Producing convincing evidence on acupuncture in psychiatry and pain: an analysis of progress

Acupuncture is widely used for a range of health problems including pain and depression. The quantity of basic and clinical research has rapidly increased over time but, for many conditions, systematic reviews conclude that the evidence is still insufficient or difficult to interpret. The aims of this study are to examine how the focus in pain research changed over time, to explore the current evidence base and compare this against use and clinical guidelines, and to analyze the methods used to assess clinical trial quality. Methods used involve analysis of publication patterns, studies of prevalence of use and systematic review methodology following searches primarily of PubMed and the Cochrane Library. Clinical guidelines on relevant topics are also identified and analyzed. The results indicate that the scope of pain trials has continued to increase and currently the focus is more on musculoskeletal pain than conditions such as fibromyalgia, neuralgia or gynaecological pain. Addressing specific pain conditions reflects patterns of use of acupuncture in Western populations. Quality of the research is assessed using broader criteria in place of scoring systems but significant challenges in trial design and reporting remain which affect conclusions of systematic reviews and incorporation of acupuncture into clinical guidelines.