The Acupuncture Trialists’ Collaboration: individual patient data meta-analysis of chronic pain trials

The purpose of clinical trials of acupuncture is to help clinicians and patients make decisions about treatment. But using acupuncture trials to aid clinical decisions is not straightforward. Take the case of a patient consulting an evidence-based physician for chronic low back pain and asking whether acupuncture might be of value. The doctor searches MEDLINE and, as of May 2009, finds 65 English-language randomised trials. Even if the doctor were to obtain copies of all of these trials, he or she would find that the results were inconsistent. Some report acupuncture to be superior to sham (placebo) acupuncture1 while others show evidence that acupuncture is superior to no treatment but not sham2 and still others conclude that acupuncture is no better than usual care.3

Clearly what is needed is a meta-analysis to synthesise the results from the different studies. Indeed, many meta-analyses of acupuncture for chronic pain have been published. These studies have tended to come to somewhat indeterminate conclusions, such as “there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo”.4 This appears to be because, until recently, acupuncture research was dominated by small trials of questionable quality.

The landscape of clinical acupuncture research has recently been dramatically altered by the publication of several large, high quality trials. These include the two NHS funded trials of acupuncture chronic headache disorders (n = 401)5 and back pain (n = 241)6 and the German Acupuncture Randomised Trials (ART) studies2 7 8 9 which randomised 300 patients each in four separate trials on osteoarthritis, chronic low back pain, migraine and chronic tension headache. But even these trials are dwarfed by the German Acupuncture (GERAC) trials which accrued close to 1000 patients each in trials …