Table 1. Clinical Efficacy and Safety.

Author (Year)	Groups Studied and Intervention	Results and Findings	Conclusions
Lauche et al. (2011) ( 68 )	(NCT01289964) Fifty patients, ages 18 to 75, with chronic non-specific neck were randomized into a treatment or waitlist group. Assessments included pain at rest (PR), pain related to movement (PM), neck disability index (NDI), and quality of life (SF-36). Sensory tests included vibration-detection threshold (VDT), mechanical-detection threshold (MDT), and pressure-pain threshold (PPT). The treatment group received five dry cupping treatments over a two week period, in contrast to the waiting-list group who received no treatment. Participants again completed questionnaires and underwent sensory testing a second time 18 days after baseline assessment. The study offered the waiting-list group cupping treatment upon completion the post-intervention assessment.	The treatment group reported significantly less pain after dry cupping treatment than the waiting-list group (PR: Δ-22.5 mm, P = 0.00002; PM: Δ-17.8 mm, P = 0.01). Analysis of the pain diaries (PD) demonstrated a gradual decrease in neck pain for the treatment group and after the fifth session, there was significant difference in pain between the treatment and waiting-list group (Δ-1.1, P = 0.001). The SF-36 subscales for bodily pain (Δ13.8, p = 0.006) and vitality (Δ10.2, P = 0.006) demonstrated significant differences. There were significant differences between the two groups regarding PPT at pain-related and control areas (all P < 0.05), but not for MDT or VDT.	Five dry cupping sessions were efficacious, safe, and generally well tolerated in treating chronic non-specific neck pain. Additionally, there was a significant difference in mechanical pain sensitivity between the two groups, which indicated that cupping has a role in functional pain processing.
Chi et al. (2016) ( 69 )	A RCT analyzed cupping therapy’s effectiveness for chronic neck and shoulder pain (NSP) and measured changes in skin surface temperature (SST). The study recruited sixty-two participants and excluded two cases due to analgesic consumption before the study. The study randomized participants into a cupping or control group.	The ANCOVA test demonstrated significant differences between the groups at each time point for GB 21, SI 15, and LI 15 acupuncture points (P < 0.05). In the cupping group, the VAS of neck pain intensity (NPI) was 9.7 ± 1.6 at baseline; posttreatment NPI decreased by 6.1. In the control group, the VAS of NPI was 9.7 ±1.6 at baseline; posttreatment NPI decreased by 0.2. The ANCOVA test showed significant differences between the two groups (P < 0.001). In the cupping group, the VAS of shoulder pain intensity (SPI) was 8.5 ± 0.9 at baseline; posttreatment SPI decreased by 5.9. For the control group, the VAS of SPI was 8.5 ± 0.9; posttreatment SPI decreased by 0.6. The difference was statistically significant (P < 0.001) between the two groups.	After one treatment session, SST increased and SBP decreased. Dry cupping therapy is considered a safe and effective treatment for chronic neck and shoulder pain.
Trofa et al. (2020) ( 71 )	A review analyzed publications on cupping and blood flow restriction as non-surgical treatment modalities for musculoskeletal conditions.	Due to the low risks associated with dry cupping therapy and present data, physicians can suggest this cupping therapy to those athletes with neck, shoulder, or back pain who are interested. Studies suggest that low-load BFR training can improve muscle strength, endurance, and possibly improve injury recovery.	The review concluded that additional studies are needed to further evaluate these non-surgical modalities of treatment.
