Author/Study Level of evidence Findings/Adverse effects 1. Itoh et al (2007) Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain 1+ Trigger Point acupuncture more effective for pain relief & improved Qualify Of Life compared to non-trigger point or sham acupuncture Trigger point acupuncture may be more effective on chronic neck pain in aged patients than standard acupuncture therapy Adverse effects – none reported 2. White et al (2004) Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a 1- Acupuncture was more effective than mock treatment for pain relief at short term follow up A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 10 randomized, controlled trial Mock treatment demonstrates some therapeutic effect The beneficial effects of acupuncture for pain may be due to both nonspecific and specific effects Adverse effects – none reported 3. Zhu et al (2002) A controlled trial on acupuncture for chronic neck pain 1+ Sham & Chinese medicine acupuncture are effective for pain relief & increasing activity level for up to 16 weeks post treatment Chinese Medicine acupuncture is more effective than Sham acupuncture Acupuncture not applicable to those with neurological or psychosocial signs present Adverse effects – none reported 4. He et al 2005 Effect of intensive acupuncture on pain-related social and psychological variables for women with chronic neck and shoulder pain - a randomized control trial with six month and three year follow up 1- Acupuncture more effective than sham for improving activity at work and social & psychological variables for women with chronic pain in the neck and shoulders The effect may last for at least 3 years Adverse effects – none reported 5. He et al (2004) Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3- year follow-up study 1+ Acupuncture treatment may have long term effect in reducing chronic pain in neck & shoulders & related headache Acupuncture is more effective than sham Sham acupuncture may have immediate pain relieving effect on chronic neck & shoulder pain Adverse effects – none reported A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 11 5. Fu et al (2009) Randomized controlled trials of acupuncture for neck pain: systematic review and metaanalysis 1++ Acupuncture provides short term pain relief in chronic neck pain Adverse effects – reported in 6 studies (8-33%) none resulted in serious complications 6. Trinh et al (2007) Acupuncture for neck disorders 1++ 1. Moderate evidence that acupuncture more effective for pain relief than some types of sham therapy post-treatment 2. Limited evidence that acupuncture significantly better than massage for pain relief at short term follow-up 3. Moderate evidence that acupuncture is more effective than inactive treatment for pain relief post treatment and at short term follow up 4. Moderate evidence that patients receiving acupuncture report less pain than those on a wait list control at short term follow up Adverse effects – reported in 4 studies, including increased pain, bruising & dizziness. None resulted in serious complication 3.3 Ankle The search returned no RCT’s or systematic reviews for the use of acupuncture in the treatment of ankle pain. At best 3 case studies28-30 relating the ankle area were returned. One of which reported on Achilles tendinopathy28, one on medial tibial stress syndrome29, and one on bilateral heel pain due to plantar fasciitis30. 3.4 Shoulder Shoulder pain is a common complaint among adults in the general population29 and may be due to rotator cuff disorders, adhesive capsulitis (‘frozen shoulder’) or osteoarthritis of the gleno-humeral joint30. It may also be caused by referred pain from the neck or thorax31. Many interventions are used for the treatment of shoulder pain, including non-steroidal antiinflammatory drugs (NSAIDs), steroid injections, laser, heat, ice, and surgical tendon repair31. According to Guerra de Hoyos (2004)31 et al, "though individual RCTs claim benefit, systematic reviews find little overall evidence of effectiveness". A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 12 With respect to shoulder pain, the best evidence comes from two RCTs30 31. One, a wellconducted pragmatic, multi-centre RCT30 showed that that acupuncture improved pain and mobility compared to sham acupuncture or conventional therapy for up to three months postintervention and the other31 that reported that acupuncture improved pain in a mixed population significantly more than ‘sham’ acupuncture. This is contrasted with the finding from a Cochrane review29 of nine RCTs that 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.” The other two** RCTs24 32 33 located for this report do not substantially change these conclusions as both have been assessed as having a high risk of bias. There is a similar pattern of evidence for the efficacy of acupuncture for treating frozen shoulder. A systematic review34 from 2011 which included 4 RCTs that used acupuncture as an intervention found moderate evidence from one small study that