If research supporting the effectiveness of acupuncture isn't being incorporated into clinical practice and health policy, where does that leave the profession? Perhaps this will help: a new study published in the prestigious British Medical Journal that exposes the lack of adoption and makes recommendations for how the problem can be remedied.

L. Lu, et al., analyzed systematic reviews comparing acupuncture with no intervention, sham acupuncture, and other conventional medical interventions, identifying nearly 2,500 systematic reviews of acupuncture therapies published between 2000 and 2020. Acupuncture showed a moderate or large effect with moderate or high certainty evidence in eight diseases or conditions: improvement in functional communication of patients with post-stroke aphasia; relief of neck and shoulder pain; relief of myofascial pain; relief of fibromyalgia-related pain; relief of non-specific lower back pain; increased lactation success rate within 24 hours of delivery; reduction in the severity of vascular dementia symptoms; and improvement of allergic rhinitis nasal symptoms.

Problem #1

The research team discovered that "instead of endorsement in health policies and wide use in clinical practice, only a few healthcare systems incorporated acupuncture into clinical practice guidelines and national health coverage for these conditions."

Problem #2

Equally concerning, among "promising acupuncture therapies" (described by the authors as large effect supported by low-certainty evidence), "existing funding and research [endeavors] in these areas have ... increased little in the past decade." The analysis noted 22 conditions (such as depressive disorders, migraine and opioid use disorders) for which acupuncture therapies were classified as promising.

A Roadmap for Change

Lu and colleagues offer a set of recommendations to address the gap between the evidence base and mainstream adoption, including incorporating acupuncture evidence into decision-making within health systems; building a joint research production effort; digitizing and disseminating evidence on acupuncture to facilitate access; enabling the use of existing evidence in health system decision-making; and aligning knowledge gaps and research with funding priorities "Acupuncture funding and research need to focus on conditions for which acupuncture therapies have had substantial beneficial effects but for which evidence is of low certainty. A coordinated multistakeholder effort to generate acupuncture evidence and support its implementation will enable a more evidence based approach to practice and research."

Source

• Lu L, et al. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ, 2022;376:e067475. Full text available at www.bmj.com/content/376/bmj-2021-06747.

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