Abstract
The aims of this systematic review were to study the analgesic effect of real acupuncture and to explore whether sham acupuncture (SA) type is related to the estimated effect of real acupuncture for musculoskeletal pain. Five databases were searched. The outcome was pain or disability immediately (≤1 week) following an intervention. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. Meta-regression was used to explore possible sources of heterogeneity. Sixty-three studies (6382 individuals) were included. Eight condition types were included. The pooled effect size was moderate for pain relief (59 trials, 4980 individuals, SMD −0.61, 95% CI −0.76 to −0.47; P < 0.001) and large for disability improvement (31 trials, 4876 individuals, −0.77, −1.05 to −0.49; P < 0.001). In a univariate meta-regression model, sham needle location and/or depth could explain most or all heterogeneities for some conditions (e.g., shoulder pain, low back pain, osteoarthritis, myofascial pain, and fibromyalgia); however, the interactions between subgroups via these covariates were not significant (P < 0.05). Our review provided low-quality evidence that real acupuncture has a moderate effect (approximate 12-point reduction on the 100-mm visual analogue scale) on musculoskeletal pain. SA type did not appear to be related to the estimated effect of real acupuncture.
Highlights
Several sham procedures are available, such as the use of penetrating acupuncture on non-acupoints, superficial penetration of the skin on acupoints and nonpenetration on acupoints with sham needle devices[14]
A total of 731 duplicates were excluded, and 2205 additional records were excluded based on their titles or abstracts for reasons such as not related to acupuncture or musculoskeletal disorders, not SA controlled, or not an randomized controlled trials (RCTs)
After full-text articles were assessed for eligibility, 253 records were excluded for reasons such as irrelevance of the specified PICO, not an RCT, or in systematic review format
Summary
Several sham procedures are available, such as the use of penetrating acupuncture on non-acupoints, superficial penetration of the skin on acupoints and nonpenetration on acupoints with sham needle devices[14]. Several reviews[15,16,17] have evaluated the effects of acupuncture for musculoskeletal pain. All of them focused on only one disorder and almost all of them lacked analysis of the impact of SA type on the assessment of real acupuncture for musculoskeletal pain. We sought to analyze all previous studies of acupuncture for musculoskeletal pain that included a SA control group. Our objectives were to study the analgesic effect of real acupuncture and to explore whether SA type is related to the estimated effect of real acupuncture
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