Acupuncture for smoking cessation

Adrian R White; Hagen Rampes; Edzard Ernst

doi:10.1002/14651858.CD000009

Acupuncture for smoking cessation

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Referencias

References to studies included in this review

Ir a:

estudios excluidos
otras referencias

Cai Y, Zhao C, Wong SU, Zhang L, Lim SK. Laser acupuncture for adolescent smokers ‐ a randomized double‐blind controlled trial. Am J Chin Med 2000;25(3‐4):443‐449.

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Clavel F, Benhamou S, Company‐Huertas A, Flamant R. Helping people to stop smoking: randomised comparison of groups being treated with acupuncture and nicotine gum with control group. Br Med J Clin Res Ed 1985;291:1538‐1539. [MEDLINE: 1986052541]

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Clavel F, Paoletti C, Benhamou S. A randomised 2x2 factorial design to evaluate different smoking cessation methods. Rev Epidemiol Sante Publique 1992;40:187‐190. [MEDLINE: 1993067364]

Clavel‐Chapelon F, Paoletti C, Benhamou S. Smoking cessation rates 4 years after treatment by nicotine gum and acupuncture. Prev Med 1997;26:25‐28.

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Cottraux JA, Harf R, Boissel JP, Schbath J, Bouvard M, Gillet J. Smoking cessation with behaviour therapy or acupuncture ‐ a controlled study. Behav Res Ther 1983;21(4):417‐424. [MEDLINE: 1984023618]

Georgiou AJ, Spencer CP, Davies GK, Stamp J. Electrical stimulation therapy in the treatment of cigarette smoking. J Subst Abuse 1998;10:265‐274.

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He D, Medbo JI, Hostmark AT. Effect of acupuncture on smoking cessation or reduction: an 8‐month and 5‐year follow‐up study. Prev Med 2001;33(5):364‐372.

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Pickworth W, Fant R, Goffman A, Henningfield J. Cranial electrostimulation therapy: Response. Biol Psychiatry 1998;43:468‐469.

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Steiner RP, Hay DL, Davis AW. Acupuncture therapy for the treatment of tobacco smoking addiction. Am J Chin Med 1982;10:107‐121. [MEDLINE: 1983227974]

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References to studies excluded from this review

Ir a:

estudios incluidos
otras referencias

Boureau F, Willer JC. Failure of naloxone to modify the anti‐tobacco effect of acupuncture [Desintoxification tabagique par l'acupuncture: essai negative de blocage par la naloxone]. Nouv Presse Med 1978;7:1401. [MEDLINE: 1978225246]

Boutros NN, Krupitsky EM. Cranial electrostimulation therapy. Biol Psychiatry 1998;43(6):468.

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Tan CH. The use of laser on acupuncture points for smoking cessation. Am J Acupunct 1987;15(2):137‐141.

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Additional references

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estudios incluidos
estudios excluidos

Ashenden R, Silagy CA, Lodge M, Fowler G. A meta‐analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review 1997;16:33‐40.

Brewington V, Smith M, Lipton D. Acupuncture as a detoxification treatment: an analysis of controlled research. J Subst Abuse Treat 1994;11(4):289‐307. [MEDLINE: 1995055931]

Cheng RS, Pomeranz B, Yu G. Electroacupuncture treatment of morphine‐dependent mice reduces signs of withdrawal, without showing cross‐tolerance. Eur J Pharmacol 1980;68:477‐481. [MEDLINE: 1981138427]

Choy YM, Tso WW, Fung KP, Leung KC, Tsang YF, Lee CY, et al. Suppression of narcotic withdrawals and plasma ACTH by auricular electroacupuncture. Biochem Biophys Res Comm 1978;82:305‐309.

Choy DS, Lutzker L, Meltzer L. Effective treatment for smoking cessation. Am J Med 1983;75:1033‐6. [MEDLINE: 1984077073]

Clement‐Jones V, McLoughlin L, Lowry PJ, Besser GM, Rees LH, Wen HL. Acupuncture in heroin addicts: changes in met‐enkephalin and beta‐endorphin in blood and cerebrospinal fluid. Lancet 1979;2:380‐383. [MEDLINE: 1979243465]

Fuller JA. Smoking withdrawal and acupuncture. Med J Aust 1982;1:28‐29. [MEDLINE: 1982147931]

Han JS, Zhang RL. Suppression of morphine abstinence syndrome by body electroacupuncture of different frequencies in rats. Drug Alcohol Depend 1993;31:169‐175. [MEDLINE: 1993170127]

He D, Medbo JI, Hostmark AT. Effect of acupuncture on smoking cessation or reduction: an 8‐month and 5‐year follow‐up study. Prev Med 2001;33(5):364‐372.

Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers TC. Meta‐analysis of randomized controlled trials of cranial electrostimulation. Journal fo Nervous and Mental Disease 1995;183:478‐485.

Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med 1995;155:1933‐1941. [MEDLINE: 1996006131]

Lewith GT. The treatment of tobacco addiction. Comp Ther Med 1995;3:142‐145.

Ng LKY, Douthitt TC, Thoa NB, Albert CA. Modification of morphine‐withdrawal syndrome in rats following transauricular stimulation: an experimental paradigm for auricular acupuncture. Biol Psychiatry 1975;10:575‐580. [MEDLINE: 1976040277]

Patterson MA, Patterson L, Flood NV, Winston JR, Paterson SI. Electrostimulation in drug and alcohol detoxification: significance of stimulation criteria in clinical success. Addiction Research 1993;1:130‐144.

Schwartz JL. Evaluation of acupuncture as a treatment for smoking. Am J Acupunct 1988;16:135‐142.

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Ter Riet G, Kleijnen J, Knipschild P. A meta‐analysis of studies into the effect of acupuncture on addiction. Br J Gen Pract 1990;40:379‐382. [MEDLINE: 1991090957]

Vincent CA, Richardson PH. Acupuncture for some common disorders: a review of evaluative research. J R Coll Gen Pract 1987;37:77‐81. [MEDLINE: 1988035802]

Wen HL, Cheung SYC. Treatment of drug addiction by acupuncture and electrical stimulation. Asian Med J 1973;9:138‐141.

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

estudios excluidos

Cai 2000

Methods	Country: Singapore Recruitment: not stated
Participants	330 smokers aged 12 to 18 smoking 3 y and minimum 5 cigs/day
Interventions	a) laser or b) deactivated laser to points in left ear, 12 times in 4 weeks. Patients wore blindfold during treatment
Outcomes	Smoking cessation immediately after and 3 mo later. Validation: expired air CO concentration at 6th and 11th treatments
Notes	Added 2002 update Therapist not blinded: blinded assessor
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Circo 1985

Methods	Country: Italy Recruitment: from patients with cardiovascular disorders, method of recruitment unclear Randomisation method: not stated
Participants	90 adults, no inclusion or exclusion criteria reported
Interventions	All participants received counselling in addition to: a) illustration material b) medical treatment combining vitamins with herbal extract (Hawthorn), for 30 days c) acupuncture to 9 ear points ('Nogier' anti‐smoking) given 6 hours after stopping smoking; repeated after 4 days and a further 7 days; combined with 3 indwelling needles for 15 days
Outcomes	Reported cessation, time‐point unspecified (we assume end‐of‐treatment) Validation: none
Notes	Added 2001 update
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	D ‐ Not used

Clavel 1985

Methods	Country: France Recruitment: Community volunteers, per advertisement Randomisation method: not stated
Participants	651 adults smoking >5 cigs/day
Interventions	a) facial acupuncture, single session b) nicotine gum c) cigarette case with lock controlled by time‐switch All groups also received 3 one‐hour sessions of group therapy in first month
Outcomes	Sustained cessation at one and 13 months Validation: none at one month; at 13 months, expired air CO concentration was tested in half of those claiming success
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Clavel 1990

Methods	Country: France Recruitment: Community volunteers responding to circulated leaflet Randomisation method: not stated 2x2 factorial design
Participants	996 adults over 18, smoking >10 cigs/day
Interventions	a) facial acupuncture, with genuine or placebo nicotine gum b) sham acupuncture (wrong points), with genuine or placebo nicotine gum Both given on days 0, 7 and 28
Outcomes	Sustained abstinence at 1 and 13 months, and after 4 years 'Need for cigarette' estimated weekly for 1 month Validation: nil
Notes	Later results were reported as Clavel 1990; long‐term follow‐up as Clavel 1997 Analysis: for comparison of acupuncture vs sham acupuncture, arms with placebo gum entered in this study and arms with nicotine gum in Clavel 1990 +NG The comparison of acupuncture v nicotine gum was performed between 'genuine acupuncture and placebo gum' group and 'sham acupuncture and genuine gum' group
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Clavel 1990 +NG

