Acupuncture for treating whiplash associated disorder: a systematic review of randomised clinical trials

Efficacy of acupuncture for whiplash injury: a systematic review and meta-analysis

OBJECTIVES

This study aimed to establish clinical evidence for acupuncture by analysing data from trials that demonstrated the efficacy of acupuncture for whiplash-associated disorder (WAD) with the following research question: Is acupuncture treatment effective for symptom alleviation in patients with WAD compared with other usual care?

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Ovid Medline, Embase, The Cochrane Library, China National Knowledge Infrastructure, ScienceOn, KMBASE, Korean Studies Information Service System, Korea Med, Oriental Medicine Advanced Searching Integrated System and Research Information Sharing Service were searched from their inception to 1 October 2023.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) using acupuncture on patients with WAD. The outcomes were the pain visual analogue scale (VAS) score or numerical rating scale score for neck pain, the range of motion (ROM) of the neck, the Neck Disability Index and safety.

DATA EXTRACTION AND SYNTHESIS

Two independent researchers analysed and extracted data from the selected literatures. The risk of bias and the quality of evidence were assessed according to the Cochrane Handbook for Systematic Reviews of Interventions and the Grading of Recommendations Assessment, Development, and Evaluation method, respectively.

RESULTS

A total of 525 patients with WAD from eight RCTs were included in this study. The meta-analysis revealed that the outcomes showed significant differences in the pain VAS score (standard mean difference (SMD): -0.57 (-0.86 to -0.28), p<0.001) and ROM-extension (SMD: 0.47 (0.05 to 0.89), p=0.03). The risk of bias assessment revealed that four studies published after 2012 (50%, 4 out of 8 studies) showed low bias in most domains. The pain VAS score was graded as having moderate certainty.

CONCLUSION

Acupuncture may have clinical value in pain reduction and increasing the ROM for patients with WAD. High-quality RCTs must be conducted to confirm the efficacy of acupuncture in patients with WAD.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42021261595.

Effect of acupuncture on pain and substance P levels in middle-aged women with chronic neck pain

Chronic neck pain is a leading health issue affecting a significant proportion of the global population. Multiple treatment options for chronic neck pain include anti-inflammatory drugs and analgesics. Acupuncture has been widely used for the treatment of chronic pain. In this study, we aimed to determine the efficacy of acupuncture for female patients with chronic neck pain. Twenty-three participants were enrolled in the study, and participants waited 4 weeks without acupuncture treatment and then received 4 weeks of treatment. One-way ANOVA with repeated measures was used to determine differences in the visual analogue scale (VAS), neck disability index (NDI), and substance P (SP) over time. The subjects' pain intensity and degree of disability due to neck pain were measured as primary outcomes. SP in the blood was also analyzed as a secondary outcome. There was no significant difference between the VAS score and NDI value of baseline and after 4 weeks waiting. However, there was an improvement in both VAS and NDI after 4 weeks treatment. SP level was decreased after 4 weeks treatment. We could conclude that acupuncture is effective in alleviating chronic neck pain. Moreover, our findings revealed the efficacy of acupuncture on chronic pain with potential underlying biological mechanisms.

A Single-Center Retrospective Study on the Effects of Korean Medicine in 342 Traffic Accident Cases

Objectives

In South Korea, traffic accident victims can be treated under automobile insurance coverage. Korean medicine (KM) clinics have reported the largest number of automobile insurance fee claims among medical institutions. This study investigated the status of the KM automobile insurance system in a single KM clinic.

Methods

We retrospectively surveyed the medical charts of 342 traffic accident patients treated at the Jisung KM clinic between January 2009 and June 2017.

Results

Most of the patients were men and in their 30s. The most common method of locating the clinic was an internet search. The most common traffic accident type was collision between vehicles (83.63%), with 70.76% of patients visiting during the most acute phase. The major disease codes included S434, M4836, F072, S0600, and S3350. The most frequent treatment period was within 1 month of the accident, and most patients received 10 or fewer treatments. The mean treatment duration and number of treatments were 37.68 ± 45.11 days and 11.68 ± 10.63 treatments, respectively. The initial pain numerical rating scale (NRS), 7.32 ± 0.96, decreased to 3.57 ± 1.40 at the end of treatment, with a symptom improvement score of 1.87 ± 0.60. Regarding sex, age, disease duration, location at the time of the accident, presence of additional and psychological symptoms, and chuna, there were statistically significant differences in treatment duration and number of treatments. A higher number of treatments and the longer treatment duration was associated with a higher initial NRS, lower post-treatment NRS, and better improvement score. Since the introduction of traffic accident (TA) pharmacopuncture, the rate of use of a single type of pharmacopuncture increased; however, no significant differences in treatment duration and number, NRS before and after treatment, and improvement score were observed between treatment groups before and after TA pharmacopuncture. No adverse reactions were observed for any treatment.

Conclusion

This study confirmed the previous findings of a high treatment effect of KM under automobile insurance. We also observed significant correlations based on a detailed medical status, which may explain the increasing use of KM in the automobile insurance system. Additional multi-center studies in different regions are needed.

Acupuncture for whiplash-associated disorder following road traffic collision: a physiotherapy service evaluation

BACKGROUND

Whiplash-associated disorder (WAD) is a common musculoskeletal condition that frequently occurs following a road traffic collision. Physiotherapy is often prescribed to help with the symptoms and injuries. Research evidence has demonstrated that acupuncture may be beneficial, but no studies have examined the routine clinical use of acupuncture by physiotherapists for treatment of WAD. Therefore, a physiotherapy service evaluation was conducted to examine the effects of acupuncture on WAD following a road traffic collision.

METHODS

This study involved 87 patients who attended a private physiotherapy practice following a road traffic collision after referral by their solicitor as part of a personal injury claim. Patients were included if they had been diagnosed with WAD (grades I-III) and received acupuncture as part of their treatment. An average of three sessions of acupuncture were received, which primarily involved needling of traditional acupuncture points and/or myofascial trigger points of the neck and upper/lower back.

RESULTS

Pain significantly reduced (p < 0.001). Musculoskeletal outcome measures including neck disability index, Oswestry low back pain scale and Quick disabilities of the arm, shoulder and hand (Quick-DASH) scale also significantly improved (all p < 0.001). Adverse events were minor. The majority of the patients (n = 66) were able to return to full-work duties following treatment.

CONCLUSION

Acupuncture appears to be an effective clinical treatment for WAD following a road traffic collision and should be considered by physiotherapists working with such patient groups.

Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

Acupuncture for treating whiplash-associated disorder: A systematic review and meta-analysis protocol

BACKGROUND

This review aims to evaluate the effectiveness and safety of acupuncture treatment for patients with whiplash-associated disorder (WAD).

METHODS

We will search the following databases from their inception to October 2018: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, 1 Chinese database (China National Knowledge Infrastructure), 1 Japanese database (Japan Science and Technology Information Aggregator, Electronic), and 5 Korean databases (KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, and Oriental Medicine Advanced Searching Integrated System). All randomized controlled trials of acupuncture for WAD will be considered for inclusion without language restrictions. The risk of bias will be assessed using the Cochrane risk of bias tool. The mean difference or standard mean difference for continuous data and risk ratio for dichotomous data will be calculated with 95% confidence intervals.

DISSEMINATION

The results of this review will be disseminated through peer-reviewed journal articles or conference presentations, and may provide important guidance for clinicians and patients regarding the use of acupuncture treatment for treating WAD.

TRIAL REGISTRATION NUMBER

PROSPERO 2018: CRD42018106964.