Excerpt

Many Veterans desire complementary and alternative medicine or integrative medicine modalities such as acupuncture, both for treatment and for the promotion of wellness. However, the effectiveness and adverse events associated with acupuncture are not firmly established. Given the VA's desire to promote evidence-based practice, this evidence mapping project will help provide guidance to VA leadership about the distribution of evidence to inform policy and clinical decision making.

In general, acupuncture is the stimulation of specific acupuncture points through penetration of the skin with needles, which aims to correct imbalances in the flow of qi, a concept of energy in traditional Chinese medicine (TCM), through meridians (ie, energy channels). The available published literature on acupuncture is extensive. PubMed searches in 2013 identified almost 20,000 citations with the term “acupuncture” and almost 1,500 randomized controlled trials (RCTs) with “acupuncture” in the title. Not surprisingly, a large number of systematic reviews and meta-analyses have been published to-date, and even a number of “reviews of reviews” are available in the published literature on acupuncture in general or for a specific clinical condition.

Results from existing reviews of reviews about the effectiveness of acupuncture are non-conclusive. A systematic review of systematic reviews of acupuncture published between 1996 and 2005 included 35 reviews. The overview noted that 12 reviews reported support for acupuncture and 6 reported strong support; however, when applying strict inclusion criteria, such as randomized and double blind studies, good evidence of no benefit was shown. In 2007, Adams compiled a “Brief Overview - A summary of the evidence for use of acupuncture from systematic reviews and meta-analyses” for the Veterans Health Administration Office of Patient Care Services Technology Assessment Program. The report included 42 systematic reviews published since 2002 and concluded that higher quality studies are only beginning to emerge, the evidence base is heterogeneous, and the review results highlight the overall poor quality of studies and reporting. Thus, it is timely to assess the current state of reviews of acupuncture.

Contents

• PREFACE
• BACKGROUND
  • KEY QUESTIONS/SCOPE OF PROJECT
• METHODS
  • INCLUSION CRITERIA
  • SEARCH
  • PROCEDURE
  • DATA SYNTHESIS
  • BUBBLE PLOTS
  • OTHER RESULTS
  • FUTURE RESEARCH
  • TECHNICAL EXPERT PANEL
  • PEER REVIEW
• RESULTS
• EVIDENCE MAP OF ACUPUNCTURE FOR PAIN
  • EXECUTIVE SUMMARY: PAIN
• EVIDENCE MAP OF ACUPUNCTURE FOR WELLNESS
  • EXECUTIVE SUMMARY: WELLNESS
• EVIDENCE MAP OF ACUPUNCTURE FOR MENTAL HEALTH
  • EXECUTIVE SUMMARY: MENTAL HEALTH
• OTHER INDICATIONS
• ADVERSE EVENTS OF ACUPUNCTURE
  • REVIEWS OF ADVERSE EVENTS OF ACUPUNCTURE
• FUTURE RESEARCH
  • FUTURE RESEARCH: PAIN DOMAIN
  • FUTURE RESEARCH: WELLNESS DOMAIN
  • FUTURE RESEARCH: MENTAL HEALTH DOMAIN
  • FUTURE RESEARCH: OTHER INDICATIONS
• ONGOING RESEARCH
• SUMMARY AND LIMITATIONS
• REFERENCES
• APPENDIX PEER REVIEW COMMENTS/AUTHOR RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, Paul G. Shekelle, MD, PhD, Director

Suggested citation:

Hempel, S., Taylor, S. L., Solloway, M., Miake-Lye, I. M., Beroes, J. M., Shanman, R., Booth, M. J., Siroka, A. M., Shekelle, P. G. Evidence Map of Acupuncture. VA-ESP Project #05-226; 2013

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.