Clinical Question

Is acupuncture effective for the treatment of chronic pain?

Bottom Line

Acupuncture, with its meridians, chi, and other concepts that do not seem to line up with anything physiologic, is vexing to most of us who trained in Western medicine. However, this meta-analysis, based on data from almost 21,000 patients, found it to be more effective than no treatment and, to a lesser extent, more effective than sham acupuncture. Given this evidence of benefit and our limited options for chronic pain treatments that do not harm more than help, acupuncture should be added to our armamentarium. (Level of Evidence = 1a–)

Synopsis

To conduct this meta-analysis, the authors identified 44 randomized studies that evaluated the use of acupuncture to treat specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain lasting at least four weeks. The researchers only included studies for which treatment allocation was unambiguously concealed. They combined raw patient data in their meta-analyses for 20,827 patients from 39 trials. For each chronic pain condition, acupuncture was superior to no-acupuncture control, with a moderate effect size of 0.5. Acupuncture was still more effective than sham acupuncture, with an average effect size of 0.2. Treatment effects persisted over time with only a small decrease. There was significant heterogeneity among the studies, which the authors attribute to differences in the control groups. There was limited evidence of publication bias, meaning that small studies showing no benefit may not have been published. This meta-analysis is an update of a previous meta-analysis that identified slightly better effects (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1357513).

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference:VickersAJVertosickEALewithGet alAcupuncture Trialists' CollaborationAcupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain2018;19(5):455–474.