submitted by the Oregon Acupuncture Association (OAA) to the Oregon Pain Management Commission of the Oregon Health AuthorityJanuary 2024
written by Kelly Ilseman, LAc/OAA Research Committee Chair
Audience: Oregon Health Authority, Oregon Pain Management Commission, Medical Providers
Outline:
*Bullet Points
A. Supporting Agencies
B. Clinical Effectiveness
C. Cost-Effectiveness
D. Mechanisms
E. Insurance Coverage
F. References
Note: This post contains partial content (B. Clinical Effectiveness for Mental Health) of the original due to limitations posed by the Wix blog platform. Please see previous and future posts for the rest of the content, or find the full document here. Additionally, due to Wix platform features, AMA citations appear in parentheses rather than superscript.
*Bullet Points: A. Supporting Agencies: The use of acupuncture as an effective, evidence-based pain-management option has strong support from leading healthcare institutions. (1-7) B. Clinical Effectiveness: Acupuncture is a safe, effective, and evidence-based non-pharmacological pain management option for chronic and acute pain,(8-30) lower need for opioids,(31-36) and improved mental-health outcomes,(37-53) and The benefits persist over time, further underscoring the cost-effectiveness of acupuncture. (9,54-69)
C. Cost-Effectiveness: Acupuncture and electroacupuncture are cost-effective first-line treatments for chronic pain (9, 54-68) and for the opioid epidemic.(69)
D. Mechanisms: Biomedical understanding of the mechanisms of acupuncture is emerging at the forefront of biological research at a level of physiological detail on par with other biological science disciplines, and is understood to work via the connective tissue stimulating biochemical, bioelectrical, and molecular cascades, producing tangible physiological effects that can reduce pain and the experience of pain. (70-106)
E. Insurance Coverage: Leading Oregon health plans cover acupuncture for chronic pain management, including the Oregon Health Plan (OHP) as well as other private insurance carriers.(107-121)
Note: Due to Wix features, this blog post contains only parts A and B of this presentation, plus references pertinent to A and B. Please see past and future blog posts for the rest of the document, or click here for the full pdf.
B. Clinical Effectiveness
3. Acupuncture for Mental Health Outcomes
Li Z, Feng J, Yin S, Chen X, Yang Q, Gao X, Che D, Zhou L, Yan H Zhong Y, Zhu F. BMC Complement Med Ther. Effects of acupuncture on mental health of migraine patients: a systematic revie and meta-analysis. 2023 Aug 4;23(1):278. doi:10.1186/s12906-023-04103-8. (37)
13 RCT’s involving a total of 1,766 migraine patients were pooled for analysis
Acupuncture versus sham acupuncture or medication improved migraine patients’ rating scores and mental health exam performance:
Self-Rated Anxiety Scale (SAS) scores (WMD: -5.64; 95% CI: -10.89, -0.39; p = 0.035)
Self-Rated Depression Scale (SDS) scores (WMD: -4.65; 95% CI: -9.25, -0.05; p = 0.048)
Short Form 36 Mental Health (MH) scores (SMD: 0.77; 95% CI: 0.19, 1.35; p = 0.009)
Visual Analog Scale (VAS) (SMD: -1.06; 95% CI: -1.73, -0.4; p = 0.002;)
Migraine-Specific Quality of Life Questionnaire (MSQ) (WMD: 4.76; 95% CI: 2.36, 7.15; p < 0.001)
Conclusion: “Compared with Western medicine and sham acupuncture, acupuncture seems to be able to effectively improve anxiety and depression in migraine patients. And it may be more effective in improving SF36-mental health, VAS and MSQ than [sham] acupuncture or Western medicine.”
