Acupuncture for shoulder pain

 

Abstract

Background

There are many commonly employed forms of treatment for shoulder disorders. This review of acupuncture is one in a series of reviews of varying interventions for shoulder disorders including adhesive capsulitis (frozen shoulder), rotator cuff disease and osteoarthritis. Acupuncture to treat musculoskeletal pain is being used increasingly to confer an analgesic effect and to date its use in shoulder disorder has not been evaluated in a systematic review.

Objectives

To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain.

Search methods

The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed.

Selection criteria

Randomised and quasi-randomised trials, in all languages, of acupuncture compared to placebo or another intervention in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica, cervically referred pain and fracture.

Data collection and analysis

Two reviewers independently extracted trial and outcome data. For continuous outcome measures where the standard deviations were not reported it was either calculated from the raw data or converted from the standard error of the mean. If neither of these was reported, authors were contacted. Where results were reported as median and range, the trial was not included in the meta-analysis, but presented in Additional Tables. Effect sizes were calculated and combined in a pooled analysis if the study end-points population and intervention were homogenous. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis to indicate effect of acupuncture across all shoulder disorders.

Main results

Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. Two trials assessed short-term success (post intervention) of acupuncture for rotator cuff disease and could be combined in meta analysis. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo, but due to small sample sizes this may be explained by Type II error. Acupuncture was of benefit over placebo in improving the Constant Murley Score (a measure of shoulder function) at four weeks (WMD 17.3 (7.79, 26.81)). However, by four months, the difference between the acupuncture and placebo groups, whilst still statistically significant, was no longer likely to be clinically significant (WMD 3.53 (0.74, 6.32)). The Constant Murley Score is graded out of 100, hence a change of 3.53 is unlikely to be of substantial benefit. The results of a small pilot study demonstrated some benefit of both traditional and ear acupuncture plus mobilization over mobilization alone. There was no difference in adverse events related to acupuncture when compared to placebo, however this was assessed by only one trial

Authors' conclusions

Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

 

Plain language summary

Acupuncture for shoulder pain

Does acupuncture work for treating shoulder pain?
To answer this question, scientists found and analyzed 9 research studies. The studies tested over 500 people who had shoulder pain. People had either acupuncture, a placebo (fake therapy), ultrasound, gentle movement or exercises usually for 20-30 minutes, two to three times a week for 3 to 6 weeks. Even though the studies were small and not of the highest quality, this Cochrane review provides the best evidence we have today.

What causes shoulder pain and how can acupuncture help?
Shoulder pain can be caused by a number of different conditions. It can be caused by rotator cuff disease, periarthritis or adhesive capsulitis (frozen shoulder). Shoulder pain can sometimes go away on its own but may last up to 12 to 18 months. Drug and non-drug treatments are used to relieve pain and/or swelling. Acupuncture is a non-drug therapy being used more and more to treat shoulder pain. It is thought that acupuncture works either by releasing chemical compounds in the body that relieve pain, by overriding pain signals in the nerves or by allowing energy (Qi) or blood to flow freely through the body. It is not known whether acupuncture works or is safe.

How well does acupuncture work?
The improvements with acupuncture for pain and function were about the same as the effects of receiving a fake therapy for 2 to 4 weeks.

One study showed that acupuncture improved shoulder function more than fake therapy after 4 weeks. But after 4 months, improvements were about the same with only an improvement of 4 more points on a scale of 0 to 100 with acupuncture.

One small study showed that acupuncture plus exercise was better than just exercise for improving pain, range of motion and function for up to 5 months.

How safe is it?
Side effects were not measured in many of the studies. One study showed that side effects such as fainting, headache, dizziness, swelling or leg weakness, were about the same with acupuncture or fake therapy.

What is the bottom line?
There is not enough evidence to say whether acupuncture works to treat shoulder pain or whether it is harmful.

From the little evidence that there is, acupuncture may improve pain and function over the short term (2 to 4 weeks).

