1. Acupuncture in Pain Management Zekeriya AKTÜRK Şifa University Medical Faculty, Department of Family Medicine 17 March 2016 zekeriya.akturk@sifa.edu.trzekeriya.akturk@sifa.edu.tr, http://aile.sifa.edu.trhttp://aile.sifa.edu.tr / 42 1

2.  The definition: What is acupuncture?  The popularity: funds and media  The science: review of meta analyses  The indication: international lists  The example: group acupuncture  The end: personal suggestions / 42 2 About my Presentation

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4. 4 Despite the Skeptics Acupuncture is Getting Popular National Center for Complementary and Integrative Health (formerly National Center for Complementary and Alternative Medicine) https://nccih.nih.gov/about/budget/appropriations.htm https://nccih.nih.gov/about/budget/appropriations.htm https://www.youtube.com/watch?v=S5M0iGC1as0

5. / 42 5 Suggested indications http://www.medscape.com/viewarticle/501973_4

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9. 9 http://www.resmigazete.gov.tr/eskiler/2014/10/20141027-3.htm

10. / 42 10 Trend of PubMed publications

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12. / 42 12  Full text of 28 out of the 33 articles could be retrieved

13. / 42 13 1.Laser acupuncture for treating musculoskeletal pain: a systematic review with meta-analysis. 2.Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. 3.Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis. 4.Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials. 5.Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. 6.Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials. 7.Acupuncture for chronic pain: individual patient data meta- analysis. 8.Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. 9.Acupuncture or acupressure for pain management in labour. 10.Individual patient data meta-analysis of acupuncture for chronic pain: protocol of the Acupuncture Trialists' Collaboration. 11.Acupuncture for pain relief in labour: a systematic review and meta-analysis. 12.Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. 13.The Acupuncture Trialists' Collaboration: individual patient data meta-analysis of chronic pain trials. 14.Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. 15.Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. 16.Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. 17.Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. 18.Bee venom acupuncture for musculoskeletal pain: a review. 19.Acupuncture treatment for chronic knee pain: a systematic review. 20.Acupuncture for shoulder pain. 21.Meta-analysis: acupuncture for low back pain. 22.Acupuncture and dry-needling for low back pain. 23.The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. 24.Is acupuncture effective for the treatment of chronic pain? A systematic review. 25.Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. 26.Acupuncture for back pain: a meta-analysis of randomized controlled trials. 27.The effectiveness of acupuncture in treating acute dental pain: a systematic review. 28.Acupuncture and chronic pain: a criteria-based meta- analysis.

14. / 42 14 Laser acupuncture for treating musculoskeletal pain: a systematic review with meta-analysis.  Moderate-quality evidence supports the effectiveness of laser acupuncture in managing musculoskeletal pain when applied in an appropriate treatment dosage; however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment.

15.  The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis. / 42 15 Pain management with acupuncture in osteoarthritis: a systematic review and meta- analysis.

16.  Acupuncture is significantly superior to control irrespective of the subtype of control. While the choice of control should be driven by the study question, our findings can help inform study design in acupuncture, particularly with respect to sample size. / 42 16 Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis.

17.  There was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes. Increased number of needles and more sessions appear to be associated with better outcomes when comparing acupuncture to non-acupuncture controls.  This suggests that dose of acupuncture could be more important than previously thought. / 42 17 Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials.

18.  As a summary of the current available research, the network meta-analysis results indicate that acupuncture can be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term.  However, much of the evidence in this area of research is of poor quality, meaning there is uncertainty about the efficacy of many physical treatments. / 42 18 Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis.

19. / 42 19 Acupuncture for chronic low back pain in long- term follow-up: a meta-analysis of 13 randomized controlled trials.  Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture

20.  Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.  Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.  How ever, 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. / 42 20 Acupuncture for chronic pain: individual patient data meta-analysis.

21.  The total number of RCTs included in the analysis and their methodological quality were too low to draw firm conclusions. Future rigorous RCTs will be necessary to assess the clinical efficacy of acupuncture in this area. / 42 21 Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials.