1
|
Tao QF, Huang YB, Yuan L, Shi YZ, Qin D, Ye K, Peng WY, Xie CR, Zheng H. Acupuncture versus tricyclic antidepressants in the prophylactic treatment of tension-type headaches: an indirect treatment comparison meta-analysis. J Headache Pain 2024; 25:67. [PMID: 38679721 PMCID: PMC11057108 DOI: 10.1186/s10194-024-01776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/21/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Acupuncture showed better improvement than sham acupuncture in reducing attack frequency of tension-type headache (TTH), but its effectiveness relative to first-line drugs for TTH is unknown, which impedes the recommendation of acupuncture for patients who are intolerant to drugs for TTH. We aimed to estimate the relative effectiveness between acupuncture and tricyclic antidepressants (TCAs) through indirect treatment comparison (ITC) meta-analysis. METHODS We searched Ovid Medline, Embase, and Cochrane Library from database inception until April 13, 2023. Randomized controlled trials of TCAs or acupuncture in the prevention of TTH in adults were included. The primary outcome was headache frequency. The secondary outcomes were headache intensity, responder rate, and adverse event rate. Bayesian random-effect models were used to perform ITC meta-analysis, and confidence of evidence was evaluated by using the GRADE approach. RESULTS A total of 34 trials involving 4426 participants were included. Acupuncture had similar effect with TCAs in decreasing TTH frequency (amitriptyline: mean difference [MD] -1.29, 95% CI -5.28 to 3.02; amitriptylinoxide: MD -0.05, 95% CI -6.86 to 7.06) and reducing TTH intensity (amitriptyline: MD 2.35, 95% CI -1.20 to 5.78; clomipramine: MD 1.83, 95% CI -4.23 to 8.20). Amitriptyline had a higher rate of adverse events than acupuncture (OR 4.73, 95% CI 1.42 to 14.23). CONCLUSION Acupuncture had similar effect as TCAs in reducing headache frequency of TTH, and acupuncture had a lower adverse events rate than amitriptyline, as shown by very low certainty of evidence.
Collapse
Affiliation(s)
- Qing-Feng Tao
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Yan-Bing Huang
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Lu Yuan
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Yun-Zhou Shi
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Di Qin
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Kun Ye
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Wen-Yan Peng
- TCM Cancer Treatment Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Chao-Rong Xie
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Hui Zheng
- The Third Hospital/Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China.
| |
Collapse
|
2
|
Issac A, Nayak SG, T P, Balakrishnan D, Halemani K, Mishra P, P I, Vr V, Jacob J, Stephen S. Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis. J Glob Health 2023; 13:04023. [PMID: 36896808 PMCID: PMC9999308 DOI: 10.7189/jogh.13.04023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Background Prolonged labour intensifies labour pain, and failure to address labour pain may lead to abnormal labour and augments the usage of operative interventions. Prolonged labour is common among women, resulting in maternal morbidity, increased caesarean section (CS) rates, and postpartum complications. It may bring forth negative birth experiences that may increase the preference for CS. There is a dearth of evidence concerning the effectiveness of breathing exercises on the duration of labor. As per our knowledge, this is the first systematic review and meta-analysis on the effect of breathing exercises on the duration of labor. This systematic review and meta-analysis aimed to appraise the evidence concerning the effectiveness of breathing exercises on the duration of labour. Methods Electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, SCOPUS, and ClinicalKey were searched for randomized controlled trials, quasi-experimental studies published in the English language between January 2005 to March 2022 that reported on the effectiveness of breathing exercises on the duration of labour. Duration of labour was the primary analysed outcome. The secondary outcomes assessed were anxiety, duration of pain, APGAR scores, episiotomy, and mode of delivery. Meta-analysis was done using RevMan v5.3. Results The reviewed trials involved 1418 participants, and the study participants ranged from 70 to 320. The mean gestational weeks of the participants among the reported trials was 38.9 weeks. Breathing exercise shortened the duration of the intervention group's second stage of labour compared with the control group. Conclusions Breathing exercise is a beneficial preventive intervention in shortening the duration of second stage of labour. Registration The review protocol was registered with PROSPERO (CRD42021247126).
