1. Acupuncture for chronic primary pain

1.3. PICO table

For full details see the review protocol in appendix A.

Table 1

PICO characteristics of review question.

1.4. Clinical evidence

1.4.1. Included studies

32 studies were included in the review^{5, 7, 10, 16, 28, 32, 33, 42, 49, 55, 82, 85, 86, 93, 101, 111, 126, 131, 136, 139, 143, 150, 152, 168, 175, 176, 183, 201, 208, 211, 216, 220, 232} and these are summarised in Table 2 below. Evidence from these studies is summarised in the clinical evidence summary tables below (Table 3, Table 4 and Table 5).

See also the study selection flow chart in appendix C, study evidence tables in appendix D, forest plots in appendix E and GRADE tables in appendix F.

1.4.2. Excluded studies

One Cochrane review was identified but did not match the PICO characteristics of this review (Deare 2013⁴⁷), due to differences in the population, outcomes and comparisons. All included studies were cross-checked for inclusion in this review as relevant.

See the excluded studies list in appendix I.

1.4.3. Summary of clinical studies included in the evidence review

Table 2

Summary of studies included in the evidence review.

See appendix D for full evidence tables.

1.4.4. Quality assessment of clinical studies included in the evidence review

Table 3

Acupuncture compared to sham acupuncture.

Table 4

Acupuncture compared to usual care.

Table 5

Electro-acupuncture compared to sham electro-acupuncture.

See appendix F for full GRADE tables.

1.5. Economic evidence

1.5.1. Included studies

Two health economic studies were identified with the relevant comparison and have been included in this review.²¹⁸ These are summarised in the health economic evidence profiles below (Table 6 and Table 7) and the health economic evidence table in appendix H.

1.5.2. Excluded studies

No health economic studies that were relevant to this question were excluded due to assessment of limited applicability or methodological limitations.

See also the health economic study selection flow chart in appendix G.

1.5.3. Summary of studies included in the economic evidence review

Table 6

Health economic evidence profile: Acupuncture in addition to usual care vs. waiting list control.

Table 7

Health economic evidence profile: Acupuncture in addition to usual care vs. usual care.

1.5.4. Health economic modelling

This area was prioritised for new economic modelling. The rationale, methods and results are summarised below. Full details are available in the ‘Acupuncture modelling report’.

The clinical evidence showed a benefit of acupuncture compared to both sham acupuncture and usual care, in reducing pain and improving quality of life.

Two economic evaluations were identified for this review comparing acupuncture to treatment as usual. One UK-based within-trial economic analysis compared acupuncture in addition to usual care with usual care. This was in people with chronic neck pain, and had a 1 year follow up, although the intervention itself was around 5 months long. Resource use included all appointments and prescriptions. The study found that acupuncture was cost effective (using complete case analysis). The 95% confidence interval was very wide (95% CI: £,4,426 to £74,562). However, a sensitivity analysis where missing data was imputed (40% of data was missing in the acupuncture arm) showed an ICER of £43,838, again with a very large confidence interval (−£216,427 to £395,047). The committee opinion was that the confidence interval led to uncertainty around cost effectiveness, although this would be the more relevant study as it is from a UK perspective. The costs of providing acupuncture (£35 per session) are likely to be lower than current staff costs that might provide acupuncture in the NHS. This might be because of the date of the costs (2012/13) or also because the costs of the sessions were based on the level of practitioner delivering the intervention in the trial, which was unclear. The second study was a German within-trial analysis, comparing acupuncture to a waiting list control in people with chronic neck pain, with a three month follow-up. People in the acupuncture group received between 10 to 15 sessions of acupuncture over the three months. The study considered costs of acupuncture as well as physician visits, medication and hospital stays in both groups. This paper suggested that acupuncture is cost effective compared to waiting list control (ICER: £11,430 per QALY gained). Although acupuncture costs per session used in the analysis (€35/£28) seem lower than current UK costs. Both studies had limitations regarding intervention costs potentially being underestimated, and uncertainty remained around cost effectiveness.

Uncertainty remained about the cost effectiveness of acupuncture from the included studies. Also, acupuncture for chronic primary pain is not currently used in the NHS, therefore, a recommendation could have a resource impact to the NHS in England given the large size of the population living with chronic primary pain. For the above reasons, a probabilistic lifetime cost-utility analysis was undertaken, from the NHS perspective, that compared acupuncture with no acupuncture (both groups had usual care therefore this was not included in the model).

The analysis was based on studies from the clinical review that were compared to usual care (not sham), as the committee agreed usual care was the most appropriate comparator for the economic analysis as would give the full benefit likely to be achieved in a real world scenario and sham would not be used in the NHS except in research (for a more detailed rationale for this decision see the full technical report). Studies were included in the analysis if they reported utilities (EQ-5D), or measures that could be mapped to utilities like QoL measures (the SF-36), and pain scales (this was 7 out of 9 usual care comparison studies). All acupuncture types were pooled. For each study, the difference between EQ-5D outcomes (whether this was during treatment, at the end of treatment or later) and the baseline EQ-5D was taken for the intervention and usual care group, to take account of any baseline differences between the two groups. The difference in EQ-5D was then taken between the intervention and usual care group for each study. Therefore, the treatment benefit is the EQ-5D gain from acupuncture compared to usual care, taking into account baseline differences.

In the economic analysis, the EQ-5D data from different time points (meta-analysed if there was more than one study with a measurement at a particular time point) were used to estimate QALY gain with acupuncture. Looking at the pattern of the QoL improvement from acupuncture over time plotted graphically showed that there was an increasing QoL trend up to 12 weeks in the data. It was also noted that in studies that measured QoL at the end of the intervention and then again at a later follow-up point, the QoL gain at the follow point was lower, but a difference remained. It was agreed that the analysis should be split into two parts for the economic analysis: the first analysing the data up to 12 weeks and a second looking at how treatment effect changed over time after the end of the intervention. A trend line was estimated using all observed data points up to and including 12 weeks. The linear trend line was generated using weighted least squares regression to apply a higher weight to the treatment effect from timepoints that had smaller variance. In addition, the average change per week was estimated after the end of the intervention using studies that reported at least 2 time points after the end of the intervention (for example one post intervention and a follow-up a number of weeks later). In the economic analysis QOL gain over time was initially modelled using the ≤12 weeks trend line. A linear increase in EQ-5D from zero difference at time zero to the point estimated by the trend line at the first trial observation was also assumed. After 12 weeks the change per week from the follow-up analysis was applied up to 18 weeks (6 weeks follow-up data from studies included) in the base case. Analyses were included with and without further extrapolation of treatment effect beyond this point. . Extrapolation assumptions were based on committee opinion, and different assumptions were needed for different scenarios that occurred in probabilistic analyses. Note the treatment effect was extrapolated only until there was no additional quality of life benefit from acupuncture. QALY gain with acupuncture was estimated by calculating the area under the curve.

The key difference in costs was agreed to be those related to delivering acupuncture. No other costs were incorporated in the analysis. The average resource use from the interventions in each study were identified and costed, and a weighted average cost calculated, weighting by the number of participants in the studies. The committee agreed that in the base case a band 6 staff member should be used for costing purposes. Use of other staff bands and other cost assumptions were tested in sensitivity analyses.

Results

The probabilistic and deterministic base case results can be seen in the table below. Results are presented for both base cases. Both analyses show the ICER is below the NICE threshold of £20,000, and therefore acupuncture would be considered cost effective. The probability of acupuncture being cost effective is also high.

Table 8

Base case results (discounted).

The deterministic results are somewhat different to the probabilistic in the lifetime analysis as there is a larger incremental QALY gain in the probabilistic analysis because the QALY gains have a skewed distribution. This occurs because there are some simulations in the probabilistic model where the post intervention QOL is a shallow downward slope which leads to a large QALY gain in the lifetime analysis because the point at which there is no longer a difference in treatment effect from acupuncture are far into the future. This was visualised by reviewing the patterns of the regression lines graphically and summarising the distribution of QALY gains. In the first base case, where no extrapolation of the data is modelled, then the probabilistic and deterministic results are very close, proving that the extrapolation assumptions and the nature of the data in the probabilistic analysis created the discord between the probabilistic and deterministic models using a lifetime horizon. However, both models and both base cases are still well below the NICE cost effectiveness threshold.

