User:BriannaJohnston/New sandboxacupuncture

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Specific conditions[edit]

Pain[edit]

The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. A 2011 systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. The same review found that neck pain was one of only four types of pain for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias. A 2009 overview of Cochrane reviews found acupuncture is not effective for a wide range of conditions.

A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficacy of acupuncture (in comparison to sham) for the treatment of four different types of chronic pain (back and neck pain, knee osteoarthritis, chronic headache, and shoulder pain) and on that basis concluded that it "is more than a placebo" and a reasonable referral option. Commenting on this meta-analysis, both Edzard Ernst and David Colquhoun said the results were of negligible clinical significance. Ernst later stated that "I fear that, once we manage to eliminate this bias [that operators are not blind] … we might find that the effects of acupuncture exclusively are a placebo response." In 2017, the same research group updated their previous meta-analysis and again found acupuncture to be superior to sham acupuncture for non-specific musculoskeletal pain, osteoarthritis, chronic headache, and shoulder pain. They also found that the effects of acupuncture decreased by about 15% after one year.

A 2010 systematic review suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective. A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. A 2009 systematic review and meta-analysis found that acupuncture had a small analgesic effect, which appeared to lack any clinical importance and could not be discerned from bias.The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. A 2017 systematic review and meta-analysis found that ear acupuncture may be effective at reducing pain within 48 hours of its use, but the mean difference between the acupuncture and control groups was small.

Lower back pain[edit]

A 2013 systematic review found that acupuncture may be effective for nonspecific lower back pain, but the authors noted there were limitations in the studies examined, such as heterogeneity in study characteristics and low methodological quality in many studies. A 2012 systematic review found some supporting evidence that acupuncture was more effective than no treatment for chronic non-specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment approaches. A 2011 systematic review of systematic reviews found that "for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin." A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects. A 2005 Cochrane review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. The same review found low quality evidence for pain relief and improvement compared to no treatment or sham therapy for chronic low back pain only in the short term immediately after treatment. The same review also found that acupuncture is not more effective than conventional therapy and other alternative medicine treatments. A 2017 systematic review and meta-analysis concluded that, for neck pain, acupuncture was comparable in effectiveness to conventional treatment, while electroacupuncture was even more effective in reducing pain than was conventional acupuncture. The same review noted that "It is difficult to draw conclusion [sic] because the included studies have a high risk of bias and imprecision." A 2015 overview of systematic reviews of variable quality showed that acupuncture can provide short-term improvements to people with chronic Low Back Pain. The overview said this was true when acupuncture was used either in isolation or in addition to conventional therapy. A 2017 systematic review for an American College of Physiciansclinical practice guideline found low to moderate evidence that acupuncture was effective for chronic low back pain, and limited evidence that it was effective for acute low back pain. The same review found that the strength of the evidence for both conditions was low to moderate. Another 2017 clinical practice guideline, this one produced by the Danish Health Authority, recommended against acupuncture for both recent-onset low back pain and lumbar radiculopathy.

Headaches and migraines[edit]

Two separate 2016 Cochrane reviews found that acupuncture could be useful in the prevention of tension-type headaches and episodic migraines.The 2016 Cochrane review evaluating acupuncture for episodic migraine prevention concluded that true acupuncture had a small effect beyond sham acupuncture and found moderate-quality evidence to suggest that acupuncture is at least similarly effective to prophylactic medications for this purpose.A 2012 review found that acupuncture has demonstrated benefit for the treatment of headaches, but that safety needed to be more fully documented in order to make any strong recommendations in support of its use.

Arthritis pain[edit]

A 2014 review concluded that "current evidence supports the use of acupuncture as an alternative to traditional analgesics in osteoarthritis patients." As of 2014, a meta-analysis showed that acupuncture may help osteoarthritis pain but it was noted that the effects were insignificant in comparison to sham needles. A 2012 review found "the potential beneficial action of acupuncture on osteoarthritis pain does not appear to be clinically relevant." A 2010 Cochrane review found that acupuncture shows statistically significant benefit over sham acupuncture in the treatment of peripheral joint osteoarthritis; however, these benefits were found to be so small that their clinical significance was doubtful, and "probably due at least partially to placebo effects from incomplete blinding".

A 2013 Cochrane review found low to moderate evidence that acupuncture improves pain and stiffness in treating people with fibromyalgia compared with no treatment and standard care. A 2012 review found "there is insufficient evidence to recommend acupuncture for the treatment of fibromyalgia." A 2010 systematic review found a small pain relief effect that was not apparently discernible from bias; acupuncture is not a recommendable treatment for the management of fibromyalgia on the basis of this review.

A 2012 review found that the effectiveness of acupuncture to treat rheumatoid arthritis is "sparse and inconclusive." A 2005 Cochrane review concluded that acupuncture use to treat rheumatoid arthritis "has no effect on ESR, CRP, pain, patient's global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics." A 2010 overview of systematic reviews found insufficient evidence to recommend acupuncture in the treatment of most rheumatic conditions, with the exceptions of osteoarthritis, low back pain, and lateral elbow pain. A 2018 systematic review found some evidence that acupuncture could be effective for the treatment of rheumatoid arthritis, but that the evidence was limited because of heterogeneity and methodological flaws in the included studies.