Collapse
Affiliation(s)
- Alwin Issac
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | - Prabhakar Mishra
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Indumathi P
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vijay Vr
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jaison Jacob
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Shine Stephen
- All India Institute of Medical Sciences, Bhubaneswar, India
| |
Collapse
|
3
|
Repiso-Guardeño A, Moreno-Morales N, Armenta-Pendón MA, Rodríguez-Martínez MDC, Pino-Lozano R, Armenta-Peinado JA. Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4466. [PMID: 36901475 PMCID: PMC10001815 DOI: 10.3390/ijerph20054466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
(1) Objective: The aim of this study is to synthesize the effects of physical therapy on pain, frequency, or duration management in the short, medium, and long term in adult patients diagnosed with Tension-type headache (TTH). (2) Background: Tension-type headache (TTH) is the most common headache with migraine and its pathophysiology and treatment has been discussed for years without reaching a consensus. (3) Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42020175020). The systematic search for clinical trials was performed in the databases PubMed, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, Scopus, SciELO and Dialnet. Articles were selected according to the inclusion and exclusion criteria, regarding the effectiveness of physical therapy interventions on adult patients with TTH published in the last 11 years with a score ≥ 6 in the PEDro Scale (Physiotherapy Evidence Database). (4) Results: In total, 120 articles were identified, of which 15 randomized controlled trials were finally included in order to determine the inclusion criteria. Changes in pain intensity, headache frequency or headache duration of individual studies were described (5) Conclusions: This systematic review shows that there is no standardized physical therapy protocol for the approach to tension headache, although all the techniques studied to date address in one way or another the cranio-cervical-mandibular region. The approach to the cranio-cervical-mandibular region reports significant effects in terms of decreasing the intensity of pain and frequency of headache episodes in the short and medium term. More long-term longitudinal studies are needed.
Collapse
Affiliation(s)
- Angela Repiso-Guardeño
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Clínica de Fisioterapia Ángela Repiso, Villanueva del Rosario, 29312 Málaga, Spain
| | - Noelia Moreno-Morales
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina—IBIMA Plataforma BIONAND (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
| | | | - María del Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina—IBIMA Plataforma BIONAND (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
| | - Ricardo Pino-Lozano
- Centre d´Atenció Primària Vilafranca Nord, Institut Catalá de la Salut, Vilafranca del Penedès, 08720 Barcelona, Spain
| | - Juan Antonio Armenta-Peinado
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, C/Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina—IBIMA Plataforma BIONAND (IBIMA Plataforma BIONAND), 29590 Málaga, Spain
| |
Collapse
|
4
|
Saldanha IJ, Cao W, Bhuma MR, Konnyu KJ, Adam GP, Mehta S, Zullo AR, Chen KK, Roth JL, Balk EM. Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review. Headache 2021; 61:11-43. [PMID: 33433020 DOI: 10.1111/head.14041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. OBJECTIVE We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. METHODS We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. RESULTS We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; low-to-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments. CONCLUSIONS For prevention of primary headache, calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects. For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine. Triptans and low-dose aspirin may not be associated with fetal/child adverse effects. Future research should identify effective and safe interventions in pregnancy and postpartum.
Collapse
Affiliation(s)
- Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Monika Reddy Bhuma
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kristin J Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Shivani Mehta
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kenneth K Chen
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.,Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Julie L Roth
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
5
|
Foroughinia S, Hessami K, Asadi N, Foroughinia L, Hadianfard M, Hajihosseini A, Pirasteh N, Vossoughi M, Vafaei H, Faraji A, Kasraeian M, Doroudchi M, Rafiee Monjezi M, Roozmeh S, Bazrafshan K. Effect of Acupuncture on Pregnancy-Related Insomnia and Melatonin: A Single-Blinded, Randomized, Placebo-Controlled Trial. Nat Sci Sleep 2020; 12:271-278. [PMID: 32494210 PMCID: PMC7231755 DOI: 10.2147/nss.s247628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of the current study is to evaluate the efficacy and safety of acupuncture on sleep quality and overnight melatonin secretion, measured as urinary 6-sulfatoxymelatonin, in pregnant women. PATIENTS AND METHODS This randomized, parallel, single-blinded (participant), controlled trial was conducted on 72 pregnant women with insomnia. Study participants were randomly assigned to either the intervention, 10 sessions of acupuncture treatment over a 3-week period, or control group by block randomization (1:1). Patients in both groups were evaluated at baseline and post-treatment (third week) using the Pittsburgh Sleep Quality Index (PSQI) score (as the primary outcome) and urinary 6-sulfatoxymelatonin. RESULTS Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline (P=0.169 and P=0.496). At the end of the study period, treatment with acupuncture significantly improved the PSQI score (P<0.001) with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level (P=0.020) with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits. CONCLUSION Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.