 

摘要

背景

針灸治療肩部疼痛

肩部疼痛有許多治療法，本文針灸治療肩部疼痛是回顧治療肩部疼痛包括肩部粘黏性關節囊炎(冷凍肩)，肩部的旋轉肌疾病及退化關節炎。針灸治療骨骼肌肉疼痛漸被採用，但治療肩部疼痛尚未被系統性回顧。

目標

評估針灸治療肩部疼痛之效果及安全性。

搜尋策略

搜尋包括Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched to December 2003。同時手動搜尋所選文章之參考文獻。

選擇標準

隨機對照試驗或擬隨機對照試驗，評估針灸治療肩部疼痛與安慰劑或另一種處置之效果。排除肩痛少於3個月者，類風濕性關節炎，多發性肌炎，頸部傳引痛及骨折。

資料收集與分析

兩位作者獨立進行資料摘錄，並對每篇試驗研究的品質進行評估。連續性資料若未報告標準差，可由初始資料計算或由平均值之標準誤計算，若兩者皆無報告則接觸作者。若僅報告中位數及範圍，則該研究不放入統合分析，但放於附表。若處置與研究結果為同質，則計算效應值(effect size又稱為標準化之反應平均值)。肩部的旋轉肌疾病，肩部粘黏性關節囊炎(冷凍肩)及全層旋轉肌撕裂及混合診斷之結果分別呈現，若可能則作統合分析。

主要結論

不同方法品質的9個研究包含於分析中，所有研究描述處置不清楚，且安慰劑在不同研究也不同。2篇研究短期針灸治療肩部的旋轉肌疾病包含於統合分析。短期針灸治療與安慰劑並無顯著差異，但因人數少可能有第二型誤差。 針灸治療比安慰劑在4週時改善Constant Murley Score (測肩功能 MD 17.3 (7.79, 26.81)。但4個月後雖仍統計有差異，但臨床無顯著差異WMD 3.53 (0.74, 6.32)。Constant Murley Score 是百分級，因此改變3.53可能無大的臨床助益(WMD 17.3 (7.79, 26.81)。一小型研究顯示傳統及耳朵針灸加運動比上只有運動有益處。一篇研究指出與安慰劑組比，副作用並無顯著差異。

作者結論

因僅有少量臨床及方法不同的試驗研究，本回顧無法下結論。少有證據支持或反對以針灸治療肩部的疼痛，雖然針灸對疼痛及功能可能有些短期效果。需設計良好之隨機對照試驗。

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

請問針灸治療肩痛有用嘛？要回答這個問題，科學家們發現和分析9個研究報告。該研究測試了超過 500位肩部疼痛患者。患者針灸，安慰劑(假治療)，超音波，輕柔的動作或運動約20 – 30分鐘，每週2至3次，共 至6個星期。即使是小的研究，而不是最高的品質，這 Cochrane review提供了我們今日擁有最好的證據。什麼原因導致肩部疼痛以及如何針灸幫助患者？肩膀疼痛可能是由一些不同的情況造成的。它可能因肩旋轉肌疾病，肩周炎或粘黏性肩關節囊炎(冷凍肩)造成。肩部疼痛有時會自行消失，但也可能長達 12至18個月。藥物和非藥物治療可以緩解疼痛和/或腫脹。針灸是一種非藥物療法，越來越常用於治療肩部疼痛。據認為，針灸可以透過釋放人體的化學物質來減輕疼痛，通過重寫神經疼痛信號或允許能量(Qi)或血液在體內自由流動。目前還不知道針灸的效用或安全性。。針灸如何發揮作用？與接受假治療 2至4週相比，針灸改善疼痛和功能的效果大致相同。一項研究表明，針灸可改善功能勝過假治療 4週。但經過 個月，針灸的改善是大約一樣的，只是改善4% (量表為 0到100)。一個小型研究顯示，比起只是運動，針灸加運動在改善疼痛，關節活動度和功能長達 5個月的效果更好。安全性如何呢？副作用在許多研究都沒有測量。一項研究表明，副作用如頭昏，頭痛，頭暈，浮腫或腿部虛弱，針灸或假療法大約相同。什麼是底線？沒有足夠的證據來說明是否針灸治療肩痛是有用的或有害的。從目前少少的證據證明，針灸在短期內(2至4週)可以改善疼痛和功能。