Abstract
BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.
Highlights
IntroductionCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma
Co-morbid symptoms are common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma
Because safety is not well documented in these reviews, we believe there can only be a weak recommendation in favor of acupuncture in this area and that more high powered studies that report on safety of acupuncture are needed for this condition
Summary
Co-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. Individuals with posttraumatic stress disorder (PTSD) have high rates of cooccurring conditions including suicide [24,25], substance abuse [26], anxiety [27], headache [28] and chronic pain [29,30], greater emotional distress [31], more interference with activities of daily living [32] and more pronounced disability than in pain patients without a history of trauma or PTSD [33] These overlapping conditions, potentially triggered by combined mind-body/brain injuries have been termed the Trauma Spectrum Response (TSR) [29] and often include: (1) psychological and emotional distress (that is, depression, anxiety, PTSD); (2) cognitive impairment (for example, memory, attention); (3) chronic and, often refractory pain of organic and psychosomatic origins; (4) headache; (5) substance abuse; and (6) somatic dysfunction (that is, sexual function, fatigue, sleep disturbances; (Figure 1). Because the majority of individuals, after a psychological or physical injury, experience disturbances in one or more of these areas at varying degrees, the TSR, much like Seyle’s general stress response [34], is useful for understanding the whole person response to stress and injury
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