Abstract
BackgroundAcupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.MethodsRevised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.ResultsAll studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone.ConclusionModerate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.
Highlights
Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP)
They found that needle acupuncture may be more effective at improving functional impairment at 2-week follow-up compared with sham acupuncture, and electro-acupuncture may be more effective than manual acupuncture in reducing pain
Results from efficacy studies of AMC must be interpreted with caution, as all studies had at least one domain rated as high risk of bias by the Cochrane risk of bias tool
Summary
A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP. Lateral elbow pain (LEP), commonly known as tennis elbow, is a common disorder with a prevalence of at least 1-3% [1]. They found that needle acupuncture may be more effective at improving functional impairment at 2-week follow-up compared with sham acupuncture, and electro-acupuncture may be more effective than manual acupuncture in reducing pain They concluded the acupuncture intervention as "unknown effectiveness" in their report, due to the fact that the analyzed studies were of very small sample size and had flaws in the study design, including uncertain allocation concealment, substantial loss to follow up and lack of assessments for potential adverse effects
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