Background Evidence mapping presents the current status of evidence on a specific field. The "Evidence Map of Acupuncture" published in 2014 gave an overall picture of the evidence on acupuncture treatments for various conditions/diseases. In this study, evidence in 2024 for the effect of acupuncture was reassessed.
Methods The systematic reviews (SRs) on acupuncture for the 43 conditions/diseases where evidence was previously unclear or potentially effective in the "Evidence Map of Acupuncture" 2014 were searched in the PubMed and the Cochrane Library, and included SRs up to February, 2024. The Grading of Recommendations, Assessment, Development, and Evaluations assessment in the included SRs was used for assessing the confidence level in the evidence of each condition.
Results When compared with the results of the "Evidence Map of Acupuncture" 2014, the average number of randomized controlled trials included in a SR increased from 11 to 19.5 by 2024. However, the confidence level showed an overall decrease. The reasons for unclear evidence were mainly methodological limitations such as poor research design, small sample size and small number of studies, and the results of the 2024 reassessment did not show a significant difference in the reasons compared with the "Evidence Map of Acupuncture" 2014.
Discussion To improve clinical evidence for acupuncture, simple repetition and increasing the number of new randomized controlled trials does not seem to be effective. To reduce redundancy, large scaled studies should be conducted, and a new critical appraisal tool for acupuncture is needed to avoid unfair evaluation of risk of bias in acupuncture research.
This letter discusses concerns in a currently published meta-epidemiological study on commonly observed large effect sizes in the Chinese literature, focusing on potential selection bias and analysis methods. Researchers should be cautious when conducting systematic reviews that include the literature from specific countries or regions. Regardless of the country, the key issue is to enhance future research quality.
The potential use of acupuncture for shoulder pain of various etiologies and whether clinicians make recommendations about the use of acupuncture was examined. Shoulder pain is a common clinical problem. What is the level of evidence and how often is acupuncture recommended for shoulder pain? A manual and database (PubMed) search of review articles of related clinical trials and guidelines was performed. The evidence for effectiveness of acupuncture treatment of different types of shoulder pain was weak. However, there are some studies, with a weak to moderate level of evidence, on shoulder pain (across nine subtypes of shoulder pain). Acupuncture is safe and may be a cost-effective treatment for shoulder pain. There were 131 statements recommending the use of acupuncture for shoulder pain across 12 subtypes of shoulder pain. The most common statements were for non-specific ‘shoulder pain.’ There were 11 statements against the use of acupuncture for shoulder pain and three subtypes of shoulder pain. The level of evidence in studies of acupuncture treatment for shoulder pain is low, therefore, further research is needed. Recommendations for the use of acupuncture for shoulder pain are increasing but lag behind those for other pain problems such as low back pain.
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