Durable Effect of Acupuncture for Chronic Neck Pain: A Systematic Review and Meta-Analysis

Abstract

Objective: Chronic neck pain, a prevalent health concern characterized by frequent recurrence, requires exploration of treatment modalities that provide sustained relief. This systematic review and meta-analysis aimed to evaluate the durable effects of acupuncture on chronic neck pain.

Methods: We conducted a literature search up to March 2024 in six databases, including PubMed, Embase, and the Cochrane Library, encompassing both English and Chinese language publications. The main focus of evaluation included pain severity, functional disability, and quality of life, assessed at least 3 months post-acupuncture treatment. The risk of bias assessment was conducted using the Cochrane Risk of Bias 2.0 tool, and meta-analyses were performed where applicable.

Results: Eighteen randomized controlled trials were included in the analysis. Acupuncture as an adjunct therapy could provide sustained pain relief at three (SMD: - 0.79; 95% CI - 1.13 to - 0.46; p < 0.01) and six (MD: - 18.13; 95% CI - 30.18 to - 6.07; p < 0.01) months post-treatment. Compared to sham acupuncture, acupuncture did not show a statistically significant difference in pain alleviation (MD: - 0.12; 95% CI - 0.06 to 0.36; p = 0.63). However, it significantly improved functional outcomes as evidenced by Northwick Park Neck Pain Questionnaire scores 3 months post-treatment (MD: - 6.06; 95% CI - 8.20 to - 3.92; p < 0.01). Although nine studies reported an 8.5%-13.8% probability of adverse events, these were mild and transitory adverse events.

Conclusion: Acupuncture as an adjunct therapy may provide post-treatment pain relief lasting at least 3 months for patients with chronic neck pain, although it is not superior to sham acupuncture, shows sustained efficacy in improving functional impairment for over 3 months, with a good safety profile.

Keywords: Acupuncture; Chronic neck pain; Durable effect; Meta-analysis; Systematic review.

Fig. 1

PRISMA flow diagram

Fig. 2

Risk of bias graph

Fig. 3

Risk of Bias of included studies

Fig. 4

Forest plot of the mean difference in change of NPQ scores between acupuncture and sham acupuncture at the 3-month follow-up after intervention, compared to baseline, for CNP

Fig. 5

Forest plot comparing the standardized mean difference in pain score changes between acupuncture and active control at the 3-month follow-up after intervention, relative to baseline, for CNP

Fig. 6

Forest plot comparing the mean difference in pain score changes between acupuncture and active control at the 3-month follow-up after intervention, relative to baseline, for CNP

Fig. 7

Forest plot of the mean difference in change of NDI scores between acupuncture and active control at the 3-month follow-up after intervention, compared to baseline, for CNP

Fig. 8

Forest plot of the mean difference in change of NPQ scores between acupuncture and active control at the 3-month follow-up after intervention, compared to baseline, for CNP

Fig. 9

Forest plot comparing the standardized mean difference in pain score changes between acupuncture with active control and active control at the 3-month follow-up after intervention, relative to baseline, for CNP

Fig. 10

Forest plot comparing the mean difference in pain score changes between acupuncture with active control and active control at the 6-month follow-up after intervention, relative to baseline, for CNP

Fig. 11

Forest plot of the mean difference in change of NDI scores between acupuncture with active control and active control at the 3-month follow-up after intervention, compared to baseline, for CNP

Fig. 12

Forest plot of the mean difference in change of NDI scores between acupuncture with active control and active control at the 6-month follow-up after intervention, compared to baseline, for CNP