3a. Acupuncture for Mental Health Outcomes: Depression Zheng L, Sun Z, Liu C, Zhang J, Jin Y, Jin H. Acupuncture-adjuvant therapies for treating perimenopausal depression: a network meta-analysis. Medicine (Baltimore). 2023 Aug 18;102(33):e34694. doi: 10.1097/MD.0000000000034694. (38)
27 studies involving 2,269 PMD patients with perimenopausal depression (PMD) pooled for meta-analysis
8 different interventions
Primary outcomes: Hamilton Depression Scale score and efficacy rate
Secondary outcomes: levels of follicle-stimulating hormone, luteinizing hormone, estradiol, and the Kupperman score.
Results: “warm acupuncture (OR = 1.55, 95% CI: 1.00-2.44), electroacupuncture (OR = 1.34, 95% CI: 1.00-1.8), abdominal acupuncture (OR = 1.19, 95% CI: 0.73-1.96), and common acupuncture (OR = 1.4, 95% CI: 0.9-2.17) more effective than fluoxetine and menopausal hormone treatment in the treatment of PMD.”
Warm acupuncture more effective at reducing Hamilton Depression Scale scores than “electroacupuncture (SMD = -1.22, 95% CI: -2.34 to -0.09), thread embedding (SMD = -1.31, 95% CI: -2.21 to -0.40), abdominal acupuncture (SMD = -1.33, 95% CI: -2.42 to -0.24), and common acupuncture (SMD = -1.46, 95% CI: -2.26 to -0.66).”
Conclusion: warm acupuncture provided the most effective treatment for PMD
Xu G, Lei H, Huang L, Xiao Q, Huang B, Zhou Z, Tian H, Huang F, Liu Y, Zhao L, Li X, Liang F. The dose-effect association between acupuncture sessions and its effects on major depressive disorder: A meta-regression of randomized controlled trials. J Affect Disord. 2022 Aug 1:310:318-327. doi: 10.1016/j.jad.2022.04.155. Epub 2022 May 2. (39)
62 studies involving 2,269 patients diagnosed with major depressive disorder (MDD) included for meta-regression analysis
Outcomes: Hamilton rating scale for depression (HAMD) to measure symptom severity
Results dose-dependent: more acupuncture sessions associated with greater reduction in HAMD scores and improved MDD symptoms
8 acupuncture treatments: HAMD score decreased from 17.68 (95% CI: -11.81, -4.80) to 8.30 (95% CI: 14.23-21.13)
24 acupuncture treatments: decrease in HAMD scores for 51% of cases (95% CI: 48% to 54%).
36 acupuncture treatments: “improvement in HAMD scores peaked at 66% of cases” (95% CI: 59% to 72%).”
Conclusions: “A dose-effect relationship was found between the number of acupuncture sessions and HAMD scores. 36 acupuncture sessions were associated with optimal clinical response.”
Xu G, Xiao Q, Huang B, Lei H, Yin Z, Huang L, Zhou Z, Tian H, Huang F, Liu Y, Sun M, Zhao L, Liang F. Clinical evidence for association of acupuncture with improved major depressive disorder: a systematic review and meta-analysis of randomized control trials. Neuropsychobiology. 2023;82(1):1. Epub 2022 Dec 22. (40)
43 studies involving 3,756 participants with major depressive disorder (MDD) pooled for meta-analysis
Primary outcomes: Hamilton rating scale for depression (HAMD) and Self-Rating Depression Scale (SDS)
Results yielded “high-quality evidence” for use of acupuncture or acupuncture + antidepressant medications to treat MDD compared with sham acupuncture or antidepressants alone.
“High-quality evidence showed that acupuncture led to fewer adverse effects than antidepressants.”
Conclusions: According to high-quality evidence, acupuncture and acupuncture + antidepressant treatment of MDD yielded a statistically significant reduction in HAMD scores.
