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Review Article
Shoulder Pain and the Potential Role of Acupuncture: A Narrative Review of Clinical Practice and Treatment Guidelines
Stephen Birch1,*orcid, Myeong Soo Lee2orcid, Tae-Hun Kim3orcid, Terje Alraek1,4orcid
Perspectives on Integrative Medicine 2022;1(1):3-9.
DOI: https://doi.org/10.56986/pim.2022.09.002
Published online: September 30, 2022
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1School of Health Sciences, Kristiania University College, Oslo, Norway

2Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea

3Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea

4Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT, The Arctic University of Norway Tromso, Norway

*Corresponding author: Stephen Birch, School of Health Sciences, Kristiania University College, Oslo, Norway, E-mail: sjbirch@gmail.com
• Received: June 4, 2022   • Revised: August 9, 2022   • Accepted: August 11, 2022

©2022 Jaseng Medical Foundation.

This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

  • 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.
Shoulder pain is a relatively common problem that patients present with in clinical practice [1]. While estimates of the number of cases of shoulder pain vary considerably [2], few studies examining the prevalence have been conducted [3]. Shoulder pain has been reported to be the third most common musculoskeletal problem in general practice and it accounts for around 1% of all consultations [1,4,5]. Of the consultations for musculoskeletal pain, 16% are for shoulder pain [1,6]. The cumulative incidence in the age group 45–64 was 2.4% [3], and a lifetime prevalence was estimated as 70% [5]. Furthermore, females and the elderly are at higher risk of shoulder pain [1,2,4,6].
Shoulder pain can develop following injury or stroke but it more commonly occurs during daily activities such as athletic injuries, machine handling, and overhead lifting. In general practice, the four most common causes of shoulder pain are rotator cuff disorders (including injuries, and bursitis), glenohumeral disorders (including adhesive capsulitis and arthritis), acromioclavicular joint disease (including injuries, and osteoarthritis), and pain referred from the neck [1,5,7]. Other forms of shoulder pain include intrinsic or extrinsic instability, cancer pain [7], and post-stroke pain [8].
Once the case has been triaged, early treatment commonly includes referral for physiotherapy [9]. Surgery is an option for some shoulder problems, but is usually only offered when conservative treatments have been tried and failed [1]. As with other pain problems, active treatments such as exercise are encouraged, but pain control is necessary. Inadequate pain management reduces compliance with the active treatments [10]. Exercise and stretching are recommended but it has been reported that the evidence for them is not strong, and usually exercise and stretching comes with the recommendation to use over the counter analgesics [1,4]. Other therapies such as acupuncture have been recommended because, “Acupuncture can reduce pain, allowing the patient to participate in exercise therapy” [10].
The recent clinical practice guideline (CPG) from the UK National Institute of Health and Care Excellence (NICE) for chronic pain reported that most forms of pharmacological intervention were not very effective and/or have significant adverse effect profiles [11], thus, only anti-depressant medications are now recommended, and non-pharmacological therapies such as exercise, cognitive behavioral therapy, and acupuncture are the primary treatments recommended for chronic pain in patients who are 16 years and older [11]. Furthermore, acupuncture may be helpful for more acute pain conditions including postoperative pain [12]. Acupuncture is also recommended for treatment of acute pain in adults [13] and children in Australia [14]. The New Zealand Government group, the Accident Compensation Corporation, recommended acupuncture for adhesive capsulitis as early as 2004 [15] despite the paucity of evidence for acupuncture in shoulder pain [16].
What is the evidence for efficacy in acupuncture treatment for shoulder pain and how often have experts applied that evidence and made recommendations about acupuncture for shoulder pain? This brief narrative review will present an overview of current evidence for acupuncture in the treatment of shoulder pain, and a summary of current findings regarding recommendations for or against the use of acupuncture in the treatment of shoulder pain.
Recommendations are made in two forms of publication. The first, the CPG is a formal document that follows scientifically established rules for collecting, evaluating, and judging evidence for therapies for a particular condition. CPGs also tend to be more technical and published in specialized websites or medical journals. Treatment guidelines (TGs) are less formal publications aimed at increasing accessibility to patients. They are less technical, simpler, and written using lay language [17]. The primary purpose of the TG is to inform the patient (with minimal inclusion of technical evidence or terminology) for the purposes of increasing implementation of treatment recommendations.