Methods	See Clavel 1990 Used to enter results of Acupuncture plus nicotine gum vs Sham acupuncture plus nicotine gum
Participants
Interventions
Outcomes
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	D ‐ Not used

Cottraux 1983

Methods	Country: France Recruitment: Community volunteers responding to TV and radio adverts Randomisation method: not stated
Participants	558 French citizens, aged 18‐50, smoking >10 cigs/day for 2 years
Interventions	a) behaviour therapy, weekly for 3 weeks b) facial acupuncture, 3 weekly sessions c) placebo capsules prescribed at 2 consultations d) waiting‐list control (assessed at 12 months only)
Outcomes	Sustained abstinence at 2 weeks, and 3, 6, 9 and 12 months. Validation: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Georgiou 1999

Methods	Country: England Recruitment: general public, nursing staff, government employees
Participants	265 adults smoking at least 10/day for 1 year
Interventions	a) electrical stimulation with modulated current to mastoid process b) stimulation to back c) continuous current stimulation to mastoid d) continuous stimulation to ear. All groups also performed with inactive apparatus. After initial stimulation, home use as required for 7 days
Outcomes	Smoking cessation, validated by expired air CO. Withdrawal symptoms by VAS
Notes	Added 2002 update Unclear which groups should be regarded as controls. 18% dropouts, groups unknown. Follow‐up data given as aggregate only. No significant differences.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	D ‐ Not used

Gilbey 1977

Methods	Country: Canada Recruitment: Community volunteers responding to newspaper adverts Randomisation method: not stated
Participants	92 subjects aged 30‐39 who smoked >15 cigs/day for 3 years
Interventions	a) indwelling needle in active auricular point ('Lung') for 1 week b) indwelling needle in inactive auricular point ('Kidney') for 1 week
Outcomes	Sustained abstinence at 1 week, 1 month and 3 months Validation: none
Notes	Some authors regard 'Kidney' point (used as a control) as an effective treatment for dependency
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Gillams 1984

Methods	Country: UK Recruitment: volunteers responding to poster in health centre Randomisation: sealed envelopes
Participants	81 adults smoking >50 cigs/week for 5 years
Interventions	a) indwelling needle in active auricular point ('Lung') for 4 weeks b) indwelling needle in inactive auricular point (as far from 'Lung' as possible) for 4 weeks c) group therapy sessions, one hour/ week for 4 weeks
Outcomes	Sustained abstinence at 4 weeks, 3 months, and 6 months Validation: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

He 1997

Methods	Country: Norway Recruitment: employees recruited through internal advertisement through occupational health service Randomisation: drawing lots with replacement
Participants	46 adults smoking for at least 5 years, daily average of 10‐30 cigarettes in the last year; no other form of treatment for smoking cessation: no current acupuncture Exclusions: diabetes, coronary heart disease, pregnancy, breast‐feeding
Interventions	Both groups received a combination of body electroacupuncture, ear acupuncture and ear acupressure: a) using genuine points described for smoking cessation b) using sham points described for treating musculoskeletal conditions 6 treatments over 3 weeks Manual and electrical stimulation were the same in the 2 groups In addition, 6 plant seeds were placed on either a) 'correct' or b) 'incorrect' points in the ear, according to group, and retained in place with adhesive tape: subjects were instructed to press on each seed 100 times on 4 occasions each day
Outcomes	Abstinence at 1 week, 8 months and 5 years after the last acupuncture treatment (sustained at each previous point) Validation: cessation confirmed by serum cotinine and thiocyanate concentrations. (Serum concentrations of fibrinogen and lipid peroxide were also measured) Daily cigarette consumption, taste for tobacco and desire to smoke were assessed by questionnaire
Notes	Standardised interaction 8 month data used in 6 month meta‐analysis. 5 year data used in 1 year + comparison does not include participants lost to f‐up due to change of address etc
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Labadie 1983