Various sensitivity analyses were undertaken for both base cases. Alternative data about post-treatment effects was incorporated that was not included in the base cases. Sensitivity analysis also tested various resource use assumptions about bands of staff, treatment overlap (i.e. people being simultaneously treated), and resource use considered more typical in England. All sensitivity analyses did not change the conclusions.

Limitations of the analysis include that data was pooled across clinical studies that had different intensities (in terms of frequency of sessions and overall number of sessions) of acupuncture, differences in the type of acupuncture and differences in the number of acupuncture points. This is likely to affect costs and treatment effects. However, there is uncertainty around whether the pooled costs correspond with the pooled treatment effect. This is because it is unclear what it is about acupuncture that causes a benefit i.e. the frequency, or the number of sessions, type of acupuncture, number of acupuncture points or the training and experience of the individual and therefore the extent of the contextual effect. Another limitation of the model is that the linear trend lines representing treatment effect over time is a simplification of how people’s quality of life would fluctuate in reality. The quality of life gain taken from the studies could also be an overestimate because it is likely that people who respond to follow up questionnaires or that have not dropped out of a trial are more engaged with the intervention. Additionally uncertainty not captured by the model included what outcomes and resource use occurred after the intervention or, for instance, whether some people received further courses of acupuncture. Some assumptions were made regarding patterns of extrapolation of the regression trend lines following discussion with the committee. No other costs have been accounted for in the analysis except for intervention costs.

Overall, this analysis has pooled data from the clinical review that reported utilities or measures that could be mapped to utilities, to estimate the potential cost effectiveness of acupuncture in general. The heterogeneity of the studies, and the number of studies used, should be taken into account when interpreting this analysis.

1.5.5. Unit costs

The unit cost of acupuncture is presented below for illustration. Acupuncture for pain management is most commonly performed as an outpatient procedure.

Table 9

Unit costs of acupuncture for pain management.

Alternatively, acupuncture can be provided in a community setting. The unit cost for the bands of staff that might deliver acupuncture are provided below for consideration of cost effectiveness. The cost of acupuncture equipment has also been included for consideration.

Table 10

UK costs of healthcare professionals.

Table 11

UK costs of acupuncture equipment.

1.5.6. Threshold calculations

As the economic evaluations that have been identified for inclusion in this review have limitations, such as the costs of delivering acupuncture appearing low compared to UK costs, some threshold calculations have been undertaken to crudely identify what level of acupuncture might be afforded based on UK staff costs, that would make acupuncture cost effective at the £20,000 per QALY gained threshold.

Note that for Essex 2017, this had two analyses that could be treated as base cases, and the QALYs from both have been reported here.

Table 12

Summary of QALYs from the included economic evaluations.

Assuming no difference in resource use other than acupuncture treatment between usual care and acupuncture groups, the table below illustrates some threshold calculations on the maximum cost of acupuncture that would make it cost effective, and what this cost could fund. The number of sessions afforded have been calculated based on a band 6 staff member (used as the base case cost in the original model on acupuncture undertaken for this guideline), and band 7. The threshold calculations have been undertaken for each QALY from Table 12 individually.

Table 13

Incremental cost needed to make acupuncture cost effective.

The results of the threshold calculations in Table 13 show the range of hours of staff time that could be afforded, depending on the magnitude of the QALY, and based on UK staff costs. The committee discussed that each session of acupuncture is not usually an hour. Sometimes it can be as little as 10 minutes, although if traditional Chinese medicine is undertaken this can take an hour. Typically, the committee opinion was that although there might be variation in how acupuncture is delivered, there was some agreement that around 6 sessions of about 30 minutes might be considered a typical course that would be offered to patients. Using the lowest QALY estimate from Table 13, shows that this could afford around 5 hours of staff time, which would mean roughly 10 sessions of 30 minutes. Therefore 6 sessions of 30 minutes could be cost effective based on the above calculations.

References

1.

Aigner N, Fialka C, Radda C, Vecsei V. Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial. Wiener Klinische Wochenschrift. 2006; 118(3–4):95–99 [PubMed: 16703253]

2.

Airaksinen O, Pontinen PJ. Effects of the electrical stimulation of myofascial trigger points with tension headache. Acupuncture and Electro-Therapeutics Research. 1992; 17(4):285–290 [PubMed: 1362038]

3.

Amin MM, Ait-Allah AS, Ali Ael S, Salem RA, Ahmed SR, Alsammani MA. Inferior hypogastric plexus blockade versus acupuncture for the management of idiopathic chronic pelvic pain: A randomized clinical trial. Biomedical Journal. 2015; 38(4):317–322 [PubMed: 25673173]

4.

An K, Kim YS, Kim HY, Lee H, Hahm DH, Lee KS et al. Needle-free acupuncture benefits both patients and clinicians. Neurological Research. 2010; 32(Suppl 1):S22–S26 [PubMed: 20034440]

5.

Aranha MF, Muller CE, Gaviao MB. Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial. Brazilian Journal of Physical Therapy. 2015; 19(1):34–43 [PMC free article: PMC4351606] [PubMed: 25714602]

6.

Aridici R, Yetisgin A, Boyaci A, Tutoglu A, Bozdogan E, Sen Dokumaci D et al. Comparison of the efficacy of dry needling and high-power pain threshold ultrasound therapy with clinical status and sonoelastography in myofascial pain syndrome. American Journal of Physical Medicine and Rehabilitation. 2016; 95(10):e149–158 [PubMed: 27552352]

7.

Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Annals of Internal Medicine. 2005; 143(1):10–19 [PubMed: 15998750]

8.

Bahrami-Taghanaki H, Liu Y, Azizi H, Khorsand A, Esmaily H, Bahrami A et al. A randomized, controlled trial of acupuncture for chronic low-back pain. Alternative Therapies in Health and Medicine. 2014; 20(3):13–19 [PubMed: 24755566]

9.

Batra YK, Chari P, Negi ON. Comparison of acupuncture and placebo in treatment of chronic shoulder pain. American Journal of Acupuncture. 1985; 13(1):69–71

10.

Birch S, Jamison RN. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clinical Journal of Pain. 1998; 14(3):248–255 [PubMed: 9758075]

11.

Boureau F, Kisielnicki E. Effects of transcutaneous nerve stimulation (TNS), electrotherapy (ET), electroacupuncture (EA) on chronic pain. A comparative study. Pain. 1981; 11(Suppl 1):S277

12.

Brennan KL, Allen BC, Maldonado YM. Dry needling versus cortisone injection in the treatment of greater trochanteric pain syndrome: A noninferiority randomized clinical trial. Journal of Orthopaedic and Sports Physical Therapy. 2017; 47(4):232–239 [PubMed: 28257614]

13.

Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of Internal Medicine. 2006; 166(4):450–457 [PubMed: 16505266]

14.

Campa-Moran I, Rey-Gudin E, Fernandez-Carnero J, Paris-Alemany A, Gil-Martinez A, Lerma Lara S et al. Comparison of dry needling versus orthopedic manual therapy in patients with myofascial chronic neck pain: A single-blind, randomized pilot study. Pain Research and Treatment. 2015; 2015:327307 [PMC free article: PMC4657116] [PubMed: 26640708]

15.

Carlsson CP, Sjolund BH. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clinical Journal of Pain. 2001; 17(4):296–305 [PubMed: 11783809]

16.

Casanueva B, Rivas P, Rodero B, Quintial C, Llorca J, Gonzalez-Gay MA. Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatology International. 2014; 34(6):861–866 [PubMed: 23609584]

17.

Castro-Sanchez AM, Garcia-Lopez H, Mataran-Penarrocha GA, Fernandez-Sanchez M, Fernandez-Sola C, Granero-Molina J et al. Effects of dry needling on spinal mobility and trigger points in patients with fibromyalgia syndrome. Pain Physician. 2017; 20(2):37–52 [PubMed: 28158152]

18.

Castro Sanchez AM, Garcia Lopez H, Fernandez Sanchez M, Perez Marmol JM, Aguilar-Ferrandiz ME, Luque Suarez A et al. Improvement in clinical outcomes after dry needling versus myofascial release on pain pressure thresholds, quality of life, fatigue, pain intensity, quality of sleep, anxiety, and depression in patients with fibromyalgia syndrome. Disability and Rehabilitation. 2019; 41(19):2235–2246 [PubMed: 29681188]

19.