Gerber et al. (2015) ( 72 )	A nonrandomized, controlled, clinical study investigated the pain reducing effects of dry needling on a myofascial trigger point (MTrP). 52 participants completed the study and each participant received three weekly dry needling treatment sessions.	Primary outcome: 41 subjects experienced a trigger point status change from active to latent or resolved, and 11 subjects reported no change (P < 0.001). Reduction in all pain scores was significant (P < 0.001). Secondary outcomes: pain pressure threshold in participants with unilateral MTrPs (P = 0.006) and bilateral MTrPs (P = 0.012); improvement in the SF-36 mental health (P = 0.019) and physical functioning subscale scores (P = 0.03); and a decrease in the Oswestry Disability Index score (P = 0.003) improvement in posttreatment cervical range of motion in participants with unilateral (P = 0.001) and bilateral MTrPs (and P = 21).	Dry needling significantly reduced pain and changed trigger point status. The reduced pain was associated with an improvement in function, disability, and mood.
Cerezo-Tellez et al. (2016) ( 73 )	(ISRCTN22726482) The study examined the effectiveness of deep dry needling (DDN) of MTrPs as a treatment for chronic nonspecific neck pain. One hundred and twenty eight participants completed all assessments of the study, out of the recruited 130. Participants were randomized to either the DDN group (DDN-plus passive stretching) or control group (only passive stretching). The program for both groups occurred for two weeks with treatment sessions twice/week; 4 treatment sessions in total and a six-month follow-up meeting.	Pain intensity was the primary outcome measurement. Pressure pain threshold, active ROM of the neck, neck strength, and perceived disability associated with the neck were secondary outcome measurements. The study found clinically important and significant differences regarding dry needling as a treatment in all the measured outcomes (all P < 0.001).	DDN and passive stretching are more effective compared to only passive stretching in treating nonspecific neck pain. DDN is an effective treatment of myofascial pain syndrome in the setting of chronic nonspecific neck pain.
De Meulemeester et al. (2017) ( 74 )	(NCT02301468) The study included 42 females who were randomized to either a DN (20 subjects) or MP (22 subjects) group and received a total of four treatment sessions. During the study, 1 from the MP group and 3 from the DN group stopped participating.	Primary outcome measurements: pressure pain threshold, muscle characteristics pre-and post-treatment, the neck disability index, and general numeric rating scale. The study did not find significant differences between the two groups. The neck disability index improved for both groups after 4 treatments and 3 months (P < 0.001); after 3 months, the general numerical rating scale significantly decreased. Pain pressure threshold, muscle elasticity, and stiffness showed significant improvement.	The findings of the study showed that both DN and MP had short- and long-term effects. Dry needling was no more effective in treating myofascial neck/shoulder pain when compared to manual pressure.
Fu et al. (2009) ( 76 )	A systematic review and meta-analysis examined fourteen randomized controlled trials of acupuncture for neck pain.	Seven of nine meta-analyses showed positive results that acupuncture was significantly better than the control (P < 0.05). The meta-analysis of short-term pain reduction showed acupuncture more effective in treating neck pain compared to the control (standardized mean difference of -0.45 (95% confidence interval [CI], -0.69 to -0.22)). The meta-analysis also showed that acupuncture was better for pain relief than sham acupuncture (standardized mean difference of -0.53 (95% CI, -0.94 to -0.11)). The two negative meta-analyses noted no significant difference regarding improving disability in patients with neck pain between acupuncture vs. sham TENS; and the difference between acupuncture vs. sham TENS in long-term pain relief for neck pain was not statistically significant	The findings of the meta-analysis showed acupuncture to be effective in treating neck pain. The review stated that additional studies are needed to further investigate the acupuncture’s effectiveness long-term and improvement in disability
Que et al. (2013) ( 77 )	(ChiCTR-TRC-12002206) This article outlines the design and rationale of a randomized, double-blind, controlled trial that intends to examine the safety and efficacy of acupuncture compared to sham acupuncture in the treatment of neck pain caused by cervical spondylosis.	The study’s design is to randomize 456 recruited participants into either an active acupuncture or sham acupuncture group. Treatments will occur five times/week for a total of two weeks. The Northwick Park Neck Pain questionnaire (NPQ) scale, short-form 36 (SF-36) scale, and McGill pain scale, demographics, adverse events, and neck physiological function will be assessed at baseline and intervention for both weeks. Follow-ups will occur at 4, 8, and 12 weeks post-intervention.