Collapse
Affiliation(s)
- Saeedeh Foroughinia
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammadjavad Hadianfard
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Hajihosseini
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Pirasteh
- Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrnoosh Doroudchi
- Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
6
|
Levett KM, Sutcliffe KL, Betts D. Using Forbidden Points in Pregnancy: Adverse Outcomes and Quality of Evidence in Randomized Controlled Trials-A Systematic Narrative Review. Med Acupunct 2019; 31:346-360. [PMID: 31871522 DOI: 10.1089/acu.2019.1391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: Pregnancy is a complex physical and hormonal condition. Many women experience back and pelvic pain, reflux, and headaches during pregnancy. There has been a significant rise in the popularity of acupuncture for pain conditions in pregnancy, wherein nonpharmacologic options are important. Concerns have been raised by both traditional and medical acupuncturists about using "forbidden points" during pregnancy and the risk of preterm contractions (PTC), as this could limit women's and practitioners' willingness to continue treatment during pregnancy. There is also a risk of bias introduced into clinical trials when participants are highly selected or they drop out of studies due to adverse outcomes. This review examined randomized controlled trials (RCTs) of acupuncture using forbidden points prior to 37 weeks of pregnancy to treat pain conditions, with the primary outcome of PTC. Methods: A database search identified RCTs, including trials of penetrating acupuncture that used forbidden points in their protocols to treat pregnancy-related pain conditions. STRICTA [Standards for Reporting Interventions in Clinical Trials of Acupuncture] and GRADE [Grades of Recommendation, Assessment, Development, and Evaluation] criteria were used to assess the quality of evidence. This review includes 8 RCTs reporting on 713 women. Results: Only 2 studies reported on the primary outcome of PTC, and there were insufficient data to perform a primary analysis. In these 2 studies, 6 participants withdrew due to PTC. No study was at a low risk of bias for all GRADE domains, and 3 studies were at high or unclear risk of bias in all domains. Conclusions: PTC is an important clinical outcome and should be reported routinely. The strength of evidence to date is insufficient to recommend using forbidden points prior to 37 weeks of pregnancy. Highly selected patient populations, risk of bias in study design, and participant withdrawal rates, suggest that high-quality trials are required.
Collapse
Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, New South Wales, Australia.,NICM Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
| | - Kerry L Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, New South Wales, Australia
| | - Debra Betts
- NICM Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia.,New Zealand School of Acupuncture, Wellington, New Zealand
| |
Collapse
|
7
|
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin B, Vickers A, White AR. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 2016; 4:CD007587. [PMID: 27092807 PMCID: PMC4955729 DOI: 10.1002/14651858.cd007587.pub2] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acupuncture is often used for prevention of tension-type headache but its effectiveness is still controversial. This is an update of our Cochrane review originally published in Issue 1, 2009 of The Cochrane Library. OBJECTIVES To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in adults with episodic or chronic tension-type headache. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE and AMED to 19 January 2016. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials. SELECTION CRITERIA We included randomised trials with a post-randomisation observation period of at least eight weeks, which compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another prophylactic intervention in adults with episodic or chronic tension-type headache. DATA COLLECTION AND ANALYSIS Two review authors checked eligibility; extracted information on participants, interventions, methods and results; and assessed study risk of bias and the quality of the acupuncture intervention. The main efficacy outcome measure was response (at least 50% reduction of headache frequency) after completion of treatment (three to four months after randomisation). To assess safety/acceptability we extracted the number of participants dropping out due to adverse effects and the number of participants reporting adverse effects. We assessed the quality of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). MAIN RESULTS Twelve trials (11 included in the previous version and one newly identified) with 2349 participants (median 56, range 10 to 1265) met the inclusion criteria.Acupuncture was compared with routine care or treatment of acute headaches only in two large trials (1265 and 207 participants), but they had quite different baseline headache frequency and management in the control groups. Neither trial was blinded but trial quality was otherwise high (low risk of bias). While effect size estimates of the two trials differed considerably, the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups (moderate quality evidence; trial 1: 302/629 (48%) versus 121/636 (19%); risk ratio (RR) 2.5; 95% confidence interval (CI) 2.1 to 3.0; trial 2: 60/132 (45%) versus 3/75 (4%); RR 11; 95% CI 3.7 to 35). Long-term effects (beyond four months) were not investigated.Acupuncture was compared with sham acupuncture in seven trials of moderate to high quality (low risk of bias); five large studies provided data for one or more meta-analyses. Among participants receiving acupuncture, 205 of 391 (51%) had at least 50% reduction of headache frequency compared to 133 of 312 (43%) in the sham group after treatment (RR 1.3; 95% CI 1.09 to 1.5; four trials; moderate quality evidence). Results six months after randomisation were similar. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects and 0 of 343 receiving sham (six trials; low quality evidence). Three trials reported the number of participants reporting adverse effects: 29 of 174 (17%) with acupuncture versus 12 of 103 with sham (12%; odds ratio (OR) 1.3; 95% CI 0.60 to 2.7; low quality evidence).Acupuncture was compared with physiotherapy, massage or exercise in four trials of low to moderate quality (high risk of bias); study findings were inadequately reported. No trial found a significant superiority of acupuncture and for some outcomes the results slightly favoured the comparison therapy. None of these trials reported the number of participants dropping out due to adverse effects or the number of participants reporting adverse effects.Overall, the quality of the evidence assessed using GRADE was moderate or low, downgraded mainly due to a lack of blinding and variable effect sizes. AUTHORS' CONCLUSIONS The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials - particularly comparing acupuncture with other treatment options - are needed.
