Acupuncture for chronic pain in Japan: a review

Abstract

Many Japanese reports of acupuncture and moxibustion for chronic pain are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside of Japan. To complement existing reviews of acupuncture and moxibustion for chronic pain and to provide more detailed discussion and analysis, we did a literature search using 'Igaku Chuo Zasshi Wed' (Japana Centra Revuo Medicina) and 'Citation Information by National Institute of Information' covering the period 1978-2006. Original articles and case reports of acupuncture and moxibustion treatment of chronic pain were included. Animal studies, surveys, and news articles were excluded. Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed the likelihood of causality in each case. We located 57 papers written in Japanese (20 full papers, 37 case reports). Conditions examined were headache (12 trials), chronic low back pain (9 trials), rheumatoid arthritis (8 trials), temporomandibular dysfunction (8 trials), katakori (8 trials) and others (12 trials). While 23 were described as clinical control trials (CCTs), 11 employed a quasi-random method. Applying the 5-point Jadad quality assessment scoring system, the mean score was 1.5 +/- 1.3 (SD). Eleven (52%) of the CCTs were conducted to determine a more effective procedure for acupuncture; these compared a certain type of acupuncture with another type of acupuncture or specific additional points. In particular, the trigger point acupuncture was widely used to treat chronic low back pain in Japan. Many reports of chronic pain treatment by acupuncture and moxibustion are listed in Japanese databases. From the data, we conclude that there is limited evidence that acupuncture is more effective than no treatment, and inconclusive evidence that trigger point acupuncture is more effective than placebo, sham acupuncture or standard care.

Keywords: Japanese literature; acupuncture; chronic pain; clinical trials; trigger point.

Figure 1.

Published articles by years regarding acupuncture treatment of chronic pain in the Japanese literature

Figure 2.

The number of case reports regarding acupuncture treatment of chronic pain in the Japanese literature.

Figure 3.

The number of controlled trials regarding acupuncture treatment of chronic pain in the Japanese literature.

Figure 4.

The number of control groups for acupuncture treatment of chronic pain in the Japanese literature control groups were classified into one of five categories as follows: (i) waiting lists; (ii) physiologically inert controls, e.g. sham TENS, sugar pills, placebo acupuncture; (iii) sham acupuncture; (iv) standard medical care, e.g. drug therapy or physiotherapy and (v) other acupuncture method.

Figure 5.

The distributions of Jadad score for studies of acupuncture treatment for chronic pain in the Japanese literature. The 5-point Jadad quality assessment score is suited to assess internal validity of a trial and this simple method has already been validated. 0 is low quality, 5 is high quality. Mean Jadad score for studies of acupuncture treatment for chronic pain reported in the Japanese literature was 1.5 ± 1.3.