Ching WL, Li HJ, Guo J, Yao L, Chau J, Lo S, Yuen CS, Ng BFL, Yu EC-L, Zhaoxiang Bian Z, Lau AY, Zhong LLD. Acupuncture for post-stroke depression: a systematic review and network meta-analysis. BMC Psychiatry 2023;23:314. doi: 10.1186/s12888-023-04749-1 (41)
62 randomized controlled trials involving 5,308 participants included
Primary outcome: survey post-stroke depression measuring depressive symptoms
Secondary outcomes: effectiveness for neurological function and the quality of life
Results: acupuncture alone or acupuncture plus use of “repetitive transcranial magnetic stimulation (RTMS),” significantly reduced Hamilton Depression Rating Scale scores
Acupuncture with this therapy had “the highest probability of improving depressive symptoms with a probability of 49.43%.”
“Traditional Chinese medicine (TCM) alone or with pharmaceuticals” was better at reducing depressive symptoms
Conclusions: “The results of this study indicate that AC alone or combined with other therapies appears to be effective in improving depression symptoms of stroke survivors.”
Xu M-M, Guo P, Ma Q-Y, Zhou X, Wei Y-L, Wang L, Chen Y, Guo Y. Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis. J Integr Med. 2022 Jul;20(4):305-320. doi: 10.1016/j.joim.2022.05.002. Epub 2022 May 6. (42)
16 studies involving 1,958 participants with depression included for meta-analysis
Primary outcomes: (1) severity of depression symptoms based on Hamilton Depression Rating Scale-17 (HAMD-17), World Health Organization Quality of Life-BREF scores, Self-Rating Depression Scale (SDS), and Self-Esteem Rating Scales (SERS)
Secondary outcomes: remission rate, treatment response, social function, and antidepressant dose changes
Most studies had “high risk of performance bias and low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias.”
Acupuncture plus antidepressants compared with antidepressants alone:
Reduced HAMD-17 scores (standard mean difference [SMD] -0.44, 95% confidence interval [CI] -0.55 to -0.33, P < 0.01; I2 = 14%)
HAMD-17 scores showed “significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I2 = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I2 = 19%)”
Reduced Self-rating Depression Scale (SDS) scores (SMD -0.53, 95% CI -0.84 to -0.23, P < 0.01; I2 = 79%)
Reduced Side Effect Rating Scale (SERS) scores (SMD -1.11, 95% CI -1.56 to -0.66, P < 0.01; I2 = 89%)
Enhanced World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I2 = 15%)
“Decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I2 = 0%)”
Conclusion: “Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants.” Note: interpret findings with caution: low or moderate quality evidence and “lack of comparative, placebo-controlled data”
Hang X, Li J, Zhang Y, Li Z, Zhang Y, Ye X, Tang Q, Sun W. Efficacy of frequently-used acupuncture methods for specific parts and conventional pharmaceutical interventions in treating post-stroke depression patients: a network meta-analysis. Complement Ther Clin Pract. 2021 Nov:45:101471. doi: 10.1016/j.ctcp.2021.101471. Epub 2021 Aug 4. (43)
51 studies involving 3,966 participants with post-stroke depression (PSD)
12 acupuncture interventions were offered
“Scalp acupuncture plus conventional acupuncture was considered to be the most effective method, followed by auricular acupuncture, eye acupuncture, eye acupuncture plus drug, auricular acupuncture plus drug, auricular acupuncture plus conventional acupuncture, scalp acupuncture, scalp acupuncture plus drug, abdominal acupuncture, conventional acupuncture plus drug, drug, conventional acupuncture.”
Conclusions: “12 acupuncture methods may be effective and safe in improving the condition of patients with PSD.”
Armour M, Smith CA, Wang LQ, Naidoo D, Yang GY, MacPherson H, Lee MS, Hay P. Acupuncture for depression: a systematic review and meta-analysis. J Clin Med. 2019;8(8) Epub 2019 Jul 31. (44)
29 studies involving 2,268 participants diagnosed with depression pooled for meta-analysis
Acupuncture treatment resulted in “clinically significant reductions in the severity of depression compared to usual care” (Hedges (g) = 0.41, 95% confidence interval (CI) 0.18 to 0.63), sham acupuncture (g = 0.55, 95% CI 0.31 to 0.79), adjunct to antidepressant medication (g = 0.84, 95% CI 0.61 to 1.07).
