), and larger differences between acupuncture versus a no-acupuncture controls (i.e., non-specific effects). (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture includes a variety of approaches which mimic this procedure; some approaches do not pierce the skin or use specific points on the body.) The sizes of the effects were generally similar across all pain conditions studied.

The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant. They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.

Reference

• Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. September 10, 2012; Epub ahead of print.