The search for review articles of acupuncture treatment of shoulder pain was conducted manually and electronically (PubMed on April 22, 2022) using the terms ‘shoulder pain,’ ‘acupuncture’ and ‘review.’ Reviews of shoulder pain conditions and levels of evidence for each are summarized narratively. The first author has been searching for CPGs and TGs since 2013, building a data base of these publications. The search methods are described elsewhere [17] and elaborated in the supplemntary file.
Several articles have been published from this data base presenting overviews of findings for the recommendation of use for acupuncture in general [17], back pain [18], overall health [19], oncology [20], palliative care [21], chronic pain [22], and post-stroke care [23]. The library created had more than 3,500 publications making almost 9,000 recommendations, covering over 500 different symptoms including shoulder pain, adhesive capsulitis, rotator cuff injury, and impingement syndrome.
1. Clinical evidence
Some reviews have reported that studies on acupuncture for shoulder pain have provided a very low level of evidence [2426] for adhesive capsulitis [27,28], rotator cuff disorder [24,29], shoulder pain [30,31], subacromial pain [32], and subacromial impingement syndrome [28,33]. Other reviews have reported a low level of evidence across a range of shoulder pain conditions. In some reviews acupuncture has been reported to be effective compared with sham acupuncture for shoulder pain [3436]. In other reviews, acupuncture has been reported to be effective for shoulder pain [28,3440], shoulder-hand syndrome [41,43], shoulder impingement syndrome [39,44,45], rotator-cuff pathology [46], shoulder injuries [39,47], subacromial shoulder pain [48,49], adhesive capsulitis [46,5052], pain of humeral fractures [53], post-stroke shoulder pain [8,39,54], and post-stroke shoulder-hand syndrome [55]. A review by MacPherson et al reported that the effects of acupuncture including sham acupuncture-controlled trials persisted up to one year after treatment [56].
2. Safety and cost-effectiveness
Over the decades, acupuncture has been described as a safe therapy when in the hands of qualified practitioners [16,46,5763]. While the literature search did not retrieve specific studies on the cost-effectiveness of acupuncture in shoulder pain, one study of dry needling reported the cost-effectiveness of treatment (for subacromial pain syndrome) [64]. However, the findings of cost-effectiveness for acupuncture treatment for pain in the neck, back, knee (OA pain), and head [65,66] may imply that acupuncture treatment for chronic shoulder pain could be cost effective, but this needs to be studied. For a therapy to be considered for inclusion in CPGs/TGs, a therapy is required to be safe, show evidence of effectiveness, and cost-effectiveness [17].
3. Recommendations
Many groups have recommended the use of acupuncture as an adjunctive treatment to help with shoulder pain. The number of times acupuncture was recommended for each type of pain problem, and the range of years in which these recommendations were made are listed in Table 1. Only publications that specified the shoulder or shoulder structures were included, thus publications recommending acupuncture for conditions such as ‘joint pain,’ ‘arthritis pain,’ ‘osteoarthritis pain,’ ‘rheumatic pain,’ ‘rheumatoid arthritis,’ ‘chronic pain,’ ‘acute pain,’ neck pain,’ ‘pain management,’ ‘stroke rehab,’ have not been included. Several groups have recommended against the use of acupuncture due to inadequate studies or a weak level of evidence for shoulder pain (5 negative recommendations), adhesive capsulitis (2 negative recommendations), rotator cuff impingement (1 negative recommendation) and stroke related shoulder pain (3 negative recommendations; Table 1). Four of the recommendations against acupuncture for shoulder pain came from the US insurance company AETNA, which updates its statements about acupuncture regularly [67]. The number of positive recommendations over time are shown in Table 2. CPGs and TGs have made recommendations for the use of acupuncture as a treatment option for various forms of shoulder pain (Table 3) [6874].
This review reports relatively weak, but emergent positive evidence that acupuncture may be effective for shoulder pain resulting from a variety of causes. Safety, efficacy, and cost-effectiveness of acupuncture allows guideline development groups to examine the potential use of acupuncture for the treatment of shoulder pain. The literature search in this review revealed 131 CPGs and TGs recommendations to use acupuncture for shoulder pain (in general and 12 subtypes of shoulder pain). There were 11 recommendations against the use of acupuncture for shoulder pain (in general and three subtypes of shoulder pain). Recommendations for acupuncture treatment of nonspecific ‘shoulder pain’ were the most common, and most recommendations were TGs rather than CPGs, of which most came from the UK, USA, Australia, and New Zealand.
