Are acupuncture and related therapies effective in reducing pain and improving function for patients with lateral elbow pain?
Date of publication of the systematic review: April 2014
Design
Systematic review of 19 randomized controlled trials (RCTs).
Participants
1190 patients (age range: 17 to 76 years, male %: not reported) with lateral elbow pain (LEP), which referred to pain at the lateral side of the elbow region, especially to pain which was originated from the lateral epicondyle. The duration of the LEP varied from seven days to five years and follow-up periods varied from one day up to one year after last treatment.
Intervention
Acupuncture and related therapies included manual acupuncture, electro-acupuncture and auricular acupuncture that employed needle penetration. Needle retention lasted for 20 to 25 minutes and the treatment course was given 1 to 2 times weekly for 5 weeks.
Comparator
Comparison 1: Acupuncture and related therapies versus sham acupuncture;
Comparison 2: Acupuncture and related therapies versus pulsated ultrasound and massage at area of lateral epicondyle.
Major Outcomes
Outcome 1: Pain intensity assessed by visual analogue scale (VAS) from baseline to week 2 (cm);
Outcome 2: Pain intensity assessed by VAS at the end of treatment (cm);
Outcome 3: Pain intensity assessed by VAS at 6 months follow-up (cm);
Outcome 4: Functional impairment assessed by disability of arms, shoulder and hand (DASH) questionnaire from baseline to week 2.
Settings
The reviewers did not state whether the studies were conducted in inpatient or outpatient settings.
Comparison    Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies significantly reduced pain intensity (mean difference (MD): -4.25, 95% CI: -7.44 to -1.06) and improved function of the arm, shoulder and hand (MD: -10.80, 95% CI: -19.26 to -2.34) among patients with lateral elbow pain at week 2.
Comparison 1: Acupuncture and related therapies versus sham acupuncture among LEP patients
Outcomes (units) No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (cm) 1(29) 8.03(4.60)/ 14 12.28 (4.14)/ 15 Not applicable as there is only 1 trial. −4.25 (−7.44 to −1.06) 0.009 Moderate
4 (NA) 1(29) 14.38 (9.35)/14 25.18 (13.63)/ 15 Not applicable as there is only 1 trial. −10.80 (−19.26 to −2.34) 0.01 Moderate
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Acupuncture and related therapies versus pulsated ultrasound and massage
Main Results
Compared to pulsated ultrasound and massage, acupuncture and related therapies significantly reduced pain intensity at the end of treatment (MD: −1.64, 95% CI: −2.71 to −0.57) and at 6 months follow-up (MD: −2.85, 95% CI: −3.73 to −1.97).
Comparison 2: Acupuncture and related therapies versus pulsated ultrasound and massage among LEP patients
Outcomes (units) No. of studies (Total no. of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
2 (cm) 1 (40) 2.85 (1.81)/ 20 4.49 (1.64)/ 20 Not applicable as there is only 1 trial. −1.64 (−2.71 to −0.57) 0.003 Moderate
3 (cm) 1 (40) 2.05 (1.39)/ 20 4.90 (1.45)/ 20 Not applicable as there is only 1 trial. −2.85 (−3.73 to −1.97) < 0.001 Moderate
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies significantly reduced pain intensity (mean difference (MD): -4.25, 95% CI: -7.44 to -1.06) and improved function of the arm, shoulder and hand (MD: -10.80, 95% CI: -19.26 to -2.34) among patients with lateral elbow pain at week 2.
Comparison 1: Acupuncture and related therapies versus sham acupuncture among LEP patients
Outcomes (units) 1 (cm) 4 (NA)
No. of studies (Total number of participants) 1(29) 1(29)
Mean (SD)/ No. of participants Intervention 8.03(4.60)/ 14 14.38 (9.35)/14
Comparator 12.28 (4.14)/ 15 25.18 (13.63)/ 15
MD (95% CI) −4.25 (−7.44 to −1.06) −10.80 (−19.26 to −2.34)
p value 0.009 0.01
Overall quality of evidence* Moderate Moderate
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Acupuncture and related therapies versus pulsated ultrasound and massage
Main Results
Compared to pulsated ultrasound and massage, acupuncture and related therapies significantly reduced pain intensity at the end of treatment (MD: −1.64, 95% CI: −2.71 to −0.57) and at 6 months follow-up (MD: −2.85, 95% CI: −3.73 to −1.97).
Comparison 2: Acupuncture and related therapies versus pulsated ultrasound and massage among LEP patients
Outcomes (units) 2 (cm) 3 (cm)
No. of studies (Total no. of participants) 1 (40) 1 (40)
Mean (SD)/ No. of participants Intervention 2.85 (1.81)/ 20 2.05 (1.39)/ 20
Comparator 4.49 (1.64)/ 20 4.90 (1.45)/ 20
MD (95% CI) −1.64 (−2.71 to −0.57) −2.85 (−3.73 to −1.97)
p value 0.003 < 0.001
Overall quality of evidence* Moderate Moderate
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
This study showed that acupuncture and related therapies may significantly reduce pain intensity and improve function of the arm, shoulder and hand among patients with lateral elbow pain at 2 weeks follow-up when compared to sham acupuncture. Acupuncture and related therapies may also significantly reduce pain intensity among patients when compared to pulsated ultrasound and massage. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse events were reported in four included studies. Two studies stated that no adverse event was observed during acupuncture and related therapies. The other two studies reported that blister-forming ginger-moxibustion resulted in permanent scar tissue.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012509/
The synopsis is based on the following article:
Gadau M, Yeung WF, Liu H, Zaslawski C, Tan YS, Wang FC, et al. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC Complementary and Alternative Medicine. 2014 Apr 12;14(1):1.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.