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Cochrane Database of Systematic Reviews

Acupuncture for neck disorders

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Information

DOI:
https://doi.org/10.1002/14651858.CD004870.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 04 May 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Back and Neck Group

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Kien Trinh

    Correspondence to: DeGroote School of Medicine, Office of MD Admissions, McMaster University, Hamilton, Canada

    [email protected]

  • Nadine Graham

    School of Rehabilitation Science, McMaster University, Hamilton, Canada

  • Dominik Irnich

    Department of Anesthesiology, University of Munich, Munich, Germany

  • Ian D Cameron

    John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia

  • Mario Forget

    Canadian Forces Health Services Group/Groupe de Services de Santé des Forces Canadiennes, National Defence/Défense Nationale, Government of Canada/Gouvernement du Canada, Kingston, Canada

Contributions of authors

Primary reviewers for this review ‐ Trinh K, Graham N, Irnich D, Cameron ID, Forget M.

Statistician ‐ Trinh K, Goldsmith CH (Cervical Overview Group ‐ COG).
Methodological quality assessment ‐ COG Validity Team; Burnie S, Empey B, Forget M, Goldsmith CH, Graham N, LeBlanc F, Szeto G.
Study identification and selection ‐ Brunarski D, Graham N, Gross A, Haines T (COG).
Research librarian ‐ Rice M.
Data abstraction, synthesis, manuscript preparation, public responsibility, grants, administration ‐ primary review authors.
Final synthesis ‐ primary review authors.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Candian Institute of Health Research, Canada.

    Knowledge Synthesis Grant "Synthesizing Research Evidence into Clinical Recommendations for Managing Neck Pain"

Declarations of interest

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.

Acknowledgements

Thank you to the primary authors who responded to requests for information. We also thank our volunteers, our translators and the Cochrane Back Review Group editors.

Version history

Published

Title

Stage

Authors

Version

2016 Nov 17

Acupuncture for neck disorders

Review

Kien Trinh, Nadine Graham, Dominik Irnich, Ian D Cameron, Mario Forget

https://doi.org/10.1002/14651858.CD004870.pub5

2016 May 04

Acupuncture for neck disorders

Review

Kien Trinh, Nadine Graham, Dominik Irnich, Ian D Cameron, Mario Forget

https://doi.org/10.1002/14651858.CD004870.pub4

2006 Jul 19

Acupuncture for neck disorders

Review

Kien Trinh, Nadine Graham, Anita Gross, Charles H Goldsmith, Ellen Wang, Ian D Cameron, Theresa M Kay, Cervical Overview Group

https://doi.org/10.1002/14651858.CD004870.pub3

2004 Jul 19

Acupuncture for neck disorders

Protocol

Kien Trinh, Theresa M Kay, Nadine Graham, Anita Gross, Charles H Goldsmith, Ian D Cameron, Ellen Wang, Zevko Radylovic

https://doi.org/10.1002/14651858.CD004870.pub2

2003 Apr 22

Acupuncture for neck disorders

Protocol

KV Trinh, TM Kay, N Graham, AR Gross, CH Goldsmith, I Cameron, E Wang, Z Radylovic

https://doi.org/10.1002/14651858.CD004870

Differences between protocol and review

We included only randomised controlled trials (RCTs) in this update. In the original review, we included RCTs and quasi‐RCTs, as per protocol.

We used the risk of bias assessment tool of the Cochrane Back Review Group (Furlan 2009) for this update. We previously used the assessment tools used in Jadad 1996 and van Tulder 2003.

Keywords

MeSH

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Acupuncture versus sham treatment, Outcome 1 Pain intensity (VAS) immediate post treatment.
Figures and Tables -
Analysis 1.1

Comparison 1 Acupuncture versus sham treatment, Outcome 1 Pain intensity (VAS) immediate post treatment.

Comparison 1 Acupuncture versus sham treatment, Outcome 2 Pain intensity (VAS) short term.
Figures and Tables -
Analysis 1.2

Comparison 1 Acupuncture versus sham treatment, Outcome 2 Pain intensity (VAS) short term.

