Acupuncture Research Evidence

A second, follow-up clinical trial, however, found that “Traditional Chinese medicine (TCM) acupuncture was not effective in initiating spontaneous labor or reducing the rate of cesarean delivery compared with sham acupuncture or usual medical care.”

Drs. Remy Coeytaux and Wunian Chen have conducted two randomized controlled trials of acupuncture for initiation of labor. The first study compared usual obstetrical care only to usual care plus acupuncture. That study demonstrated that “mean time to delivery occurred 21 hours sooner in the acupuncture group, but this difference did not reach statistical significance (p = 0.36).Compared to controls, women in the acupuncture group tended to be more likely to labor spontaneously (70% vs. 50%, p = 0.12) and less likely to deliver by cesarean section (39% vs. 17%, p = 0.07).”

A systematic review of the literature concluded “the current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP.”

A small randomized controlled trial involving 32 women with a diagnosis of infertility found the following: “At the end of the 8-week intervention, women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory with less social concern (mean difference [MD] -3.75, 95% confidence interval [CI] -7.58 to 0.84, p=0.05), and less relationship concern (MD -3.66, 95% CI -6.80 to -0.052, p=0.02). There were also trends toward a reduction of infertility stress on other domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI -2.20 to 26.0, p=0.09) and less anxiety (MD -2.54, 95% CI -5.95 to 0.86, p=0.08) in the acupuncture group compared with the wait-list control. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and time out, the engagement with the practitioner, and an intervention that had very few negative side-effects.”

A small randomized controlled trial involving 43 women undergoing in vitro fertilization (IVF) demonstrated that “acupuncture can reduce anxiety symptoms observed by the reduction of psychological parameters of women undergoing IVF.”

A similar conclusion was drawn by authors of a Cochrane Collaboration review of acupuncture for Bell’s palsy: “The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.”

Drs. Remy Coeytaux and Wunian Chen and colleagues at UNC Chapel Hill conducted an NIH-sponsored, randomized clinical trial of acupuncture for chronic daily headache. 74 patient with chronic daily headache from the UNC Headache clinic were randomized to either medical management by headache specialist or medical management plus acupuncture. The authors concluded: “Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL and the perception by patients that they suffered less from headaches.”

A multicenter, randomized controlled trial involving 130 patients with chronic low back pain demonstrated that “acupuncture treatment shows better effect on the reduction of the bothersomeness and pain intensity than sham control in participants with chronic low back pain (cLBP).”

A meta-analysis involving 25 clinical trials found that “acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance.”

The Acupuncture Trialists Collaboration is an NIH-sponsored collaboration of acupuncture researchers, of which Dr. Remy Coeytaux is a founding member. In 2012, the Archives of Internal Medicine published an individual patient data meta-analysis of data from 29 randomized controlled studies of acupuncture for pain conditions. This report concluded: “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”

A review of the published literature of acupuncture for the treatment of or management of chronic pain, written by Drs. Remy Coeytaux and Eric Garland, was published in the North Carolina Medical Journal in 2013. The authors conclude: “Evidence supports the safety and efficacy of acupuncture compared with no treatment, but it is unclear what role the placebo effect plays in acupuncture's efficacy.”

A meta-analysis of data from 15 randomized controlled studies of acupuncture for chronic constipation “indicated that acupuncture for chronic functional constipation was probably as effective as conventional medical therapy in the change of bowel movements.” “Acupuncture for chronic functional constipation is safe and may improve weekly spontaneous bowel movements, quality of life, and relevant symptoms. However, the evidence was limited by the small sample size and the methodological quality.”

There has not been a lot of research on the effectiveness of acupuncture for complications of diabetes. A cohort study of patients with diabetes and painful peripheral neuropathy reported that 77% of the patients who underwent a 10-week course of acupuncture noted significant improvement in their symptoms, and 21% noted that their symptoms cleared completely. The authors concluded: “These data suggest that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.”

Meta-analysis of data from clinical trials that compared acupuncture with non-acupuncture treatments for dysphagia in patients with stroke “showed that the effectiveness of treatment in the group receiving acupuncture was higher than that in the non-acupuncture group (OR=5.17, 95% CI 4.18 to 6.38; p<0.00001). However, the study quality was generally low and of insufficient quality to make recommendations about using acupuncture in the rehabilitation of patients with dysphagia due to stroke.”

