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      The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis

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          Abstract

          Background

          Postoperative pain resulting from surgical trauma is a significant challenge for healthcare providers. Opioid analgesics are commonly used to treat postoperative pain; however, these drugs are associated with a number of undesirable side effects.

          Objective

          This systematic review and meta-analysis evaluated the effectiveness of acupuncture and acupuncture-related techniques in treating postoperative pain.

          Data Source

          MEDLINE, Cochrane Library, and EMBASE databases were searched until Sep 30, 2014.

          Study Eligibility Criteria

          Randomized controlled trials of adult subjects (≥ 18 years) who had undergone surgery and who had received acupuncture, electroacupuncture, or acupoint electrical stimulation for managing acute post-operative pain were included.

          Results

          We found that patients treated with acupuncture or related techniques had less pain and used less opioid analgesics on Day 1 after surgery compared with those treated with control (P < 0.001). Sensitivity analysis using the leave-one-out approach indicated the findings are reliable and are not dependent on any one study. In addition, no publication bias was detected. Subgroup analysis indicated that conventional acupuncture and transcutaneous electric acupoint stimulation (TEAS) were associated with less postoperative pain one day following surgery than control treatment, while electroacupuncture was similar to control (P = 0.116). TEAS was associated with significantly greater reduction in opioid analgesic use on Day 1 post surgery than control (P < 0.001); however conventional acupuncture and electroacupuncture showed no benefit in reducing opioid analgesic use compared with control (P ≥ 0.142).

          Conclusion

          Our findings indicate that certain modes of acupuncture improved postoperative pain on the first day after surgery and reduced opioid use. Our findings support the use of acupuncture as adjuvant therapy in treating postoperative pain.

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          Most cited references21

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          The numeric rating scale for clinical pain measurement: a ratio measure?

          The Numeric Rating Scale (NRS-11) has been widely used clinically for the assessment of pain. Its use for clinical research is controversial. Reports differ as to whether or not the NRS-11 should be treated as a ratio pain measurement tool. This study compared the NRS-11 to a ratio measure for pain assessment: the visual analog scale (VAS). Simultaneous pain measurements using these 2 scales were compared in clinical situations commonly encountered in a tertiary community hospital. Whereas linear relationships were noted in laboring patients and in postoperative patients with thoracic or abdominal incisions during cough, no such correlations were noted for the same postoperative patients at rest or for postoperative orthopedic patients. The NRS-11 should not be considered to be interchangeable with the VAS. Its use for clinical research should be limited to situations where it has specifically demonstrated linear properties.
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            Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials.

            Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for postoperative pain management. We extracted data about postoperative opioid consumption, postoperative pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model. Fifteen RCTs comparing acupuncture with sham control in the management of acute postoperative pain were included. Weighted mean difference for cumulative opioid analgesic consumption was -3.14 mg (95% confidence interval, CI: -5.15, -1.14), -8.33 mg (95% CI: -11.06, -5.61), and -9.14 mg (95% CI: -16.07, -2.22) at 8, 24, and 72 h, respectively. Postoperative pain intensity (visual analogue scale, 0-100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group. The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74). Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.
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              The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery.

              In the present study, we examined the effects of preoperative electroacupuncture (EA) at classical bilateral acupuncture points (Zusanli, also known as ST-36) on postoperative pain and opioid-related side effects. One hundred healthy consenting women undergoing lower abdominal surgery were randomly assigned to four treatment regimens: Group I (n=25), control; Group II (n=25), sham-EA (needle insertion without electrical stimulation); Group III (n=25), low-EA (2 Hz of electrical stimulation); and Group IV (n=25), high-EA (100 Hz of electrical stimulation). EA groups received needle insertion with or without electrical stimulation 20 min prior to anesthesia. All patients received patient-controlled analgesia (PCA) of morphine postoperation. Postoperative pain was evaluated by recording (1). the time of the first required analgesic, (2). the number of PCA demands, (3). the total amount of morphine required by PCA, and (4) patients' VAS pain score. We found that the time of first analgesic requested was 10, 18, 28, and 28 min in the control, sham-, low-, and high-EA groups, respectively. During the first 24h, the total amount of morphine required was decreased by 21, 43 and 61% in the sham-, low- and high-EA groups, respectively. The incidence of nausea and dizziness during the first 24h after surgery was significantly reduced in both the low-EA and high-EA groups compared with the control and sham-EA groups. We also found that sham-EA exerts a beneficial effect with respect to its pain relieving quality but not the side effect profiles. Our findings demonstrates that preoperative treatment with low-EA and high-EA can reduce postoperative analgesic requirements and associated side effects in patients undergoing lower abdominal surgery.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                9 March 2016
                2016
                : 11
                : 3
                : e0150367
                Affiliations
                [1 ]Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
                [2 ]Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
                [3 ]Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
                [4 ]School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
                [5 ]Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
                [6 ]Institute of Management of Technology, National Chiao Tung University, Hsinchu, Taiwan
                [7 ]Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
                [8 ]Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
                [9 ]Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
                [10 ]Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
                [11 ]School of Chinese Medicine-Acupuncture Science, China Medical University, Taichung, Taiwan
                [12 ]Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
                [13 ]Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
                University of Bari, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: MSW KHC CC. Performed the experiments: KHC MLY CC. Analyzed the data: MSW IFC SKH PCT CC. Contributed reagents/materials/analysis tools: FPL JGL CC. Wrote the paper: MSW CC.

                Article
                PONE-D-15-15549
                10.1371/journal.pone.0150367
                4784927
                26959661
                db1b6219-9605-4040-a3ad-25774521fe3b
                © 2016 Wu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 April 2015
                : 12 February 2016
                Page count
                Figures: 5, Tables: 2, Pages: 12
                Funding
                This work was supported by Taipei Medical University - Wan Fang Hospital under the Grant No. 103WF-EVA-18.
                Categories
                Research Article
                Medicine and Health Sciences
                Complementary and Alternative Medicine
                Acupuncture
                Medicine and Health Sciences
                Pain Management
                Acupuncture
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pain Management
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Opioids
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Analgesics
                Medicine and Health Sciences
                Pain Management
                Analgesics
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Abdominal Surgery
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Meta-Analysis
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Statistical Methods
                Meta-Analysis
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Electrical Stimulation
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Gynecologic Surgery
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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