clinically relevant but could be associated with expectation or placebo effects.97 A recent RCT206 not yet included in the existing systematic reviews and one of the largest available studies on acupuncture and osteoarthritis (N=527) reported no statistically significant differences between acupuncture and sham, but a reanalysis combining the largest review and this trial showed that the pooled treatment effect would remain positive if included in an updated meta-analysis. The IPD metaanalysis on chronic pain47 included 9 osteoarthritis RCTs. Acupuncture for pain management regardless of the underlying conditions has been addressed in some of the identified reviews; the largest review on auriculotherapy for pain management included 17 RCTs.78 The review reported auriculotherapy was superior to controls for studies evaluating pain intensity (standardized mean difference [SMD] 1.56, 95% CI: 0.85, 2.26) but concluded that a more accurate estimate of the effect requires further large, well-designed trials. A 2009 systematic review on acupuncture for pain treatment published in the BMJ concluded that a small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias.119 A 2013 review on acupuncture for ankle sprain included 17 RCTs.30 The review found that significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture (RR 0.56, 95% CI: 0.42, 0.77), but the review was primarily based on non-indexed publications, trial quality was poor, no sham controlled RCT was identified, and the review concluded that given methodological shortcomings and the small number of high-quality primary studies, the available evidence is insufficient to recommend acupuncture as an evidence-based treatment option. Cancer-associated pain has been addressed in 15 RCTs according to the largest recent review.59 A 2012 Cochrane review identified one relevant RCT that showed statistically significant differences between the acupuncture and placebo groups but the review concluded there is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.73 Labor pain has also been addressed in a number of primary studies; a 2010 review included 10 RCTs.85 A 2011 Cochrane review reported less intense pain from acupuncture compared with no intervention (SMD -1.00, 95% CI: -1.33, -.067) and positive effects for other outcomes and comparators; however, all comparisons were based on one RCT each and the review concluded acupuncture may have a role in relieving pain during labor but more research is needed.67 Evidence Map of Acupuncture Evidence-based Synthesis Program 13 Positive effects were also reported for other clinical indications; however the evidence base was considerably smaller. A review on prostatitis / chronic pelvic pain syndrome included 9 acupuncture RCTs in total and reported a positive effect of acupuncture compared to sham (RR 1.56, 95% CI: 1.09, 2.24); however this result was based on one RCT only.71 The largest of 4 recent reviews on temporomandibular joint disorders included 7 RCTs in total.195 The review reported significant improvements in pain intensity for a visual analogue scale (weighted mean difference [WMD] -12.6, 95% CI: -21.2, -6.1) but concluded that further rigorous studies are required to establish beyond doubt whether acupuncture has therapeutic value for this indication. A review on acupuncture for plantar heel pain included 5 RCTs and the passive controlled RCTs reported statistically significant positive results for pain outcomes, but only 2 RCTs were classified as high quality and no pooled result was presented to determine the size of the treatment effect.44 A review specific to pregnancy-associated pelvic and back pain included 3 RCTs in total and both acupuncture as add-on treatment RCTs reported statistically significant results. However, no pooled effect was presented to estimate the size of the treatment effect.143 Acupuncture for the treatment of back pain has received a great deal of research attention but the evidence base regarding the effectiveness of acupuncture remains unclear judging from the available systematic reviews. We identified 10 recent systematic reviews on acupuncture for back pain and the largest review, a review on the efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine published by Furlan et al in 2012, included 33 acupuncture RCTs.62 The review showed a positive effect of acupuncture compared to no treatment but noted that sham-acupuncture controlled trials tended towards statistically nonsignificant results. A 2005 evidence synthesis on low back pain within the framework of the Cochrane Collaboration concluded that the data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain.170 It is noteworthy that the IPD metaanalysis (see above) on chronic pain which concluded that acupuncture is effective for treating chronic pain also included 10 back pain studies. The largest review on neck pain is the review by Furlan et al. 62 published in 2012; it includes 24 acupuncture RCTs. The review came to the same conclusion as for back pain while 2 smaller reviews reported favorable results for acupuncture. The IPD meta-analysis by