Dr. Remy Coeytaux and colleagues at UNC Chapel Hill conducted a systematic review of randomized controlled trials of auriculotherapy, or “ear acupuncture” in the treatment of pain conditions. They concluded: “Auriculotherapy may be effective for the treatment of a variety of types of pain, especially postoperative pain. However, a more accurate estimate of the effect will require further large, well-designed trials.”

A systematic review of 9 clinical trials involving 395 participants found that “there is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. “

A systematic review of the literature identified two randomized controlled studies that demonstrated that acupuncture significantly reduced both systolic and diastolic blood pressure compared to a sham acupuncture procedure. However, “other studies had substantial heterogeneity due to the quality of them was poor, and their sample sizes were not satisfactory as an equivalence study.” The authors concluded:
“While there are some evidences that suggest potential effectiveness of acupuncture for hypertension, the results were limited by the methodological flaws of the studies.”

A thoughtful critique of the evidence that pertains to acupuncture for women undergoing in vitro fertilization (IVF) was recently published in the journal of Complementary Therapies in Clinical Practice.

A recently published, randomized, placebo-controlled trial involving 180 with primary insomnia found that acupuncture plus placebo pill was associated with improved sleep quality, vitality, decreased daytime dysfunction, and sleepiness, compared with sham acupuncture plus placebo pill or sham acupuncture plus the sleep medication, estazolam. The results of this study suggest that acupuncture may be more effective in improving sleep quality than a commonly prescribed sleep medication.

A systematic review of 6 randomized, placebo-controlled clinical trials found that “acupuncture exhibits clinically and statistically significant control of IBS symptoms.”

A multicenter, randomized controlled trial involving 755 patients with depression compared acupuncture with counseling with usual primary care only. “In this randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.”

Drs. Coeytaux and Chen are currently conducting another NIH-sponsored clinical trial of acupuncture for menopausal hot flashes. This study is ongoing so we do not know yet if acupuncture will be shown to be effective in the treatment of hot flashes.

A discussion of the role of acupuncture in treating menopausal hot flashes can be found in the journal, Menopause. This review was written by Dr. Nancy Avis from Wake Forest University and Dr. Remy Coeytaux from Duke University.

A multicenter, randomized controlled trial involving 480 patients with migraine demonstrated “a significant reduction in the number of days with a migraine during weeks 13-16 in all acupuncture groups compared with control…” The authors stated: “We found that there was a significant, but not clinically relevant, benefit for almost all secondary outcomes in the three acupuncture groups compared with the control group.”

A Cochrane Collaboration systematic review of 22 clinical trials involving 4419 patients concluded that “there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care.”

A systematic review identified 20 randomized controlled trials of moxibustion involving 1625 patients with irritable bowel syndrome (IBS). The authors concluded “This systematic review and meta-analysis suggests that moxibustion may provide benefit to IBS patients although the risk of bias in the included studies is relatively high. Future studies are necessary to confirm whether this finding is reproducible in carefully-designed and conducted trials and to firmly establish the place of moxibustion in current practice.”

A systematic review of the literature found that “moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain, and a 16- to 20-week training program was no more successful than usual prenatal care at preventing pelvic or LBP.” “For pelvic pain, there was moderate-quality evidence that acupuncture significantly reduced evening pain better than exercise; both were better than usual care.”

A systematic review concluded: “Although acupuncture seems promising for symptom improvement in women with PMS, important methodological flaws in the included studies weaken the evidence. Considering the potential of acupuncture, further rigorous studies are needed."

A systematic review identified 10 clinical trials, the combined results of which suggest that acupuncture may reduce pain associated with menstrual periods, but further research is needed. “There was an improvement in pain relief from acupuncture compared with a placebo control (OR 9.5, 95% CI 21.17 to 51.8), NSAIDs (SMD -0.70, 95% CI -1.08 to -0.32) and Chinese herbs (SMD -1.34, 95% CI -1.74 to -0.95). In two trials acupuncture reduced menstrual symptoms (for example nausea, back pain) compared with medication (OR 3.25, 95% CI 1.53 to 6.86); in one trial acupuncture reduced menstrual symptoms compared with Chinese herbs (OR 7.0, 95% CI 2.22, 22.06); and in one trial acupuncture improved quality of life compared with usual care.”

A research team led by Dr. Jongbae Park at UNC Chapel Hill conducted a systematic review of the published literature. 105 acupuncture trials were included. The authors concluded that “acupuncture during pregnancy appears to be associated with few adverse events when correctly applied.”

A Cochrane Collaboration systematic review identified 11 clinical trials involving 2317 patients with tension-type headache. The authors concluded: “In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.”