“Significant correlation” between more acupuncture treatments and reduction of depression symptoms (p = 0.015)
Conclusions: Acupuncture may be a useful addition to standard care, including antidepressant pharmaceuticals, for treating depression.
Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev. 2018;3(3):CD004046. Epub 2018 Mar 4. (45)
64 published/unpublished randomized controlled trials involving 7,104 adult male/ female participants diagnosed with depression pooled for analysis
Acupuncture vs no treatment/waitlist/treatment-as-usual: both manual- and electroacupuncture “may moderately reduce the severity of depression” (SMD -0.66, 95% CI -1.06 to -0.25, five trials, 488 participants); low-quality evidence
Acupuncture vs control (invasive acupuncture, non-invasive sham): reduced “severity of depression [by] 1.69 points on the Hamilton Depression Rating Scale (HAMD)” (95% CI -3.33 to -0.05, 14 trials, 841 participants; low-quality evidence).
Acupuncture vs medication: “acupuncture may confer small benefit in reducing the severity of depression” (SMD -0.23, 95% CI -0.40 to -0.05, 31 trials, 3,127 participants). Note: variations exist depending on medication and mode of acupuncture; overall low-quality evidence
Acupuncture + medication vs medication alone: “acupuncture is highly beneficial in reducing the severity of depression” (SMD -1.15, 95% CI -1.63 to -0.66, 11 trials, 775 participants). Note: large variation in results depending on modality of acupuncture stimulation; very low-quality evidence.
Acupuncture vs psychotherapy: unclear if there are any statistical differences between these two types of therapy for depression (SMD -0.5, 95% CI -1.33 to 0.33, two trials, 497 participants; low-quality evidence)
Conclusions: Acupuncture reduced depression symptoms compared with no treatment or treatment-as-usual. (Reduction in depression symptom severity was less when comparing acupuncture to sham acupuncture controls.) Acupuncture may offer some benefits in combination with or in place of medication. Benefits of acupuncture vs psychotherapy are not discernible. All results based on “very low quality of evidence.”
3b. Acupuncture for Mental Health Outcomes: Anxiety
Li M, Liu X, Ye X, Zhuang L. Efficacy of acupuncture for generalized anxiety disorder: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2022 Dec 9;101(49):e30076. doi: 10.1097/MD.0000000000030076. (46)
27 studies involving 1,782 participants with generalized anxiety disorder (GAD) pooled for meta-analysis
Primary outcome: Hamilton Anxiety Scale (HAMA)
Secondary outcomes: total effective rate, Self-Rating Anxiety Scale (SAS), Treatment Emergent Symptom Scale (TESS)
Results demonstrated that the acupuncture group had superior HAMA and SAS scores when compared with control group:
HAMA score [MD = -0.78, 95%CI (-1.09, -0.46)], the total effective rate [RR = 1.14, 95%CI (1.09, 1.19)]
SAS score [MD = -2.55, 95%CI (-3.31, -1.80)]
Acupuncture group demonstrated higher safety with fewer adverse events than the control group, with lower TESS scores [MD = -1.54, 95%CI (-1.92, -1.17)].
Conclusions: “Acupuncture can effectively relieve the anxiety symptoms of generalized anxiety disorder patients with fewer side effects.”
