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acupuncture plus exercise improved function in the short-term, and limited evidence from another study that electro-acupuncture improves pain and function. Finally, there was contradictory evidence from one systematic review35 for the efficacy of acupuncture in treating subacromial impingement syndrome. Another RCT36 did not find that steroid injection or acupuncture in addition to a home exercise programme were superior to each other in improving pain or function. Shoulder Author/Study Level of evidence Findings/Adverse effects Johansson 2011 Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care - a randomized clinical trial. 1- Neither treatment (steroid injection vs. acupuncture with home exercise programme) was superior in improving pain or function Molsberger 2010 German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - A pragmatic, controlled, patientblinded, multi-centre trial in an outpatient care environment 1+ Good evidence that acupuncture reduced pain and improved mobility significantly compared to sham acupuncture or conventional therapy at end of treatment and at 3 months followup Lathia 2009 Efficacy of acupuncture as a treatment for chronic shoulder pain. 1- Limited evidence from a small study of male veterans that both traditional and standardised acupuncture improve pain and disability significantly more than sham acupuncture Guerra de Hoyos 2004 Randomised trial of long term 1+ Moderate evidence that acupuncture compared to sham acupuncture significantly ** one RCT was published as two papers 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 13 effect of acupuncture for shoulder pain. improves shoulder pain He 2004/5 Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study. Effect of intensive acupuncture on pain-related social and psychological variables for women with chronic neck and shoulder pain - an RCT with six month and three year follow up 1- Unconvincing evidence from very small study that intensive acupuncture improves pain Favajee 2011 Frozen shoulder: the effectiveness of conservative and surgical interventions - systematic review. Studies included: Sun 2001; Lin 1994; Yuan 1995 (acupuncture only) 1+ Moderate evidence from one small study that acupuncture and exercise improves function in the short term. Limited evidence from one study that electroacupuncture improves pain and function in short term (4 weeks) The other two studies compared 'traditional acupuncture' with suprascapular nerve block and acupuncture 'according to Jing Luo' respectively†† Green 2005 Acupuncture for shoulder pain. Studies included: Berry 1980; Ceccherelli 2001; Dyson-Hudson 2001; Kleinhenz 1999; Lin 1994; Moore 1976; Romoli 2000; Sun 2001; Yuan 1995 1++ 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 Nyberg 2011 Limited evidence supports the use of conservative treatment interventions for pain and function in patients with subacromial impingement syndrome: Randomized control trials Studies included: Kleinhenz 1999 , Vas 2008, Johansson 1++ Contradictory evidence for the efficacy of acupuncture for treating subacromial impingement syndrome †† see Green 200537. Green S, et al. Acupuncture for shoulder pain. Cochrane Database Syst Rev 2005(2):CD005319. for more details 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 14 2005 (acupuncture only) 3.5 Knee The research located for the efficacy of acupuncture for knee pain was all for people with knee pain due to osteoarthritis. As this has little relevance in the ACC setting, a detailed analysis was not done. To summarise: a systematic review38 of 16 studies‡‡ concluded that sham controlled trials show statistically significant benefits, however these benefits are small, probably not clinically relevant, and are probably due to, at least partially, placebo effects. The evidence tables have been included in Appendix 3 for completeness.

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