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significantly reduce pain intensity, to improve functional mobility and quality of life (53). Subgroup analysis showed greater reduction in pain intensity when treatment lasted for more than four weeks (53). The reviewers concluded that ‘current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis’ (53). 2.5 Allergic rhinitis (seasonal and perennial/persistent) [Positive effect] For allergic rhinitis, acupuncture was rated as ‘effective’ in the Australian DVA review (2010) and ‘unclear’ in the USVA Evidence map of acupuncture (2014) (5, 6). A systematic review of 13 randomised controlled trials concluded that ‘acupuncture could be a safe and valid treatment option for allergic rhinitis’ (moderate quality evidence) (54). Another systematic review (which included two large multi-centre randomised controlled trials, three comparisons of acupuncture versus medication and one cost-effectiveness study) concluded that there is high quality evidence of the efficacy and effectiveness of acupuncture and that it appears to be safe and cost-effective (15). Clinical practice guidelines for allergic rhinitis published by the Otolaryngology Head Neck Surgery Foundation in 2015 included acupuncture as Option five: ‘Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacological therapy’ (Aggregate evidence quality - Grade B) (37). 2.6 Chemotherapy-induced nausea and vomiting (CINV) [Positive effect] For chemotherapy-induced nausea and vomiting, acupuncture was rated as ‘effective’ in the Australian DVA review (2010) and was not reviewed separately to ‘cancer adverse effects’ in the USVA Evidence map of acupuncture (2014) (5, 6). In 2013, a systematic review of seven acupuncture and six acupressure RCTs found that acupuncture reduced the frequency of acute vomiting and the dose of rescue medication but did not reduce acute nausea severity or frequency compared to control. Acupressure showed a decrease in frequency of nausea but not acute vomiting or delayed symptoms. All studies used state-of-the-art combination anti-emetics in addition to acupuncture/acupressure. The reviewers rated the quality of evidence in the acupuncture studies as low to moderate while the acupressure studies were moderate to high quality. There was insufficient evidence to draw firm conclusions due to underpowered studies The Acupuncture Evidence Project © AACMA 9 (21). However, an updated systematic review by Garcia et al in 2014 (using 18 new RCTs) found that acupuncture is an appropriate referral option for chemotherapy-induced nausea and vomiting (55). On this basis, CINV has been rated as positive rather than potential positive in this review. 2.7 Post-operative nausea and vomiting (PONV) [Positive effect] For post-operative nausea and vomiting (PONV), acupuncture was rated as ‘insufficient evidence’ in the Australian DVA review (2010) and ‘potential positive effect’ in the USVA Evidence map of acupuncture (2014) (5, 6). In a systematic review and meta-analysis of 30 RCTs on acupuncture and acupressure in 2013, both acupuncture and acupressure reduced the number of cases of early nausea and vomiting (up to 24 hours post-surgery) (56). In 2015, a Cochrane update of 59 RCTs on PC6 stimulation found that PC6 stimulation was superior to sham, and equivalent to modern anti-emetics (16). 2.8 Post-operative pain [Positive effect] For post-operative pain, acupuncture was not reviewed in the Australian DVA review (2010) and rated as ‘unclear’ in the USVA Evidence map of acupuncture.

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