Acupuncture for shoulder pain

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Abstract
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. To determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain. The Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL were searched from inception to December 2003, and reference lists from relevant trials were reviewed. 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. 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. 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 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. 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。 評估針灸治療肩部疼痛之效果及安全性。 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。 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。 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。 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。 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。 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。...