Are acupuncture and related therapies effective in reducing pain of neck disorders in short term?
Date of publication of the systematic review: May 2016
Design
Systematic review of 27 randomized control trials (RCTs).
Participants
5462 adults aged 18 and above with the following neck disorders, mechanical neck disorders (MNDs), including whiplash-associated disorders (WADs) categories 1 and 2, myofascial pain syndrome (MPS) and degenerative changes (DCs); neck disorder with headache; neck disorders with radicular symptoms (NDRs), including WAD category 3. Symptom duration was defined as acute (< 30 days), subacute (30 days to 90 days) or chronic (≥ 90 days). The reviewers did not report mean age and gender proportion of the participants.
Intervention
Among included RCTs, acupuncture was used as intervention. It involves insertion of needles. Stimulation of needles may involve manual, electrical, heat, laser or other forms of stimulation.
Comparator
Comparison: Acupuncture and related therapies versus sham acupuncture.
Major Outcomes
Outcome 1: Pain intensity at short-term follow-up (between one day and three months).
Settings
The reviewers included trials conducting in various settings, mostly in outpatient setting such as university and hospital clinics.
Comparison    Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies significantly improved pain relief at short-term follow-up (pooled standardized mean difference (pooled SMD): -0.23, 95% CI: -0.40 to -0.07).
Comparison: Acupuncture and related therapies versus sham acupuncture among patients with chronic mechanical neck pain
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 8 (560) Not reported/281 Not reported/279 0% -0.23 (-0.40 to -0.07) Moderate
Keys: SD= standard deviation; SMD: standardized mean difference; CI: confidence interval.
Comparison    Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies significantly improved pain relief at short-term follow-up (pooled standardized mean difference (pooled SMD): -0.23, 95% CI: -0.40 to -0.07).
Comparison: Acupuncture and related therapies versus sham acupuncture among patients with chronic mechanical neck pain
Outcomes (units) 1 (NA)
No. of studies (Total no. of participants) 8 (560)
Mean score (SD)/ No. of participants Intervention Not reported/281
Comparator Not reported/279
Pooled SMD (95% CI) -0.23 (-0.40 to -0.07)
Overall quality of evidence* Moderate
Keys: SD= standard deviation; SMD: standardized mean difference; CI: confidence interval.
Conclusion
Benefits
This study suggested significant short-term pain relief using acupuncture in patients with chronic mechanical neck pain when compared to sham acupuncture. However, the effect did not sustain over longer term. For outcome 1, 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
Among all included studies, only 14 studies reported adverse effects, namely increased pain, bruising, fainting, worsening of symptoms, local swelling and dizziness. However, the number of adverse effects was not mentioned.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/27145001
The synopsis is based on the following article:
Trinh K, Graham N, Irnich D, Cameron ID, Forget M. Acupuncture for neck disorders. Cochrane Database Syst Rev. 2016 May 4;(5):CD004870..


* 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.