Acupuncture
Limited evidence suggests no significant difference in patient pain and function outcomes between auricular or other acupuncture and sham.
Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery (2021)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: SOMOS, OTA

Rationale

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.