Comparison 1 Acupuncture versus sham treatment, Outcome 3 Pain intensity (VAS) intermediate term.
Figures and Tables -
Analysis 1.3

Comparison 1 Acupuncture versus sham treatment, Outcome 3 Pain intensity (VAS) intermediate term.

Comparison 1 Acupuncture versus sham treatment, Outcome 4 Pain intensity (VAS) long term.
Figures and Tables -
Analysis 1.4

Comparison 1 Acupuncture versus sham treatment, Outcome 4 Pain intensity (VAS) long term.

Comparison 1 Acupuncture versus sham treatment, Outcome 5 Disability (NDI) immediate post treatment.
Figures and Tables -
Analysis 1.5

Comparison 1 Acupuncture versus sham treatment, Outcome 5 Disability (NDI) immediate post treatment.

Comparison 1 Acupuncture versus sham treatment, Outcome 6 Disability (NPQ) immediate post treatment.
Figures and Tables -
Analysis 1.6

Comparison 1 Acupuncture versus sham treatment, Outcome 6 Disability (NPQ) immediate post treatment.

Comparison 1 Acupuncture versus sham treatment, Outcome 7 Disability (NPQ) short term.
Figures and Tables -
Analysis 1.7

Comparison 1 Acupuncture versus sham treatment, Outcome 7 Disability (NPQ) short term.

Comparison 1 Acupuncture versus sham treatment, Outcome 8 Disability (NDI) short term.
Figures and Tables -
Analysis 1.8

Comparison 1 Acupuncture versus sham treatment, Outcome 8 Disability (NDI) short term.

Comparison 1 Acupuncture versus sham treatment, Outcome 9 Disability (NDI) intermediate term.
Figures and Tables -
Analysis 1.9

Comparison 1 Acupuncture versus sham treatment, Outcome 9 Disability (NDI) intermediate term.

Comparison 1 Acupuncture versus sham treatment, Outcome 10 Quality of life (SF‐36) immediate post treatment.
Figures and Tables -
Analysis 1.10

Comparison 1 Acupuncture versus sham treatment, Outcome 10 Quality of life (SF‐36) immediate post treatment.

Comparison 1 Acupuncture versus sham treatment, Outcome 11 Quality of life (SF‐36) short term.
Figures and Tables -
Analysis 1.11

Comparison 1 Acupuncture versus sham treatment, Outcome 11 Quality of life (SF‐36) short term.

Comparison 2 Acupuncture versus inactive control, Outcome 1 Pain intensity (VAS) immediate post treatment.
Figures and Tables -
Analysis 2.1

Comparison 2 Acupuncture versus inactive control, Outcome 1 Pain intensity (VAS) immediate post treatment.

Comparison 2 Acupuncture versus inactive control, Outcome 2 Pain intensity (VAS) short term.
Figures and Tables -
Analysis 2.2

Comparison 2 Acupuncture versus inactive control, Outcome 2 Pain intensity (VAS) short term.

Comparison 2 Acupuncture versus inactive control, Outcome 3 Pain intensity (VAS) intermediate term.
Figures and Tables -
Analysis 2.3

Comparison 2 Acupuncture versus inactive control, Outcome 3 Pain intensity (VAS) intermediate term.

Comparison 2 Acupuncture versus inactive control, Outcome 4 Pain intensity (VAS) long term.
Figures and Tables -
Analysis 2.4

Comparison 2 Acupuncture versus inactive control, Outcome 4 Pain intensity (VAS) long term.

Comparison 2 Acupuncture versus inactive control, Outcome 5 Pain pressure threshold immediate post treatment.
Figures and Tables -
Analysis 2.5

Comparison 2 Acupuncture versus inactive control, Outcome 5 Pain pressure threshold immediate post treatment.

Comparison 2 Acupuncture versus inactive control, Outcome 6 Pain pressure threshold short term.
Figures and Tables -
Analysis 2.6

Comparison 2 Acupuncture versus inactive control, Outcome 6 Pain pressure threshold short term.