Methods	Country: France Recruitment: Community volunteers attending anti‐smoking clinic Randomisation: by alternation
Participants	130 smokers (criteria not specified)
Interventions	a) acupuncture to auricular and body points; not stated whether repeated b) medical treatment (advice plus benzodiazepine, lobeline and a 'detoxicant') Both groups followed up weekly for 1 month, fortnightly for 3 months, monthly for a year
Outcomes	Abstinence and reduction of smoking at 8 weeks and 1 year. Validation: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

Lacroix 1977

Methods	Country: France Recruitment: not stated Randomisation method: not stated
Participants	117 smokers (criteria not specified)
Interventions	a) facial acupuncture, bilateral, weekly for 3 weeks b) sham acupuncture, bilateral, weekly for 3 weeks
Outcomes	Abstinence at 3 weeks Validation: none
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Lagrue 1977

Methods	Country: France Recruitment: not stated Randomisation: allocated by group
Participants	154 smokers (criteria not specified)
Interventions	a) facial acupuncture, repeated after 1 week b) sham acupuncture, repeated after 1 week
Outcomes	Abstinence and 80% reduction in consumption at 1 week Validation: none
Notes	Practitioner specially trained to give both treatments without knowing which was active (ie truly double‐blind study)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

Lamontagne 1980

Methods	Country: Canada Recruitment: Community volunteers responding to newspaper advert Randomisation method: not stated
Participants	75 subjects aged 20‐50, smoking between 15 and 50 cigs/day, not taking drugs, and in good health
Interventions	a) acupuncture to auricular points ('Zero' and 'Lung') b) acupuncture to body points used for 'relaxation' c) self‐monitor and report back All subjects given 2 appointments 1 week apart
Outcomes	Abstinence at 2 weeks, 3 months, and 6 months; mean smoking rates for 14 day periods during study Validation: none
Notes	Poor choice of acupuncture control procedure, since anti‐smoking effect of 'relaxation' treatment cannot be ruled out
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Leung 1991

Methods	Country: Hong Kong Recruitment: Community volunteers responding to newspaper and radio adverts Randomisation method: not stated
Participants	95 subjects who had smoked for at least 1 year and were motivated to stop
Interventions	a) 10 daily sessions of behaviour therapy lasting 1.5 hours b) Indwelling needles in auricular points ('Shenmen' and 'Lung') for 7 days or until they became uncomfortable; 10 attendances in total, for supervision of the needles c) waiting‐list control
Outcomes	Abstinence and percentage reduction in consumption immediately after treatment and at 1, 3, and 6 months.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Martin 1981a

Methods	Country: New Zealand Recruitment: Community volunteers Randomisation: in groups, method not stated
Participants	132 smokers (criteria not specified)
Interventions	a) indwelling needles to effective auricular points ('Lung' and 'hunger') for 3 weeks, plus electroacupuncture for 20 minutes to points in the hand and the ear at the second attendance b) indwelling needles to ineffective auricular points ('elbow' and 'eye')
Outcomes	Abstinence and reduction in cigarette consumption at 3 weeks, 3 months and 6 months Validation: nil
Notes	Some authors would consider 'elbow' and 'eye' points (used as controls) as possibly effective, since innervated by the vagus nerve
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

Martin 1981b

Methods	Country: New Zealand Recruitment: Community volunteers Randomisation: in groups, method not stated
Participants	128 smokers (unspecified)
Interventions	a) indwelling needles to effective auricular points ('Lung' and 'hunger') for 3 weeks b) indwelling needles to ineffective auricular points ('elbow' and 'eye') for 3 weeks
Outcomes	Abstinence and reduction in cigarette consumption at 3 weeks, 3 months and 6 months Validation: nil
Notes	Some authors would consider 'elbow' and 'eye' points (used as controls) as possibly effective, since innervated by the vagus nerve
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Parker 1977a

Methods	Country: USA Recruitment: Volunteers from hospital employees Randomisation method: not stated
Participants	20 smokers (unspecified)
Interventions	a) indwelling needles placed in effective auricular points ('Shenmen' and 'Lung') b) indwelling needles placed in points considered inactive ('Shoulder' and 'Eye') Needles replaced in both groups twice weekly for 3 weeks
Outcomes	Abstinence and reduction in consumption at 6 weeks Validation: none
Notes	Some authors would not agree that 'shoulder' and 'eye' points are 'inactive'
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Parker 1977b

