Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials - PubMed (original) (raw)

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Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials

Qi-Ling Yuan et al. Sci Rep. 2016.

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.

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Figures

Figure 1

Figure 1. Flow chart.

Figure 2

Figure 2. Risk of bias for the included studies.

Q, question. Q1, Was the method of randomization adequate? Q2, Was the treatment allocation concealed? Q3, Were the groups similar at baseline regarding the most important prognostic indicators? Q4, Was the patient blinded to the intervention? Q5, Was the care provider blinded to the intervention? Q6, Was the outcome assessor blinded to the intervention? Q7, Were co-interventions avoided or similar? Was the compliance acceptable in all groups? Was the dropout rate described and acceptable? Was the timing of the outcome assessment similar in all groups? Was intention-to-treat analysis included? Are reports of the study free from suggestion of selective outcome reporting?

Figure 3

Figure 3. Meta-analysis of Acupuncture versus SA for NP in Pain.

CI, confidence interval; NP, neck pain; SA, sham acupuncture; SD, standard deviation.

Figure 4

Figure 4. Meta-analysis of Acupuncture versus SA for NP in Disability.

CI, confidence interval; NP, neck pain; SA, sham acupuncture; SD, standard deviation.

Figure 5

Figure 5. Meta-analysis of Acupuncture versus SA for SP in Pain.

CI, confidence interval; SA, sham acupuncture; SP, shoulder pain; SD, standard deviation.

Figure 6

Figure 6. Meta-analysis of Acupuncture versus SA for NPSP in Pain.

CI, confidence interval; NPSP, neck pain and shoulder pain; SA, sham acupuncture; SD, standard deviation.

Figure 7

Figure 7. Contour-enhanced Funnel Plot of Acupuncture versus SA for NPSP in Pain.

Visual inspection of the funnel plot suggested symmetry. Specifically, most of the trials had negative results (i.e., more trials in areas of statistical non-significance), indicating no evidence of publication bias.

Figure 8

Figure 8. Meta-analysis of Acupuncture versus SA for LBP in Pain.

CI, confidence interval; LBP, low back pain; SA, sham acupuncture; SD, standard deviation.

Figure 9

Figure 9. Meta-analysis of Acupuncture versus SA for LBP in Disability.

CI, confidence interval; LBP, low back pain; SA, sham acupuncture; SD, standard deviation.

Figure 10

Figure 10. Meta-analysis of Acupuncture versus SA for OA in Pain.

CI, confidence interval; OA, osteoarthritis; SA, sham acupuncture; SD, standard deviation.

Figure 11

Figure 11. Contour-enhanced Funnel Plot of Acupuncture versus SA for OA in Pain.

Visual inspection of the funnel plot suggested symmetry. Specifically, most trials had negative results (i.e., more trials in areas of statistical non-significance), indicating no evidence of publication bias.

Figure 12

Figure 12. Meta-analysis of Acupuncture versus SA for OA in Disability.

CI, confidence interval; OA, osteoarthritis; SA, sham acupuncture; SD, standard deviation.

Figure 13

Figure 13. Metatrim Analysis of Acupuncture versus SA for OA in Pain.

The dots in the squares were the studies filled. There were two trials with positive effects filled.

Figure 14

Figure 14. Meta-analysis of Acupuncture versus SA for MP in Pain.

CI, confidence interval; MP, myofascial pain; SA, sham acupuncture; SD, standard deviation.

Figure 15

Figure 15. Meta-analysis of Acupuncture versus SA for FM in Pain.

CI, confidence interval; FM, fibromyalgia; SA, sham acupuncture; SD, standard deviation.

Figure 16

Figure 16. Meta-regression of Acupuncture versus SA for Overall Conditions in Pain (Part 1).

CI, confidence interval; SA, sham acupuncture; SD, standard deviation.

Figure 17

Figure 17. Meta-regression of Acupuncture versus SA for Overall Conditions in Pain (Part 2).

CI, confidence interval; SA, sham acupuncture; SD, standard deviation.

Figure 18

Figure 18. Contour-enhanced Funnel Plot of Acupuncture versus SA for Overall Conditions in Pain.

Visual inspection of the funnel plot suggested symmetry. Specifically, most trials had negative results (i.e., more trials in areas of statistical non-significance), indicating no evidence of publication bias.

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