Review question

Is acupuncture safe and effective in the treatment of chronic neuropathic pain in adults?

Background

Neuropathic pain is a complex, chronic pain caused by damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall or cut, or arthritic knee). Approximately 7% to 10% of the general population have neuropathic pain. Acupuncture is a traditional Chinese medicine (TCM) technique of treating disease by inserting needles into the skin, or the tissues below.

In this review, we were interested in whether acupuncture could relieve pain, improve quality of life, and cause fewer side effects than other treatment options, for adults with neuropathic pain. We looked for studies comparing acupuncture with sham acupuncture (sham acupuncture involves using a blunt needle that slides into the handle rather than penetrating the skin or tissues below). We also looked for studies comparing acupuncture with treatment as usual, or with other active therapies (such as mecobalamin, nimodipine, inositol, and Xiaoke bitong capsule).

Study characteristics

We conducted a search for relevant clinical trials in February 2017. We included six studies of manual acupuncture: one compared acupuncture with sham acupuncture; three investigated acupuncture combined with other active treatments compared with other active treatments alone; two compared acupuncture alone compared with other active treatments. The six studies involved 462 adults with chronic peripheral neuropathic pain. The participants were 52 to 63 years of age, on average. They received treatment for eight weeks or more. We did not find any study comparing acupuncture with treatment as usual, nor any study of other acupuncture techniques (such as electroacupuncture, warm needling, fire needling).

Key results and quality of evidence

We are uncertain about the beneficial effects of manual acupuncture on pain intensity, pain relief and quality of life when compared to sham acupuncture or other therapies (such as mecobalamin, nimodipine, inositol, and Xiaoke bitong capsule). There is a lack of evidence on the potential harms (side effects) of acupuncture.

We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. The quality of the evidence in this review is very low, mostly due to problems in the way the studies were conducted (such as the participants were not blinded to their treatment, or more participants in the sham acupuncture group left the study early). The studies also included a small number of participants. Moreover, these findings only apply to peripheral neuropathic pain in older adults.

Overall, we do not have sufficient evidence to support or refute the use of acupuncture in treating neuropathic pain.