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Acupuncture for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness, Cost Effectiveness and Guidelines

Last updated: October 29, 2019
Project Number: RC1202-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of acupuncture for chronic non-cancer pain?
  2. What is the cost effectiveness of acupuncture for chronic non-cancer pain?
  3. What are the evidence-based guidelines regarding acupuncture for chronic non-cancer pain?

Key Message

A total of 23 systematic reviews, one economic study, and nine evidence-based guidelines were identified regarding the clinical effectiveness, cost-effectiveness, and recommendations for the use of acupuncture (including electroacupuncture, dry needling, manual acupuncture, and warm needle acupuncture) in patients with a variety of chronic non-cancer pain conditions. The identified systematic reviews were largely considered to be high-quality, and most evaluated the clinical effectiveness of acupuncture in general compared with sham interventions or medications. When specified, the most common type of comparator medications was non-steroidal anti-inflammatory drugs (NSAIDs). Many systematic reviews suggested evidence of acupuncture effectiveness for decreased pain, with some additionally reporting no difference in adverse events between acupuncture and comparator groups, but the results were inconsistent overall and often varied depending on the patient population. Likewise, recommendations regarding acupuncture were conflicting depending on the guideline group. Six evidence-based guidelines provided recommendations of varying strengths for the use of acupuncture in several chronic pain conditions (including chronic low back pain, different types of arthritis, and other pain disorders), two guidelines did not provide recommendations for acupuncture in patients with chronic low back pain and spinal cord-related neuropathic injuries due to insufficient evidence, and one guideline recommended against acupuncture for neck pain and associated disorders due to evidence of no effectiveness. One economic evaluation conducted in Iran found that electropuncture had a lower average cost-effectiveness ratio than NSAIDs for patients with chronic low back pain. However, firm conclusions regarding the relative costs and benefits of electroacupuncture and NSAIDs cannot be drawn as the incremental cost-effectiveness ratio was not reported in this study. Despite the number of high-quality systematic reviews and evidence-based guidelines identified regarding acupuncture for chronic non-cancer pain and their support for acupuncture, evidence demonstrating clinical effectiveness of acupuncture is limited because of the low-quality primary studies contributing to the evidence base. The STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) criteria can be used while planning primary studies to increase the quality of these primary studies and to develop robust evidence. Additional high-quality economic studies conducted in Canada are also required to determine the cost-effectiveness of acupuncture for the treatment of chronic non-cancer pain in a Canadian context.