/ 42 1 Acupuncture or acupressure for pain management in labour. (review of systematic reviews)

/ 42 2

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 The evidence from RCTs does not support  the use of acupuncture for controlling labour pain. The primary  studies are diverse and often flawed. Further research seems  warranted. / 42 4 Acupuncture for pain relief in labour: a systematic review and meta-analysis.

 The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions.  If this conclusion is correct, then we ask the question: is it now time to shift research priorities away from asking placebo-related questions and shift toward asking more practical questions about whether the overall benefit is clinically meaningful and cost-effective? / 42 5 Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses.

 The quantitative meta-analysis conducted in this review confirmed the short- term effectiveness and efficacy of acupuncture in the treatment of neck pain. Further studies that address the long-term efficacy of acupuncture for neck pain are warranted / 42 6 Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis.

 A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear. / 42 7 Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.

 Perioperative acupuncture may be a useful adjunct for acute postoperative pain management. / 42 8 Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials.

 There is limited evidence deriving from one study that deep needling directly into myofascial trigger points has an overall treatment effect when compared with standardised care.  Whilst the result of the meta-analysis of needling compared with placebo controls does not attain statistically significant, the overall direction could be compatible with a treatment effect of dry needling on myofascial trigger point pain.  However, the limited sample size and poor quality of these studies highlights and supports the need for large scale, good quality placebo controlled trials in this area. / 42 9 Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials.

 Meta-analysis produced suggestive evidence for the effectiveness of BVA in musculoskeletal pain management. However, primary data were scarce. Future RCTs should assess larger patient samples for longer treatment periods and include appropriate controls / Bee venom acupuncture for musculoskeletal pain: a review.

 Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects. / Acupuncture treatment for chronic knee pain: a systematic review.

 Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review.  There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function.  There is a need for further well designed clinical trials. / Acupuncture for shoulder pain. (Cochrane)

 The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain.  For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only.  Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry- needling may be useful adjuncts to other therapies for chronic low-back pain.  Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area. / Meta-analysis: acupuncture for low back pain. (Cochrane)

/ Acupuncture compared to no treatment, placebo or sham therapy

/ Acupuncture compared to another intervention or added to other interventions

 No method could be regarded as being superior to another, and no consensus on which method is optimal for pain relief during oocyte retrieval was found. Low doses of lignocaine can, however, be recommended in paracervical block (PCB) as well as EA without pre- medication. / The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials.

 We conclude 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, we have found an important relationship between the methodology of the studies and their results that should guide future research / Is acupuncture effective for the treatment of chronic pain? A systematic review.

 Acupuncture was shown to be superior to various control interventions, although there is insufficient evidence to state whether it is superior to placebo. / Acupuncture for back pain: a meta-analysis of randomized controlled trials (1998)

 The efficacy of acupuncture in the treatment of chronic pain remains doubtful. / Acupuncture and chronic pain: a criteria-based meta-analysis. (1990)

/ Group acupuncture for osteoarthritis: Parkbury House Surgery in St Albans

 Acupuncture needs experience.  It is difficult to conduct sham acupuncture.  Modern medical paradigm sometimes contradicts.  The field has mostly practitioners; few researchers.  Evidence is important, but we can’t neglect experience.  Acupuncture works; especially for selected indications.  It is time to start discussing practical issues. / My Comments as Summary