Cerezo-Tellez E, Lacomba MT, Fuentes-Gallardo I, Mayoral Del Moral O, Rodrigo-Medina B, Gutierrez Ortega C. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial. Journal of Manual & Manipulative Therapy. 2016; 24(4):223–232 [PMC free article: PMC4987146] [PubMed: 27582622]

20.

Cerezo-Tellez E, Torres-Lacomba M, Fuentes-Gallardo I, Perez-Munoz M, Mayoral-Del-Moral O, Lluch-Girbes E et al. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain. 2016; 157(9):1905–1917 [PubMed: 27537209]

21.

Cerezo-Tellez E, Torres-Lacomba M, Mayoral-Del-Moral O, Pacheco-da-Costa S, Prieto-Merino D, Sanchez-Sanchez B. Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial. Health & Quality of Life Outcomes. 2018; 16(1):207 [PMC free article: PMC6219051] [PubMed: 30400984]

22.

Chan DK, Johnson MI, Sun KO, Doble SJ, Jenkins S. Electrical acustimulation of the wrist for chronic neck pain: a randomized, sham-controlled trial using a wrist-ankle acustimulation device. Clinical Journal of Pain. 2009; 25(4):320–326 [PubMed: 19590481]

23.

Chen LX, Mao JJ, Fernandes S, Galantino ML, Guo W, Lariccia P et al. Integrating acupuncture with exercise-based physical therapy for knee osteoarthritis: a randomized controlled trial. JCR: Journal of Clinical Rheumatology. 2013; 19(6):308–316 [PMC free article: PMC3782092] [PubMed: 23965480]

24.

Cheng RSS, Pomeranz B. Electrotheraphy of chronic musculoskeletal pain: Comparison of electroacupuncture and acupuncture-like transcutaneous electrical nerve stimulation. Clinical Journal of Pain. 1986; 2(3):143–149

25.

Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of Internal Medicine. 2001; 161(8):1081–1088 [PubMed: 11322842]

26.

Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine. 2009; 169(9):858–866 [PMC free article: PMC2832641] [PubMed: 19433697]

27.

Chiu TT, Hui-Chan CW, Chein G. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clinical Rehabilitation. 2005; 19(8):850–860 [PubMed: 16323384]

28.

Cho JH, Nam DH, Kim KT, Lee JH. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study. Acupuncture in Medicine. 2014; 32(1):17–23 [PMC free article: PMC3932742] [PubMed: 24171895]

29.

Cho YJ, Song YK, Cha YY, Shin BC, Shin IH, Park HJ et al. Acupuncture for chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Spine. 2013; 38(7):549–557 [PubMed: 23026870]

30.

Chong OT, Critchley HO, Horne AW, Elton R, Haraldsdottir E, Fallon M. The BMEA study: the impact of meridian balanced method electroacupuncture on women with chronic pelvic pain-a three-arm randomised controlled pilot study using a mixed-methods approach. BMJ Open. 2015; 5(11):e008621 [PMC free article: PMC4654391] [PubMed: 26576808]

31.

Chong OT, Critchley HOD, Williams LJ, Haraldsdottir E, Horne AW, Fallon M. The impact of meridian balance method electro-acupuncture treatment on chronic pelvic pain in women: a three-armed randomised controlled feasibility study using a mixed-methods approach. British Journal of Pain. 2018; 12(4):238–249 [PMC free article: PMC6194971] [PubMed: 30349698]

32.

Chou LW, Hsieh YL, Chen HS, Hong CZ, Kao MJ, Han TI. Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. American Journal of Physical Medicine and Rehabilitation. 2011; 90(12):1036–1049 [PubMed: 22019970]

33.

Coan RM, Wong G, Coan PL. The acupuncture treatment of neck pain: a randomized controlled study. American Journal of Chinese Medicine. 1981; 9(4):326–332 [PubMed: 7053030]

34.

Coan RM, Wong G, Liang Ku S. The acupuncture treatment of low back pain: A randomized controlled study. American Journal of Chinese Medicine. 1980; 8(1–2):181–189 [PubMed: 6446852]

35.

Collazo Cha E. Acupuncture and traditional Chinese dietary therapy in the treatment of patients with fibromyalgia. A randomized prospective study. Revista internacional de acupuntura. 2012; 6(3):94–101

36.

Collazo Chao E. Exercise and auricular acupuncture for chronic low-back pain. Revista internacional de acupuntura. 2012; 6(1):31–32

37.

Collazo Chao E, Munoz Reina MD. Scalp acupuncture and acupunture for treatment of patients with fibromyalgia. Prospective randomized study. Revista internacional de acupuntura. 2013; 7(1):6–11

38.

Collazo E, Munoz Reina MD, Aragones MA, Gomez F. Randomized prospective study to assess the effectivenes of several therapeutic procedures of traditional Chinese medicine in alleviation of pain and improvement in the standard of living in patients with fibromyalgia. Revista internacional de acupuntura. 2014; 8(4):121–128

39.

Collazo E, Ramirez Urbano I, Gonzalez-Ripoll C. Clinical trial on the efficacy of various therapeutic procedures for the relief of pain in patients with fibromyalgia. Revista internacional de acupuntura. 2015; 9(3):87–94

40.

Corujeira Rivera MC, Carregal Rañó A, Diz Gómez JC, Mayo Moldes M, Prieto Requeijo P, Areán González I. Evaluation of 2 invasive techniques for treating myofascial pain. Revista espanola de anestesiologia y reanimacion. 2010; 57(2):86–90 [PubMed: 20336999]

41.

Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Physical Therapy. 2014; 94(8):1083–1094 [PubMed: 24700136]

42.

Couto C, de Souza IC, Torres IL, Fregni F, Caumo W. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial. Clinical Journal of Pain. 2014; 30(3):214–223 [PubMed: 23629597]

43.

Curtis L, Burns A. Unit costs of health and social care 2018. Canterbury. Personal Social Services Research Unit University of Kent, 2018. Available from: https://www​.pssru.ac​.uk/project-pages/unit-costs​/unit-costs-2018/

44.

David J, Modi S, Aluko AA, Robertshaw C, Farebrother J. Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. British Journal of Rheumatology. 1998; 37(10):1118–1122 [PubMed: 9825752]

45.

Daya S. The efficacy of acupuncture in the treatment of fibromyalgia syndrome. Journal of the acupuncture association of chartered physiotherapists. 2007; (Autumn):35–46

46.

De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: A randomized clinical trial. Journal of Manipulative and Physiological Therapeutics. 2017; 40(1):11–20 [PubMed: 28017188]

47.

Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW et al. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD007070. DOI: 10.1002/14651858.CD007070.pub2. [PMC free article: PMC4105202] [PubMed: 23728665] [CrossRef]

48.

Deluze C. Electroacupuncture in the treatment of fibromyalgia syndrome: a prospective random study. . Deutsche Zeitschrift fur Akupunktur. 1993; 36(4):81–86

49.

Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ. 1992; 305(6864):1249–1252 [PMC free article: PMC1883744] [PubMed: 1477566]

50.

Department of Health. NHS reference costs 2017–18. 2017. Available from: https://improvement​.nhs​.uk/resources/reference-costs/ Last accessed: 30/10/2019.

51.

Diracoglu D, Vural M, Karan A, Aksoy C. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. Journal of Back and Musculoskeletal Rehabilitation. 2012; 25(4):285–290 [PubMed: 23220812]

52.

Dyson-Hudson TA, Kadar P, LaFountaine M, Emmons R, Kirshblum SC, Tulsky D et al. Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial. Archives of Physical Medicine and Rehabilitation. 2007; 88(10):1276–1283 [PubMed: 17908569]

53.

Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P. The effects of laser acupuncture on chronic tension headache - A randomised controlled trial. Acupuncture in Medicine. 2005; 23(1):13–18 [PubMed: 15844435]

54.

Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Canadian Anaesthetists Society Journal. 1976; 23(3):303–306 [PubMed: 132988]

55.

Edwards J, Knowles N. Superficial dry needling and active stretching in the treatment of myofascial pain--a randomised controlled trial. Acupuncture in Medicine. 2003; 21(3):80–86 [PubMed: 14620302]

56.

Eftekharsadat B, Babaei-Ghazani A, Zeinolabedinzadeh V. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical Journal of the Islamic Republic of Iran. 2016; 30:401 [PMC free article: PMC5038993] [PubMed: 27683642]

57.

