Research: EZZO and colleagues, Univ

Listed in Issue 58

Abstract

EZZO and colleagues, University of Maryland School of Medicine, Kernan Hospital Mansion, 220 Kernan Drive, Baltimore, MD 21207-6697, USA reviewed the effectiveness of acupuncture for the treatment of chronic pain.

Background

Pain is a major complaint of the estimated one million US consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, its effectiveness remains in question.

Methodology

Medline, two complementary medicine databases, 69 conference proceedings, other article bibliographies and reviews were searched. Trials were included if they were randomized, involved populations with pain of greater than 3 months, used needle rather than surface electrodes and were in English. Data were extracted by two independent reviewers using a validated instrument. Disagreements were resolved by discussion.

Results

Fifty-one studies met the inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three quarters of the studies received a low quality score and low quality trials were significantly associated with positive results (p=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) error is high due to a large sample size requirement. Six or more acupuncture treatments were significantly associated with positive outcomes (p=0.03) even after adjusting for study quality.

Conclusion

The authors concluded there is limited evidence that acupuncture is more effective than no treatment for chronic pain and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, there was an important relationship between the methodology of the studies and their results that should guide future research.

References

Ezzo J et al. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 86(3): 217-25. Jun 2000.

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