Individualized acupuncture not associated with significant improvements in chronic neck pain

1. Individualized acupuncture with high- or low-sensitivity acupuncture points was more effective than sham acupuncture or waiting in reducing chronic neck pain, but not to a clinically significant magnitude.

2. Acupuncture was associated with a low rate of mild-to-moderate adverse events, which all resolved without any medical intervention.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Chronic neck pain (CNP) refers to constant neck pain lasting 3 or more months and is often associated with a constellation of symptoms including dizziness, sleep disturbance, and depression. CNP is evolving as a worldwide public health challenge due to its effects on work productivity, contributions to long-term stress, and limitations on physical activity. Neck pain has emerged as the primary driver of disability burden in China, and neck and lower back pain together are one of the most significant sources of healthcare expenditure in the United States. Therapeutic measures for CNP include non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, but long-term use of these medications may induce various adverse effects and lead to significant complications. Acupuncture, a non-pharmacologic practice which involves puncturing the skin with needles at specific anatomical points in the body, has been used for thousands of years and is gaining traction for its efficacy in reducing CNP in Western countries. However, evidence regarding specific acupuncture practices, such as the efficacy of using remote acupoints versus targeted myofascial trigger points, has been inconsistent. Hence, this randomized controlled trial investigated the efficacy and safety of individualized acupuncture in reducing CNP compared to sham acupuncture (SA) or a waiting list (WL; no acupuncture). Overall, the study demonstrated that individualized acupuncture with high- or low-sensitivity acupuncture points was more effective than SA or WL control groups in reducing neck pain at 24 weeks, but not to a magnitude reaching a prespecified minimal clinically important difference (MCID). Moreover, individualized acupuncture was associated with a low incidence of mild-to-moderate adverse events, all of which resolved without any medical intervention. The study was limited by incomplete blinding of the WL group and a lack of generalizability due to a high proportion of middle-aged individuals with moderate pain in the study population.

Click to read the study in AIM

Relevant Reading: Acupuncture for patients with chronic neck pain

In-Depth [randomized controlled trial]: This randomized controlled trial investigated the long-term efficacy and safety of individualized acupuncture on individuals with CNP at 4 clinical centers in China. Participants between 18 and 75 years of age who experienced CNP for at least 3 months with a visual analogue scale (VAS) score of 30 mm or more (scores ranging from 0 to 100 mm with higher scores indicating worse pain severity) for at least 5 days in 1 week were included. Enrolled individuals were randomly assigned in a 1:1:1:1 ratio to high-sensitivity acupuncture (HSA), low-sensitivity acupuncture (LSA), SA and the WL. Participants in the HSA group underwent acupuncture at 5 high-sensitivity acupoints and those in the LSA group underwent acupuncture at 5 low-sensitivity acupoints. Individuals in the SA group received shallow acupuncture with the intention of not eliciting a deqi sensation, a subjective feeling of numbness or tingling. All groups received 10 total acupuncture sessions over the course of 4 weeks with 20 additional weeks of follow-up. The primary outcome was the change in the VAS score from baseline to 4 weeks, with the MCID defined as a 10 mm change. Of 2216 participants who underwent screening, 683 individuals were enrolled in the modified intention-to-treat group. The mean changes in the VAS score were -12.16 (95% confidence interval [CI], -14.45 to -9.87) with HSA, -10.19 (95% CI, -12.43 to -7.95) with LSA, -6.11 (95% CI, -8.31 to -3.91) with SA, and -2.24 (95% CI, -4.10 to -0.38) with the WL. The net difference in the VAS score between HSA and the WL of -9.93 (95% CI, -12.95 to -6.90) and that between LSA and the WL of -7.95 (95% CI, -10.98 to -4.92) did not meet the MCID threshold. Results were similar at 24 weeks. 9 total mild-to-moderate adverse events occurred among the HSA and LSA groups which resolved without any medical intervention. In summary, individualized acupuncture was not effective in reducing CNP to a clinically significant magnitude compared to SA and the WL.

Image: PD

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