Manual acupuncture reduces anxiety symptoms versus sham and usual care in meta-analysis of 20 RCTs
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Key Takeaway
Consider manual acupuncture as a safe, potentially beneficial adjunct for anxiety, but note high heterogeneity and methodological limitations in the evidence.
This systematic review and meta-analysis pooled data from 20 randomized controlled trials involving 1,462 patients with anxiety complications. The analysis compared manual acupuncture (MA) to sham acupuncture (SA) or usual care/wait list control (UC/WLC), with anxiety assessed using validated measures at post-treatment and at an unreported follow-up duration.
At post-treatment, MA significantly reduced anxiety compared to both comparators. Versus SA, the standardized mean difference (SMD) was -1.06 (95% CI: -1.74 to -0.39, p = 0.0005). Versus UC/WLC, the SMD was -1.35 (95% CI: -2.26 to -0.44, p = 0.00006). At follow-up, the effect was maintained versus SA (SMD = -0.78, 95% CI: -1.21 to -0.35, p < 0.00001) but was not significant versus UC/WLC (SMD = -0.60, 95% CI: -1.68 to 0.49, p = 0.12).
Safety data reported 79 adverse events, with no severe events. Adverse events were mainly transient discomfort, minor bleeding, or localized pain. Discontinuation rates were not reported. Key limitations include high statistical heterogeneity (I² = 94% for MA vs. SA; I² = 59% for MA vs. UC/WLC) and that some studies had unclear allocation concealment and blinding issues. Funding and conflicts of interest were not reported.
For practice, manual acupuncture appears as a promising, safe, and minimally invasive therapy for chronic anxiety based on this evidence. However, clinicians should interpret these findings cautiously due to the high heterogeneity, methodological concerns in some trials, and the lack of significant long-term effect versus usual care. Long-term efficacy is not confirmed, and methodologies need standardization.
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View Original Abstract ↓
OBJECTIVE: This systematic review and meta-analysis aim to evaluate the efficacy of acupuncture in reducing anxiety by synthesizing evidence from randomized controlled trials (RCTs).
METHODS: A comprehensive search was conducted across six databases-AMED, CINAHL, CENTRAL, Embase, Ovid MEDLINE, and PubMed-for RCTs published in English up to January 22, 2025. Eligible studies included patients with anxiety complications and compared RCTs comparing manual acupuncture (MA) with sham acupuncture (SA) or usual care or wait list control (UC/WLC) were included if anxiety was assessed as the primary outcome using validated measures. SMDs with 95% CIs were calculated using a random-effects model, and heterogeneity was assessed using I² and REML. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool.
RESULTS: A total of 20 RCTs with 1462 participants were included. MA significantly reduced anxiety at post-treatment compared to SA (SMD = -1.06, 95% CI: -1.74 to -0.39, p = 0.0005, I² = 94%) and UC/WLC (SMD = -1.35, 95% CI: -2.26 to -0.44, p = 0.00006, I² = 59%). The effect was maintained at follow-up when compared to SA (SMD = -0.78, 95% CI: -1.21 to -0.35, p < 0.00001) but not significant compared to UC/WLC (SMD = -0.60, 95% CI: -1.68 to 0.49, p = 0.12). RoB assessment showed low risk in 14 studies, while others had unclear allocation concealment and blinding issues. Seventy-nine adverse events were reported, mainly transient discomfort, minor bleeding, or localized pain, with no severe events.
CONCLUSION: MA effectively reduces anxiety symptoms in the short term, with effects sustained at follow-up when compared to SA but not UC/WLC. Further research is needed to confirm long-term efficacy and standardize methodologies. Acupuncture remains a promising, safe, and minimally invasive therapy for chronic anxiety.
CLINICAL TRIAL REGISTRATION: The review protocol was preregistered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD420250621404) and can be accessed at https://www.crd.york.ac.uk/PROSPERO/view/CRD420250621404.
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