Other joint pain[edit]

A 2014 systematic review found that although manual acupuncture was effective at relieving short-term pain when used to treat tennis elbow, its long-term effect in relieving pain was "unremarkable". A 2007 review found that acupuncture was significantly better than sham acupuncture at treating chronic knee pain; the evidence was not conclusive due to the lack of large, high-quality trials.

Post-operative pain and nausea[edit]

A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is an effective treatment for postoperative nausea and vomiting (PONV) in a clinical setting. A 2013 systematic review concluded that acupuncture might be beneficial in prevention and treatment of PONV. A 2015 Cochrane review found moderate-quality evidence of no difference between stimulation of the P6 acupoint on the wrist and antiemetic drugs for preventing PONV. A new finding of the review was that further comparative trials are futile, based on the conclusions of a trial sequential analysis.Whether combining PC6 acupoint stimulation with antiemetics is effective was inconclusive.

A 2014 overview of systematic reviews found insufficient evidence to suggest that acupuncture is effective for surgical or post-operative pain. For the use of acupuncture for post-operative pain, there was contradictory evidence. A 2014 systematic review found supportive but limited evidence for use of acupuncture for acute post-operative pain after back surgery. A 2014 systematic review found that while the evidence suggested acupuncture could be an effective treatment for postoperative gastroparesis, a firm conclusion could not be reached because the trials examined were of low quality.

Pain and nausea associated with cancer and cancer treatment[edit]

A 2015 Cochrane review found that there is insufficient evidence to determine whether acupuncture is an effective treatment for cancer pain in adults. A 2014 systematic review published in the Chinese Journal of Integrative Medicine found that acupuncture may be effective as an adjunctive treatment to palliative care for cancer patients. A 2013 overview of reviews published in the Journal of Multinational Association for Supportive Care in Cancer found evidence that acupuncture could be beneficial for people with cancer-related symptoms, but also identified few rigorous trials and high heterogeneity between trials. A 2012 systematic review of randomised clinical trials published in the same journal found that the number and quality of RCTs for using acupuncture in the treatment of cancer pain was too low to draw definite conclusions.

A 2014 systematic review reached inconclusive results with regard to the effectiveness of acupuncture for treating cancer-related fatigue. A 2013 systematic review found that acupuncture is an acceptable adjunctive treatment for chemotherapy-induced nausea and vomiting, but that further research with a low risk of bias is needed. A 2013 systematic review found that the quantity and quality of available RCTs for analysis were too low to draw valid conclusions for the effectiveness of acupuncture for cancer-related fatigue.

Sleep[edit]

Several meta-analytic and systematic reviews suggest that acupuncture alleviates sleep disturbance, particularly insomnia. However, reviewers caution that this evidence should be considered preliminary due to publication bias, problems with research methodology, small sample sizes, and heterogeneity.

Substance abuse

The National Acupuncture Detoxification Association (NADA) employs a 3-to-5-point ear acupuncture technique that is followed by most addiction treatment regimens for treating substance abuse. NADA gathered several studies of their acupuncture treatment throughout time to determine the efficacy of acupuncture treatment among persons suffering from substance abuse. In 1999, research was done with a cohort of 8,011 clients who had been discharged from a detoxification program in Boston. The study discovered that 18% of patients who received NADA protocol care were readmitted back into the detoxification program within 6 months, compared to 36% of those who did not receive NADA protocol care and had a short-term residential detoxification program. People who received the NADA protocol chose to enter the detoxification program sooner than those who did not get the NADA procedure. In 2000, 82 cocaine-addicted individuals undergoing methadone treatment were randomly assigned to the NADA protocol. A review of the urine toxicological data found that the NADA protocol was more effective in decreasing cocaine than either a relaxation or a needle insertion control, which differs from the NADA standardized 3-to-5 point ear acupuncture therapy. The study demonstrated a reduction in cocaine usage by employing the NADA protocol, but it did not detect differences between the three treatment conditions given the fact that all patients received psychosocial treatment under all treatment settings. As a result, the study found no evidence to support acupuncture as a “stand-alone treatment for cocaine addiction." Another study discovered that using the NADA treatment in conjunction with education and counseling resulted in a 40% reduction in smokers compared to a 22% reduction in smokers who received sham-acupuncture (acupuncture that does not use the 3-to-5 ear acupuncture technique) and a 10% reduction in smokers who received only the NADA protocol.

   More recent NADA research data on acupuncture efficiency may include an established control group that focuses on clinical significance rather than statistical significance. In 2011, 167 individuals were studied to determine the effectiveness of NADA in lowering the severity of behavioral symptoms associated with drug abuse, such as depression, anxiety, cravings, physical pains, and decreased energy. The research compared NADA therapy and conventional treatment to conventional treatment alone and discovered that patients who received both NADA protocol and conventional treatment showed a significant reduction in behavioral symptoms when compared to persons who did not receive NADA protocol.

Another trial conducted in 2012 on pregnant women who suffered from drug dependence discovered that women who received the NADA protocol were able to withstand bigger decreases in their methadone dose prior to birth, and their newborns required almost two less days of morphine therapy. The infants were also observed to have shorter neonatal withdrawal symptoms; hence, the NADA treatment was demonstrated to help mothers with drug misuse and to lessen the severity of neonatal abstinence syndrome.

The majority of the research reflects the use of NADA protocol, ear acupuncture, as an effective treatment among substance abusers; however, the majority of the studies do not particularly reflect ear acupuncture as an effective stand-alone treatment.

References