Tong QY, Liu R, Zhang K, Gao Y, Cui GW, Shen WD. Can acupuncture therapy reduce preoperative anxiety? A systematic review and meta-analysis. J Integr Med. 2021;19(1):20. Epub 2020 Nov 18. (47)
12 studies involving 916 patients with preoperative anxiety included for meta-analysis
Acupuncture patients compared with control group experienced reductions in:
State-Trait Anxiety Inventory Scale (STAI-S) scores (mean difference [MD] = -9.07, 95% confidence interval [CI][-13.19 to -4.96], P < 0.0001)
moderate quality evidence
Visual Analogue Scale (VAS) scores (MD = -1.37, 95% CI [-2.29 to -0.45], P = 0.003)
low-quality evidence
No difference between treatment and control groups was found for Hamilton Anxiety Scale (HAMA) scores
(MD = -3.98, 95% CI [-12.89 to 4.92], P = 0.38).”
moderate quality evidence
Conclusion: Acupuncture may decrease anxiety in preoperative patients
3c. Acupuncture for Mental Health Outcomes: Insomnia Yin X, Liang T, Lu , Yue H, Li S, Zhong VW, Zhang W, Zhou S, Mi Y, Wu H, Xu S. Effect of electroacupuncture on insomnia in patients with depression: a randomized clinical trial. JAMA Netw Open. 2022;5(7):e2220563. doi: 10.1001/jamanetworkopen.2022.20563. (48)
32-week blinded, randomized, sham-controlled clinical trial (8-week intervention with 24-week follow-up) conducted from September 1, 2016, to July 30, 2019, in China
270 participants (194 female; 76 male; age range 18-70 years) diagnosed with insomnia and depression
Treatment groups: (1) electroacupuncture (EA) + standard care (SC); (2) sham acupuncture (SA) + standard care; (3) standard care
Number of treatments: 3 treatments/week for 8 weeks = 24 sessions
Primary outcomes: Pittsburgh Sleep Quality Index (PSQI) scores at baseline and after 24 treatments
Secondary outcomes: Pittsburgh Sleep Quality Index (PSQI) scores at 12, 20, and 32 weeks; actigraphy recordings of sleep parameters; Insomnia Severity Index (ISI) scores; Hamilton Depression Rating Scale (HAMD-17) scores; Self-rating Anxiety Scale (SAS) scores
247 (91.5%) of participants completed all outcome measurements at week 32
EA group mean PSQI score differences baseline to 8 weeks: -6.2 (95% CI, -6.9 to -5.6)
EA vs SA PSQI score differences at week 8: -3.6 (95% CI, -4.4 to -2.8; P < .001) (P < .001)
EA vs control groups PSQI score differences at week 8: -5.1 (95% CI, -6.0 to -4.2; P < .001) (P < .001)
Actigraphy recordings baseline to 8 weeks showed EA resulted in “significant improvement in total sleep time” (29.1 [95% CI, 21.5-36.7] minutes) (P < .001)
Electroacupuncture benefits showed persistence at week 24 post-intervention
“Significant improvement in the 17-item Hamilton Depression Rating Scale” (-10.7 [95% CI, -11.8 to -9.7]), (P < .001)
Significant improvement in Insomnia Severity Index (-7.6 [95% CI, -8.5 to -6.7]) scores, (P < .001)
Significant improvement in Self-rating Anxiety Scale (-2.9 [95% CI, -4.1 to -1.7]) scores, (P < .001)
No differences amongst treatment groups for waking during sleep frequency
Zero serious adverse events
Conclusions: “Quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32.”
Kim S-A, L S-H, Kim J-H, van den Noort, M, Bosch P, Won T, Yeo S, Lim S. Efficacy of acupuncture for insomnia: a systematic review and meta-analysis. Am J Chin Med. 2021;49(5):1135-1150. doi: 10.1142/S0192415X21500543. Epub 2021 May 27. (49)
24 RCTs involving acupuncture, sham acupuncture, and pharmaceuticals to treat insomnia included for meta-analysis
Pittsburgh sleep quality index (PSQI) outcomes: (RR: -0.74; 95% CI: -1.07 to -0.40; 𝑃 ¡0.0001; 𝐼2 = 89%; n = 1475
Subgroup analysis: “no significant effect after weeks 1 and 2, but six studies found that acupuncture had a significant effect insomnia at week 3” (RR: -0.97; 95% CI: -1.65 to -0.28;” 𝑃 = 0.006; 𝐼2 = 91%; n = 463.