Methods	Country: USA Recruitment: Volunteers from hospital employees Randomisation method: not stated
Participants	21 smokers (unspecified)
Interventions	a) electrical stimulation to effective auricular points ('Shenmen' and 'Lung') b) electrical stimulation to points considered inactive ('Shoulder' and 'Eye') Both groups treated for 20 minutes twice weekly for 3 weeks
Outcomes	Abstinence and reduction in consumption at 6 weeks Validation: none
Notes	Some authors would not agree that 'shoulder' and 'eye' points are 'inactive'
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Pickworth 1997

Methods	Country: USA Recruitment: 'from community'
Participants	121, aged over 21 y, smoking >20/day for at least 1 y, and meeting other criteria
Interventions	5 consecutive days of 60 min of a) electrostimulation, 10Hz 2 msec pulse, 30 uamp to mastoid or b) sham
Outcomes	Abstinence after 5 d and 1 m, verified by exhaled CO. Withdrawal symptoms.
Notes	Added 2002 update Stimulation parameters were criticised by Boutros 1998
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Steiner 1982

Methods	Country: USA Recruitment: Community volunteers responding to newspaper and radio adverts Randomisation: matched pairs, one of each pair randomly assigned, method not stated
Participants	32 subjects over 21, smoking over 20 cigs/day for 2 consecutive years, not pregnant and not on chronic pain medication or mood‐altering drugs Selected from 82 volunteers, matched according to age, sex, and cigarette consumption
Interventions	a) acupuncture to genuine body and ear points; needle sensation achieved. b) sham acupuncture to nearby areas without needling sensation Both interventions given twice weekly for 2 weeks
Outcomes	Abstinence and cigarette consumption at 4 weeks Validation: none
Notes	Subjects were not advised to stop smoking at any particular time, but to 'follow your motivation and appetite to the best of your ability'
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	C ‐ Inadequate

Tian 1996

Methods	Country: China Recruitment: not stated
Participants	120 smokers over 20 y old, regularly smoking >10 cigs/day, exhaled CO>10ppm, and likely to attend follow up for 1 year
Interventions	a) acupressure, Ear Point Pressing Seed method: seed fixed to 4 points in one ear, treatment changed to alternate ear twice/wk for course of 1 m, repeated for 2 or 3 m b) advice: no description given
Outcomes	Abstinence at 1 m and 1 y, confirmed by CO measurement
Notes	Added 2002 update Report lacks details (eg. randomisation, advice given, baseline characteristics)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	D ‐ Not used

Vandevenne 1985

Methods	Country: France Recruitment: volunteers attending anti‐smoking clinic Randomisation: random number table (not stated to be concealed)
Participants	200 self‐referred smokers, no criteria stated
Interventions	a) acupuncture to 3 auricular and 2 body points b) sham acupuncture to nearby areas both interventions given on days 1, 4, 10 and 20
Outcomes	Abstinence (point‐prevalence) at 6 weeks, 6 months and 1 year
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

Waite 1998

Methods	Country: UK Recruitment: community volunteers recruited by advertisements in on‐line news pages, posters in hospital and word of mouth. Randomisation method: not stated. Stratified by gender
Participants	78 adults over 18 years old who were smoking at least 10 cigarettes a day. Exclusions: cardiac pacemaker, previous acupuncture
Interventions	Both groups received one 20‐minute session of acupuncture with electrical stimulation followed by placement of a seed on the needle site held in place with adhesive tape. Participants were instructed to keep the seed in place as long as they found it helpful and press it when they experienced the desire to smoke Points used were: a) active group, lung point in ear b) control group, medial aspect of the patella, not on recognised acupuncture point
Outcomes	Cessation at 6 months (point prevalence) Validation: urinary cotinine
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Unclear risk	B ‐ Unclear

White 1998

Methods	Country: UK Recruitment: community volunteers from media invitation Randomisation method: sealed opaque envelopes, opened immediately before intervention
Participants	76 adults over 21 years smoking at least 15 cigarettes daily Exclusions: previous acupuncture, pregnancy, breast‐feeding, cardiac pacemaker, known bleeding tendency
Interventions	a) acupuncture with electrical stimulation to lung point in both ears b) sham acupuncture consisting of either needle or carbon pad placed over the mastoid bone attached to sham (inactivated) stimulator Interventions were given on day 1, 3 and 7 of the smoking cessation
Outcomes	Sustained cessation at 2 weeks Validation: expired air carbon monoxide concentration Withdrawal symptoms assessed by Visual Analogue Scale
Notes	Credibility of interventions tested by questionnaire Standardised, minimal interaction by acupuncturist All counselling by blinded nurse
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A ‐ Adequate

