Thirty two trials (n=3,910) were included in the review: 30 RCTs and two CCTs. Methodological quality was generally considered to be low, with six trials considered average quality and 26 low quality. Follow-up ranged from less than six months to over one year.
Acupuncture versus control (21 trials): Results were conflicting. One small methodologically sound trial suggested that acupuncture was significantly more effective than placebo acupuncture (WMD -0.57, 95% CI -0.76 to -0.38, p < 0.00001), standard control (p<0.04) and waiting visit control (p<0.00001) for analgesics use. Pain scores also showed a significant effect in favour of acupuncture compared to each control (p<0.00001 in each case). One trial found a favourable result for acupuncture compared to ibuprofen for pain relief; 18 studies used other analgesics as controls: nine trials showed no significant difference between the groups and one found no difference between acupuncture and psychotherapy.
Acupressure versus control (seven trials): Two studies found acupressure was better than placebo for pain relief (WMD -0.91, 95% CI -1.78 to 0.04 and WMD -1.48, 95% CI -2.25 to 0.71); one study found no difference compared to placebo or ibuprofen. Three trials found acupressure was superior to indomethacin or somedon. One trial found no differences between acupressure and Chinese herbal medicine.
Moxibustion versus control (three trials): Two trials found that moxibustion was significantly better than analgesic drugs for pain relief (RR 1.20, 95% CI 1.06 to 1.36 and RR 1.23, 95% CI 1.03 to 1.47); one trial found no difference.
Acupoint injection versus control (one trial): The single trial found that acupoint injection was significantly better than ibuprofen for pain relief (RR 1.34, 95% CI 1.10 to 1.64).