Several acupuncture therapies, in particular the integration of catgut with acupuncture points (ACE), auricular acupuncture plus manual acupuncture (AP + MA) and electroacupuncture plus the application of acupuncture points ( EA + APA) may benefit patients with primary insomnia (PI), according to a recent meta-analysis. 1
With moderate to low-certainty evidence, researchers found better effects on Pittsburgh Sleep Quality Index (PSQI) scores for patients treated with acupuncture compared to those on usual treatment. Additionally, with low or very low certainty of evidence, there were small or insignificant differences between the different therapies assessed.
In the final analysis, lead author Long Ge, PhD, researcher, Institute of Health Data Science, Lanzhou University, and colleagues included 57 randomized clinical trials (RCTs) involving 4678 participants with a mean age range of 31 to 70 years old. A total of 14 acupuncture therapies and 2 control treatments – usual treatment and sham acupuncture – were evaluated, with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system used to assess the certainty of the evidence and interpret the results .
On the PSQI, ACE was found to be the most effective acupuncture therapy compared to usual treatment among people with high or moderate certainty evidence. For others, such as Head Penetration Needling (HPN), ACE+MA, Plum Blossom Needle (PBN)+MA, ACE+AP, and MA, these approaches were inferior to acupuncture therapies. the most effective but superior to the less effective.
The effective rate, assessed in 39 RCTs, was significantly improved in patients who underwent CEA, CEA + MA, MA, AP + MA, PNH and PBN + MA, compared to those on usual treatment, although the certainty of the evidence is moderate. With low certainty, the evidence showed that EA and EA + APA were better than treatment as usual. No significant difference was found between acupuncture therapies.
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“We found that EA + APA is better than IN, AP, EA, PBN, BA, sham acupuncture and usual treatment. EA could better control stimulation intensity through extremely thin electrodes and could be a wider range of applications in the future,” Ge et al wrote. “Limited evidence suggests that, compared to treatment as usual, BA makes no difference in improving the effective rate and PSQI score. BA may not be considered a treatment strategy for primary insomnia until until more high-quality studies are available to demonstrate its effectiveness.”
The traditional Chinese medicine syndrome score, another secondary outcome, was improved in the AP + MA groups (mean difference, 6.57; 95% CI, 0.19-13.17) and ACE + MA ( mean difference, 5.87; 95% CI, 0.69-11.34) with moderate certainty compared to placebo. The Epworth Sleepiness Scale, recorded in 3 RCTs, showed significantly better benefit in the AP + MA (mean difference, 2.99; 95% CI, 1.18-4.80) and needle needle groups. fire (mean difference, 1.20; 95% CI, 0.07-2.33) compared to MA.
The Athens Insomnia Scale (AIS) was reported in 4 RCTs, involving 406 participants and 1 acupuncture therapy. With low certainty, AM was significantly more effective (mean difference, 3.36; 95% CI, 0.81-6.31) compared to treatment as usual. The only difference in reduction in recidivism rates, observed in 5 RCTs, was between ACE + AP and AP (RR, 0.23; 95% CI, 0.07-0.80). No significant differences were found among the other comparisons.
Due to sparse data and heterogeneity, the investigators did not perform a meta-analysis of adverse events (AEs); however, they summarized the incidence of what was observed among a larger cohort of 22 RCTs recruiting 3382 participants. Of these, the most common AEs of acupuncture procedures included hematoma, pain, headache, and bleeding. No serious AEs related to acupuncture were observed, leaving study investigators to conclude that “the safety of acupuncture is reliable.”
1. Lu Y, Zhu H, Wang Q, et al. Comparative efficacy of several acupuncture therapies for primary insomnia: a systematic review and network meta-analysis of a randomized trial. Sleep Med. 2022;93:39-48. doi:10.1016/sleep.2022.03.012