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Boureau, 1978	This study compared 2 groups who both received identical acupuncture following an injection: one group were injected with saline, the other with naloxone. Therefore, 2 hypotheses are tested simultaneously: does acupuncture help smoking cessation by releasing endogenous opioid peptides?
Boutros 1998	This letter in response to the study of Pickworth commented on the stimulus parameters used in the study, but included no original data
Fang 1983	The report is incomplete: numbers of smokers allocated to control and intervention groups cannot be extracted, so the study cannot be interpreted
MacHovec 1978	This study does not specify that the subjects were randomised
Man 1975	Subjects were allocated by place of residence, not randomly
Tan 1987	Not described as randomised: complete abstinence not reported.

Data and analyses

Open in table viewer

Comparison 1. Acupuncture vs sham acupuncture

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	14	2069	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.22 [0.99, 1.49]
Open in figure viewer Analysis 1.1 Comparison 1 Acupuncture vs sham acupuncture, Outcome 1 Smoking cessation ‐ Early.
2 Smoking cessation ‐ 6 months Show forest plot	8	765	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.50 [0.99, 2.27]
Open in figure viewer Analysis 1.2 Comparison 1 Acupuncture vs sham acupuncture, Outcome 2 Smoking cessation ‐ 6 months.
3 Smoking cessation ‐ 12 months or longer Show forest plot	4	1234	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.07 [0.76, 1.50]
Open in figure viewer Analysis 1.3 Comparison 1 Acupuncture vs sham acupuncture, Outcome 3 Smoking cessation ‐ 12 months or longer.

Open in table viewer

Comparison 2. Acupuncture vs other intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	6	1370	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.62, 1.02]
Open in figure viewer Analysis 2.1 Comparison 2 Acupuncture vs other intervention, Outcome 1 Smoking cessation ‐ Early.
2 Smoking cessation ‐ 6 months Show forest plot	3	396	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.11 [0.63, 1.94]
Open in figure viewer Analysis 2.2 Comparison 2 Acupuncture vs other intervention, Outcome 2 Smoking cessation ‐ 6 months.
3 Smoking cessation ‐ 12 months Show forest plot	4	1324	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.76 [0.54, 1.08]
Open in figure viewer Analysis 2.3 Comparison 2 Acupuncture vs other intervention, Outcome 3 Smoking cessation ‐ 12 months.

Open in table viewer

Comparison 3. Acupuncture vs waiting list/no intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	2	113	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.88 [2.66, 13.01]
Open in figure viewer Analysis 3.1 Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 1 Smoking cessation ‐ Early.
2 Smoking cessation ‐ 6 months Show forest plot	2	113	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.99 [0.30, 3.24]
Open in figure viewer Analysis 3.2 Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 2 Smoking cessation ‐ 6 months.
3 Smoking cessation ‐ 12 months Show forest plot	1	280	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.44 [1.15, 5.20]
Open in figure viewer Analysis 3.3 Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 3 Smoking cessation ‐ 12 months.

Open in table viewer

Comparison 5. Acupressure vs other treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	9.18 [3.95, 21.33]
Open in figure viewer Analysis 5.1 Comparison 5 Acupressure vs other treatment, Outcome 1 Smoking cessation ‐ Early.
3 Smoking cessation ‐ 12 months Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	10.02 [4.17, 24.10]
Open in figure viewer Analysis 5.3 Comparison 5 Acupressure vs other treatment, Outcome 3 Smoking cessation ‐ 12 months.

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Comparison 7. Laser therapy vs sham laser

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	330	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.99 [0.56, 1.74]
Open in figure viewer Analysis 7.1 Comparison 7 Laser therapy vs sham laser, Outcome 1 Smoking cessation ‐ Early.
2 Smoking cessation ‐ 6 months Show forest plot	1	330	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.94 [0.52, 1.69]
Open in figure viewer Analysis 7.2 Comparison 7 Laser therapy vs sham laser, Outcome 2 Smoking cessation ‐ 6 months.

