Review article: Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis.

Acupuncture might offer a novel approach to improve ED pain management. Our primary aim was to assess the efficacy of acupuncture in the emergency setting while secondary objectives were to explore its suitability through its side-effect profile, patient satisfaction, cost, administration time and points used. Seven databases and Google Scholar were searched up to 31 July 2016 using MeSH descriptors for three overarching themes concerning acupuncture, pain management and emergency medicine. Meta-analysis was performed on randomised trials for three comparator groups: acupuncture versus sham, acupuncture versus standard analgesia care and acupuncture-as-an-adjunct to standard care, to calculate the standardised mean difference and weighted mean difference for pain scores out of 10. Data for secondary outcomes was extracted from both randomised and observational studies. Nineteen randomised controlled trials and 11 uncontrolled observational studies totaling 3169 patients were retrieved after exclusions. Meta-analyses were performed on data from 14 randomised controlled trials representing 1210 patients. The three resulting comparator groups (as above) resulted in standardised mean differences of 1.08, 0.02 and 1.68, and weighted mean differences of 1.60, -0.04 and 2.84, respectively (all positive figures favour acupuncture). Where measured, acupuncture appears to be associated with improved patient satisfaction, lower cost and a low adverse effects profile. The data available were inadequate to ascertain the effect of acupuncture on analgesia use. Significant study bias was found, especially with respect to practitioner and patient blinding. We conclude that for some acute pain conditions in the ED, acupuncture was clinically effective compared to sham and non-inferior to conventional therapy. As an adjunct, limited data was found indicating superiority to standard analgesia care. Further studies will elucidate the most appropriate acupuncture training and techniques, use as an adjunct and the clinical situations in which they can be best applied.