otherwise arising from the use of or reliance on this document. This document can be downloaded from the AACMA website. http://www.acupuncture.org.au. The Acupuncture Evidence Project © AACMA ii ABSTRACT Background The acupuncture evidence project investigated the state of the evidence regarding acupuncture, with the focus on systematic reviews and meta-analyses. The Australian Department of Veterans’ Affairs 2010 Alternative Therapies Review and United States Department of Veterans Affairs Acupuncture Evidence Map 2014 were used as baselines, then evidence levels were updated to reflect subsequent research. Methods A search of PubMed and Cochrane Library for systematic reviews and meta-analyses from March 2013 to September 2016 was conducted. Three reviews from October 2016 to January 2017 were also included. Evidence levels were graded using NHMRC levels. Risk of bias was assessed using the Cochrane GRADE system where possible. All results were displayed in tables to demonstrate changes in evidence level over time, as well as the current state of evidence by clinical area. Results Of the 122 conditions reviewed, evidence of effect was found at various levels for 117 conditions. Five conditions were assessed as ‘no evidence of effect’. The level of evidence had increased for 24 conditions since the previous reviews. The findings of this review are limited by the mounting evidence that sham/placebo controls used in acupuncture trials are not inert, which is likely to lead to a consistent underestimation of the true effect size of acupuncture interventions. Conclusions Systematic reviews published up to January 2017 indicate that acupuncture has a ‘positive effect’ on eight conditions (migraine prophylaxis, headache, chronic low back pain, allergic rhinitis, knee osteoarthritis, chemotherapy-induced nausea and vomiting, post-operative nausea and vomiting and post-operative pain), ‘potential positive effect’ on a further 38 conditions, ‘unclear/insufficient evidence’ for 71 conditions and ‘no evidence of effect’ for five conditions. Evidence of cost-effectiveness was identified for 10 conditions, and evidence for safety was identified for nine conditions. ADDENDUM TO REVISED EDITION The Acupuncture Evidence Project: A Comparative Literature Review was released in limited circulation in December 2016. New research is regularly being reported and there is always a risk that a significant paper might be published just after a review is completed. Just prior to general publication, the authors became aware of three new studies with findings that were relevant to the review’s results. As the objective of the review was to identify the state of acupuncture research, the authors decided to incorporate these late papers and amend the results accordingly, even though the new papers fell outside the initial search dates. These papers concerned chronic pain and assisted reproduction. The authors have decided to leave the table headers and narrative to reflect evidence levels to 2016. This is a more accurate reflection of the study’s results, as only one study has been included from 2017. The additional studies are clearly indicated in the tables. A plain English summary has been added to the Appendix in this revised edition. 17 January 2017 The Acupuncture Evidence Project © AACMA iii PREFACE Background Evidence of effectiveness underpins the validity of all health care interventions. Acupuncture has been practised for thousands of years; however, research into its effectiveness and cost effectiveness is in its relative infancy. The first significant attempt to identify the evidence validating the role of acupuncture was undertaken by the World Health Organization (WHO) in 1979 (1). WHO conducted a Delphi-like symposium in Beijing in 1979 where physicians from around the world identified 43 diseases which they believed acupuncture may benefit (1). The 1979 report was criticised because it was not based on clinical trials, rather the clinical experience of the participants (2). The US Department of Health and Human Services National Institutes of Health (NIH) released a consensus statement on acupuncture in 1997 (3). The statement identified the efficacy of acupuncture for adult postoperative and chemotherapy nausea and vomiting, and for postoperative dental pain. In addition, the statement found support for the use of acupuncture for a range other conditions and identified the need for further research (3). In 1996, WHO held a consultation on acupuncture in Cervia, Italy. At this meeting it was decided to review acupuncture again, this time focusing on the now-numerous controlled clinical trials. The result was a review of clinical trials up until early 1999 and culminated in ‘Acupuncture: review and analysis of controlled clinical trials’ published by WHO in 2002 (4). The report identified 28 conditions for which acupuncture was found to be effective, and nearly 100 others where there was a therapeutic effect (4). It was acknowledged at the time that there were problems with the methodology in some of the trials included in the review (4). Notwithstanding these limitations, the WHO report indicated a growing and convincing body of evidence indicating that there was more to acupuncture than the placebo effect (4). The Acupuncture Evidence Project Fourteen