Open in table viewer

Comparison 8. Electrostimulation vs sham stimulation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	121	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.19 [0.50, 2.82]
Open in figure viewer Analysis 8.1 Comparison 8 Electrostimulation vs sham stimulation, Outcome 1 Smoking cessation ‐ Early.

Open in table viewer

Comparison 11. Comparison of different acupuncture techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐auricular points vs all controls (early) Show forest plot	6	2007	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.12 [0.91, 1.38]
Open in figure viewer Analysis 11.1 Comparison 11 Comparison of different acupuncture techniques, Outcome 1 Non‐auricular points vs all controls (early).
2 Non‐auricular acupuncture vs all controls (6 months) Show forest plot	1	279	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.56 [0.77, 3.17]
Open in figure viewer Analysis 11.2 Comparison 11 Comparison of different acupuncture techniques, Outcome 2 Non‐auricular acupuncture vs all controls (6 months).
3 Non‐auricular acupuncture vs all controls (12 months) Show forest plot	3	1705	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.82 [0.60, 1.12]
Open in figure viewer Analysis 11.3 Comparison 11 Comparison of different acupuncture techniques, Outcome 3 Non‐auricular acupuncture vs all controls (12 months).
4 Auricular acupuncture vs all controls (early) Show forest plot	9	648	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.08 [0.75, 1.55]
Open in figure viewer Analysis 11.4 Comparison 11 Comparison of different acupuncture techniques, Outcome 4 Auricular acupuncture vs all controls (early).
5 Auricular acupuncture vs all controls (6 months) Show forest plot	6	533	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.00 [0.54, 1.84]
Open in figure viewer Analysis 11.5 Comparison 11 Comparison of different acupuncture techniques, Outcome 5 Auricular acupuncture vs all controls (6 months).
6 Auricular acupuncture vs all controls (12 months)	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Analysis 1.1

Comparison 1 Acupuncture vs sham acupuncture, Outcome 1 Smoking cessation ‐ Early.

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Analysis 1.2

Comparison 1 Acupuncture vs sham acupuncture, Outcome 2 Smoking cessation ‐ 6 months.

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Analysis 1.3

Comparison 1 Acupuncture vs sham acupuncture, Outcome 3 Smoking cessation ‐ 12 months or longer.

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Analysis 2.1

Comparison 2 Acupuncture vs other intervention, Outcome 1 Smoking cessation ‐ Early.

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Analysis 2.2

Comparison 2 Acupuncture vs other intervention, Outcome 2 Smoking cessation ‐ 6 months.

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Analysis 2.3

Comparison 2 Acupuncture vs other intervention, Outcome 3 Smoking cessation ‐ 12 months.

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Analysis 3.1

Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 1 Smoking cessation ‐ Early.

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Analysis 3.2

Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 2 Smoking cessation ‐ 6 months.

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Analysis 3.3

Comparison 3 Acupuncture vs waiting list/no intervention, Outcome 3 Smoking cessation ‐ 12 months.

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Analysis 5.1

Comparison 5 Acupressure vs other treatment, Outcome 1 Smoking cessation ‐ Early.

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Analysis 5.3

Comparison 5 Acupressure vs other treatment, Outcome 3 Smoking cessation ‐ 12 months.

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Analysis 7.1

Comparison 7 Laser therapy vs sham laser, Outcome 1 Smoking cessation ‐ Early.

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Analysis 7.2

Comparison 7 Laser therapy vs sham laser, Outcome 2 Smoking cessation ‐ 6 months.

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Analysis 8.1

Comparison 8 Electrostimulation vs sham stimulation, Outcome 1 Smoking cessation ‐ Early.

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Analysis 11.1

Comparison 11 Comparison of different acupuncture techniques, Outcome 1 Non‐auricular points vs all controls (early).

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Analysis 11.2

Comparison 11 Comparison of different acupuncture techniques, Outcome 2 Non‐auricular acupuncture vs all controls (6 months).

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Analysis 11.3

Comparison 11 Comparison of different acupuncture techniques, Outcome 3 Non‐auricular acupuncture vs all controls (12 months).

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Analysis 11.4

Comparison 11 Comparison of different acupuncture techniques, Outcome 4 Auricular acupuncture vs all controls (early).

