Chronic pain is a significant condition that affects millions of Americans. While family physicians play an important role for many of these patients, survey results indicate that many physicians consider the training they received in pain management inadequate, and may not feel comfortable in their ability to care for patients with chronic pain effectively.

One therapy that has received considerable attention for the treatment of chronic pain is acupuncture. In an update of patient data meta-analysis published in the May edition of the Journal of Pain, researchers with the Acupuncture Trialists' Collaboration concluded that acupuncture is effective for the treatment of chronic pain, that the effects of acupuncture persist over time, and that the benefits of acupuncture cannot be explained away solely by the placebo effect.

Study Details

The Journal of Pain research updated a previous meta-analysis published by the same group of authors in 2012. In the 2012 meta-analysis, the researchers included patient data from randomized controlled trials (RCTs) published through November 2008. The new meta-analysis included eligible RCTs published between December 2008 and December 2015.

Trials were considered eligible for inclusion if they met the following criteria:

• patients experienced one of four chronic pain conditions (nonspecific back or neck pain, shoulder pain, chronic headache or osteoarthritis);
• duration of pain lasted at least four weeks for musculoskeletal disorders;
• at least one patient group in each trial received acupuncture and one group received no acupuncture or sham acupuncture;
• the primary endpoint was measured at least four weeks after the initial acupuncture treatment session; and
• patient allocation concealment was determined unambiguously to be adequate.

Thirteen RCTs met eligibility criteria. Individual patient data was received from 10 RCTs, representing 2,905 patients. When combined with the 2012 research, the new meta-analysis incorporated data from 20,827 patients over 39 trials.

More than half of the RCTs (23) used acupuncture based on traditional Chinese techniques; the rest used Western techniques or a combination of the two. In nine RCTs, acupuncture points were selected according to a fixed needle formula (i.e., the same points were used on all study participants); the remaining trials selected points according to a flexible formula (in which a fixed formula is used on all participants, and additional points are chosen for each participant based on individual diagnosis or symptoms) or an individualized formula (in which the practitioner is free to choose the points to be stimulated).

In 80 percent of the RCTs, patients underwent between six and 15 acupuncture sessions. Most patients received acupuncture one to two times per week. In slightly more than half of the RCTs, the typical acupuncture session lasted less than 30 minutes.

Results

"The results confirm and strengthen previous key findings that acupuncture has a clinically relevant effect compared with no acupuncture control," the authors wrote. These effects appeared to persist for at least 12 months after receiving acupuncture. The authors added that "the effects of acupuncture are not completely explicable in terms of placebo effects," but cautioned that "factors other than the specific effects of needling at correct acupuncture point locations" contribute to the benefits derived from receiving acupuncture.

The authors addressed the issue of effect size and relevance. They argued that relevance should be determined by comparing acupuncture with no-acupuncture control because the decision physicians make to treat or refer patients "is not between acupuncture and sham but between acupuncture and no acupuncture."

They suggested that acupuncture would be "a reasonable option" to consider in patients with chronic pain, and called for additional research to determine the best way of incorporating acupuncture into the care of these patients.

Posted on April 9th, 2022.

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