A scientific review on Immediate effect of acupuncture
Evid Based Complement Alternat Med. 2017; 2017: 3837194. Published online 2017 Oct 25. doi: 10.1155/2017/3837194PMCID: PMC5676441PMID: 29234385
The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis
Although acupuncture is gaining popularity for the treatment of nonspecific pain, the immediate analgesic effect of acupuncture has never been reviewed. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on disease-related pain to critically evaluate the immediate effect of acupuncture for pain relief. The PubMed and Cochrane Central Register of Controlled Trials databases as well as three Chinese databases including the China National Knowledge Infrastructure (CNKI), Wanfang, and VIP platforms were searched through November 2016. The outcome was the extent of pain relief from baseline within 30 min of the first acupuncture treatment. We evaluated all RCTs comparing acupuncture with other interventions for disease-related pain. Real acupuncture showed statistically significantly greater pain relief effect compared to sham acupuncture (SMD, −0.56; 95% confidence interval [CI], −1.00 to −0.12; 9 RCTs) and analgesic injection (SMD, −1.33; 95% CI, −1.94 to −0.72; 3 RCTs). No serious adverse events were documented. Acupuncture was associated with a greater immediate pain relief effect compared to sham acupuncture and analgesic injections. Further RCTs with stricter design and methodologies are warranted to evaluate the immediate pain relief effect of acupuncture for more disease-related pain.
Pain is a major health problem with serious social and economic consequences. The annual cost of pain management in the USA in 2010 was $560-635 billion, which was a conservative estimate because it excluded the cost of management of pain affecting institutionalized individuals . Conventional medical treatments are only moderately effective, and they often cause adverse side effects. A majority of people suffering pain in the USA and Europe have reported inadequate pain control, and one-third worry about addiction to pain medications [2, 3]. Pain conditions appear to have a greater negative impact on the factors affecting the quality of life, such as work performance, sleep, and mood, compared with other health problems [4, 5]. Given the increasing life expectancy and the aging population, appropriate management of pain and reduction of disability are likely to assume greater importance.
Acupuncture, which is a mainstay in the healthcare practices of traditional Chinese medicine, is commonly used for the treatment of pain. There is substantial evidence for acupuncture being effective in the treatment of acute [6-8] and chronic pain . To date, over 80 systematic reviews have been conducted to assess the role of acupuncture and related therapies in the relief of pain. However, the results of these systematic reviews are far from unanimous. The majority of the reviews reported positive results for pain relief in low back pain and osteoarthritis by acupuncture [10-12]. Two recent systematic reviews [13, 14] examined the efficacy of acupuncture in the relief of cancer-related pain, and both reported positive results. The systematic review and meta-analysis by Lu et al. suggested that acupuncture was useful in decreasing postoperative pain . However, the efficacy of acupuncture as a treatment of pain in other pain conditions such as neuropathic pain  or fibromyalgia  remains inconclusive. Ernst et al. conducted a review of reviews  and concluded that acupuncture is not effective in reducing pain.
Various factors, such as acupuncture manipulation [19, 20], acupuncture sensation , acupoint prescription , pathological status , and types of pain , can affect the assessment of the therapeutic effect of acupuncture. The duration of acupuncture stimulation and acupuncture paradigm as well as the assessment of analgesic effect following acupuncture treatment in different clinical trials have been varied, and these time-dependent factors might be a crucial determinant in evaluating the analgesic effect of acupuncture. The effects of acupuncture can be classified as either the immediate effects (immediately after the end of the first treatment) or the cumulative effects of multiple acupuncture treatments [25, 26]. To date, most clinical trials and systematic reviews have focused on the cumulative analgesic effects. In fact, immediate analgesic effect could have clinical significance in determining the ultimate efficacy of acupuncture in pain management because of the following factors. (1) Psychological components such as conditioning and expectation may play important roles in acupuncture-induced analgesia. Patients who receive little benefit or no immediate analgesic effect following the first treatment might expect to be less likely to gain benefit from the subsequent treatment. (2) For many patients with acute postoperative pain and labor pain, the reported analgesic effect of acupuncture usually reflects the immediate effect. (3) The results of some fMRI studies have suggested that the immediate and cumulative acupuncture-induced analgesic effect elicit different temporal neural responses in a wide range of brain networks [27, 28], suggesting there is specific underlying mechanisms for the immediate analgesic effect of acupuncture.
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