Endres HG, Victor N, Haake M, Witte S, Streitberger K, Zenz M. Acupuncture for the treatment of chronic knee and back pain. 574. Deutsches Arzteblatt,. 2007; 104(3):123–130

58.

Ernst E, Resch KL, Fialka V, Ritter-Dittrich D, Alcamioglu Y, Chen O et al. Traditional acupuncture for reflex sympathetic dystrophy: a randomised, sham-controlled, double-blind trial. Acupuncture in Medicine. 1995; 13(2):78–80

59.

Eroglu PK, Yilmaz O, Bodur H, Ates C. A comparison of the efficacy of dry needling, lidocaine injection, and oral flurbiprofen treatments in patients with myofascial pain syndrome: A double-blind (For Injection, Groups Only), randomized clinical trial. Turkish Journal of Rheumatology. 2013; 28(1):38–46

60.

Essex H, Parrott S, Atkin K, Ballard K, Bland M, Eldred J et al. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PloS One. 2017; 12(12):e0178918 [PMC free article: PMC5718562] [PubMed: 29211741]

61.

Fan AY, Zhou K, Gu S, Ming Li Y. Acupuncture is effective for chronic knee pain: A reanalysis of the australian acupuncture trial. Alternative Therapies in Health and Medicine. 2016; 22(3):32–36 [PubMed: 27228270]

62.

Fernandes L, Berry N, Clark RJ, Bloom B, Hamilton EB. Clinical study comparing acupuncture, physiotherapy, injection, and oral anti-inflammatory therapy in shoulder-cuff lesions. Lancet. 1980; 1(8161):208–209 [PubMed: 6153441]

63.

Fox EJ, Melzack R. Comparison of transcutaneous electrical stimulation and acupuncture in the treatment of chronic pain. Advances in Pain Research Therapy. 1976; 1:797–801

64.

Ga H, Choi JH, Park CH, Yoon HJ. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. Journal of Alternative and Complementary Medicine. 2007; 13(6):617–624 [PubMed: 17718644]

65.

Gallego-Sendarrubias GM, Rodriguez-Sanz D, Calvo-Lobo C, Martin JL. Efficacy of dry needling as an adjunct to manual therapy for patients with chronic mechanical neck pain: a randomised clinical trial. Acupuncture in Medicine. 2020:1–11 [PubMed: 32202124]

66.

Gaw AC, Chang LW, Shaw LC. Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study. New England Journal of Medicine. 1975; 293(8):375–378 [PubMed: 1097921]

67.

Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of Manipulative and Physiological Therapeutics. 1999; 22(6):376–381 [PubMed: 10478769]

68.

Giles LG, Muller R. Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine. 2003; 28(14):1490–1503 [PubMed: 12865832]

69.

Glazov G, Schattner P, Lopez D, Shandley K. Laser acupuncture for chronic non-specific low back pain: a controlled clinical trial. Acupuncture in Medicine. 2009; 27(3):94–100 [PubMed: 19734378]

70.

Glazov G, Yelland M, Emery J. Low-dose laser acupuncture for non-specific chronic low back pain: a double-blind randomised controlled trial. Acupuncture in Medicine. 2014; 32(2):116–123 [PMC free article: PMC3995277] [PubMed: 24280948]

71.

Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of Orofacial Pain. 2002; 16(1):71–76 [PubMed: 11889662]

72.

Goldman RH, Stason WB, Park SK, Kim R, Schnyer RN, Davis RB et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clinical Journal of Pain. 2008; 24(3):211–218 [PubMed: 18287826]

73.

Gonzalez-Perez LM, Infante-Cossio P, Granados-Nunez M, Urresti-Lopez FJ, Lopez-Martos R, Ruiz-Canela-Mendez P. Deep dry needling of trigger points located in the lateral pterygoid muscle: Efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction. Medicina Oral, Patología Oral y Cirugía Bucal. 2015; 20(3):e326–333 [PMC free article: PMC4464920] [PubMed: 25662558]

74.

Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up. Spine. 1980; 5(3):279–291 [PubMed: 6446774]

75.

Haake M, Muller HH, Schade-Brittinger C, Basler HD, Schafer H, Maier C et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Archives of Internal Medicine. 2007; 167(17):1892–1898 [PubMed: 17893311]

76.

Haake M, Muller HH, Schade-Brittinger C, Prinz H, Basler HD, Streitberger K et al. The German multicenter, randomized, partially blinded, prospective trial of acupuncture for chronic low-back pain: a preliminary report on the rationale and design of the trial. Journal of Alternative and Complementary Medicine. 2003; 9(5):763–770 [PubMed: 14629854]

77.

Hadianfard MJ, Hosseinzadeh Parizi M. A randomized clinical trial of fibromyalgia treatment with acupuncture compared with fluoxetine. Iranian Red Crescent Medical Journal. 2012; 14(10):631–640 [PMC free article: PMC3518980] [PubMed: 23285415]

78.

Hakim IK, Takamjani IE, Sarrafzadeh J, Ezzati K, Bagheri R. The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes. Journal of Back and Musculoskeletal Rehabilitation. 2019; 32(5):717–724 [PubMed: 30636729]

79.

Hall M. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a peliminary study. NZ Journal of Physiotherapy. 2014; 42(3):177

80.

Hansen PE, Hansen JH. Acupuncture treatment of chronic facial pain--a controlled cross-over trial. Headache. 1983; 23(2):66–69 [PubMed: 6853155]

81.

Hansen PE, Hansen JH. Acupuncture treatment of chronic facial pain. A double-blind cross- over investigation. Ugeskr-Laeg. 1981; 143(44):2885–2887 [PubMed: 7034338]

82.

Harris RE, Sundgren PC, Pang Y, Hsu M, Petrou M, Kim SH et al. Dynamic levels of glutamate within the insula are associated with improvements in multiple pain domains in fibromyalgia. Arthritis and Rheumatism. 2008; 58(3):903–907 [PubMed: 18311814]

83.

Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. Journal of Alternative and Complementary Medicine. 2005; 11(4):663–671 [PubMed: 16131290]

84.

Harris RE, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage. 2009; 47(3):1077–1085 [PMC free article: PMC2757074] [PubMed: 19501658]

85.

He D, Hostmark AT, Veiersted KB, Medbo JI. Effect of intensive acupuncture on pain-related social and psychological variables for women with chronic neck and shoulder pain--an RCT with six month and three year follow up. Acupuncture in Medicine. 2005; 23(2):52–61 [PubMed: 16025785]

86.

He D, Veiersted KB, Hostmark AT, Medbo JI. Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study. Pain. 2004; 109(3):299–307 [PubMed: 15157691]

87.

Hinman RS, McCrory P, Pirotta M, Relf I, Forbes A, Crossley KM et al. Acupuncture for chronic knee pain: a randomized clinical trial. JAMA. 2014; 312(13):1313–1322 [PubMed: 25268438]

88.

Hirota S. Trigger point acupuncture treatment for chronic low back pain in elderly patients. Bulletin of Meiji University of Oriental Medicine. 2007; 38:19–26

89.

Hollisaz MT. Use of electroacupuncture for treatment of chronic sciatic pain. Internet Journal of Pain, Symptom Control and Palliative Care. 2007; 5(1)

90.

Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. American Journal of Physical Medicine and Rehabilitation. 2007; 86(5):397–403 [PubMed: 17449984]

91.

Hunter RF, McDonough SM, Bradbury I, Liddle SD, Walsh DM, Dhamija S et al. Exercise and auricular acupuncture for chronic low-back pain: A feasibility randomized-controlled trial. Clinical Journal of Pain. 2012; 28(3):259–267 [PubMed: 21753728]

92.

Ichida MC, Zemuner M, Hosomi J, Pai HJ, Teixeira MJ, de Siqueira JTT et al. Acupuncture treatment for idiopathic trigeminal neuralgia: A longitudinal case-control double blinded study. Chinese Journal of Integrative Medicine. 2017; 23(11):829–836 [PubMed: 29080198]

93.

Ilbuldu E, Cakmak A, Disci R, Aydin R. Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomedicine and Laser Surgery. 2004; 22(4):306–311 [PubMed: 15345173]

94.

Irnich D, Behrens N, Gleditsch JM, Stor W, Schreiber MA, Schops P et al. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain. 2002; 99(1–2):83–89 [PubMed: 12237186]

95.

Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M et al. Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. BMJ. 2001; 322(7302):1574–1578 [PMC free article: PMC33515] [PubMed: 11431299]

96.

Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M et al. Acupuncture - Superplacebo for backache? Forschende komplementarmedizin und klassische naturheilkunde. 2001; 8(6):387–388

97.

Irnich De. Acupuncture in chronic neck pain: an overview and results of a randomized large scale trial of acupuncture compared with conventional massage and sham laser acupuncture. Deutsche Zeitschrift fur Akupunktur. 2001; 44(2a):205

98.

Irnich De. Randomised, placebo, controlled, multicentre trial of acupuncture for the treatment of chronic neck pain. Deutsche Zeitschrift fur Akupunktur. 2000; 43(1):40

99.

Itoh K, Katsumi Y, Hirota S, Kitakoji H. Effects of trigger point acupuncture on chronic low back pain in elderly patients--a sham-controlled randomised trial. Acupuncture in Medicine. 2006; 24(1):5–12 [PubMed: 16618043]

100.

Itoh K, Kitakoji H. Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chinesische Medizin. 2010; 5:11 [PMC free article: PMC2852376] [PubMed: 20331844]

101.

Itoh K, Saito S, Sahara S, Naitoh Y, Imai K, Kitakoji H. Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. Jams Journal of Acupuncture & Meridian Studies. 2014; 7(2):59–64 [PubMed: 24745863]

102.

Itoh S. Effect of trigger point acupuncture treatment in older patients with chronic low back pain. Journal of the japan society of acupuncture and moxibustion. 2009; 59(1):13–21

103.

Jang ZY, Li CD, Qiu L, Guo JH, He LN, Yue Y et al. Combination of acupuncture, cupping and medicine for treatment of fibromyalgia syndrome: a multi-central randomized controlled trial. Zhongguo zhen jiu [Chinese acupuncture & moxibustion]. 2010; 30(4):265–269 [PubMed: 20568427]

104.

Jiang GM, Lin MD, Wang LY. Comparative study on effect of acupuncture and lidocaine block for lumbar myofascial pain syndrome. Zhongguo zhen jiu [Chinese acupuncture & moxibustion]. 2013; 33(3):223–226 [PubMed: 23713304]

105.

Johansson A, Wenneberg B, Wagersten C, Haraldson T. Acupuncture in treatment of facial muscular pain. Acta Odontologica Scandinavica. 1991; 49(3):153–158 [PubMed: 1882649]

106.

Junnila SYT. Acupuncture therapy for chronic pain. A randomized comparison between acupuncture and pseudo-acupuncture with minimal peripheral stimulus. American Journal of Acupuncture. 1982; 10(3):259–262

107.

Jurisic Kvesic A, Zavoreo I, Basic Kes V, Vucicevic Boras V, Ciliga D, Gabric D et al. The effectiveness of acupuncture versus clonazepam in patients with burning mouth syndrome. Acupuncture in Medicine. 2015; 33(4):289–292 [PubMed: 25987645]

108.

Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001; 26(13):1418–1424 [PubMed: 11458142]

109.

Kamali F, Mohamadi M, Fakheri L, Mohammadnejad F. Dry needling versus friction massage to treat tension type headache: A randomized clinical trial. Journal of Bodywork and Movement Therapies. 2019; 23(1):89–93 [PubMed: 30691768]

110.

Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatology International. 2005; 25(8):604–611 [PubMed: 15372199]

111.

Karatay S, Okur SC, Uzkeser H, Yildirim K, Akcay F. Effects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance P levels: A randomized sham and placebo-controlled clinical trial. Pain Medicine. 2018; 19(3):615–628 [PubMed: 29220534]

112.

Karst M, Rollnik JD, Fink M, Reinhard M, Piepenbrock S. Pressure pain threshold and needle acupuncture in chronic tension-type headache--a double-blind placebo-controlled study. Pain. 2000; 88(2):199–203 [PubMed: 11050375]

113.

Kerr DP, Walsh DM, Baxter D. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Clinical Journal of Pain. 2003; 19(6):364–370 [PubMed: 14600536]

114.

Kho KH. The impact of acupuncture on pain in patients with reflex sympathetic dystrophy. Pain Clinic. 1995; 8(1):59–61

115.

Kim CY, Kwon NH, Shin YJ, Nam DW, Kim KH, Kim JI. Randomized Controlled Trial : effect of Master Dong’s Acupuncture in Chronic Shoulder Pain Patients. The journal of korean acupuncture & moxibustion society. 2007; 24(6):89–96

116.

Kim SM, Kim HJ, Lee MJ, Shin YJ. Effects of local and Sa-am acupuncture on hypoadrenia and chronic low back pain. Journal of korean oriental medicine. 2009; 30(2):104–116

117.

König A, Radke S, Molzen H, Haase M, Müller C, Drexler D et al. Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain - range of motion analysis. Zeitschrift für Orthopädie und Ihre Grenzgebiete. 2003; 141(4):395–400 [PubMed: 12928995]

118.

Korpan MI, Dezu Y, Schneider B, Leitha TH, Fialka-Moser V. Acupuncture in the treatment of posttraumatic pain syndrome. Acta Orthopaedica Belgica. 2002; 68(Suppl 1):134–138

119.

Kucuk EV, Suceken FY, Bindayi A, Boylu U, Onol FF, Gumus E. Effectiveness of acupuncture on chronic prostatitis-chronic pelvic pain syndrome category IIIB patients: a prospective, randomized, nonblinded, clinical trial. Urology. 2015; 85(3):636–640 [PubMed: 25582816]

120.

Kumnerddee W. Effectiveness comparison between Thai traditional massage and Chinese acupuncture for myofascial back pain in Thai military personnel: a preliminary report. Journal of the Medical Association of Thailand. 2009; 92(Suppl 1):S117–123 [PubMed: 21299184]

121.

Kwon YD, Lee SG, Lee CW, Jung SK, Kim DE, Choi SM. The short-term efficacy of acupuncture for chronic low back pain: randomised sham controlled trial. J oriental rehab med. 2007; 17(2):123–132

122.

Langley GB, Sheppeard H, Johnson M, Wigley RD. The analgesic effects of transcutaneous electrical nerve stimulation and placebo in chronic pain patients. A double-blind non-crossover comparison. Rheumatology International. 1984; 4(3):119–123 [PubMed: 6611576]

123.

Lathia AT, Jung SM, Chen LX. Efficacy of acupuncture as a treatment for chronic shoulder pain. Journal of Alternative and Complementary Medicine. 2009; 15(6):613–618 [PubMed: 19489707]

124.

Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009; 73(5):1036–1041 [PubMed: 19394499]

125.

Lee SW, Liong ML, Yuen KH, Leong WS, Chee C, Cheah PY et al. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. American Journal of Medicine. 2008; 121(1):79.e71–77 [PMC free article: PMC4497585] [PubMed: 18187077]

126.

Lee SW, Liong ML, Yuen KH, Leong WS, Khan NK, Krieger JN. Validation of a sham acupuncture procedure in a randomised, controlled clinical trial of chronic pelvic pain treatment. Acupuncture in Medicine. 2011; 29(1):40–46 [PubMed: 21245238]

127.

Lehmann TR, Russell DW, Spratt KF. The impact of patients with nonorganic physical findings on a controlled trial of transcutaneous electrical nerve stimulation and electroacupuncture. Spine. 1983; 8(6):625–634 [PubMed: 6228019]

128.

Lehmann TR, Russell DW, Spratt KF, Colby H, Liu YK, Fairchild ML et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain. 1986; 26(3):277–290 [PubMed: 2946016]

129.

Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R et al. Acupuncture treatment of chronic low-back pain -- a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain. 2002; 96(1–2):189–196 [PubMed: 11932074]

130.

Li D, Yang L, Li J. Fibromyalgia syndrome treated with acupuncture at the acupoints of the affected meridians and heavy moxibustion at painful points: a randomized controlled trial. Zhongguo zhen jiu [Chinese acupuncture & moxibustion]. 2016; 36(2):147–151 [PubMed: 27348913]

131.

Liang Z, Zhu X, Yang X, Fu W, Lu A. Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study. Complementary Therapies in Medicine. 2011; 19(Suppl 1):S26–32 [PubMed: 21195292]

132.

