Acupuncture for neck disorders

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

doi:10.1002/14651858.CD004870.pub4

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Figure 1

Study flow diagram.

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Figure 2

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 1.5

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

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Analysis 1.6

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

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Analysis 1.7

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

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Analysis 1.8

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

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Analysis 1.9

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

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Analysis 1.10

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

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Analysis 1.11

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 2.4

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

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Analysis 2.5

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

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Analysis 2.6

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

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Analysis 2.7

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

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Analysis 2.8

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

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Analysis 2.9

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

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Analysis 2.10

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

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Analysis 2.11

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

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Analysis 2.12

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

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Analysis 2.13

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

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Analysis 2.14

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

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Analysis 3.1

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

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Analysis 3.2

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

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Analysis 3.3

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

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Analysis 3.4

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

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Analysis 3.5

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

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Analysis 3.6

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

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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

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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

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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

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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]

Comparison 1. Acupuncture versus sham treatment

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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]

Comparison 2. Acupuncture versus inactive control

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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]

Comparison 3. Acupuncture versus wait‐list

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