Individual Patient Data Meta-analysis

Methods: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17922 patients analyzed. Results: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and noacupuncture control for each pain condition (P.001 for all comparisons). After exclusion of an outlying set ofRCTsthatstronglyfavoredacupuncture,theeffectsizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to noacupuncturecontrolswere0.55(95%CI,0.51-0.58),0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. Theseresultswererobusttoavarietyofsensitivityanalyses, including those related to publication bias. Conclusions: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referraloption.Significantdifferencesbetweentrueandsham acupunctureindicatethatacupunctureismorethanaplacebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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