Comparison 2 Acupuncture versus inactive control, Outcome 7 Pain intensity (proportion pain relief) immediate post treatment.
Figures and Tables -
Analysis 2.7

Comparison 2 Acupuncture versus inactive control, Outcome 7 Pain intensity (proportion pain relief) immediate post treatment.

Comparison 2 Acupuncture versus inactive control, Outcome 8 Disability (NDI) short term.
Figures and Tables -
Analysis 2.8

Comparison 2 Acupuncture versus inactive control, Outcome 8 Disability (NDI) short term.

Comparison 2 Acupuncture versus inactive control, Outcome 9 Disability (NDI) intermediate term.
Figures and Tables -
Analysis 2.9

Comparison 2 Acupuncture versus inactive control, Outcome 9 Disability (NDI) intermediate term.

Comparison 2 Acupuncture versus inactive control, Outcome 10 Disability (NDI) long term.
Figures and Tables -
Analysis 2.10

Comparison 2 Acupuncture versus inactive control, Outcome 10 Disability (NDI) long term.

Comparison 2 Acupuncture versus inactive control, Outcome 11 Function (NHP) immediate post treatment.
Figures and Tables -
Analysis 2.11

Comparison 2 Acupuncture versus inactive control, Outcome 11 Function (NHP) immediate post treatment.

Comparison 2 Acupuncture versus inactive control, Outcome 12 Function (NHP) intermediate term.
Figures and Tables -
Analysis 2.12

Comparison 2 Acupuncture versus inactive control, Outcome 12 Function (NHP) intermediate term.

Comparison 2 Acupuncture versus inactive control, Outcome 13 Function (NPQ) short term.
Figures and Tables -
Analysis 2.13

Comparison 2 Acupuncture versus inactive control, Outcome 13 Function (NPQ) short term.

Comparison 2 Acupuncture versus inactive control, Outcome 14 Quality of life (SF‐36, Functional Component) short term.
Figures and Tables -
Analysis 2.14

Comparison 2 Acupuncture versus inactive control, Outcome 14 Quality of life (SF‐36, Functional Component) short term.

Comparison 3 Acupuncture versus wait‐list, Outcome 1 Pain intensity (VAS) short term.
Figures and Tables -
Analysis 3.1

Comparison 3 Acupuncture versus wait‐list, Outcome 1 Pain intensity (VAS) short term.

Comparison 3 Acupuncture versus wait‐list, Outcome 2 Disability (neck and pain disability scale) short term.
Figures and Tables -
Analysis 3.2

Comparison 3 Acupuncture versus wait‐list, Outcome 2 Disability (neck and pain disability scale) short term.

Comparison 3 Acupuncture versus wait‐list, Outcome 3 Disability (neck and pain disability scale) intermediate term.
Figures and Tables -
Analysis 3.3

Comparison 3 Acupuncture versus wait‐list, Outcome 3 Disability (neck and pain disability scale) intermediate term.

Comparison 3 Acupuncture versus wait‐list, Outcome 4 Quality of life (SF‐36 mental score) short term.
Figures and Tables -
Analysis 3.4

Comparison 3 Acupuncture versus wait‐list, Outcome 4 Quality of life (SF‐36 mental score) short term.

Comparison 3 Acupuncture versus wait‐list, Outcome 5 Quality of life (SF‐36 mental score) intermediate term.
Figures and Tables -
Analysis 3.5

Comparison 3 Acupuncture versus wait‐list, Outcome 5 Quality of life (SF‐36 mental score) intermediate term.

Comparison 3 Acupuncture versus wait‐list, Outcome 6 Quality of life (SF‐36 physical score) intermediate term.
Figures and Tables -
Analysis 3.6

Comparison 3 Acupuncture versus wait‐list, Outcome 6 Quality of life (SF‐36 physical score) intermediate term.