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Analysis 11.5

Comparison 11 Comparison of different acupuncture techniques, Outcome 5 Auricular acupuncture vs all controls (6 months).

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Comparison 1. Acupuncture vs sham acupuncture

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	14	2069	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.22 [0.99, 1.49]

2 Smoking cessation ‐ 6 months Show forest plot	8	765	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.50 [0.99, 2.27]

3 Smoking cessation ‐ 12 months or longer Show forest plot	4	1234	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.07 [0.76, 1.50]

Comparison 1. Acupuncture vs sham acupuncture

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Comparison 2. Acupuncture vs other intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	6	1370	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.62, 1.02]

2 Smoking cessation ‐ 6 months Show forest plot	3	396	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.11 [0.63, 1.94]

3 Smoking cessation ‐ 12 months Show forest plot	4	1324	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.76 [0.54, 1.08]

Comparison 2. Acupuncture vs other intervention

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Comparison 3. Acupuncture vs waiting list/no intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	2	113	Peto Odds Ratio (Peto, Fixed, 95% CI)	5.88 [2.66, 13.01]

2 Smoking cessation ‐ 6 months Show forest plot	2	113	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.99 [0.30, 3.24]

3 Smoking cessation ‐ 12 months Show forest plot	1	280	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.44 [1.15, 5.20]

Comparison 3. Acupuncture vs waiting list/no intervention

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Comparison 5. Acupressure vs other treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	9.18 [3.95, 21.33]

3 Smoking cessation ‐ 12 months Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	10.02 [4.17, 24.10]

Comparison 5. Acupressure vs other treatment

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Comparison 7. Laser therapy vs sham laser

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	330	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.99 [0.56, 1.74]

2 Smoking cessation ‐ 6 months Show forest plot	1	330	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.94 [0.52, 1.69]

Comparison 7. Laser therapy vs sham laser

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Comparison 8. Electrostimulation vs sham stimulation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Smoking cessation ‐ Early Show forest plot	1	121	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.19 [0.50, 2.82]

Comparison 8. Electrostimulation vs sham stimulation

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Comparison 11. Comparison of different acupuncture techniques

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Non‐auricular points vs all controls (early) Show forest plot	6	2007	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.12 [0.91, 1.38]

2 Non‐auricular acupuncture vs all controls (6 months) Show forest plot	1	279	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.56 [0.77, 3.17]

3 Non‐auricular acupuncture vs all controls (12 months) Show forest plot	3	1705	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.82 [0.60, 1.12]

4 Auricular acupuncture vs all controls (early) Show forest plot	9	648	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.08 [0.75, 1.55]

5 Auricular acupuncture vs all controls (6 months) Show forest plot	6	533	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.00 [0.54, 1.84]

6 Auricular acupuncture vs all controls (12 months)	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 11. Comparison of different acupuncture techniques

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Referencias

References to studies included in this review

Cai 2000 {published data only}

Circo 1985 {published data only}

Clavel 1985 {published data only}

Clavel 1990 {published and unpublished data}

Clavel 1990 +NG {published data only}

Cottraux 1983 {published data only}

Georgiou 1999 {published data only}

Gilbey 1977 {published data only}

Gillams 1984 {published data only}

He 1997 {published data only}

Labadie 1983 {published data only}

Lacroix 1977 {published data only}

Lagrue 1977 {published data only}

Lamontagne 1980 {published data only}

Leung 1991 {published data only}

Martin 1981a {published data only}

Martin 1981b {published data only}

Parker 1977a {published data only}

Parker 1977b {published data only}

Pickworth 1997 {published data only}

Steiner 1982 {published data only}

Tian 1996 {published data only}

Vandevenne 1985 {published data only}

Waite 1998 {published data only}

White 1998 {published data only}

References to studies excluded from this review

Boureau, 1978 {published data only}

Boutros 1998 {published data only}

Fang 1983 {published data only}

MacHovec 1978 {published data only}

Man 1975 {published data only}

Tan 1987 {published data only}

Additional references

Ashenden 1997

Brewington 1994

Cheng 1980

Choy 1978

Choy 1983

Clement‐Jones 1979

Fuller 1982

Han 1993

He 2001

Klawansky 1995

Law 1995

Lewith 1995

Ng 1975

Patterson 1993

Schwartz 1988

Ter Riet 1990

Vincent 1987

Wen 1973

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

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