Vickers at al included some back pain and neck pain studies but was limited to chronic pain (defined as the current episode of pain being of at least 4 weeks’ duration), a pooled result was only given for a combined back and neck pain analysis, and indication-specific effects or the individual size of the treatment effect are not known. Acupuncture effects on analgesia during surgery were reviewed by Lee and Ernst in 2005; the review included 19 RCTs and the evidence was judged to be inconclusive. Two systematic reviews on postoperative pain were published in 2008. The study selection was not identical across reviews and there were inconsistent results across included studies; one of the review concluded the evidence that auricular acupuncture reduces postoperative pain is promising but not compelling.123 Fibromyalgia has been addressed in 12 RCTs according to one of 3 recent systematic reviews; effectiveness results are inconsistent within and across reviews. Results regarding shoulder pain are also inconclusive. A 2012 review on shoulder pain after stroke included 3 relevant acupuncture RCTs but did not report a pooled treatment effect estimate; a Cochrane review on shoulder pain, last updated in 2005, identified 9 RCTs with varying results and concluded that due to a small number of clinical and methodological diverse trials, little can be concluded from the review.167,207 The evidence base for rheumatoid arthritis is also unclear Evidence Map of Acupuncture Evidence-based Synthesis Program 14 and insufficient data were reported to determine the effectiveness across reviews and included trials. A Cochrane review last updated in 2005 highlighted that conclusions are limited by methodological considerations such as the type of acupuncture, the site of intervention, the small number of clinical trials, and the small sample size of the included studies.165 A single review on carpal tunnel syndrome was identified that included 6 RCTs. The review did not find statistically significant differences in 2 sham controlled RCTs and conflicting results across outcomes for acupuncture as an add-on treatment in a further RCT. In addition, a small number of reviews were identified that could not be incorporated in the bubble plot. They addressed primarily the comparative effectiveness of acupuncture in relation to other treatments. The reviews reported that acupuncture was more effective than conventional pharmacological therapies in the treatment of gouty arthritis35 and neurovascular headache (although this is based on a very limited number of studies),69 more effective than Chinese herbal medicine for endometriosis,65 but no more effective than pharmacological sedation for egg retrieval during assisted reproductive therapy173 and of similar efficacy as carbamazepine for trigeminal neuralgia in the existing low-quality studies.181 One systematic review on myofascial trigger point pain reported positive results. However, the number of traditional acupuncture trials, rather than trials on dry needling inserted directly into the trigger points, supporting the result was not reported. A systematic review on acupuncture or acupoint injection for management of burning mouth syndrome180 found injections to be superior to laser acupuncture; no passive controlled acupuncture RCTs were identified. Evidence Map of Acupuncture Evidence-based Synthesis Program 15 EVIDENCE MAP OF ACUPUNCTURE FOR WELLNESS The results for Wellness-relevant indications and outcomes are presented in the bubble plot and text summary below. The bubble plot represents 43 systematic reviews and 3 recent large RCTs not yet incorporated in existing reviews summarizing effects for 20 distinct clinical indications relevant to Wellness [search date: March 2013]. Legend: The bubble plot shows an estimate of the evidence base for wellness-related indications judging from systematic reviews and recent large trials. The plot shows the estimated size of the literature (y-axis, number of RCTs included in largest review), the estimated effect (x-axis), and the confidence in the estimate (bubble size). Evidence Map of Acupuncture Evidence-based Synthesis Program 16 The figure provides a visual overview of the evidence base of acupuncture for wellness indications. The bubble plot depicts the estimated research volume based on the number of acupuncture RCTs included in the largest review for each of the differentiated clinical areas, the estimated treatment effect compared to passive control, and the confidence in the effect estimate, judging from published systematic reviews. Effect size estimates of the treatment effect based on specific individual reviews, as well as reason for classifying the evidence base as inconclusive, are reported in the narrative synthesis. The evidence map used the clinical topics as addressed in existing reviews and individual research studies may have contributed to a number of included reviews and clinical indications. All 3 depicted dimensions (literature size, effect, and confidence) are estimates and can only provide a broad overview of the evidence base. EXECUTIVE SUMMARY: WELLNESS As shown in the bubble plot, the largest research area was the indication insomnia. We identified 7 recent systematic reviews by independent author groups; the largest review, published in 2009, included