The Acupuncture recommendation has been downgraded two levels because of inconsistent evidence.
Three high quality (Crawford 2019, Wetzel 2011, Usichenko 2007) papers focusing on auricular acupuncture were evaluated. One paper showed improved pain with acupuncture versus sham; a second paper showed decreased opioid consumption with acupuncture versus sham; a third paper showed no difference.
One high quality (Petersen 2018) and one moderate (Mikashima 2012) quality papers evaluated acupuncture on various body areas and showed no difference or improvement in pain. One paper showed improved function after acupuncture, but the other showed no difference or slight improvement with standard care.
One high quality (Chen 2015) paper combined auricular and acupuncture on the body and compared it against sham acupuncture. The results showed an improvement in pain and decreased opioid use with fewer side effects in the acupuncture group.
Benefits/Harms of Implementation
Overall, effect size is limited with these studies, however the low cost and risk to the patient of acupuncture weigh positively in considering use of this physical treatment.
Cost Effectiveness/Resource Utilization
Minimal cost and resource utilization, however acupuncture-trained professional would have to be hired/available.
Acceptability
May have some challenge gaining acceptability in Western medicine, however acupuncture is more widely acknowledged as a reasonable medical treatment than in prior decades.
Feasibility
Most patients would have no limitation in receiving this treatment, however feasibility may be limited by the number of skilled acupuncture professionals available.
Future Research
Increased studies comparing auricular with other body acupuncture, better examination of pain and opioid consumption after these interventions, better examination of functional scores and outcomes after this intervention.
- Chen, C. C., Yang, C. C., Hu, C. C., Shih, H. N., Chang, Y. H., Hsieh, P. H. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med 2015; 1: 31-6
- Crawford, P., Moss, D. A., Crawford, A. J., Sharon, D. J. Modified Battlefield Acupuncture Does Not Reduce Pain or Improve Quality of Life in Patients with Lower Extremity Surgery. Mil Med 2019; 0: 545-549
- Mikashima, Y., Takagi, T., Tomatsu, T., Horikoshi, M., Ikari, K., Momohara, S. Efficacy of acupuncture during post-acute phase of rehabilitation after total knee arthroplasty. J Tradit Chin Med 2012; 4: 545-8
- Petersen, T., Hautopp, H., Duus, B., Juhl, C. No Effect of Acupuncture as Adjunctive Therapy for Patients with Total Knee Replacement: A Randomized Controlled Trial. Pain Med 2018; 6: 1280-1289
- Usichenko, T. I., Kuchling, S., Witstruck, T., Pavlovic, D., Zach, M., Hofer, A., Merk, H., Lehmann, C., Wendt, M. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. Cmaj 2007; 2: 179-83
- Wetzel, B., Pavlovic, D., Kuse, R., Gibb, A., Merk, H., Lehmann, C., Wendt, M., Usichenko, T. I. The effect of auricular acupuncture on fentanyl requirement during hip arthroplasty: a randomized controlled trial. Clin J Pain 2011; 3: 262-7