Acupuncture for Pain

 

Am Fam Physician. 2019 Jul 15;100(2):89-96.

  Patient information: See related handout on acupuncture for pain relief, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Acupuncture has been increasingly used as an integrative or complementary therapy for pain. It is well-tolerated with little risk of serious adverse effects. Traditional acupuncture and nontraditional techniques, such as electroacupuncture and dry needling, often result in reported pain improvement. Multiple factors may contribute to variability in acupuncture's therapeutic effects, including needling technique, number of needles used, duration of needle retention, acupuncture point specificity, number of treatments, and numerous subjective (psychological) factors. Controlled trials have been published on pain syndromes, such as acupuncture for acute and chronic low back pain, knee osteoarthritis, headache, myofascial pain, neck pain, and fibromyalgia. For some conditions, enough data are available for systematic evaluations or meta-analyses. Acupuncture may provide modest benefits in the treatment of chronic low back pain, tension headache and chronic headache, migraine headache prophylaxis, and myofascial pain. Although patients receiving acupuncture for acute low back pain and knee osteoarthritis report less pain, the improvement with true (verum) acupuncture over sham acupuncture is not clinically significant for these conditions. These two conditions illustrate a recurring pattern in acupuncture trials, in which the additional improvement that can be attributed to verum over sham acupuncture, even when statistically significant, is of less clinical significance. This pattern supports the notion that acupuncture treatment has a notable placebo response, or meaning response, that may be responsible for much of its demonstrated benefits. For certain patients, especially those who are unresponsive or intolerant to standard therapies, acupuncture is a reasonable treatment option.

Ever since a National Institutes of Health consensus panel concluded that acupuncture is effective for postoperative dental pain,1 interest in and use of acupuncture in the United States has grown significantly.2,3 Acupuncture has been increasingly used as an integrative or complementary therapy for pain. This article describes the current evidence regarding the use of acupuncture for common pain conditions since the topic was previously covered in American Family Physician.4  Acupuncture resources are listed in Table 1.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

For chronic low back pain, acupuncture is significantly more effective clinically in the short term than sham acupuncture; both verum and sham acupuncture have large placebo responses.14,33,36

A

Consistent findings from multiple systematic reviews of RCTs

For acute back pain, acupuncture is only slightly more clinically effective than sham acupuncture or anti-inflammatory medications, but the differences are of borderline clinical significance.12,13,33,36

B

Systematic reviews of RCTs with inconsistent findings; the American College of Physicians recommends acupuncture as a treatment option for acute and subacute low back pain

For knee osteoarthritis, acupuncture and sham acupuncture both have clinically significant effects. Acupuncture can be an effective treatment for knee osteoarthritis in the short term.15,37

B

Network meta-analysis of RCTs with varying thresholds for clinical significance and high risk of bias

Acupuncture is effective in reducing frequency of chronic daily idiopathic or tension headaches.16

A

Consistent findings in a Cochrane review of 12 RCTs

Acupuncture reduces the frequency of episodic migraines about as well as drug prophylaxis.17,40,41

A

Consistent findings from multiple systematic reviews of RCTs

Dry needling of trigger points associated with myofascial pain syndromes can be effective in the short term for pain relief and improved range of motion.18,4952

B

Systematic reviews of dry needling for different pain conditions; variable quality studies

Acupuncture is safe and well tolerated, and significant adverse effects are uncommon.5760

A

Overview of 17 systematic reviews of adverse events with consistent results; serious adverse effects may occur in as few as one in 100,000 needles inserted


RCT = randomized controlled trials.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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ROBERT B. KELLY, MD, MS, is a director of integrative medicine at the Cleveland (Ohio) Clinic Family Medicine Residency. He is an associate professor at Case Western Reserve University School of Medicine in Cleveland....

JOEL WILLIS, DO, is a resident at the Cleveland Clinic Family Medicine Residency.

Address correspondence to Robert B. Kelly, MD, MS, Center for Family Medicine, 14601 Detroit Avenue, Lakewood OH 44107 (email: rokell@ccf.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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