Recommendations to use acupuncture for shoulder pain have increased over time and appear to follow evidence-based publications. The Cochrane review of acupuncture for shoulder pain in 2005 drew the first tentative positive conclusions for the use of acupuncture [37]. Since then, there has been an increase in the number of publications (2008–2011; Table 2). The next major publication on the use acupuncture for shoulder pain, was a high-quality meta-analysis with large sample sizes based on individual patient data (which is considered the gold-standard of evidence synthesis), drew positive conclusions about the use of acupuncture in chronic shoulder pain in 2012 [34], and is followed by a clear increase in the number of publications recommending acupuncture seen in the years between 2014–2021 (Table 2). To provide a more precise answer about the relationship between evidence and recommendations, a more formal study exploring the quality of CPGs on acupuncture for shoulder pain, and the degree to which they follow the emerging evidence is needed. This remains a problem in general CPG development [75] but may be better addressed in guidelines that recommend acupuncture [76]. As discussed above, NICE determined that the treatment of chronic pain conditions with pharmacological treatments was ineffective and led to the removal of almost all the usual medicinal drugs. Acupuncture is now recommended by NICE as a primary treatment for chronic pain, despite moderate to weak evidence, acupuncture treatment of chronic pain has a good safety record [11]. Clinicians that develop treatment guidelines weigh the benefits and risks of each therapy and compare treatments with each other, which allows recommendations to be made for a therapy, even when its evidence is not strong. Compared with back pain, the evidence for acupuncture treatment of shoulder pain is not as strong and is not as consistent, hence we see less CPGs for acupuncture treatment of shoulder pain than we do for back pain [18]. For example, NICE recommends acupuncture for non-specific chronic back pain and headaches [11,77], as does the German CPG publication group the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF) [78,79]. However, neither group recommend acupuncture for shoulder pain of any etiology, presumably because of the paucity of evidence. While evidence has recently emerged about the underutilization of acupuncture in guidelines and health policy due to insufficient application of the evidence for use of acupuncture [80], this current review reveals that this may not have occurred with regards recommending acupuncture for shoulder pain since the evidence is generally relatively low.
This study has several limitations. Evidence from clinical trials includes studies that did not clearly specify, identify, or separate the nature of the pathology that caused shoulder pain. Thus, there has been a tendency to generalize conditions with different and diverse pathologies. A systematic literature search of a range of electronic databases worldwide was not employed to find evidence for effectiveness of acupuncture, and important evidence may have been overlooked. However, recommendations to use acupuncture for shoulder pain are sometimes made even though the evidence is weak, so we determined that this was not a major limitation, especially considering the variability in how evidence is interpreted and used. There have been significant problems with trials that compare acupuncture to ‘sham acupuncture’ because the effectiveness of acupuncture may be underestimated and bias may be created against acupuncture [8183]. Different review groups address evidence from sham-controlled studies in different ways.
The search performed to retrieve publications that make recommendations about acupuncture did not employ a systematic search of electronic databases and therefore may have missed publications for and against recommending acupuncture treatment for pain. The search for publications was performed primarily in English, which may have limited the search, thus, the possibility of recommendations for acupuncture treatment for shoulder pain in other languages cannot be excluded. In addition, the number of recommendations reviewed in this study included publications that update over time and republish, so may have been counted several times. It also includes publications, that are less formal than CPGs, which are relevant in informing patients about treatment options. Low adherence to recommendations in CPGs resulting from poor implementation is not uncommon [8486]. Suggestions to improve implementation include “Development of tools to aid communication with patients” [85]. Such tools include summaries with lay language for the patient, many of these are what we have called ‘treatment guidelines,’ (TGs) [17]. While more numerous and less scientific than CPGs, TGs mostly follow the evidence, and hopefully lead to an increased implementation of related CPG recommendations. However, formal studies need to be performed to explore this.
The shoulder is a complex joint where many possible types and causes of shoulder pain can occur. An important component of treatment is exercise to recondition the shoulder. However, pain can limit these activities, hence, pain control is an important component of treatment. The most common approach is use of analgesic medications such as NSAIDs, though, non-pharmacological interventions for pain control are increasingly being recommended. This is because of the potential risks of medication use for chronic conditions, and because of the need to engage patients more in their own treatment process (for example engaging in therapeutic exercise). Within the range of available treatments for pain, acupuncture has emerged as a good candidate for a number of chronic pain problems, and may be a treatment option for shoulder pain.
Supplementary material is available at doi: https://doi.org/10.56986/pim.2022.09.002.

