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The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain

MacPherson, H.a,*; Vertosick, E.A.b; Foster, N.E.c; Lewith, G.d; Linde, K.e; Sherman, K.J.f; Witt, C.M.g,h,i; Vickers, A.J.b

doi: 10.1097/j.pain.0000000000000747
Research Paper

There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time after acupuncture, using a large individual patient data set from high-quality randomized trials of acupuncture for chronic pain. The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months (95% confidence interval: −0.014 to 0.037, P = 0.4) after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months (95% confidence interval: 0.000-0.050, P = 0.050), suggesting approximately a 50% diminution at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.

Supplemental Digital Content is Available in the Text.The beneficial effects of a course of acupuncture treatment for chronic pain seem to be largely sustained over 12 months.

aDepartment of Health Sciences, University of York, York, United Kingdom

bDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

cResearch Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom

dDepartment of Primary Care, University of Southampton, Southampton, United Kingdom

eInstitute of General Practice, Technische Universität München, München, Germany

fGroup Health Research Institute, Seattle, WA, USA

gInstitute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland

hInstitute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin, Berlin, Germany

iCenter for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

Corresponding author. Address: Department of Health Sciences, University of York, York YO10 5DD, United Kingdom. Tel.: 44+(0)1904 321394. E-mail address: hugh.macpherson@york.ac.uk (H. MacPherson).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Members of the Acupuncture Trialists' Collaboration are listed in the acknowledgements at the end of the article.

Received November 06, 2015

Received in revised form August 10, 2016

Accepted October 10, 2016

© 2017 International Association for the Study of Pain
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