Clinical Briefs: Acupuncture and Tennis Elbow
With Comments from John La Puma, MD, FAC
Source: Green S, et al. Acupuncture for lateral elbow pain (Cochrane Review). Cochrane Database Syst Rev 2002;(1):CD003527.
This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Acupuncture has long been used to treat lateral elbow pain in China and in Western countries, practitioners and consumers are increasingly exploring acupuncture as a first-line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral elbow pain.
The effectiveness of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement in function, grip strength, and adverse effects has been studied. A search of MEDLINE, CINAHL, EMBASE, and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group’s specialist trial database from 1966 to June 2001 used identified keywords and authors to retrieve as many trials as possible.
Two independent reviewers assessed all identified trials against predetermined inclusion criteria. Randomized and pseudo-randomized trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral elbow pain. Outcomes of interest were pain, function, disability, quality of life, strength, participant satisfaction with treatment, and adverse effect.
For continuous variables, means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data, numbers of events and total population were analyzed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity.
Four small, randomized controlled trials were included; due to flaws in study designs (particularly small populations, uncertain allocation concealment, and substantial loss to follow-up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomized controlled trial found that needle acupuncture results in relief of pain for significantly longer than placebo (weighted mean difference = 18.8 hours, 95% confidence interval [CI] 10.1-27.5) and is more likely to result in a 50% or greater reduction in pain after one treatment (relative risk [RR] 0.33, 95% CI 0.16-0.69).
A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant-reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01-0.64). No significant differences were found in the longer term (after three or 12 months). A randomized controlled trial of laser acupuncture vs. placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit. A fourth included trial published in Chinese demonstrated no difference between vitamin B12 injection plus acupuncture, and vitamin B12 injection alone.
There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain. This review has demonstrated needle acupuncture to be of short-term benefit with respect to pain, but this finding is based on the results of two small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilizing appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.
Comment
Acupuncture also is booming at wellness and resort spas, where the youngest still play tennis, and ice their knees before and after games. So now, from the Australasian Cochrane Center at Monash University in Australia comes this excellent assessment of tennis elbow trials.
Alas, a definitive opinion is not forthcoming, other than short-term pain relief seems to result. Which is good enough for those at resorts, but not for the court addict whose nagging elbow pain disables her, and who remains on non-steroidal anti-inflammatory drugs, and often, glucosamine.
Recommendation
Acupuncture may be tried for short-term pain relief from tennis elbow, but it is not the first tool in the toolbox.
La Puma J. Acupuncture and tennis elbow. Altern Med Alert 2002;5:52.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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