Author Contributions

Conceptualization: SB, and MSL. Methodology: SB, MSL, TA, and THK. Formal investigation: SB. Data analysis: SB, and TA. Writing original draft: SB. Writing - review and editing: SB, MSL, TA, and THK.

Conflicts of Interest

The authors declare that they have no competing interests.

Funding

None.

Ethical Statements

This research did not involve any human or animal experiments

Data Availability

All relevant data are included in this manuscript.

Table 1
Shoulder Pain Symptoms, Recommendations for Acupuncture, and Years of Publication.
Symptom No. positive recommendations Publication period No. negative recommendations
Shoulder pain 61 2004–2022 5 (2014–2021)
Adhesive capsulitis 18 2004–2020 2 (2015–2021)
Rotator cuff syndrome 12 2006–2020
Shoulder osteoarthritis 9 2011–2020
Bursitis 11 2010–2022
Shoulder injury 7 2006–2015
Myofascial shoulder pain 4 2011–2017
Shoulder impingement 2 2015–2020 1 (2015)
Periarthritis of shoulder 1 2021
Rotator cuff injuries 1 2021
Shoulder post-operative pain 1 2011
Stroke related shoulder pain 3 2013–2018 3 (2010–2017)
Stroke shoulder-hand syndrome 1 2020
Table 2
The Number Positive Recommendations for Acupuncture Treatment by Year.
2004–5 2006–7 2008–9 2010–11 2012–13 2014–15 2016–17 2018–19 2020–21 2022
4 6 11 13 5 26 21 23 20 2
Table 3
Examples of CPGs and TGs that Recommend the Use of Acupuncture for Shoulder Pain.
Author [ref] / organization Year / country Symptom
CPGs
 Teasell et al [68] / Canadian partnership for stroke recovery, EBRSR.com 2018 / Canada Hemiplegic shoulder pain
 Hegmann et al [69] / American College of Occupational and Environmental Medicine 2016 / USA Shoulder pain
 Dixon et al. [70] / www.uptodate.com 2020 / USA Shoulder impingement syndrome
 Etg [71]/ Therapeutic Guidelines Limited 2017 / Australia Rotator cuff disease

TGs
 Health Direct [72] /Australian Government Department of Health 2021 / Australia Shoulder pain
 Arthritis Foundation [73] / Arthritis.org 2017 / USA Shoulder osteoarthritis pain
 Chen et al [63]/ Braddom’s Physical Medicine and Rehabilitation 6th edition 2021 / USA Periarthritis of the shoulder
 NHS West Suffolk [74] / NHS Foundation Trust 2020 / UK Shoulder pain

CPG, clinical practice guideline; TG, treatment guidelines.