Lin ML, Lin MH, Fen JJ, Lin WT, Lin CW, Chen PQ. A comparison between pulsed radiofrequency and electro-acupuncture for relieving pain in patients with chronic low back pain. Acupuncture and Electro-Therapeutics Research. 2010; 35(3–4):133–146 [PubMed: 21319602]

133.

Lin ML, Wu JH, Lin CW, Su CT, Wu HC, Shih YS et al. Clinical effects of laser acupuncture plus chinese cupping on the pain and plasma cortisol levels in patients with chronic nonspecific lower back pain: A randomized controlled trial. Evidence-Based Complementary & Alternative Medicine: eCAM. 2017; 2017:3140403 [PMC free article: PMC5564089] [PubMed: 28848615]

134.

Liu W, Xue L, Tian M, Zhang F. Clinical research on a myofascial pain trigger point combining baihui acupoint therapy of myofascial pain syndrome and living quality analysis. International Journal of Clinical and Experimental Medicine. 2016; 9(2):866–876

135.

Llamas-Ramos R, Pecos-Martin D, Gallego-Izquierdo T, Llamas-Ramos I, Plaza-Manzano G, Ortega-Santiago R et al. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. Journal of Orthopaedic and Sports Physical Therapy. 2014; 44(11):852–861 [PubMed: 25269764]

136.

Lopez-Martos R, Gonzalez-Perez LM, Ruiz-Canela-Mendez P, Urresti-Lopez FJ, Gutierrez-Perez JL, Infante-Cossio P. Randomized, double-blind study comparing percutaneous electrolysis and dry needling for the management of temporomandibular myofascial pain. Medicina Oral, Patología Oral y Cirugía Bucal. 2018; 23(4):e454–462 [PMC free article: PMC6051683] [PubMed: 29924769]

137.

Ma C, Wu S, Li G, Xiao X, Mai M, Yan T. Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clinical Journal of Pain. 2010; 26(3):251–257 [PubMed: 20173440]

138.

Macdonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Annals of the Royal College of Surgeons of England. 1983; 65(1):44–46 [PMC free article: PMC2494194] [PubMed: 6218776]

139.

MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K et al. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: A randomized trial. Annals of Internal Medicine. 2015; 163(9):653–662 [PubMed: 26524571]

140.

Madani A, Ahrari F, Fallahrastegar A, Daghestani N. A randomized clinical trial comparing the efficacy of low-level laser therapy (LLLT) and laser acupuncture therapy (LAT) in patients with temporomandibular disorders. Lasers in Medical Science. 2020; 35(1):181–192 [PubMed: 31396794]

141.

Maeda Y, Kettner N, Lee J, Kim J, Cina S, Malatesta C et al. Acupuncture-evoked response in somatosensory and prefrontal cortices predicts immediate pain reduction in carpal tunnel syndrome. Evidence-Based Complementary & Alternative Medicine: eCAM. 2013; 2013:795906 [PMC free article: PMC3703406] [PubMed: 23843881]

142.

Maeda Y, Kim H, Kettner N, Kim J, Cina S, Malatesta C et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain. 2017; 140(4):914–927 [PMC free article: PMC5837382] [PubMed: 28334999]

143.

Martin DP, Sletten CD, Williams BA, Berger IH. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clinic Proceedings. 2006; 81(6):749–757 [PubMed: 16770975]

144.

Mavrommatis CI, Argyra E, Vadalouka A, Vasilakos DG. Acupuncture as an adjunctive therapy to pharmacological treatment in patients with chronic pain due to osteoarthritis of the knee: a 3-armed, randomized, placebo-controlled trial. Pain. 2012; 153(8):1720–1726 [PubMed: 22727499]

145.

Melzack R, Jeans ME, Stratford JG, Monks RC. Ice massage and transcutaneous electrical stimulation: comparison of treatment for low-back pain. Pain. 1980; 9(2):209–217 [PubMed: 6450393]

146.

Mendelson G, Kidson MA, Loh ST, Scott DF, Selwood TS, Kranz H. Acupuncture analgesia for chronic low back pain. Clinical and Experimental Neurology. 1978; 15:182–185 [PubMed: 158752]

147.

Mendelson G, Selwood TS, Kranz H, Loh TS, Kidson MA, Scott DS. Acupuncture treatment of chronic back pain. A double-blind placebo-controlled trial. American Journal of Medicine. 1983; 74(1):49–55 [PubMed: 6217745]

148.

Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Rheumatology. 2003; 42(12):1508–1517 [PubMed: 12890859]

149.

Mira TA, Giraldo PC, Yela DA, Benetti-Pinto CL. Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2015; 194:1–6 [PubMed: 26319650]

150.

Mist SD, Jones KD. Randomized controlled trial of acupuncture for women with fibromyalgia: Group acupuncture with traditional chinese medicine diagnosis-based point selection. Pain Medicine. 2018; 19(9):1862–1871 [PMC free article: PMC6127237] [PubMed: 29447382]

151.

Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain--a randomized, blinded, controlled trial with 3 months follow up. Pain. 2002; 99(3):579–587 [PubMed: 12406534]

152.

Molsberger AF, Schneider T, Gotthardt H, Drabik A. German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain. 2010; 151(1):146–154 [PubMed: 20655660]

153.

Moore ME, Berk SN. Acupuncture for chronic shoulder pain. An experimental study with attention to the role of placebo and hypnotic susceptibility. Annals of Internal Medicine. 1976; 84(4):381–384 [PubMed: 769630]

154.

Muller R, Giles LG. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. Journal of Manipulative and Physiological Therapeutics. 2005; 28(1):3–11 [PubMed: 15726029]

155.

Nabeta T, Kawakita K. Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial. Complementary Therapies in Medicine. 2002; 10(4):217–222 [PubMed: 12594972]

156.

Najafi TF, Hejazi M, Meshkat M, Hajibabakashani S. Quality of life and performing acupuncture on 150 patients suffering from chronic pains: A randomized and intervention study before and after performing. Iranian Red Crescent Medical Journal. 2013; 15(3):269–271 [PMC free article: PMC3745761] [PubMed: 23984012]

157.

Najm WI. Acupuncture vs sham acupuncture for chronic prostatitis/chronic pelvic pain. Medical Acupuncture. 2008; 20(2):132–133

158.

National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October 2018]. London. National Institute for Health and Care Excellence, 2014. Available from: http://www​.nice.org.uk​/article/PMG20/chapter​/1%20Introduction%20and%20overview

159.

NHS Supply Chain Catalogue. NHS Supply Chain, 2019. Available from: http://www​.supplychain.nhs.uk/

160.

Olivan BB, Perez PS, Gaspar CE, Romo CL, Serrano AB, Torre Beldarrain ML et al. Effectiveness of the dry needling in the treatment of chronic low back pain. Fisioterapia. 2007; 29(6):270–277

161.

Organisation for Economic Co-operation and Development (OECD). Purchasing power parities (PPP). 2012. Available from: http://www​.oecd.org/std/ppp Last accessed: 13/12/2019.

162.

Pecos-Martin D, Montanez-Aguilera FJ, Gallego-Izquierdo T, Urraca-Gesto A, Gomez-Conesa A, Romero-Franco N et al. Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2015; 96(5):775–781 [PubMed: 25582412]

163.

Peng AT, Behar S, Yue SJ. Long-term therapeutic effects of electro-acupuncture for chronic neck and shoulder pain--a double blind study. Acupuncture and Electro-Therapeutics Research. 1987; 12(1):37–44 [PubMed: 2883835]

164.

Perez-Palomares S, Olivan-Blazquez B, Perez-Palomares A, Gaspar-Calvo E, Perez-Benito M, Lopez-Lapena E et al. Contribution of dry needling to individualized physical therapy treatment of shoulder pain: A randomized clinical trial. Journal of Orthopaedic and Sports Physical Therapy. 2017; 47(1):11–20 [PubMed: 27937046]

165.

Petrie JP, Hazleman BL. A controlled study of acupuncture in neck pain. British Journal of Rheumatology. 1986; 25(3):271–275 [PubMed: 3524727]

166.

Petrie JP, Langley GB. Acupuncture in the treatment of chronic cervical pain. A pilot study. Clinical and Experimental Rheumatology. 1983; 1(4):333–336 [PubMed: 6335859]

167.

Prady SL, Thomas K, Esmonde L, Crouch S, MacPherson H. The natural history of back pain after a randomised controlled trial of acupuncture vs usual care--long term outcomes. Acupuncture in Medicine. 2007; 25(4):121–129 [PubMed: 18160922]

168.

