Many Veterans desire complementary and alternative medicine or integrative medicine
modalities such as acupuncture, both for treatment and for the promotion of wellness. However,
the effectiveness and adverse events associated with acupuncture are not firmly established.
Given the VA's desire to promote evidence-based practice, this evidence mapping project will
help provide guidance to VA leadership about the distribution of evidence to inform policy and
clinical decision making.
In general, acupuncture is the stimulation of specific acupuncture points through penetration of
the skin with needles, which aims to correct imbalances in the flow of qi, a concept of energy
in traditional Chinese medicine (TCM), through meridians (ie, energy channels). The available
published literature on acupuncture is extensive. PubMed searches in 2013 identified almost
20,000 citations with the term "acupuncture" and almost 1,500 randomized controlled trials
(RCTs) with "acupuncture" in the title. Not surprisingly, a large number of systematic reviews
and meta-analyses have been published to-date, and even a number of "reviews of reviews"
are available in the published literature on acupuncture in generalor for a specific clinical
Results from existing reviews of reviews about the effectiveness of acupuncture are nonconclusive.
A systematic review of systematic reviews of acupuncture published between
1996 and 2005 included 35 reviews. The overview noted that 12 reviews reported support for
acupuncture and 6 reported strong support; however, when applying strict inclusion criteria,
such as randomized and double blind studies, good evidence of no benefit was shown. In 2007,
Adams compiled a "Brief Overview - A summary of the evidence for use of acupuncture from
systematic reviews and meta-analyses" for the Veterans Health Administration Office of Patient
Care Services Technology Assessment Program. The report included 42 systematic reviews
published since 2002 and concluded that higher quality studies are only beginning to emerge,
the evidence base is heterogeneous, and the review results highlight the overall poor quality of
studies and reporting. Thus, it is timely to assess the current state of reviews of acupuncture.