  • [1] Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ 2005;331(7525):1124−8.ArticlePubMedPMC
  • [2] Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population: A systematic review. Scand J Rheumatol 2004;33(2):73−81.ArticlePubMed
  • [3] Djade CD, Porgo TV, Zomahoun HTV, Perrault-Sullivan G, Dionne CE. Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review. Eur J Pain 2020;24(1):39−50.ArticlePubMedPDF
  • [4] Artus M, Holt TA, Rees J. The painful shoulder: An update on assessment, treatment, and referral. Br J Gen Pract 2014;64(626):e593−5.ArticlePubMedPMC
  • [5] Singh S, Gill S, Mohammad F, Kumar S, Kumar D, Kumar S. Prevalence of shoulder disorders in tertiary care centre. Int J Res Med Sci 2015;3(4):917−20.Article
  • [6] Khosravi F, Amiri Z, Masouleh NA, Kashfi P, Panjizadeh F, Hajilo Z, et al. Shoulder pain prevalence and risk factors in middle-aged women: A cross-sectional study. J Bodyw Mov Ther 2019;23(4):752−7.ArticlePubMed
  • [7] Tidy C, Knott L. [Internet]. Shoulder pain, causes, assessment and treatment: UK; Patient.info: 2021 [cited 2022 Apr 22]. Available from: https://patient.info/doctor/shoulder-pain-pro#nav-6
  • [8] Dyer S, Mordaunt DA, Adey-Wakeling Z. Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews. Int J Gen Med 2020;13:1411−26.PubMedPMC
  • [9] NHS Bournemouth and Poole; NHS Dorset [Internet]. Musculoskeletal Treatment Guidelines: Shoulder. UK; NHS: 2016 [cited 2022 Apr 30]. Available from: https://www.dorsetccg.nhs.uk/Downloads/aboutus/finance/04_MSKT_0007%20MSK%20Interface%20Service/04_MSKT_0007%20Shoulder%20Treatment%20Guidance.pdf
  • [10] Greenberg DL. Evaluation and treatment of shoulder pain. Med Clin N Am 2014;98(3):487−504.ArticlePubMed
  • [11] National Institute for Health and Care Excellence [Internet]. Chronic pain (primary and secondary) in over 16s: Assessment of all chronic pain and management of chronic primary pain: UK; NICE guideline: 2021 [cited 2021 Apr 13]. Available from: https://www.nice.org.uk/guidance/ng193/resources/chronic-pain-primary-and-secondary-in-over-16s-assessment-of-all-chronic-pain-and-management-of-chronic-primary-pain-pdf-66142080468421
  • [12] Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. [Intenret]. Acute Pain Management: Scientific Evidence: 4th ed. Melbourne (Australia); ANZCA & FPM: 2015 [cited 2016 Dec 31]. Available from: https://www.anzca.edu.au/getattachment/4c3b03b7-52bf-4c10-9115-83d827c0fc38/Acute-Pain-Management-Scientific-Evidence
  • [13] Better Health. Pain and pain management - adults [Internet]: Department of Health, State Government of Victoria: 2021 [cited 2022 Mar 1]. Available from: https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/pain-and-pain-management-adults
  • [14] Boston Children’s Hospital [Internet]: Pain treatment services / acute pain service: 2021 [cited 2021 Jan 13]. Available from: https://www.childrenshospital.org/centers-and-services/programs/o-_-z/pain-treatment-center/programs-and-services/acute-pain-service
  • [15] Accident, Compensation Corporation [Internet]. The diagnosis and management of soft tissue shoulder injuries and related disorders. Best practice evidence-based guideline: 2004 [cited 2019 May 17]. Available from: https://www.acc.co.nz/assets/provider/124909b5e6/acc1616-shoulder-treatment-guidelines.pdf
  • [16] Birch S, Keppel Hesselink J, Jonkman FAM, Hekker TAM, Bos A. Clinical research of acupuncture: Part one - what have reviews of the efficacy and safety of acupuncture told us so far? J Alt Complem Med 2004;10(3):468−80.Article
  • [17] Birch S, Lee MS, Alraek T, Kim TH. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: A bibliometric analysis. J Altern Complem Med 2018;24(8):752−69.Article
  • [18] Birch S. [Internet] Acupuncture and chronic pain - the case of back pain: Centers for Medicare and Medicaid Services US Government, CMS.gov: 2019 [cited 2022 Apr 22]. Available from: https://www.cms.gov/medicare-coverage-database/staticpages/public-comment.aspx?commentID=31450&ReportType=nca
  • [19] Birch S. Treating the patient not the symptoms: Acupuncture to improve overall health - evidence, acceptance and strategies. Integr Med Res 2019;8(1):33−41.ArticlePubMedPMC
  • [20] Birch S, Lee MS, Alraek T, Kim TH. Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: A narrative review. Integr Med Res 2019;8(3):160−6.ArticlePubMedPMC
  • [21] Birch S, Bovey M, Alraek T, Robinson N, Kim TH, Lee MS. Acupuncture as a treatment within integrative health for palliative care - a brief narrative review of evidence and recommendations. J Alter Complem Med 2020;26(9):786−93.Article