Collapse
Affiliation(s)
- Klaus Linde
- Klinikum rechts der Isar, Technical University MunichInstitute of General PracticeOrleansstrasse 47MünchenGermany81667
| | - Gianni Allais
- University of TorinoWomen's Headache Center and Service for Acupuncture in Gynecology and Obstetrics, Department of Surgical SciencesVia Ventimiglia 3TorinoItaly10126
| | - Benno Brinkhaus
- Charité ‐ Universitätsmedizin BerlinInstitute for Social Medicine, Epidemiology and Health EconomicsLuisenstrasse 57BerlinGermany10117
| | - Yutong Fei
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Michael Mehring
- Klinikum rechts der Isar, Technical University MunichInstitute of General PracticeOrleansstrasse 47MünchenGermany81667
| | - Byung‐Cheul Shin
- School of Korean Medicine, Pusan National UniversityRehabilitation MedicineBeom‐eu, MeulgeumYangsanKyungnamKorea, South626‐870
| | - Andrew Vickers
- Memorial Sloan‐Kettering Cancer CenterDepartment of Epidemiology and Biostatistics1275 York AvenueNew YorkUSA10021
| | - Adrian R White
- Plymouth University Peninsula Schools of Medicine and DentistryPrimary Care25 Room N32, ITTC BuildingTamar Science ParkPlymouthUKPL6 8BX
| | | |
Collapse
|
8
|
Karaman F, Cene E. Generalisation of Mood's Test to Factorial Designs to Detect Heterogeneity of Variances. AUST NZ J STAT 2015. [DOI: 10.1111/anzs.12138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Filiz Karaman
- Department of Statistics; Yildiz Technical University; Davutpasa Campus Esenler Istanbul 34220 Turkey
| | - Erhan Cene
- Department of Statistics; Yildiz Technical University; Davutpasa Campus Esenler Istanbul 34220 Turkey
| |
Collapse
|
9
|
|
10
|
Betts D, Smith CA, Dahlen HG. “Well I'm Safe Because…” — Acupuncturists Managing Conflicting Treatment Recommendations When Treating Threatened Miscarriage: A Mixed-Methods Study. J Altern Complement Med 2014; 20:838-45. [DOI: 10.1089/acm.2014.0139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Debra Betts
- The National Institute of Complementary Medicine, University of Western Sydney, Penrith, Australia
| | - Caroline A. Smith
- The National Institute of Complementary Medicine, University of Western Sydney, Penrith, Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Australia
| |
Collapse
|
11
|
Abstract
Objective Although there is a growing interest in the use of acupuncture during pregnancy, the safety of acupuncture is yet to be rigorously investigated. The objective of this review is to identify adverse events (AEs) associated with acupuncture treatment during pregnancy. Methods We searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and five Korean databases up to February 2013. Reference lists of relevant articles were screened for additional reports. Studies were included regardless of their design if they reported original data and involved acupuncture needling and/or moxibustion treatment for any conditions in pregnant women. Studies of acupuncture for delivery, abortion, assisted reproduction or postpartum conditions were excluded. AE data were extracted and assessed in terms of severity and causality, and incidence was determined. Results Of 105 included studies, detailed AEs were reported only in 25 studies represented by 27 articles (25.7%). AEs evaluated as certain, probable or possible in the causality assessment were all mild/moderate in severity, with needling pain being the most frequent. Severe AEs or deaths were few and all considered unlikely to have been caused by acupuncture. Total AE incidence was 1.9%, and the incidence of AEs evaluated as certainly, probably or possibly causally related to acupuncture was 1.3%. Conclusions Acupuncture during pregnancy appears to be associated with few AEs when correctly applied.
Collapse
Affiliation(s)
- Jimin Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Youngjoo Sohn
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Adrian R White
- Department of General Practice and Primary Care, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Centre, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
12
|
Robinson N, Liu J. Oriental and traditional medicine – Supporting the vision for integrated health. Eur J Integr Med 2012. [DOI: 10.1016/j.eujim.2012.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|