The first systematic review of acupuncture to use individual patient data to conduct a meta-analysis has found acupuncture effective for chronic pain. The Acupuncture Trialists’ Collaboration analysed raw individual patient data, which was available for 17,922 participants enrolled in 29 high-quality, randomised trials of acupuncture for four chronic pain conditions:
- back and neck pain
- shoulder pain
This method is superior to the usual method of using summary data. It enables different outcomes to be combined and allows use of statistical methods that generate more precise results.
The study, published in the prestigious Archives of Internal Medicine, showed that for each of the four chronic pain conditions, the analgesic effect of true acupuncture was slightly better than that of placebo acupuncture. However, as discussed before on this blog, placebo acupuncture is really not a true placebo and is often found effective. The study found the difference between true acupuncture and usual care alone was much larger and of clear clinical significance.
Acupuncture better than sham.
The authors of the study point out that while true acupuncture was only slightly better than placebo (or sham) acupuncture, there was still a robust difference that could be clearly distinguished from bias. Theirs is the first study to unequivocally demonstrate this.
Although the data indicate that acupuncture is more than a placebo, the relatively small difference between true and sham acupuncture suggests that factors in addition to the specific effects of needling contribute to its therapeutic effects. However, the authors also emphasise that the clinical choice made by doctors and patients is not between acupuncture and sham, but between acupuncture and no acupuncture, and, for this comparison, there is a clear and clinically relevant difference. The collaborators conclude that this landmark study provides the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain. They hope their findings will encourage clinicians to recommend acupuncture as a safe and effective treatment and inform future clinical and policy decisions.