  • [22] Birch S, Bovey M, Robinson N. Acupuncture for chronic primary pain - are UK guidelines now consistent with other countries. Eur J Integr Med 2021;2021:101257. Article
  • [23] Birch S, Robinson N. Acupuncture as a post-stroke treatment option: A narrative review of clinical guideline recommendations. Phytomedicine 2022;104:154297. ArticlePubMed
  • [24] Murphy RJ, Carr AJ. Shoulder pain. BMJ Clin Evid 2010;2010:1107. PubMedPMC
  • [25] Lee SH, Lim SM. Acupuncture for Poststroke Shoulder Pain: A Systematic Review and Meta-. Analysis Evid Based Complement Alternat Med 2016;2016:3549878. PubMed
  • [26] Lee JA, Park SW, Hwang PW, Lim SM, Kook SJ, Choi KI, et al. Acupuncture for Shoulder Pain After Stroke: A Systematic Review. J Altern Complement Med 2012;18(9):818−23.ArticlePubMedPMC
  • [27] Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: The effectiveness of conservative and surgical interventions-systematic review. Br J Sports Med 2011;45(1):49−56.ArticlePubMed
  • [28] Hardaker N, Ayson M. [Internet]. Pragmatic Evidence Based Review. The efficacy of acupuncture in the management of musculoskeletal pain. Accident, Compensation Corporation: 2014 [cited 2022 Apr 30]. Available from: https://www.acc.co.nz/assets/research/9bcd4814ed/acupuncture-musculoskeletal-review.pdf
  • [29] Choi S, Lee J, Lee S, Yang GY, Kim KH. Acupuncture for Symptomatic Rotator Cuff Disease: A Systematic Review and Meta-Analysis. J Acupunct Res 2021;38(1):20−31.ArticlePDF
  • [30] Australian Government Department of Veterans' Affairs [Internet]. Australian Government Department of Veterans' Affairs. Alternative therapies and Department of Veterans' Affairs Gold and White Card arrangements: 2010 Available from: https://www.pc.gov.au/__data/assets/pdf_file/0005/229370/sub065-veterans.pdf
  • [31] Hempel S, Taylor SL, Solloway M, Miake-Lye IM, Beroes JM, Shanman R, et al. [Internet]. Evidence Map of Acupuncture. US Department of Veterans Affairs - Evidence Synthesis Program. Project #05-226: 2013 [cited 2015 Apr 6]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0063214/pdf/TOC.pdf
  • [32] Haik MN, Alburquerque-Sendín F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: A systematic review of randomised controlled trials. Br J Sports Med 2016;50(18):1124−34.ArticlePubMed
  • [33] Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: A systematic review. J Hand Ther 2004;17(2):152−64.ArticlePubMed
  • [34] Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for Chronic Pain Individual Patient Data Meta-analysis. Arch of Int Med 2012;172(19):1444−53.Article
  • [35] Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain 2018;19(5):455−74.ArticlePubMedPMC
  • [36] Yuan Q, Peng W, Liu L, Sun F, Cai Y, Wu W, et al. Acupuncture for musculoskeletal pain: A meta-analysis and meta regression of sham-controlled randomized clinical trials. Sci Rep 2016;6:30675. ArticlePubMedPMCPDF
  • [37] Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev 2005;(2):CD005319. ArticlePubMed
  • [38] Swedish Council on Health Technology Assessment [Internet]. Methods of Treating Chronic Pain: A Systematic Review: Stockholm (Sweden); Swedish Council on Health Technology Assessment (SBU): 2006 SBU Yellow Report no 177/1+2. Available from: https://pubmed.ncbi.nlm.nih.gov/28876750/#:~:text=Physical%20Activity%2C%20Physical%20Exercise%2C%20Relaxationactivity%20(strong%20scientific%20evidence)
  • [39] McDonald J, Janz S. [Internet]. The acupuncture evidence project: A comparative evidence review: Australian Acupuncture and Chinese Medicine Association: January 2017 [cited 2017 Feb 17]. Available from: http://www.acupuncture.org.au
  • [40] Yin CS, Buchheit TE, Park JB. Acupuncture for chronic pain: An update and critical overview. Curr Opin Anaesthesiol 2017;30(5):583−92.PubMed
  • [41] Malaysian Ministry of Health [Internet]. Acupuncture for post-stroke rehabilitation. Health Technology Assessment Section: Medical Development Division Ministry of Health Malaysia: 2015 [cited 2018 May 15]. Available from: http://www.moh.gov.my/penerbitan/mymahtas/TR-Acupuncture%20for%20post-stroke%20rehabilitation.pdf
  • [42] Liu SN, Zhang CSQ, Cai YY, Guo XF, Zhang AL, Xue CC, et al. Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-. Analysis Front Neurol 2019;10:433. PubMed
  • [43] Lin H, Ma TM. A meta-analysis on acupuncture treatment of shoulder-hand syndrome. Zhen Ci Yan Jiu 2012;37(1):77−82. [in Chinese].PubMed
  • [44] Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome: A PRISMA systematic review and network meta-analysis. Medicine (Baltimore) 2015;94(10):e510. PubMedPMC
