Evaluation of the effectiveness and safety of acupuncture in the management of shoulder pain in adults
Creators: name: Huang, Yisu
Publisher: name: RMIT University
Year: 2024

description: Shoulder pain affects 6-26% of the population globally with a substantial health and economic impact on the community. This review was to evaluate the effectiveness and safety of acupuncture in the management of shoulder pain in adults by systematically reviewing the currently available randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs). A total of 16 English and Chinese electronic databases were searched from their respective inceptions to 18 September 2012. <br><br>The data on pain intensity, range of motion and adverse events as well as risk of bias were analysed. Meta-analysis was performed using Review Manager 5.1. A total of 6,609 studies were identified. Thirty-eight RCTs and six non-RCTs met the inclusion criteria and were included in this review. Among the 38 RCTs, 4,115 participants were randomised. There was a high risk of performance bias and an unclear risk of selection, detection, attrition and reporting bias across most RCTs. The pooled data showed that acupuncture was more effective than sham acupuncture to relieve pain and improve abduction degree of the shoulder at the end of treatment and follow-up. There was no significant difference in alleviating pain between acupuncture and Western medication (WM) at the end of treatment period. However, nerve block (Xylocaine) was superior to acupuncture in improving shoulder movement in all directions after one-session treatment. Acupuncture reduced more pain than conventional orthopaedic therapy after three-month treatment and three-month follow-up. Comparing with other therapy (such as Trager psychophysical integration and conventional orthopaedic therapy), the pooled data indicated that acupuncture was more beneficial for improving abduction degree at the end of treatment. However, the synthesised data did not show any significant difference in pain relief or improvement of abduction degree between acupuncture plus WM and WM alone. It demonstrated that acupuncture was more effective to alleviate pain as an adjunct treatment to Tuina at the end of treatment. However, there was no significant difference between acupuncture plus Tuina group and Tuina alone group for abduction degree or between electroacupuncture plus exercise and interferential electrotherapy plus exercise for pain relief after the last treatment. Six non-RCTs involved 570 participants. All the non-RCT studies had a high a risk of selection bias (random sequence generation) and performance bias (blinding of participants). Majority had an unclear risk of selection (allocation concealment), detection, attrition, reporting and other bias. <br><br>Although all the investigators claimed that the acupuncture treatment group was more effective than the control group, due to lack of data for outcome measures, meta-analysis was not performed. No severe adverse events were observed in either RCTs or non-RCTs. The outcomes from the current project indicate that acupuncture is potentially beneficial and safe for relieving pain and improving abduction movement of the shoulder joint. However, due to the various confounders and high or unclear risk of bias, the findings need to be interpreted with caution. A large scaled, rigorously designed RCT is warranted to confirm the current results.