Are acupuncture and acupressure effective for improving success for smoking cessation?
Date of publication of the systematic review: January 2011
Design
Systematic review of 38 randomized controlled trial (RCTs).
Participants
Tobacco smokers of any age who wished to stop smoking. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Among included RCTs, manual acupuncture or acupressure was provided. Acupoints on the ear, face and body as specific for smoking cessation were used in manual acupuncture. The reviewers did not report the duration and frequency of intervention.
Comparator
Comparison 1: Manual acupuncture versus sham acupuncture;
Comparison 2: Manual acupuncture versus nicotine replacement therapy (NRT);
Comparison 3: Acupressure versus sham acupressure.
Major Outcomes
Outcome 1: Short-term smoking abstinence as measured after the treatment (up to a maximum of 6 weeks from the quit date);
Outcome 2: Long-term smoking abstinence as measured after the treatment (between 6 months and 1 year from the quit date).
Settings
The reviewers did not state whether the trials were conducted in inpatient or outpatient settings.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture provided significant effect for short-term smoking abstinence (pooled risk ratio (RR): 1.22, 95% CI: 1.08 to 1.38). However, it did not provide significant long-term benefit in smoking cessation (pooled RR: 1.10, 95% CI: 0.86 to 1.40).
Comparison 1: Manual acupuncture versus sham acupuncture among tobacco smokers who wished to stop smoking
Outcomes (units) No of studies ( Total no. of participants) No. of events/ No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 19 (2588) 419/1415 295/1173 46% 1.22 (1.08 to 1.38) 0.002 High
2 (NA) 11 (1892) 122/997 97/895 23% 1.10 (0.86 to 1.40) 0.44 High
Keys: RR = risk ratio, CI = confidence interval.
Comparison    Manual acupuncture versus NRT
Main Results
Compared to NRT, manual acupuncture was less effective both in the short-term smoking abstinence (pooled RR: 0.76, 95% CI: 0.59 to 0.98) and in the long-term smoking abstinence (pooled RR: 0.64, 95% CI: 0.42 to 0.98).
Comparison 2: Manual acupuncture versus NRT among tobacco smokers who wished to stop smoking
Outcomes (units) No of studies ( Total no. of participants) No. of events/ No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 2 (914) 91/496 101/418 0% 0.76 (0.59 to 0.98) 0.031 High
2 (NA) 2 (914) 34/496 45/418 0% 0.64 (0.42 to 0.98) 0.041 High
Keys: RR = risk ratio, CI = confidence interval.
Comparison    Acupressure versus sham acupressure
Main Results
Compared with sham acupressure, acupressure was more effective for short-term smoking cessation (pooled RR: 2.54, 95%CI: 1.27 to 5.08). However, no trials in this comparison reported long-term outcomes.
Comparison 3: Acupressure versus sham acupressure among tobacco smokers who wished to stop smoking
Outcomes (units) No of studies ( Total no. of participants) No. of events/ No. of participants Heterogeneity test (I2) Pooled RR (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 3 (253) 24/128 9/125 0% 2.54 (1.27 to 5.08) 0.0083 High
Keys: RR = risk ratio, CI = confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to sham acupuncture, manual acupuncture provided significant effect for short-term smoking abstinence (pooled risk ratio (RR): 1.22, 95% CI: 1.08 to 1.38). However, it did not provide significant long-term benefit in smoking cessation (pooled RR: 1.10, 95% CI: 0.86 to 1.40).
Comparison 1: Manual acupuncture versus sham acupuncture among tobacco smokers who wished to stop smoking
Outcomes (units) 1 (NA) 2 (NA)
No of studies ( Total no. of participants) 19 (2588) 11 (1892)
No. of events/ No. of participants Intervention 419/1415 122/997
Comparator 295/1173 97/895
Pooled RR (95% CI) 1.22 (1.08 to 1.38) 1.10 (0.86 to 1.40)
p value 0.002 0.44
Overall quality of evidence* High High
Keys: RR = risk ratio, CI = confidence interval.
Comparison    Manual acupuncture versus NRT
Main Results
Compared to NRT, manual acupuncture was less effective both in the short-term smoking abstinence (pooled RR: 0.76, 95% CI: 0.59 to 0.98) and in the long-term smoking abstinence (pooled RR: 0.64, 95% CI: 0.42 to 0.98).
Comparison 2: Manual acupuncture versus NRT among tobacco smokers who wished to stop smoking
Outcomes (units) 1 (NA) 2 (NA)
No of studies ( Total no. of participants) 2 (914) 2 (914)
No. of events/ No. of participants Intervention 91/496 34/496
Comparator 101/418 45/418
Pooled RR (95% CI) 0.76 (0.59 to 0.98) 0.64 (0.42 to 0.98)
p value 0.031 0.041
Overall quality of evidence* High High
Keys: RR = risk ratio, CI = confidence interval.
Comparison    Acupressure versus sham acupressure
Main Results
Compared with sham acupressure, acupressure was more effective for short-term smoking cessation (pooled RR: 2.54, 95%CI: 1.27 to 5.08). However, no trials in this comparison reported long-term outcomes.
Comparison 3: Acupressure versus sham acupressure among tobacco smokers who wished to stop smoking
Outcomes (units) 1 (NA)
No of studies ( Total no. of participants) 3 (253)
No. of events/ No. of participants Intervention 24/128
Comparator 9/125
Pooled RR (95% CI) 2.54 (1.27 to 5.08)
p value 0.0083
Overall quality of evidence* High
Keys: RR = risk ratio, CI = confidence interval.
Conclusion
Benefits
Compared with sham acupuncture, there was significant short-term benefit but not of any long-term benefits for smoking abstinence. Compared with NRT, manual acupuncture was less effective both in the short-term and long-term smoking abstinence. Acupressure was more effective for short-term smoking cessation as compared to sham acupressure. For all outcomes, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
The included trials did not provide any information of adverse events.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/21249644
The synopsis is based on the following article:
White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD000009. doi: 10.1002/14651858.CD000009.pub3.


* 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.