title: Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials.
abstract: The aims of this systematic review were to study the analgesic effect of real acupuncture and to explore whether sham acupuncture (SA) type is related to the estimated effect of real acupuncture for musculoskeletal pain. Five databases were searched. The outcome was pain or disability immediately (≤1 week) following an intervention. Standardized mean differences (SMDs) with 95% confidence intervals were calculated. Meta-regression was used to explore possible sources of heterogeneity. Sixty-three studies (6382 individuals) were included. Eight condition types were included. The pooled effect size was moderate for pain relief (59 trials, 4980 individuals, SMD -0.61, 95% CI -0.76 to -0.47; P < 0.001) and large for disability improvement (31 trials, 4876 individuals, -0.77, -1.05 to -0.49; P < 0.001). In a univariate meta-regression model, sham needle location and/or depth could explain most or all heterogeneities for some conditions (e.g., shoulder pain, low back pain, osteoarthritis, myofascial pain, and fibromyalgia); however, the interactions between subgroups via these covariates were not significant (P < 0.05). Our review provided low-quality evidence that real acupuncture has a moderate effect (approximate 12-point reduction on the 100-mm visual analogue scale) on musculoskeletal pain. SA type did not appear to be related to the estimated effect of real acupuncture.
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
authors.forename: Qi-Ling
authors.initials: QL
authors.lastname: Yuan
authors.affiliation: Xi'an 521 Hospital, Xi'an 710065, Shaanxi, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.|Department of Orthopaedics of the First Affiliated Hospital of Xi'an Medical College, Xi'an 710077, Shaanxi, China.
authors.forename: Fu
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
authors.forename: Yong-Song
authors.initials: YS
authors.lastname: Cai
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wu
authors.affiliation: Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China.
authors.forename: Mao-Lin
authors.initials: ML
authors.lastname: Ye
authors.affiliation: Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China.
authors.forename: Jiang-Tao
authors.initials: JT
authors.lastname: Ma
authors.affiliation: Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China.
authors.forename: Bang-Bang
authors.initials: BB
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics of the First Affiliated Hospital, Medical School, Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.|Henan Province Hospital of TCM, Henan University of TCM, Zhengzhou 450008, Henan, China.
authors.forename: Yin-Gang
authors.initials: YG
authors.lastname: Zhang
mesh_terms: D026881:Acupuncture / Q000379:methods*; D006801:Humans; D059352:Musculoskeletal Pain / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome