Background: Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

Methods: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

Results: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

Conclusions: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

Publications:

MacPherson H, Vertosick E, Lewith G, Linde K, Sherman KJ, Witt CM, Vickers AJ; Acupuncture Trialists' Collaboration. Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis. PLoS One. 2014 Apr 4;9(4):e93739.

MacPherson H, Maschino AC, Lewith G, Foster NE, Witt C, Vickers AJ; Acupuncture Trialists' Collaboration. Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials. PLoS One. 2013 Oct 11;8(10):e77438

Vickers A, Maschino A, Lewith G, MacPherson H, Sherman K, Witt C. Acupuncture Trialists™ Collaboration. Response to the Acupuncture Trialists™ Collaboration individual patient data meta-analysis. Acupunct Med, 2013. 31(1):98-100.

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K; Acupuncture Trialists' Collaboration. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22;172(19):1444-53.

Vickers A, Cronin A, Maschino A, Lewith G, MacPherson H, Victor N, Sherman K, Witt C, Linde K. Individual patient data meta-analysis of acupuncture for chronic pain: protocol of the Acupuncture Trialists' Collaboration. Trials, 2010. 11:90.

Principle investigator:
Andrew Vickers, USA

Steering Group:
Klaus Linde, Germany
Hugh MacPherson, England
Karen Sherman, USA
Andrew Vickers, USA
Norbert Victor, Germany
Claudia M. Witt, Germany

Coorperation:
Claire Allen, USA
Mac Beckner, USA
Brian Berman, USA
Benno Brinkhaus, Germany
Remy Coeytaux, USA
Angel M. Cronin, USA
Hans-Christoph Diener, Germany
Nadine Foster, England
Michael Haake, Germany
Richard Hammerschlag, USA
Dominik Irnich, Germany
Wayne B. Jonas, USA
Kai Kronfeld, USA
Lixing Lao, USA
George Lewith, England
Klaus Linde, Germany
Dieter Melchart, Deutschland Albrecht Molsberger, Germany
Hugh MacPherson, England
Eric Manheimer, USA
Karen Sherman, USA
Hans Trampisch, Germany
Jorge Vas, Spanien
Andrew J. Vickers
Norbert Victor, Germany
Peter White, England
Stefan N. Willich, Germany

Project duration:
2006-2014

Project status:
completed

Funding:
National Center of Complementary and Alternative Medicine (NCCAM) of the NIH