9 studies “demonstrated a significant effect at week 4” (RR: -0.70; 95% CI: -1.15 to -0.25; P = 0.002; 𝐼2 = = 85%; n = 594).
Three weeks of acupuncture may provide statistically significant alleviation of insomnia symptoms when compared with the use of pharmaceuticals for insomnia.
Zhao F-Y, Fu Q-Q, Kennedy GA, Conduit R, Zhang W-J, Wu W-Z, Zheng Z. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. Sleep Med. 2021 Apr:80:244-259. doi: 10.1016/j.sleep.2021.01.053. Epub 2021 Feb 2. (50)
Primary outcomes assessed via polysomnography (PSG), actigraphy, and “micromovement sensitive mattress/pillow sleep monitoring systems”
11 randomized controlled trials involving involving acupuncture, sham acupuncture, or waitlist control with a total of 775 patients with primary insomnia (PI) included for meta-analysis
Acupuncture results compared with sham acupuncture or waitlist:
Improved total sleep time [MD = 55.29, 95%CI (29.16, 81.42), p < 0.01]”
Improved sleep efficiency [MD = 8.96, 95%CI (3.97, 13.95), p < 0.01],”
Less waking after sleep onset [MD = -49.54, 95%CI (-82.98, -16.09), p < 0.01]”
Awakened during sleep fewer times [MD = -6.29, 95%CI (-10.75, -1.82), p< 0.01]
Acupuncture outperformed sham acupuncture or waitlist when participants received at least 12 acupuncture treatments
Researchers reported, “most studies reviewed were heterogeneous and at risk of bias due to methodological issues.”
Conclusions: “acupuncture was significantly associated with improvements in several objective sleep parameters (increases in total sleep time and sleep efficiency, and reductions in wake after sleep onset and number of awakening times) as well as subjective sleep quantity and quality in patients with PI. A minimum therapeutic threshold dosage (≥12 sessions) is recommended.”
Zhang J, He Y, Huang X, Liu Y, Yu H. The effects of acupuncture versus sham/placebo acupuncture for insomnia: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2020 Nov:41:101253. doi: 10.1016/j.ctcp.2020.101253. Epub 2020 Nov 1. (51)
15 studies involving 1,108 patients with insomnia were included for meta-analysis
Primary outcome measurement: Pittsburgh sleep quality index (PSQI)
Acupuncture therapy was significantly more effective than sham acupuncture at improving the following scores:
Pittsburgh sleep quality index (PSQI)
Insomnia Severity Index (ISI)
Total Sleep Time (TST)
Sleep-Onset Latency (SOL)
Wake after Sleep Onset (WASO)
Sleep Efficiency (SE)
Acupuncture more effective than other acupuncture modalities for PSQI scores subgroup analysis:
acupuncture superior to sham (3RCTs, MD = -7.34,95% [-8.02,-6.66],I2 = 86%)
acupuncture superior to minimal acupuncture (5RCTs, MD = -3.29,95% [-3.95, -2.63],I2 = 53%)
auricular acupressure superior to sham (1RCT, MD = -4.16,95% [-6.57, -1.75])
minimal acupuncture superior to electroacupuncture (2RCTs, MD = 0.70,95%CI [0.52, 0.87],I2 = 0%)
auricular acupressure vs “minimal acupuncture,” electroacupuncture vs sham, and electroacupuncture vs “minimal acupuncture” showed no significant differences
During follow-up, acupuncture therapy was still significantly more effective than sham acupuncture on the PSQI
Conclusion: Acupuncture more effective than placebo/sham acupuncture in the treatment of insomnia
Yin X, Gou M, Xu J, Dong B, Yin P, Masquelin F, Wu J, Lao L, Xu S. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep Med. 2017;37:193. Epub 2017 Mar 8. (52)
Single-center, single-blinded, randomized controlled clinical trial to evaluate the efficacy and safety of acupuncture treatment for primary insomnia.