  • [45] Goldgrub R, Côté P, Sutton D, Wong JJ, Yu H, Randhawa K, Varatharajan S, et al. The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. J Manipulative Physiol Ther 2016;39(2):121−39e1.ArticlePubMed
  • [46] Accident, Compensation Corporation [Internet]. Acupuncture Expert Reference Group: Consensus document - The effectiveness and safety of acupuncture for the treatment of musculoskeletal conditions: August 2019 [cited 2020 May 18]. Available from: https://www.acc.co.nz/assets/research/dc1104f788/aerg-consensus-acupuncture-musculoskeletal-conditions.pdf
  • [47] Cox J, Varatharajan S, Cote P. Optima collaboration. Effectiveness of acupuncture therapies to manage musculoskeletal disorders of the extremities: A systematic review. J Orthop Sports Phys Ther 2016;46(6):409−29.ArticlePubMed
  • [48] Babatunde OO, Ensor J, Littlewood C, Chesterton L, Jordan JL, Corp N, et al. Comparative effectiveness of treatment options for subacromial shoulder conditions: A systematic review and network meta-analysis. Ther Adv Musculoskelet Dis 2021;13:1759720X211037530.ArticlePDF
  • [49] Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One 2017;12(6):e0178621. ArticlePubMedPMC
  • [50] Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: A systematic review. J Back Musculoskel Rehabil 2014;27(3):247−73.Article
  • [51] Ben-Arie E, Kao PY, Lee YC, Ho WC, Chou LW, Liu HP. The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2020;2020:9790470. ArticlePubMedPMCPDF
  • [52] Meng X, Xiu WC, Hu XY, Jiao RM, Shi LJ, Yang JW, et al. Clinical study on acupuncture and moxibustion for frozen shoulder: an evidence map. Zhongguo Zhen Jiu 2022;42(2):227−30. [in Chinese].PubMed
  • [53] Chang H, Lee H, Kim H, Chung WS. The Use of Acupuncture in the Management of Patients with Humeral Fractures: A Systematic Review and Meta-analysis. J Manipulative Physiol Ther 2021;44(2):146−53.ArticlePubMed
  • [54] Chau JPC, Lo SHS, Yu X, Choi KC, Lau AYL, Wu JCY, et al. Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review. Front Neurol 2018;9:30. ArticlePubMedPMC
  • [55] Peng L, Zhang C, Zhou L, Zuo HX, He XK, Niu YM. Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis. Clin Rehabil 2018;32(4):429−39.ArticlePubMedPDF
  • [56] MacPherson H, Vertosick EA, Foster NE, Lewith G, Linde K, Sherman KJ, et al. The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain 2017;158(5):784−93.ArticlePubMedPMC
  • [57] Lytle CD. An overview of acupuncture. U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, Center for Devices and Radiological Health, Bethesda, 1993.
  • [58] Vickers A, Wilson P, Kleijnen J. Effectiveness Bulletin: Acupuncture. Qual Saf Health Care 2002;11:92−7.PubMedPMC
  • [59] MacPherson H, Hammerschlag R. Acupuncture and the Emerging Evidence Base: Contrived Controversy and Rational Debate. J Acupunct Meridian Stud 2012;5(4):141−7.ArticlePubMed
  • [60] Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, et al. Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 2009;16(2):91−7.ArticlePubMedPDF
  • [61] Chan MWC, Wu XY, Wu JCY, Wong SYS, Chung VCH. Safety of Acupuncture:Overview of Systematic Reviews. Sci Rep 2017;7:3369. ArticlePubMedPMCPDF
  • [62] Bäumler P, Zhang W, Stübinger T, Irnich D. Acupuncture-related adverse events: Systematic review and meta-analyses of prospective clinical studies. BMJ Open 2021;11(9):e045961. ArticlePubMedPMC
  • [63] Chen WS, Annaswammy TM, Yang WB, Wang TG, Kwon DR, Chou LW. 17. Physical agent modalities. Edited by Cifu DX, Eapen BC, Johns JS, Kowalske K, Lew HL, Miller MA, Worsowicz G: Braddom’s Physical Medicine and Rehabilitation. 6th ed. Philadelphia (PA), Elsevier, 2021, pp 338−63.
  • [64] Arias-Buría JL, Martín-Saborido C, Cleland J, Koppenhaver SL, Plaza-Manzano G, Fernández-de-Las-Peñas C. Cost-effectiveness Evaluation of the Inclusion of Dry Needling into an Exercise Program for Subacromial Pain Syndrome: Evidence from a Randomized Clinical Trial. Pain Med 2018;19(12):2336−47.ArticlePubMed
  • [65] Ambrósio EMM, Bloor K, MacPherson H. Costs and consequences of acupuncture as a treatment for chronic pain: A systematic review of economic evaluations conducted alongside randomised controlled trials. Complem Ther in Med 2012;20(5):364−374.Article
  • [66] Kim SY, Lee HS, Chae YB, Park HJ, Lee HJ. A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupunct Med 2012;30(4):273−85.ArticlePDF
  • [67] Aetna Insurance Company [Internet]. Acupuncture: 2020 [cited 2020 May 18]. Available from: http://www.aetna.com/cpb/medical/data/100_199/0135.html
