Acupuncture for lateral elbow pain

 

Abstract

Background

This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Acupuncture has long been used to treat lateral elbow pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral elbow pain.

Objectives

To determine the effectiveness of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement in function, grip strength and adverse effects.

Search methods

We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible.

Selection criteria

Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral elbow pain (tennis elbow). Outcomes of interest were pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect.

Data collection and analysis

For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity.

Main results

Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994) . A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a) . No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997).

Authors' conclusions

There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.

 

Plain language summary

Acupuncture for elbow pain

Acupuncture might be able to provide short-term relief from tennis elbow, but more research is needed.

 

摘要

背景

針灸用於治療肘部側面疼痛﹝網球肘﹞

用針灸治療肘部側面疼痛﹝網球肘﹞在中西方國家已有一段時間，並且逐漸增加中，但無系統回顧看針灸治療肘部側面疼痛是否有效。

目標

針灸用於治療肘部側面疼痛是否在疼痛減輕、功能改善、握力及副作用之效果。

搜尋策略

搜尋包括MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group搜1966到2001年6月。

選擇標準

兩位作者獨立進行資料摘錄。隨機臨床試驗及準隨機臨床試驗，比較針灸與安慰劑或其它治療肘部側面疼痛﹝網球肘﹞。結果為疼痛減輕、功能改善、生活品質、握力、參與者滿意度及副作用之效果。

資料收集與分析

連續性資料使用加權平均差異(weighted mean difference：WMD)來分析，二分法的資料使用相對風險(RR)來表示。臨床及統計無異質性才做統合分析。

主要結論

4個小型隨機對照臨床試驗被納入此篇回顧，但因研究方法缺失﹝特別是小樣本，分配隱密性及失去追蹤﹞，無法做統合分析。1篇隨機對照臨床試驗發現針灸減輕疼痛時間比安慰劑久(WMD = 18.8 hours, 95% CI 10.1 to 27.5)且較可能產生50% 以上的緩解，RR 0.33, 95% CI 0.16 to 0.69。另1篇隨機對照臨床試驗發現針灸與安慰劑比起來，似乎較能減輕受試者自我報告短期進步(RR = 0.09 95% CI 0.01 to 0.64)，但長期3到12月後並無顯著差異。1篇隨機對照試驗發現雷射針灸與安慰劑比起來，整體效益並無顯著差異。第4篇為中文，顯示維生素B12注射與維生素B12注射加上針灸並無顯著差異。

作者結論

資料不足以支持或排除針灸用於治療肘部側面疼痛﹝網球肘﹞。雖然針灸顯示可以減少短期疼痛，但證據來自2篇小型研究。並未被證實療效超過24小時。並無副作用分析。未來需進一步採用良好設計及適當病人樣本數的研究。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針灸對於網球肘可能有療效，不過尚待更多的研究。