The state of evidence in acupuncture: A review of metaanalyses and systematic reviews of acupuncture evidence (update 2017–2022)

Abstract

INTRODUCTION: Over the last decades, acupuncture research has increased drastically. As a result, it has become more and more difficult to oversee the amount of evidence concerning its effect in various medical conditions. Different comparative reviews aimed to roughly assess individual strength of acupuncture evidence, covering the years 2005-2017. Our review intends to assess the level of acupuncture evidence for any medical condition available, concerning the years 2017-2022. METHODS: We searched the pubmed database for 'acupuncture' and filtered the results towards systematic reviews and metanalyses (SR/MA). Results were allocated towards medical disciplines and sorted to medical conditions. Each SR/MA was rated concerning quality of review (QoR), quality of data (QoD), and quality of evidence (QoE). To facilitate a rough overview, results were assessed into either of four categories: i) evidence of positive effect, ii) evidence of potential positive effect, iii) insufficient/unclear evidence, iv) no evidence of effect/evidence of no effect. RESULTS: After considering exclusion criteria, 862 SR/MA remained for evaluation. Results were allocated and sorted as described, resulting in 184 medical conditions. Of these, in ten medical conditions SR/MA supported evidence of positive effect: chronic pain, low-back pain, knee osteoarthritis, postoperative nausea and vomiting (PONV), migraine, tension-type headache, cancer-related fatigue, menopausal symptoms, female infertility (additional to medical reproductive treatment), chronic prostatitis/chronic pelvic pain syndrome in men. In another 82 medical conditions SR/MA supported evidence of potential positive effect, in another 86 medical conditions SR/MA revealed unclear/insufficient evidence, and in another six medical conditions no evidence of effect/evidence of no effect was found. Compared with previous reviews until the year 2017, the number of medical conditions with higher quality evidence levels has increased, namely evidence of positive effect and evidence of potential positive effect. DISCUSSION AND CONCLUSION: Compared to previous years, the amount and quality of acupuncture evidence has increased in the years 2017-2022. In total, 862 included SR/MA resulted in a comparative review of 184 medical conditions. Evidence of positive effect was revealed ten medical conditions, another 82 showed evidence of potential positive effect. 86 medical indications showed insufficient evidence for a firm conclusion, six conditions showed no evidence of effect/evidence of no effect. Although general quality of evidence has dramatically increased compared to the previous years, lack of underlying high-quality trials in some cases seems to compromise a consistent comparability between SR/MA. This issue should be addressed for future studies and guidelines such as STRICTA and CONSORT should strictly be obtained.

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