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Is acupuncture or electroacupuncture providing benefits to patients with opiate-withdrawal symptoms?
Date of publication of the systematic review: June 2009
Design
Systematic review of 11 randomized controlled trials (RCTs).
Participants
975 adults with heroin dependence and were in the acute stage of the abstinence syndrome (mean age: 24.0 to 34.2 years, male %: 82.0%).
Intervention
Needling or electrical acupuncture (AT) at a frequency of 20 to 50 minutes a time, once or twice a day for 10 or 15 days. The most commonly used acupoints were neiguan, zusanli, shenmen, hegu, and sanyinjiao.
Comparator
Comparison: Acupuncture plus opioid receptor agonists versus opioid receptor agonists only.
Baseline treatment for both groups was opioid receptor agonists (ORA). The dosage of opioid agonist was determined in accordance with the amount of heroin abused, and decreased gradually across 10 or 15 days. The starting doses were less than 60 mg/day for methadone, 0.8 to 1.6 mg/day for buprenorphine, and 300 mg/day for morphine. No extra treatment was applied in the comparison group.
Baseline treatment for both groups was opioid receptor agonists (ORA). The dosage of opioid agonist was determined in accordance with the amount of heroin abused, and decreased gradually across 10 or 15 days. The starting doses were less than 60 mg/day for methadone, 0.8 to 1.6 mg/day for buprenorphine, and 300 mg/day for morphine. No extra treatment was applied in the comparison group.
Major Outcomes
Outcome 1: The severity of withdrawal symptoms at day 10 of treatment as measured by the Total Withdrawal Symptom Score (TWSS) using the withdrawal symptom scale. The reviewers did not specify the range of scores of the withdrawal symptom scale.
Outcome 2: Relapse at 6 months.
Outcome 2: Relapse at 6 months.
Settings
All included trials were conducted in China. The reviewers did not state whether the trials were conducted in inpatient or outpatient settings.
Comparison Acupuncture plus opioid receptor agonists versus opioid receptor agonists only
Main Results
Compared to opioid receptor agonists alone, addition of acupuncture on opioid receptor agonists significantly reduced the total withdrawal symptom score at day 10 of treatment (pooled weighted mean difference (pooled WMD): -7.51, 95% CI: -11.80 to -3.22), but did not significantly reduce the relapse rate at 6 months (pooled relative risk reduction (pooled RRR): 40%, 95% CI: -10% to 68%).
| Outcomes (units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | Pooled WMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 1 (NA) | 7 (451) | Not reported | Not reported | Not reported | -7.51 (-11.80 to -3.22) | Moderate |
| Outcomes (units) | No. of studies (Total number of participants) | No. of events/No. of participants | Heterogeneity test (I2) | Pooled RRR (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 2 (NA) | 4 (524) | 123/290 | 159/234 | 92.8% | 40% (-10% to 68%) | Moderate |
Comparison Acupuncture plus opioid receptor agonists versus opioid receptor agonists only
Main Results
Compared to opioid receptor agonists alone, addition of acupuncture on opioid receptor agonists significantly reduced the total withdrawal symptom score at day 10 of treatment (pooled weighted mean difference (pooled WMD): -7.51, 95% CI: -11.80 to -3.22), but did not significantly reduce the relapse rate at 6 months (pooled relative risk reduction (pooled RRR): 40%, 95% CI: -10% to 68%).
Comparison: Acupuncture plus opioid receptor agonists versus opioid receptor agonists only in patients with opiate withdrawal symptoms
| Outcomes (units) | 1 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 7 (451) | |
| Mean/No. of participants | Intervention | Not reported |
| Comparator | Not reported | |
| Pooled WMD (95% CI) | -7.51 (-11.80 to -3.22) | |
| Overall quality of evidence* | Moderate | |
| Outcomes (units) | 2 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 4 (524) | |
| No. of events/No. of participants | Intervention | 123/290 |
| Comparator | 159/234 | |
| Pooled RRR (95% CI) | 40% (-10% to 68%) | |
| Overall quality of evidence* | Moderate | |
Keys: WMD: weighted mean difference; RRR: relative risk reduction; CI: confidence interval.
Conclusion
Benefits
Compared to opioid receptor agonists alone, addition of acupuncture on opioid receptor agonists can benefit patients with opioid withdraw syndrome on the total withdrawal symptom score at day 10 of treatment, but did not show significant benefit on the relapse rate at 6 months.
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
Among the 11 included trials, only four trials reported side effects during the treatment. The most common side effects reported were nausea, vomiting, dry mouth, blurred vision, and headache. One study showed no significant differences in side effects between the groups; another found that the incidence of side effects was significantly less in the AT plus ORA group than in the ORA alone group; the two other studies found that the most common complaint in AT plus ORA recipients was muscle twitching from electro-acupuncture, which was well tolerated after explanation and intensity adjustment.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/19109766The synopsis is based on the following article:
Liu TT, Shi J, Epstein DH, Bao YP, Lu L. A meta-analysis of acupuncture combined with opioid receptor agonists for treatment of opiate-withdrawal symptoms. Cell Mol Neurobiol. 2009 Jun;29(4):449-54.
Liu TT, Shi J, Epstein DH, Bao YP, Lu L. A meta-analysis of acupuncture combined with opioid receptor agonists for treatment of opiate-withdrawal symptoms. Cell Mol Neurobiol. 2009 Jun;29(4):449-54.
* 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.
• 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.
