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Meta-Analysis
. 2005 Apr 18;2005(2):CD005319.
doi: 10.1002/14651858.CD005319.

Acupuncture for shoulder pain

S Green  1 , R Buchbinder, S Hetrick
Affiliations
Meta-Analysis

Acupuncture for shoulder pain

S Green et al. Cochrane Database Syst Rev. .

Abstract

Background: There are many commonly employed forms of treatment for shoulder disorders. This review of acupuncture is one in a series of reviews of varying interventions for shoulder disorders including adhesive capsulitis (frozen shoulder), rotator cuff disease and osteoarthritis. Acupuncture to treat musculoskeletal pain is being used increasingly to confer an analgesic effect and to date its use in shoulder disorder has not been evaluated in a systematic review.

Objectives: To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain.

Search strategy: The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed.

Selection criteria: Randomised and quasi-randomised trials, in all languages, of acupuncture compared to placebo or another intervention in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica, cervically referred pain and fracture.

Data collection and analysis: Two reviewers independently extracted trial and outcome data. For continuous outcome measures where the standard deviations were not reported it was either calculated from the raw data or converted from the standard error of the mean. If neither of these was reported, authors were contacted. Where results were reported as median and range, the trial was not included in the meta-analysis, but presented in Additional Tables. Effect sizes were calculated and combined in a pooled analysis if the study end-points population and intervention were homogenous. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis to indicate effect of acupuncture across all shoulder disorders.

Main results: Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. Two trials assessed short-term success (post intervention) of acupuncture for rotator cuff disease and could be combined in meta analysis. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo, but due to small sample sizes this may be explained by Type II error. Acupuncture was of benefit over placebo in improving the Constant Murley Score (a measure of shoulder function) at four weeks (WMD 17.3 (7.79, 26.81)). However, by four months, the difference between the acupuncture and placebo groups, whilst still statistically significant, was no longer likely to be clinically significant (WMD 3.53 (0.74, 6.32)). The Constant Murley Score is graded out of 100, hence a change of 3.53 is unlikely to be of substantial benefit. The results of a small pilot study demonstrated some benefit of both traditional and ear acupuncture plus mobilization over mobilization alone. There was no difference in adverse events related to acupuncture when compared to placebo, however this was assessed by only one trial

Authors' conclusions: Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

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Conflict of interest statement

No author involved in this review has any known conflict of interest in regard to this review.

Figures

1.1
1.1. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 1 Pain Post Intervention.
1.2
1.2. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 2 Range of abduction Post Intervention.
1.3
1.3. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 3 Success rate (short term).
1.4
1.4. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 4 Overall success (Constant Murley score) at 4 weeks.
1.5
1.5. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 5 Overall success (Constant Murley score) at 4 months.
1.6
1.6. Analysis
Comparison 1 ACUPUNCTURE VERSUS PLACEBO, Outcome 6 Adverse effect.
2.1
2.1. Analysis
Comparison 2 ACUPUNCTURE VERSUS STEROID INJECTION, Outcome 1 Pain Post Intervention.
2.2
2.2. Analysis
Comparison 2 ACUPUNCTURE VERSUS STEROID INJECTION, Outcome 2 Range of abduction Post Intervention.
2.3
2.3. Analysis
Comparison 2 ACUPUNCTURE VERSUS STEROID INJECTION, Outcome 3 Success rate (short term).
3.1
3.1. Analysis
Comparison 3 ACUPUNCTURE VERSUS ULTRASOUND, Outcome 1 Pain Post Intervention.
3.2
3.2. Analysis
Comparison 3 ACUPUNCTURE VERSUS ULTRASOUND, Outcome 2 Range of abduction Post Intervention.
3.3
3.3. Analysis
Comparison 3 ACUPUNCTURE VERSUS ULTRASOUND, Outcome 3 Success rate (short term).
4.1
4.1. Analysis
Comparison 4 ELECTRO ACUPUNCTURE VERSUS STELLATE GANGLION AND SUPRASCAPULAR NERVE BLOCK, Outcome 1 Pain at 30 hours.
4.2
4.2. Analysis
Comparison 4 ELECTRO ACUPUNCTURE VERSUS STELLATE GANGLION AND SUPRASCAPULAR NERVE BLOCK, Outcome 2 Time to maximum pain relief.
4.3
4.3. Analysis
Comparison 4 ELECTRO ACUPUNCTURE VERSUS STELLATE GANGLION AND SUPRASCAPULAR NERVE BLOCK, Outcome 3 Range of flexion after treatment.
5.1
5.1. Analysis
Comparison 5 ACUPUNCTURE PLUS MOBILZATION VERSUS MOBILIZATION, Outcome 1 Pain at rest.
5.2
5.2. Analysis
Comparison 5 ACUPUNCTURE PLUS MOBILZATION VERSUS MOBILIZATION, Outcome 2 Pain on movement.
5.3
5.3. Analysis
Comparison 5 ACUPUNCTURE PLUS MOBILZATION VERSUS MOBILIZATION, Outcome 3 Active flexion.
5.4
5.4. Analysis
Comparison 5 ACUPUNCTURE PLUS MOBILZATION VERSUS MOBILIZATION, Outcome 4 Active abduction.
7.1
7.1. Analysis
Comparison 7 ACUPUNCTURE VERSUS EXERCISE, Outcome 1 Constant Shoulder Assessment (Pain, Range of Motion, Function) post intervention.
7.2
7.2. Analysis
Comparison 7 ACUPUNCTURE VERSUS EXERCISE, Outcome 2 Constant Shoulder Assessment (Pain, Range of Motion, Function) 20 weeks.
8.1
8.1. Analysis
Comparison 8 ACUPUNCTURE VERSUS TRAGAR, Outcome 1 Wheelchair Users Shoulder Pain Index (WUSPI) post intervention.
8.2
8.2. Analysis
Comparison 8 ACUPUNCTURE VERSUS TRAGAR, Outcome 2 Wheelchair Users Shoulder Pain Index (WUSPI) at 5 week follow‐up.
9.1
9.1. Analysis
Comparison 9 DEEP ACUPUNCTURE VERSUS SHALLOW ACUPUNCTURE, Outcome 1 McGill Pain Questionnaire Post Intervention.
9.2
9.2. Analysis
Comparison 9 DEEP ACUPUNCTURE VERSUS SHALLOW ACUPUNCTURE, Outcome 2 McGill Pain Questionnaire 3 Months Follow‐up.
10.1
10.1. Analysis
Comparison 10 TRADITIONAL ACUPUNCTURE VERSUS JING LUO ACUPUNCTURE, Outcome 1 Recovery.
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References

References to studies included in this review

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References to studies excluded from this review

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References to studies awaiting assessment

Batra 1985 {published data only}
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