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Meta-Analysis
. 2016 Nov 17;11(11):CD004870.
doi: 10.1002/14651858.CD004870.pub5.

WITHDRAWN: Acupuncture for neck disorders

Kien Trinh  1 , Nadine Graham, Dominik Irnich, Ian D Cameron, Mario Forget
Affiliations
Meta-Analysis

WITHDRAWN: Acupuncture for neck disorders

Kien Trinh et al. Cochrane Database Syst Rev. .

Abstract

Background: Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are perceptions of benefit. Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain. This update replaces our 2006 Cochrane review update on this topic.

Objectives: To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015. We searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.

Selection criteria: We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomised controlled trials (RCTs).

Data collection and analysis: Two review authors made independent decisions for each step of the review: article inclusion, data abstraction and assessment of quality of trial methods. We assessed study quality by using the Cochrane Back Review Group 'Risk of bias' tool. We used consensus to resolve disagreements, and when clinical heterogeneity was absent, we combined studies by using random-effects meta-analysis models.

Main results: Of the 27 included studies, three represented individuals with whiplash-associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non-specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants).For mechanical neck pain, we found that acupuncture is beneficial at immediate-term follow-up compared with sham acupuncture for pain intensity; at short-term follow-up compared with sham or inactive treatment for pain intensity; at short-term follow-up compared with sham treatment for disability; and at short-term follow-up compared with wait-list control for pain intensity and neck disability improvement. Statistical pooling was appropriate for acupuncture compared with sham for short-term outcomes due to statistical homogeneity (P value = 0.83; I2 = 20%). Results of the meta-analysis favoured acupuncture (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.20 to -0.07; P value = 0.0006). This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.Acupuncture appears to be a safe treatment modality, as adverse effects are minor. Reported adverse effects include increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. These studies reported no life-threatening adverse effects and found that acupuncture treatments were cost-effective.Since the time of our previous review, the quality of RCTs has improved, and we have assessed many of them as having low risk of bias. However, few large trials have provided high-quality evidence.

Authors' conclusions: Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up.

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Conflict of interest statement

D Irnich is an author of two included studies. He did not take part in data extraction.

Use of raters from diverse professional backgrounds (sports medicine physician, rheumatologist, occupational health physician, physiatrist, statistician, physiotherapist, manual therapist, chiropractor, massage therapist) should serve to limit any conflicts of interest that might have been present during the review process.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Analysis 1.1
Analysis 1.1
Comparison 1 Acupuncture versus sham treatment, Outcome 1 Pain intensity (VAS) immediate post treatment.
Analysis 1.2
Analysis 1.2
Comparison 1 Acupuncture versus sham treatment, Outcome 2 Pain intensity (VAS) short term.
Analysis 1.3
Analysis 1.3
Comparison 1 Acupuncture versus sham treatment, Outcome 3 Pain intensity (VAS) intermediate term.
Analysis 1.4
Analysis 1.4
Comparison 1 Acupuncture versus sham treatment, Outcome 4 Pain intensity (VAS) long term.
Analysis 1.5
Analysis 1.5
Comparison 1 Acupuncture versus sham treatment, Outcome 5 Disability (NDI) immediate post treatment.
Analysis 1.6
Analysis 1.6
Comparison 1 Acupuncture versus sham treatment, Outcome 6 Disability (NPQ) immediate post treatment.
Analysis 1.7
Analysis 1.7
Comparison 1 Acupuncture versus sham treatment, Outcome 7 Disability (NPQ) short term.
Analysis 1.8
Analysis 1.8
Comparison 1 Acupuncture versus sham treatment, Outcome 8 Disability (NDI) short term.
Analysis 1.9
Analysis 1.9
Comparison 1 Acupuncture versus sham treatment, Outcome 9 Disability (NDI) intermediate term.
Analysis 1.10
Analysis 1.10
Comparison 1 Acupuncture versus sham treatment, Outcome 10 Quality of life (SF‐36) immediate post treatment.
Analysis 1.11
Analysis 1.11
Comparison 1 Acupuncture versus sham treatment, Outcome 11 Quality of life (SF‐36) short term.
Analysis 2.1
Analysis 2.1
Comparison 2 Acupuncture versus inactive control, Outcome 1 Pain intensity (VAS) immediate post treatment.
Analysis 2.2
Analysis 2.2
Comparison 2 Acupuncture versus inactive control, Outcome 2 Pain intensity (VAS) short term.
Analysis 2.3
Analysis 2.3
Comparison 2 Acupuncture versus inactive control, Outcome 3 Pain intensity (VAS) intermediate term.
Analysis 2.4
Analysis 2.4
Comparison 2 Acupuncture versus inactive control, Outcome 4 Pain intensity (VAS) long term.
Analysis 2.5
Analysis 2.5
Comparison 2 Acupuncture versus inactive control, Outcome 5 Pain pressure threshold immediate post treatment.
Analysis 2.6
Analysis 2.6
Comparison 2 Acupuncture versus inactive control, Outcome 6 Pain pressure threshold short term.
Analysis 2.7
Analysis 2.7
Comparison 2 Acupuncture versus inactive control, Outcome 7 Pain intensity (proportion pain relief) immediate post treatment.
Analysis 2.8
Analysis 2.8
Comparison 2 Acupuncture versus inactive control, Outcome 8 Disability (NDI) short term.
Analysis 2.9
Analysis 2.9
Comparison 2 Acupuncture versus inactive control, Outcome 9 Disability (NDI) intermediate term.
Analysis 2.10
Analysis 2.10
Comparison 2 Acupuncture versus inactive control, Outcome 10 Disability (NDI) long term.
Analysis 2.11
Analysis 2.11
Comparison 2 Acupuncture versus inactive control, Outcome 11 Function (NHP) immediate post treatment.
Analysis 2.12
Analysis 2.12
Comparison 2 Acupuncture versus inactive control, Outcome 12 Function (NHP) intermediate term.
Analysis 2.13
Analysis 2.13
Comparison 2 Acupuncture versus inactive control, Outcome 13 Function (NPQ) short term.
Analysis 2.14
Analysis 2.14
Comparison 2 Acupuncture versus inactive control, Outcome 14 Quality of life (SF‐36, Functional Component) short term.
Analysis 3.1
Analysis 3.1
Comparison 3 Acupuncture versus wait‐list, Outcome 1 Pain intensity (VAS) short term.
Analysis 3.2
Analysis 3.2
Comparison 3 Acupuncture versus wait‐list, Outcome 2 Disability (neck and pain disability scale) short term.
Analysis 3.3
Analysis 3.3
Comparison 3 Acupuncture versus wait‐list, Outcome 3 Disability (neck and pain disability scale) intermediate term.
Analysis 3.4
Analysis 3.4
Comparison 3 Acupuncture versus wait‐list, Outcome 4 Quality of life (SF‐36 mental score) short term.
Analysis 3.5
Analysis 3.5
Comparison 3 Acupuncture versus wait‐list, Outcome 5 Quality of life (SF‐36 mental score) intermediate term.
Analysis 3.6
Analysis 3.6
Comparison 3 Acupuncture versus wait‐list, Outcome 6 Quality of life (SF‐36 physical score) intermediate term.
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