Acupuncture for postherpetic neuralgia Systematic review and meta-analysis

Background: Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN. Methods: The Cochrane Skin Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the gray literature were searched. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture, or comparing acupuncture with another active therapy versus the same active therapy were included. Results: Seven RCTs comparing acupuncture versus pharmacologic therapy were included. Meta-analysis was conducted for acupuncture's effect on PHN evaluating by pain intensity. Results from 2 RCTs showed that compared with pharmacologic therapy, acupuncture was better in decreasing the pain intensity measured by visual analog scale score (mean difference: 1.80, 95% confidence interval 1.72-1.87; P<.001). The limitations of the study are as follows: only trials comparing acupuncture versus pharmacologic therapy were included and all of the included trials were performed in China. Conclusion: There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.