Acupuncture for chronic pain and depression in primary care: a programme of research
| Autor: | Andrew J. Vickers, Martin Bland, Stewart Richmond, Hugh MacPherson, Janet Eldred, Ann Hopton, Mark Corbett, Beth Woods, Ian Watt, Eldon Spackman, Helen Weatherly, Mark Sculpher, Andrea Manca, David J. Torgerson, Pedro Saramago |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Referral business.industry lcsh:Public aspects of medicine Chronic pain lcsh:RA1-1270 Osteoarthritis medicine.disease Transcutaneous electrical nerve stimulation law.invention 03 medical and health sciences 0302 clinical medicine Physical medicine and rehabilitation Migraine Randomized controlled trial law Health care medicine Acupuncture Physical therapy 030212 general & internal medicine business 030217 neurology & neurosurgery |
| Zdroj: | Programme Grants for Applied Research, Vol 5, Iss 3 (2017) |
| ISSN: | 2050-4330 2050-4322 |
| Popis: | BackgroundThere has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.AimOur aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.Methods and resultsWe synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p p ConclusionWe have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.Trial registrationCurrent Controlled Trials ISRCTN63787732.FundingThe National Institute for Health Research Programme Grants for Applied Research programme. |
| Databáze: | OpenAIRE |
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