Qin Z, Zang Z, Zhou K, Wu J, Zhou J, Kwong JSW et al. Acupuncture for chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham acupuncture-controlled trial. Journal of Urology. 2018; 200(4):815–822 [PubMed: 29733836]

169.

Ratcliffe J, Tohmas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ. 2006; 333(7569):626–628 [PMC free article: PMC1570795] [PubMed: 16980315]

170.

Raustia AM, Pohjola RT, Virtanen KK. Acupuncture compared with stomatognathic treatment for TMJ dysfunction. Part I: A randomized study. Journal of Prosthetic Dentistry. 1985; 54(4):581–585 [PubMed: 3862818]

171.

Rayegani SM, Bayat M, Bahrami MH, Raeissadat SA, Kargozar E. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clinical Rheumatology. 2014; 33(6):859–864 [PubMed: 24352752]

172.

Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich SN. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. European Journal of Health Economics. 2008; 9(3):209–219 [PubMed: 17638034]

173.

Riikonen A. Acupuncture and proquazone in the treatment of chronic pain in the neck and shoulder region. Acupuncture and Electro-Therapeutics Research. 1985; 10(3):228–230

174.

Ruth M, Weber M, Zenz M. Laser acupuncture for chronic back pain. A double-blind clinical study. Schmerz. 2010; 24(5):485–493 [PubMed: 20872127]

175.

Sahin N, Ozcan E, Sezen K, Karatas O, Issever H. Efficacy of acupunture in patients with chronic neck pain--a randomised, sham controlled trial. Acupuncture and Electro-Therapeutics Research. 2010; 35(1–2):17–27 [PubMed: 20578644]

176.

Sahin S, Bicer M, Eren GA, Tas S, Tugcu V, Tasci AI et al. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial. Prostate Cancer and Prostatic Diseases. 2015; 18(3):249–254 [PubMed: 25939517]

177.

Salter GC, Roman M, Bland MJ, MacPherson H. Acupuncture for chronic neck pain: a pilot for a randomised controlled trial. BMC Musculoskeletal Disorders. 2006; 7:99 [PMC free article: PMC1713236] [PubMed: 17156464]

178.

Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, Szeles JC, Finster G, Schiesser AW et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia. 2004; 98(5):1359–1364 [PubMed: 15105215]

179.

Sator-Katzenschlager SM, Szeles JC, Scharbert G, Michalek-Sauberer A, Kober A, Heinze G et al. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia and Analgesia. 2003; 97(5):1469–1473 [PubMed: 14570667]

180.

Schaeffer EM. Re: Effectiveness of Acupuncture on Chronic Prostatitis-Chronic Pelvic Pain Syndrome Category IIIB Patients: A Prospective, Randomized, Nonblinded, Clinical Trial. Journal of Urology. 2015; 194(4):1007–1008 [PubMed: 26382782]

181.

Scharf HP, Mansmann U, Streitberger K, Witte S, Kramer J, Maier C et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Annals of Internal Medicine. 2006; 145(1):12–20 [PubMed: 16818924]

182.

Scharf HP, Mansmann U, Streitberger K, Witte S, Kramer J, Maier C et al. A three-armed randomized trial. Revista internacional de acupuntura. 2007; 1(1):41–42

183.

Schlaeger JM, Xu N, Mejta CL, Park CG, Wilkie DJ. Acupuncture for the treatment of vulvodynia: a randomized wait-list controlled pilot study. Journal of Sexual Medicine. 2015; 12(4):1019–1027 [PubMed: 25639289]

184.

Schmid-Schwap M, Simma-Kletschka I, Stockner A, Sengstbratl M, Gleditsch J, Kundi M et al. Oral acupuncture in the therapy of craniomandibular dysfunction syndrome -- a randomized controlled trial. Wiener Klinische Wochenschrift. 2006; 118(1–2):36–42 [PubMed: 16489524]

185.

Seo BK, Han K, Kwon O, Jo DJ, Lee JH. Efficacy of bee venom acupuncture for chronic low back pain: A randomized, double-blinded, sham-controlled trial. Toxins. 2017; 9(11):361 [PMC free article: PMC5705976] [PubMed: 29112155]

186.

Shankar N, Thakur M, Tandon OP, Saxena AK, Arora S, Bhattacharya N. Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial. Indian Journal of Physiology and Pharmacology. 2011; 55(1):25–36 [PubMed: 22315807]

187.

Shen YF, Goddard G. The short-term effects of acupuncture on myofascial pain patients after clenching. Pain Practice. 2007; 7(3):256–264 [PubMed: 17714105]

188.

Shen YF, Younger J, Goddard G, Mackey S. Randomized clinical trial of acupuncture for myofascial pain of the jaw muscles. Journal of Orofacial Pain. 2009; 23(4):353–359 [PMC free article: PMC2894813] [PubMed: 19888488]

189.

Shi GX, Liu BZ, Wang J, Fu QN, Sun SF, Liang RL et al. Motion style acupuncture therapy for shoulder pain: a randomized controlled trial. Journal of Pain Research. 2018; 11:2039–2050 [PMC free article: PMC6165767] [PubMed: 30310308]

190.

Shin BC, Kong JC, Park TY, Yang CY, Kang KW, Choi SM. Bee venom acupuncture for chronic low back pain: A randomised, sham-controlled, triple-blind clinical trial. European Journal of Integrative Medicine. 2012; 4(3):e271–e280

191.

Simma I, Gleditsch JM, Simma L, Piehslinger E. Immediate effects of microsystem acupuncture in patients with oromyofacial pain and craniomandibular disorders (CMD): a double-blind, placebo-controlled trial. British Dental Journal. 2009; 207(12):E26 [PubMed: 19876045]

192.

Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z. The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial. Journal of Dentistry. 2007; 35(3):259–267 [PubMed: 17095133]

193.

Sobhani V, Shamsoddini A, Khatibi-Aghda A, Mazloum V, Kia HH, Emami Meybodi MK. Effectiveness of dry needling, manual therapy, and Kinesio Tapingfi for patients with chronic myofascial neck pain: A single-blind clinical trial. Trauma Monthly. 2017; 22(6):e39261

194.

Song YJ, Zhang DQ, Su DP. Clinical study on abdominal acupuncture plus herbal medicine for chronic pelvic pain due to Qi Stagnation and Blood Stasis. Shanghai journal of acupuncture and moxibustion [shang hai zhen jiu za zhi]. 2015; 34(5):442–443

195.

Sprott H. Efficiency of acupuncture in patients with fibromyalgia. Clinical Bulletin of Myofascial Therapy. 1998; 3(1):37–43

196.

Stieven FF, Ferreira GE, Wiebusch M, de Araujo FX, da Rosa LHT, Silva MF. No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Journal of Orthopaedic and Sports Physical Therapy. 2020:1–21 [PubMed: 32272030]

197.

Stival RS, Cavalheiro PR, Stasiak CE, Galdino DT, Hoekstra BE, Schafranski MD. Acupuncture in fibromyalgia: a randomized, controlled study addressing the immediate pain response. Revista Brasileira de Reumatologia. 2014; 54(6):431–436 [PubMed: 25458024]

198.

Streitberger K, Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K et al. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Revista internacional de acupuntura. 2007; 1(1):40–41 [PubMed: 17075849]

199.

Sun MY, Hsieh CL, Cheng YY, Hung HC, Li TC, Yen SM et al. The therapeutic effects of acupuncture on patients with chronic neck myofascial pain syndrome: a single-blind randomized controlled trial. American Journal of Chinese Medicine. 2010; 38(5):849–859 [PubMed: 20821817]

200.

Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD et al. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. Journal of Rehabilitation Medicine. 2008; 40(7):582–588 [PubMed: 18758677]

201.

Tekin L, Akarsu S, Durmus O, Cakar E, Dincer U, Kiralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clinical Rheumatology. 2013; 32(3):309–315 [PubMed: 23138883]

202.

Tobbackx Y, Meeus M, Wauters L, De Vilder P, Roose J, Verhaeghe T et al. Does acupuncture activate endogenous analgesia in chronic whiplash-associated disorders? A randomized crossover trial. European Journal of Pain. 2013; 17(2):279–289 [PubMed: 22968837]

203.