Acupuncture compared with sham for chronic neck pain

Patient or population: patients with chronic mechanical neck pain (pain for more than 90 days)

Settings: varied, mostly at university or hospital clinics

Intervention: acupuncture

Comparison: sham

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Sham

Acupuncture

Pain intensity (VAS) short term

Mean pain intensity ranged across sham groups from

3 points on a 0 to 10 scale to 47 points on a 0 to 100 scale

Mean pain intensity in intervention groups was

0.23 standard deviations lower (0.20 to 0.07 higher)

‐0.23 (‐0.20 to ‐0.07)

560

(8 studies)

⊕⊕⊕⊝
Moderate

Limitations: ‐1

Inconsistency: 0

Indirectness: 0

Imprecision: 0

Other: 0

Statistical pooling was appropriate in this instance because of statistical homogeneity. Results of the meta‐analysis favoured acupuncture

Disability (NPQ) short term

Mean disability ranged across control groups from

24 points on a 0 to 100 scale to 26 points on a 0 to 100 scale

Mean disability in intervention groups was
0.38 standard deviations lower (0.62 to 0.15 higher)

‐0.38 (‐0.62 to ‐0.15)

290

(2 studies)

⊕⊕⊝⊝
Low

Limitations: ‐1

Inconsistency: 0

Indirectness: 0

Imprecision: ‐1

Other: 0

Two small trials were in favour of acupuncture. On the basis of the GRADE scale, quality level of evidence was downgraded to low because only 1 of the 2 studies (50%) was at low risk with small sample size

Disability (NDI) short term

Mean disability ranged across control groups from
11 points on a 0 to 100 scale to 15 points on a 0 to 100 scale

Mean disability in intervention groups ranged from
3 points on a 0 to 10 scale to 11 points on a 0 to 100 scale

‐‐

173
(3 studies)

N/A

All 3 studies, 2 with low risk of bias, did not show a statistically significant result in favour of acupuncture

Quality of life (SF‐36) short term

Mean quality of life across control groups ranged from

86 points on a 0 to 100 scale to 86 points on a 0 to 100 scale

Mean quality of life in intervention groups ranged from

84 points on a 0 to 100 scale to 85 points on a 0 to 100 scale

‐‐

178

(1 study)

⊕⊕⊝⊝
Low

Limitations: 0

Inconsistency: 0

Indirectness: ‐1

Imprecision: ‐1

Other: 0

One study with low risk of bias favoured acupuncture

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

Adverse effects were reported in 14 studies and included increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. No life‐threatening adverse effects were noted by these studies.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

Figures and Tables -

Acupuncture compared with inactive treatments for chronic neck pain

Patient or population: patients with chronic neck pain (pain for more than 90 days)

Settings: primary care, general practitioners' clinics to secondary care, outpatient pain clinics or speciality clinics

Intervention: acupuncture

Comparison: inactive treatments

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Inactive treatment

Acupuncture

Pain intensity (VAS) short term

Mean pain intensity ranged across control groups from

17 points on a 0 to 100 scale to 31 points on a 0 to 100 scale

Mean pain intensity in intervention groups was

17 points on a 0 to 100 scale to 9 points on a 0 to 10 scale

‐‐

404

(5 studies)

⊕⊕⊕⊝
Moderate

Limitations: 0

Inconsistency: 0

Indirectness: 0

Imprecision: ‐1

Other: 0

Five studies (n = 461) assessed participants with mechanical neck disorders. Four were at low risk of bias. Statistical pooling was inappropriate in this instance because of statistical heterogeneity. Four of these studies favoured acupuncture

Pain pressure threshold short term

Mean pain pressure threshold ranged across control groups from

0 points on a 0 to 10 scale to 7 points on a 0 to 10 scale

Mean pain pressure threshold in intervention groups ranged from

0.2 points on a 0 to 10 scale to 7 points on a 0 to 10 scale

‐‐

132

(2 studies)