  • [68] Teasell R, Cotoi A, Chow J, Wiener J, Iliescu A, Hussein N, et al. [Internet]. Evidence-based review of stroke rehabilitation. 18th edition. Canadian Partnership for stroke recovery, EBRSR.com: 2018 [cited 2018 Apr 26]. Available from: http://www.ebrsr.com/sites/default/files/documents/v18-SREBR-ExecutiveSummary_0.pdf
  • [69] Hegmann KT, Hughes MA, Kaufman LR, Green A, Haas NS, Hoffman H, et al. [Internet]. Shoulder Disorders Guideline: On behalf of the American College of Occupational and Environmental Medicine (ACOEM): 2016 [cited 2019 May 17]. Available from: https://www.dir.ca.gov/dwc/MTUS/ACOEM_Guidelines/Shoulder-Disorders-Guideline.pdf
  • [70] Dixon JB, Kruse D, Simons SM, Fields KB, Grayzel J. [Internet]. Patient education: Shoulder impingement syndrome (Beyond the Basics). UpToDate: 2020 [cited 2020 Mar 15]. Available from: https://www.uptodate.com/contents/shoulder-impingement-syndrome-beyond-the-basics?search=acupuncture&source=search_result&selectedTitle=9~20&usage_type=default&display_rank=9
  • [71] eTG [Internet]. Therapeutic Guidelines. Limb conditions: 2017 [cited 2019 Oct 2]. Available from: https://tgldcdp.tg.org.au/searchAction?appendedInputButtons=acupuncture
  • [72] Health Direct [Internet]. Acupuncture: Australian Government, Department of Health: 2021 [cited 2021 Dec 20]. Available from: https://www.healthdirect.gov.au/acupuncture
  • [73] Arthritis Foundation [Internet]. Osteoarthritis of the shoulder: 2017 [cited 2017 Nov 30]. Available from: http://www.arthritis.org/about-arthritis/types/osteoarthritis/articles/shoulder-oa.php
  • [74] NHS West Suffolk [Internet]. Pain management. NHS Foundation Trust: 2020 [cited 2020 Feb 21]. Available from: https://www.wsh.nhs.uk/Services-A-Z/Pain-management/Pain-management.aspx
  • [75] Lunny C, Ramasubbu C, Puil L, Liu T, Gerrish S, Salzwedel DM, et al. Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study. PLoS One 2021;16(4):e0250356. ArticlePubMedPMC
  • [76] Zhang YQ, Lu LM, Xu NG, Tang XR, Shi XS, Carrasco-Labra A, et al. Increasing the usefulness of acupuncture guideline recommendations. BMJ 2022;376:e070533. ArticlePubMedPMC
  • [77] National Clinical Guideline Centre (UK) [Internet]. Headaches: Diagnosis and management of headaches in young people and adults: London (UK); Royal College of Physicians: September 2012 Available from: http://guidance.nice.org.uk/cg150
  • [78] Bundesärztekammer, Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftli-chen Medizinischen Fachgesellschaften (AWMF) [Internet]. Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuz-schmerz - Langfassung, 2. Auflage. Version 1: 2017 [cited 2018 Apr 30]. Available from: https://www.leitlinien.de/mdb/downloads/nvl/kreuzschmerz/kreuzschmerz-2aufl-vers1-lang.pdf . PMID: 10.6101/AZQ/000353. www.kreuzschmerz.versorgungsleitlinien.de
  • [79] Diener H, Gaul C, Kropp P. [Internet]. Therapie der Migräneattacke und Prophylaxe der Migräne, S1-Leitlinie. 2018 Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie: [cited 2022 Feb 8]. Available from: https://www.awmf.org/uploads/tx_szleitlinien/030-057l_S1_Migraene-Therapie_2020-12.pdf
  • [80] Lu L, Zhang Y, Tang X, Ge S, Wen H, Zeng J, et al. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ 2022;376:e067475. ArticlePubMedPMC
  • [81] Appleyard I, Lundeberg T, Robinson N. Should systematic reviews assess the risk of bias from sham-placebo acupuncture control procedures? Eur J Integr Med 2014;6(2):234−43.Article
  • [82] MacPherson H, Vertosick E, Lewith G, Linde K, Sherman KJ, Witt CM, et al. Influence of control group on effect size in trials of acupuncture for chronic pain: A secondary analysis of an individual patient data meta-analysis. PLoS One 2014;9(4):e93739. ArticlePubMedPMC
  • [83] Fei YT, Cao HJ, Xia RY, Chai QY, Liang CH, Feng YT, et al. Methodological challenges in design and conduct of randomised controlled trials in acupuncture. BMJ 2022;376:e064345. ArticlePubMedPMC
  • [84] Murad MH. Clinical Practice Guidelines: A Primer on Development and Dissemination. Mayo Clin Proc 2017;92(3):423−33.PubMed
  • [85] Ferreira de Meneses S, Rannou F, Hunter DJ. Osteoarthritis guidelines: Barriers to implementation and solutions. Ann Phys Rehabil Med 2016;59(3):170−3.ArticlePubMed
  • [86] Gómez Doblas JJ, Rodríguez-Padial L. Implementation of clinical practice guidelines: Wishful thinking or reality. Decision algorithm. Clin Investig Arterioscler: 2021 33(Suppl 1):33−9.PubMed

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        Shoulder Pain and the Potential Role of Acupuncture: A Narrative Review of Clinical Practice and Treatment Guidelines
        Perspect Integr Med. 2022;1(1):3-9.   Published online September 22, 2022
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