72 patients with primary insomnia randomized into acupuncture treatment or control (sham acupuncture) groups
Number of treatments: 3x/week for 4 weeks = 12 sessions
Primary outcome: Insomnia Severity Index (ISI)
Secondary outcomes: sleep efficiency (SE), sleep awakenings (SA), total sleep time (TST) recorded by Actigraphy, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS)
Both groups showed improvement in sleep
Paired T-Test results demonstrated significant differences for all outcome measurements before and after acupuncture treatment.
ISI scores in acupuncture group “improved dramatically” … with “similar significant improvements … observed in the SE, TST and SDS scores”
2 weeks after treatment (F = 11.3, p = 0.001)
4 weeks after treatment (F = 33.6, p < 0.001)
at 2-week follow-up (F = 39.4, p < 0.001)
at 4-week follow-up (F = 34.1, p < 0.001)
SA and SAS scores showed no significant differences between treatment groups until the end of 8 weeks, but “remarkable decrements in SA and SAS were found in the acupuncture treatment group after the two-week and four-week follow-ups.”
Conclusion: “Acupuncture treatment is more effective than sham acupuncture treatment in increasing insomnia patients' sleep quality and improving their psychological health.”
3d. Acupuncture for Mental Health Outcomes: PTSD (Fight, Flight, Freeze)
Engel CC, Cordova EH, Benedek DM, Liu X, Gore KL, Goertz C, Freed MC, Crawford C, Jonas WB, Ursano RJ. Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Med Care. 2014 Dec;52(12 Suppl 5):S57-64. doi: 10.1097/MLR.0000000000000237. 53
55 military service members diagnosed with PTSD
Treatments: 8 one-hour acupuncture treatments 2x/week plus “usual PTSD care (UPC)” or UPC only
Primary outcomes: PTSD Checklist (PCL) and the Clinician-administered PTSD Scale (CAPS) scores at baseline, 4, 8, and 12 weeks
Secondary outcomes: depression, pain severity, and mental/physical health functioning
Results: acupuncture group experienced significantly greater “mean improvement in PTSD severity” than the usual care group (PCLΔ=19.8±13.3 vs. 9.7±12.9, P<0.001; CAPSΔ=35.0±20.26 vs. 10.9±20.8, P<0.0001) // acupuncture group experienced “significantly greater improvements in depression, pain, and physical and mental health functioning.”
Conclusions: “Acupuncture was effective for reducing PTSD symptoms” in this small sample size group.
References 37. Li Z, Feng J, Yin S, Chen X, Yang Q, Gao X, Che D, Zhou L, Yan H Zhong Y, Zhu F. BMC Complement Med Ther. Effects of acupuncture on mental health of migraine patients: a systematic review and meta-analysis. 2023 Aug 4;23(1):278. doi: 10.1186/s12906-023-04103-8.
38. Zheng L, Sun Z, Liu C, Zhang J, Jin Y, Jin H. Acupuncture-adjuvant therapies for treating perimenopausal depression: a network meta-analysis. Medicine (Baltimore). 2023 Aug 18;102(33):e34694. doi: 10.1097/MD.0000000000034694.