N/A

Two studies with low risk of bias did not favour acupuncture

Disability (NDI) short term

Function (NPQ) short term

Mean disability ranged across control groups from

12 points on a 0 to 100 scale to 13 points on a 0 to 100 scale

Mean function across control groups was

13 points on a 0 to 100 scale

Mean disability in intervention groups ranged from
11 points on a 0 to 100 scale to 12 points on a 0 to 100 scale

Mean function in intervention groups was

30 points on a 0 to 100 scale

‐‐

118

(1 study)

123

(1 study)

N/A

⊕⊕⊝⊝
Low

Limitations: 0

Inconsistency: 0

Indirectness: ‐1

Imprecision: ‐1

Other: 0

One study with low risk of bias did not favour acupuncture

One study with low risk of bias favoured acupuncture

Quality of life (SF‐36, Functional Component) short term

Mean function ranged across control groups from

0.7 points on a 0 to 10 scale to 5 points on a 0 to 10 scale

Mean function in intervention groups ranged from

41 points on a 0 to 100 scale to 9 points on a 0 to 10 scale

‐‐

143

(2 studies)

N/A

Two studies with low risk of bias did not favour acupuncture

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

Adverse effects were reported in 14 studies and included increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. No life‐threatening adverse effects were noted by these studies.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

Figures and Tables -

Acupuncture compared with wait‐list control for chronic neck pain

Patient or population: patients with chronic neck pain (pain for more than 90 days)

Settings: primary care newspaper advertisement or recruited through participating physicians

Intervention: acupuncture

Comparison: wait‐list control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Wait‐list control

Acupuncture

Pain intensity (VAS) short term

Mean pain intensity across control groups was

5 points on a 0 to 10 scale

Mean pain intensity in intervention groups was
4 points on a 0 to 10 scale

‐‐

30

(1 study)

⊕⊕⊕⊝
Moderate

Limitations: 0

Inconsistency: 0

Indirectness: ‐1

Imprecision: 0

Other: 0

One trial with low risk of bias showed a small reduction in pain. Moderate evidence supporting acupuncture is helpful

Disability (neck and pain disability scale) short term

Mean disability across control groups was
6 points on a 0 to 100 scale

Mean disability in intervention groups was

29 points on a 0 to 100 scale

‐‐

3451

(1 study)

⊕⊕⊕⊝
Moderate

Limitations: 0

Inconsistency: 0

Indirectness: ‐1

Imprecision: 0

Other: 0

One large study with low risk of bias favoured acupuncture

Quality of life (SF‐36 mental score) short term

Mean quality of life score across control groups was
1 point on a 0 to 10 scale

Mean quality of life score in intervention groups was

4 points on a 0 to 10 scale

‐‐

3451

(1 study)

N/A

One large study showed no statistically significant findings in favour of acupuncture

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

Adverse effects were reported in 14 studies and included increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. No life‐threatening adverse effects were noted by these studies Cost of care was calculated in 1 study, which found that acupuncture treatment was cost‐effective

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

Figures and Tables -
Comparison 1. Acupuncture versus sham treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain intensity (VAS) immediate post treatment Show forest plot

11

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Chronic MPS 1 treatment session

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Chronic MND 3 to 4 wk treatment

4

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Chronic MPS 12 wk treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Chronic MND SA group 10 wk treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.5 Cervical osteoarthritis 1 treatment session

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.6 Chronic MPS 3 wk treatment, pain with movement scale

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Pain intensity (VAS) short term Show forest plot

8

560

Std. Mean Difference (IV, Random, 95% CI)

‐0.23 [‐0.40, ‐0.07]

2.1 Chronic MPS 3 wk treatment, 3 mo follow‐up, pain with movement scale

1

34

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.67, 0.67]

2.2 Chronic MND 3 to 4 wk treatment, 1 to 4 wk follow‐up

1

34

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.82, 0.52]

2.3 Chronic MND 3 to 4 wk treatment, 3 mo follow‐up

3

319

Std. Mean Difference (IV, Random, 95% CI)

‐0.18 [‐0.40, 0.04]

2.4 Subacute/chronic WAD 6 wk treatment, 3 mo follow‐up

1

124

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.73, ‐0.02]

2.5 WAD myofascial 2 to 6 sessions, 6 wk follow‐up

1

34

Std. Mean Difference (IV, Random, 95% CI)

‐0.60 [‐1.29, 0.09]

2.6 Chronic MND SA group 10 wk treatment, 3 wk follow‐up

1

15

Std. Mean Difference (IV, Random, 95% CI)

‐0.10 [‐1.11, 0.92]

3 Pain intensity (VAS) intermediate term Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Chronic MPS ESNS 3 to 4 wk treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Chronic WAD 6 wk treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Pain intensity (VAS) long term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Chronic MPS ESNNS 3 to 4 wk treatment, 3 year follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Disability (NDI) immediate post treatment Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Chronic MND SA group 10 wk treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Disability (NPQ) immediate post treatment Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Chronic MND, 3 wk treatment

3

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Disability (NPQ) short term Show forest plot

2

290

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.62, ‐0.15]

7.1 Chronic MND, 3 wk treatment, 3 mo follow‐up

2

290

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.62, ‐0.15]

8 Disability (NDI) short term Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

8.1 Chronic MND SA group 10 wk treatment, 3 wk follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Chronic WAD 6 wk treatment, 3 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.3 WAD II myofascial 2 to 6 treatment, 6 wk follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.4 Chronic MPS 1 treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

9 Disability (NDI) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

9.1 Chronic WAD 6 wk treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

10 Quality of life (SF‐36) immediate post treatment Show forest plot

1

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 Chronic MND, 3 wk treatment

1

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Quality of life (SF‐36) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

11.1 Chronic MND, 3 wk treatment, 3 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 1. Acupuncture versus sham treatment
Comparison 2. Acupuncture versus inactive control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain intensity (VAS) immediate post treatment Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Chronic MPS 4 wk treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Chronic MND NLA group 1 treatment session, movement scale

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Chronic MND 3 to 4 wk treatment

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Cervical osteoarthritis 1 treatment session

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Pain intensity (VAS) short term Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Chronic MND 3 to 4 wk treatment, 1 to 4 wk follow‐up

5

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Pain intensity (VAS) intermediate term Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Chronic MPS 4 wk treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Chronic MND 3 to 4 wk treatment, 6 mo follow‐up

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Pain intensity (VAS) long term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Chronic MND 3 to 4 wk treatment, 12 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Pain pressure threshold immediate post treatment Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Chronic MND 3 to 4 wk treatment

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Pain pressure threshold short term Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Chronic MND 3 to 4 wk treatment, 1 to 3 month follow‐up

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

7 Pain intensity (proportion pain relief) immediate post treatment Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

7.1 Chronic MND 4 wk treatment

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Disability (NDI) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

9 Disability (NDI) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

9.1 Chronic MND 4 wk treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

10 Disability (NDI) long term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

10.1 Chronic MND 4 wk treatment, 12 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

11 Function (NHP) immediate post treatment Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

11.1 Chronic MPS 4 wk treatment

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

12 Function (NHP) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

12.1 Chronic MPS 4 wk treatment 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

13 Function (NPQ) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

13.1 Chronic MND 1 wk follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

14 Quality of life (SF‐36, Functional Component) short term Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

14.1 Chronic MND 3 to 4 wk treatment, 8 wk follow‐up

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Acupuncture versus inactive control
Comparison 3. Acupuncture versus wait‐list

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain intensity (VAS) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Chronic NDR 4 wk treatment, 8 wk follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Disability (neck and pain disability scale) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Chronic MND 3 mo treatment, 3 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Disability (neck and pain disability scale) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Chronic MND 3 mo treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Quality of life (SF‐36 mental score) short term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Chronic MND 3 mo treatment, 3 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Quality of life (SF‐36 mental score) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Chronic MND 3 mo treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Quality of life (SF‐36 physical score) intermediate term Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Chronic MND 3 mo treatment, 6 mo follow‐up

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Acupuncture versus wait‐list