Acupoint specificity in acupuncture clinical practice for chronic low back pain and migraine : a systematic review and meta-analysis

Abstract

Purpose : To examine clinical acupoint specificity, a systematic review and meta-analysis of randomized controlled trials (RCT) of chronic low back pain and migraine were conducted.

Methods : Medical literature database were searched, and then RCTs comparing needling acupoints and non-acupoints (or acupoints which are not usually selected for the relevant disease or symptoms) were selected based on pre-defined inclusion and exclusion criteria. We used Review Manager 5.4 for meta-analysis to obtain mean difference (MD) or standardized mean difference (SMD).

Results : No relevant RCT was found for chronic low back pain. As for migraine, six RCTs were selected, but their heterogeneity was high in frequency and duration of treatment, stimulation method, acupoint selection, and time point of evaluation. Meta-analysis of two included RCTs showed a significantly larger effect on headache intensity (10 cm Visual Analog Scale) after 4 weeks of treatment in a group of needling standard acupoints compared with that of needling acupoints which are not usually selected (MD [95% CI] : −0.81 [−1.23, −0.40] ). There was no significant difference in SMD of headache incidence.

Conclusion : For migraine, acupuncture needling at empirically selected acupoints might be clinically significant. However, imprecision and heterogeneity prevented a definitive conclusion. To verify clinical acupoint specificity, more RCTs with a control group in which only acupoint selection differs from the intervention group need to be performed.