title: The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain.
abstract: There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time after acupuncture, using a large individual patient data set from high-quality randomized trials of acupuncture for chronic pain. The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months (95% confidence interval: -0.014 to 0.037, P = 0.4) after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months (95% confidence interval: 0.000-0.050, P = 0.050), suggesting approximately a 50% diminution at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.
authors.affiliation: Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: MacPherson
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Vertosick
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
authors.forename: N E
authors.initials: NE
authors.lastname: Foster
authors.affiliation: Department of Primary Care, University of Southampton, Southampton, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Lewith
authors.affiliation: Institute of General Practice, Technische Universität München, München, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Linde
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Sherman
authors.affiliation: Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.|Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany.|Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Witt
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Vickers
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000818:Animals; D059350:Chronic Pain / Q000628:therapy*; D006801:Humans