THE BACK PAGE RESEARCH REVIEW Reviewing evidence on effectiveness of acupuncture BY SHAWN THISTLE Study title: Acupuncture for Neck Disorders Authors: Trinh K, Graham N, Irnich D et al Publication information: Cochrane Database of Systematic Reviews 2016; Issue 5. Art. No.: CD004870. DOI: 10.1002/14651858.CD004870.pub4. fainting, worsening of symptoms, local swelling and dizziness. No life-threaten-ing adverse effects were reported. The authors found acupuncture is more beneficial than sham for mechanical neck pain in the immediate post-treat-ment period. They also found it superior to sham and inactive treatments at short-term follow-up for pain intensity. Acupuncture is also superior to sham for pain intensity and ratings of disabil-ity in the short-term follow-up period, compared to patients assigned to a wait-list control. Unfortunately, these effects are likely unsustainable over the long term. Interestingly, the authors found that the acupuncture treatment dose was associated with treatment outcome. Ideally, treatment should consist of six or more acupuncture sessions. Included studies with fewer than six treatments failed to show favourable outcomes. It is important to understand that the rigorous constraints inherent to per-forming RCTs in an attempt to measure a specific result might mask some of the effects of acupuncture observed in a clinical setting. Many of the effects re-ported by non-research clinicians are non-specific (things like: greater vitality, better sleep, return to activity, etc.). In many instances, these non-specific ben-efits are deliberately not observed, in favour of rigorously studying a single outcome variable. Clinicians that are speculative of the effects from acupunc-ture should bear this in mind. The notion that acupuncture can provide short-term analgesia is also important to recognize. Like many other physical treatments, acupuncture might provide temporary symptomatic relief, allowing the patient to return to normal activity, and take part in active or rehabilitative therapy. www.canadianchiropractor.ca T Application, conclusions his Cochrane review summa-rizes the most current evi-dence on the effectiveness of acupuncture on acute, suba-cute and chronic neck pain. Twenty-seven trials (including a total of 5,462 subjects) were included for review. The majority of the included studies had some variable risk of bias. The authors included RCTs, qua-si-RCTs, and clinical controlled trials. Acupuncture vs. sham acupuncture Pain intensity (VAS): Moderate quality evidence suggests that acupuncture is beneficial for mechanical neck pain in the immediate-, short-, intermediate-and long-term post-treatment periods, compared to sham. The data examining the effect of acupuncture on pain inten-sity in the short-term were homogene-ous and pooled for meta-analysis. The analysis concluded that acupuncture is favourable compared to sham at short-term follow-up. Data examining acu-puncture effect on neck disability and quality of life were also pooled for me-ta-analysis, which was in favour of acu-puncture. the authors concluded that moderate quality evidence exists in favour of acu-puncture for the treatment of chronic mechanical neck pain in the short-term (one day to three months). Interestingly, the authors initially wished to rate the evidence in favour of acupuncture in the short-term as high, because the majority of the GRADE criteria were met. They, however, downgraded their rating to moderate because of small sample sizes in the original studies. Only low-quality evidence exists for pain relief in the in-termediate post-treatment period. Disability and quality of life: There was no convincing evidence favouring acupuncture in the short-, intermediate-or long-term. Acupuncture vs. wait-list control Acupuncture vs. inactive treatment Pain intensity (VAS): Of the studies included, acupuncture did not yield superior effects compared to inactive treatment in the immediate and long-term post-treatment periods. However, Pain intensity (VAS) at short-term fol-low-up: One study was included for review, studying the effect of acupunc-ture on neck disorders with radiculopa-thy. The results favoured acupuncture for short-term pain relief. However, there was no evidence of improvement in the immediate post-treatment period. Disability and quality of life: One study was included for review, which assessed the effect of acupuncture on mechanical neck pain and disability (NDI) in the short-term. Acupuncture was superior to wait-list control. No convincing evidence favoured acupunc-ture in any other measures. A total of 14 studies reported adverse effects, such as bruising, increased pain, DR. SHAWN THISTLE is the founder and CEO of RRS Education (rrseducation.com), which helps busy clinicians integrate current research evidence rationally into practice. He also maintains a practice in Toronto, lectures at CMCC and provides chiropractic medicolegal consulting services. Reach him at: [email protected] 26 Canadian Chiropractor July/August 2016
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