39. Xu G, Lei H, Huang L, Xiao Q, Huang B, Zhou Z, Tian H, Huang F, Liu Y, Zhao L, Li X, Liang F. The dose-effect association between acupuncture sessions and its effects on major depressive disorder: A meta-regression of randomized controlled trials. J Affect Disord. 2022 Aug 1:310:318-327. doi: 10.1016/j.jad.2022.04.155. Epub 2022 May 2.40. Xu G, Xiao Q, Huang B, Lei H, Yin Z, Huang L, Zhou Z, Tian H, Huang F, Liu Y, Sun M, Zhao L, Liang F. Clinical evidence for association of acupuncture with improved major depressive disorder: a systematic review and meta-analysis of randomized control trials. Neuropsychobiology. 2023;82(1):1. Epub 2022 Dec 22.41. Ching WL, Li HJ, Guo J, Yao L, Chau J, Lo S, Yuen CS, Ng BFL, Yu EC-L, Zhaoxiang Bian Z, Lau AY, Zhong LLD. Acupuncture for post-stroke depression: a systematic review and network meta-analysis. BMC Psychiatry 2023;23:314. doi: 10.1186/s12888-023-04749-1
42. Xu M-M, Guo P, Ma Q-Y, Zhou X, Wei Y-L, Wang L, Chen Y, Guo Y. Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis. J Integr Med. 2022 Jul;20(4):305-320. doi: 10.1016/j.joim.2022.05.002. Epub 2022 May 6.
43. Hang X, Li J, Zhang Y, Li Z, Zhang Y, Ye X, Tang Q, Sun W. Efficacy of frequently-used acupuncture methods for specific parts and conventional pharmaceutical interventions in treating post-stroke depression patients: a network meta-analysis. Complement Ther Clin Pract. 2021 Nov:45:101471. doi: 10.1016/j.ctcp.2021.101471. Epub 2021 Aug 4.
44. Armour M, Smith CA, Wang LQ, Naidoo D, Yang GY, MacPherson H, Lee MS, Hay P. Acupuncture for depression: a systematic review and meta-analysis. J Clin Med. 2019;8(8) Epub 2019 Jul 31.
45. Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ. Acupuncture for depression. Cochrane Database Syst Rev. 2018;3(3):CD004046. Epub 2018 Mar 4.46. Li M, Liu X, Ye X, Zhuang L. Efficacy of acupuncture for generalized anxiety disorder: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2022 Dec 9;101(49):e30076. doi: 10.1097/MD.0000000000030076.47. Tong QY, Liu R, Zhang K, Gao Y, Cui GW, Shen WD. Can acupuncture therapy reduce preoperative anxiety? A systematic review and meta-analysis. J Integr Med. 2021;19(1):20. Epub
2020 Nov 18.
48. Yin X, Liang T, Lu , Yue H, Li S, Zhong VW, Zhang W, Zhou S, Mi Y, Wu H, Xu S. Effect of electroacupuncture on insomnia in patients with depression: a randomized clinical trial. JAMA Netw Open. 2022;5(7):e2220563. doi:10.1001/jamanetworkopen.2022.20563.49. Kim S-A, L S-H, Kim J-H, van den Noort, M, Bosch P, Won T, Yeo S, Lim S. Efficacy of acupuncture for insomnia: a systematic review and meta-analysis. Am J Chin Med. 2021;49(5):1135-1150. doi: 10.1142/S0192415X21500543. Epub 2021 May 27.50. Zhao F-Y, Fu Q_Q, Kennedy GA, Conduit R, Zhang W-J, Wu W-Z, Zheng Z. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. Sleep Med. 2021 Apr:80:244-259. doi:10.1016/j.sleep.2021.01.053. Epub 2021 Feb 2.
51. Zhang J, He Y, Huang X, Liu Y, Yu H. The effects of acupuncture versus sham/placebo acupuncture for insomnia: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2020 Nov;41:101253. doi: 10.1016/j.ctcp.2020.101253. Epub 2020 Nov 1.
52. Yin X, Gou M, Xu J, Dong B, Yin P, Masquelin F, Wu J, Lao L, Xu S. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep Med. 2017;37:193. Epub 2017 Mar 8.
53. Engel CC, Cordova EH, Benedek DM, Liu X, Gore KL, Goertz C, Freed MC, Crawford C, Jonas WB, Ursano RJ. Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Med Care. 2014 Dec;52(12 Suppl 5):S57-64. doi: 10.1097/MLR.0000000000000237.
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