Tonev D, Radeva S, Toncheva A. Non-pharmacological treatment of subacute and chronic low back pain without radiculopathy: acupuncture versus physiotherapy. Rheumatology. 2010; 18(2):46–50

204.

Toroski M, Nikfar S, Mojahedian MM, Ayati MH. Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain. Jams Journal of Acupuncture & Meridian Studies. 2018; 11(2):62–66 [PubMed: 29436371]

205.

Tough EA, White AR, Richards SH, Campbell JL. Myofascial trigger point needling for whiplash associated pain--a feasibility study. Manual Therapy. 2010; 15(6):529–535 [PubMed: 20580303]

206.

Tsui ML, Cheing GL. The effectiveness of electroacupuncture versus electrical heat acupuncture in the management of chronic low-back pain. Journal of Alternative and Complementary Medicine. 2004; 10(5):803–809 [PubMed: 15650469]

207.

Tuzun EH, Gildir S, Angin E, Tecer BH, Dana KO, Malkoc M. Effectiveness of dry needling versus a classical physiotherapy program in patients with chronic low-back pain: a single-blind, randomized, controlled trial. Journal of Physical Therapy Science. 2017; 29(9):1502–1509 [PMC free article: PMC5599809] [PubMed: 28931976]

208.

Ugurlu FG, Sezer N, Aktekin L, Fidan F, Tok F, Akkus S. The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial. Acta Reumatologica Portuguesa. 2017; 42(1):32–37 [PubMed: 28371571]

209.

Uhlemann C, Loth C. Randomised study on acupuncture and massage of connective tissue in patients with fibromyalgia syndrom (FMS). Zeitschrift für Rheumatologie. 2001; 60(Suppl 1):88–89 [PubMed: 11383054]

210.

Ushinohama A, Cunha BP, Costa LO, Barela AM, Freitas PB. Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2016; 20(4):328–335 [PMC free article: PMC5015670] [PubMed: 27556389]

211.

Vas J, Santos-Rey K, Navarro-Pablo R, Modesto M, Aguilar I, Campos MA et al. Acupuncture for fibromyalgia in primary care: a randomised controlled trial. Acupuncture in Medicine. 2016; 34(4):257–266 [PubMed: 26879181]

212.

Venâncio Rde A, Alencar FG, Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008; 26(2):96–103 [PubMed: 18468269]

213.

Wang L, Ma S, Zhao Y, Cao R, Wang Y, Ma TM. A randomized controlled clinical trial for treatment of shoulder-back myofascial pain syndrome with mild moxibustion at trigger points. Zhen CI yan jiu = acupuncture research. 2016; 41(4):334–337 [PubMed: 29071929]

214.

Weiner DK, Rudy TE, Morone N, Glick R, Kwoh CK. Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: an initial controlled clinical trial. Journal of the American Geriatrics Society. 2007; 55(10):1541–1547 [PubMed: 17908057]

215.

Weiss J, Quante S, Xue F, Muche R, Reuss-Borst M. Effectiveness and acceptance of acupuncture in patients with chronic low back pain: results of a prospective, randomized, controlled trial. Journal of Alternative and Complementary Medicine. 2013; 19(12):935–941 [PubMed: 23738680]

216.

White P, Lewith G, Prescott P, Conway J. Acupuncture versus placebo for the treatment of chronic mechanical neck pain. Annals of Internal Medicine. 2004; 141(12):920–928 [PubMed: 15611488]

217.

Wiles MR. “Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up” (Spine 1980;5:279–291). Spine. 1982; 7(1):86 [PubMed: 6461928]

218.

Willich SN, Reinhold T, Selim D, Jena S, Brinkhaus B, Witt CM. Cost-effectiveness of acupuncture treatment in patients with chronic neck pain. Pain. 2006; 125(1–2):107–113 [PubMed: 16842918]

219.

Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005; 366(9480):136–143 [PubMed: 16005336]

220.

Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN. Acupuncture for patients with chronic neck pain. Pain. 2006; 125(1–2):98–106 [PubMed: 16781068]

221.

Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN. Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional nonrandomized arm. Arthritis and Rheumatism. 2006; 54(11):3485–3493 [PubMed: 17075849]

222.

Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. American Journal of Epidemiology. 2006; 164(5):487–496 [PubMed: 16798792]

223.

Wu CL, Liao LL, Yang SW. Efficacy of acupuncture treatment on myofascial pain syndrome in upper trapezius. Journal of Medical and Biological Engineering. 2016; 36(5):686–692

224.

Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. Journal of Alternative and Complementary Medicine. 2003; 9(4):479–490 [PubMed: 14499023]

225.

Yoshimizu M, Teo AR, Ando M, Kiyohara K, Kawamura T. Relief of chronic shoulder and neck pain by electro-acupuncture and transcutaneous electrical nervous stimulation: A randomized crossover trial. Medical Acupuncture. 2012; 24(2):97–103

226.

Yue SJ. Acupuncture for chronic back and neck pain. Acupuncture and Electro-Therapeutics Research. 1978; 3(3–4):323–324

227.

Yun M, Shao Y, Zhang Y, He S, Xiong N, Zhang J et al. Hegu acupuncture for chronic low-back pain: a randomized controlled trial. Journal of Alternative and Complementary Medicine. 2012; 18(2):130–136 [PubMed: 22339101]

228.

Yun M, Xiong N, Guo M, Zhang J, Liu D, Luo Y et al. Acupuncture at the back-pain-acupoints for chronic low back pain of Peacekeepers in Lebanon: A randomized controlled trial. Journal of Musculoskeletal Pain. 2012; 20(2):107–115

229.

Zavareo I, Miroslav S, Vanja VB, Diana TD, Ana AR. Efficacy of acupuncture and vitamin C in burning mouth syndrome: a pilot study. Research journal of pharmaceutical, biological and chemical sciences. 2017; 8(1):26–30

230.

Zhang H, Sun J, Wang C, Yu C, Wang W, Zhang M et al. Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain. Acupuncture in Medicine. 2016; 34(3):164–170 [PubMed: 26795764]

231.

Zhang JF, Wu YC, Mi YQ. Observation on therapeutic effect of acupuncture at pain points for treatment of myofascial pain syndrome. Zhongguo zhen jiu [Chinese acupuncture & moxibustion]. 2009; 29(9):717–720 [PubMed: 19803239]

232.

Zhang SP, Chiu TTW, Chiu SN. Long-term efficacy of electroacupuncture for chronic neck pain: A randomised controlled trial. Hong Kong Medical Journal. 2013; 19(6 Suppl 9):S36–S39 [PubMed: 24473589]

233.

Zheng Z, Gibson S, Helme RD, Wang Y, Lu DS, Arnold C et al. Effects of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: A multicenter randomized controlled trial. Pain Medicine. 2019; 20(2):397–410 [PubMed: 29893942]

234.

Zheng Z, Guo RJ, Helme RD, Muir A, Da Costa C, Xue CC. The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial. European Journal of Pain. 2008; 12(5):671–676 [PubMed: 18035566]

235.

Zhou J, Liu Y, Li C, Liu Z. Comparison of 3 assessment modes of acupuncture effect on patients with chronic prostatitis/chronic pelvic pain syndrome: A study protocol for a randomized controlled trial. Medicine. 2018; 97(42):e12887 [PMC free article: PMC6211918] [PubMed: 30335011]

236.

Ziaeifar M, Arab AM, Karimi N, Nourbakhsh MR. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. Journal of Bodywork and Movement Therapies. 2014; 18(2):298–305 [PubMed: 24725800]

237.

Zotelli VL, Grillo CM, Gil ML, Wada RS, Sato JE, da Luz Rosario de Sousa M. Acupuncture effect on pain, mouth opening limitation and on the energy meridians in patients with temporomandibular dysfunction: A randomized controlled trial. Jams Journal of Acupuncture & Meridian Studies. 2017; 10(5):351–359 [PubMed: 29078971]

238.

Zucker NA, Tsodikov A, Mist SD, Cina S, Napadow V, Harris RE. Evoked pressure pain sensitivity is associated with differential analgesic response to verum and sham acupuncture in fibromyalgia. Pain Medicine. 2017; 18(8):1582–1592 [PMC free article: PMC6279294] [PubMed: 28340147]

Appendices

Intervention evidence review underpinning recommendation 1.2.5 and the research recommendation in the NICE guideline

This evidence review was developed by the National Guideline Centre based at the Royal College of Physicians

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.

Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.