Acupuncture for Acute Postoperative Pain after Back Surgery: A Systematic Review and
Meta-analysis of Randomized Controlled Trials

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Abstract

Objectives

Acupuncture is commonly used as a complimentary treatment for pain management. However, there has been no systematic review summarizing the current evidence concerning the effectiveness of acupuncture for acute postoperative pain after back surgery. This systematic review aimed at evaluating the effectiveness of acupuncture treatment for acute postoperative pain (≤1 week) after back surgery.

Methods

We searched 15 electronic databases without language restrictions. Two reviewers independently assessed studies for eligibility and extracted data, outcomes, and risk of bias. Random effect meta-analyses and subgroup analyses were performed.

Results

Five trials, including 3 of high quality, met our inclusion criteria. The meta-analysis showed positive results for acupuncture treatment of pain after surgery in terms of the visual analogue scale (VAS) for pain intensity 24 hours after surgery, when compared to sham acupuncture (standard mean difference −0.67 (−1.04 to −0.31), P = 0.0003), whereas the other meta-analysis did not show a positive effect of acupuncture on 24-hour opiate demands when compared to sham acupuncture (standard mean difference −0.23 (−0.58 to 0.13), P = 0.21).

Conclusion

Our systematic review finds encouraging but limited evidence for the effectiveness of acupuncture treatment for acute postoperative pain after back surgery. Further rigorously designed clinical trials are required.

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Most cited references 50

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Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses.

D Moher, D J Cook, S. Eastwood … (1999)

The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.

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Introducing a placebo needle into acupuncture research.

K Streitberger, J Kleinhenz (1998)

A problem acupuncture research has to face is the concept of a control group. If, in control groups, non-acupoint needling is done, physiological acupuncture effects are implied. Therefore the effects shown in this group are often close to those shown in the acupuncture group. In other trials, control groups have received obviously different treatments, such as transcutaneous electrical nervous stimulation or TENS-laser treatment; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment. We developed a placebo acupuncture needle, with which it should be possible to simulate an acupuncture procedure without penetrating the skin. In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture. Of 60 volunteers, 54 felt a penetration with acupuncture (mean visual analogue scale [VAS] 13.4; SD 10.58) and 47 felt it with placebo (VAS 8.86; SD 10.55), 34 felt a dull pain sensation (DEQI) with acupuncture and 13 with placebo. None of the volunteers suspected that the needle may not have penetrated the skin. The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture.

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United States' trends and regional variations in lumbar spine surgery: 1992-2003.

Jon Lurie, Thomas Olson, K W Brønner … (2006)

Repeated cross-sectional analysis using national Medicare data from the Dartmouth Atlas Project. To describe recent trends and geographic variation in population-based rates of lumbar fusion spine surgery. Lumbar fusion rates have increased dramatically during the 1980s and even more so in the 1990s. The most rapid increase appeared to follow the approval of a new surgical implant device. Medicare claims and enrollment data were used to calculate age, sex, and race-adjusted rates of lumbar laminectomy/discectomy and lumbar fusion for fee-for-service Medicare beneficiaries over age 65 in each of the 306 US Hospital Referral Regions between 1992 and 2003. Lumbar fusion rates have increased steadily since 1992 (0.3 per 1000 enrollees in 1992 to 1.1 per 1000 enrollees in 2003). Regional rates of lumbar discectomy, laminectomy, and fusion in 1992-1993 were highly correlated to rates of discectomy, laminectomy (R2 = 0.44), and fusion (R2 = 0.28) in 2002-2003. There was a nearly 8-fold variation in regional rates of lumbar discectomy and laminectomy in 2002 and 2003. In the case of lumbar fusion, there was nearly a 20-fold range in rates among Medicare enrollees in 2002 and 2003. This represents the largest coefficient of variation seen with any surgical procedure. Medicare spending for inpatient back surgery more than doubled over the decade. Spending for lumbar fusion increased more than 500%, from 75 million dollars to 482 million dollars. In 1992, lumbar fusion represented 14% of total spending for back surgery; by 2003, lumbar fusion accounted for 47% of spending. The rate of specific procedures within a region or "surgical signature" is remarkably stable over time. However, there has been a marked increase in rates of fusion, and a coincident shift and increase in cost. Rates of back surgery were not correlated with the per-capita supply of orthopedic and neurosurgeons.

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Author and article information

Journal

Journal ID (nlm-ta): Pain Pract

Journal ID (iso-abbrev): Pain Pract

Journal ID (publisher-id): papr

Title: Pain Practice

Publisher: Blackwell Publishing Ltd (Oxford, UK )

ISSN (Print): 1530-7085

ISSN (Electronic): 1533-2500

Publication date (Print): March 2015

Publication date (Electronic): 28 April 2014

Volume: 15

Issue: 3

Pages: 279-291

Affiliations

[* ]School of Korean Medicine, Pusan National University Yangsan, Republic of Korea

[† ]Spine & Joint Center, Korean Medicine Hospital, Pusan National University Yangsan, Republic of Korea

[‡ ]Medical Research Division, Korea Institute of Oriental Medicine Daejeon, Republic of Korea

[§ ]Jaseng Spine & Joint Research Institute, Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine Seoul, Republic of Korea

[¶ ]Department of Neurosurgery, School of Medicine & Medical Research Institute, Pusan National University Yangsan Hospital Yangsan, Republic of Korea

Author notes

Address correspondence and reprint requests to: Byung-Cheul Shin, MD (DKM), PhD, Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, 626-870, Republic of Korea. E-mails: drshinbc@ 123456gmail.com ; drshinbc@ 123456pusan.ac.kr .

Article

DOI: 10.1111/papr.12208

PMC ID: 4409074

PubMed ID: 24766648

SO-VID: e3e34285-11f9-46e2-88e9-84bb8b1a9eab

License:

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Acupuncture for Acute Postoperative Pain after Back Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Abstract

Objectives

Methods

Results

Conclusion

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Most cited references 50

Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses.

Introducing a placebo needle into acupuncture research.

United States' trends and regional variations in lumbar spine surgery: 1992-2003.

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