Zuo et al. (2019) ( 91 )	(CRD42019119941) This article outlines the design and rationale of a systemic review and meta-analysis that aims to assess the safety and effectiveness of acupuncture and chiropractic for treating cervical spondylosis radiculopathy (CSR).		This article was published in 2019; and the review status is ongoing per PROSPERO.
Gu et al. (2019) ( 78 )	A study examined acupuncture efficacy with seven acupoint-penetrating needles on sixty patients with cervical spondylosis. The patients were randomized into either group A, which received acupuncture with seven acupoint-penetrating needles plus traction or group B, which received acupuncture of non-relevant acupuncture points plus traction.	The two groups were compared on the basis of efficacy and score changes for the VAS, neck disability index (NDI), and Pittsburgh sleep quality index (PSQI). Group A demonstrated a significantly higher total effective rate (90.0%) compared to group B (76.6%) (P < 0.05). The post-treatment scores for VAS, NDI, and PSQI were significantly lower for both groups than the pre-treatment scores (P < 0.05). Group A demonstrated significantly lower NDI and PSQI scores post-treatment than group B (P < 0.05).	The study concluded that in patients with cervical spondylosis, acupuncture with seven acupoint-penetrating needles plus traction had greater efficacy, pain reduction, and better quality of sleep versus acupuncture of non-relevant acupuncture points.
Yang et al. (2017) ( 87 )	(ChiCTR-IOR-15006886) This article outlines the rationale and design of a five-arm, randomized, controlled trial that aims to investigate the effectiveness of acupuncture in treating chronic neck pain versus sham acupuncture.	The study’s design is to randomize 175 recruited patients into five separate groups: A traditional acupuncture group, a shallow-puncture group, a non-acupoint acupuncture group, a non-acupoint shallow-puncture group, and a sham-puncture group. Treatments will occur twice/week for a total of five weeks with each session lasting twenty minutes. The Northwick Park Neck Pain questionnaire (NPQ) will be used to assess the primary outcome. The pain threshold, the short form McGill Pain questionnaire-2 (SF-MPQ-2), the 36-Item Short-Form Health survey (SF-36) and diary entries will be used to assess secondary outcomes. Data analysis will occur at baseline, after the treatment intervention, and at the 3 month follow-up meeting; the study will evaluate acupuncture safety at the end of each treatment period.	The trial was designed to be completed by December 31, 2017.
Ho et al. (2017) ( 80 )	(ChiCTR-TRC-14004932) An RCT investigated the efficacy of abdominal acupuncture for the treatment of neck pain. One hundred and fifty four neck pain patients were randomized to either receive abdominal acupuncture (group A) or non-penetrating sham abdominal acupuncture (group S) and received three treatments/week for two weeks.	Group A demonstrated greater improvement vs. Group S in NPQ scores at two weeks (intergroup mean differences, -5.75; 95% confidence interval [CI], -9.48 to -2.03; P = 0.008) and at six weeks (intergroup mean difference, -8.65; 95% CI, -12.13 to -5.16; P < 0.001). At 14 weeks, group A had significantly greater improvement in NPQ scores compared to baseline. Group A had significantly greater improvement compared to group S regarding the intensity of neck pain and health-associated quality of life measurements.	The study concluded that abdominal acupuncture was efficacious in treating neck pain.
Calamita et al. (2018) ( 81 )	A randomized blinded crossover study examined alterations in the myoelectric activity of the upper trapezius and non-specific neck pain after one acupuncture session. The study included fifteen subjects with neck pain (NPG) and fifteen subjects who were healthy (control group; HPG). Within each group, participants were randomized to either receive one session of acupuncture or sham acupuncture treatment. The acupuncture targeted acupoints of triple energizer 5 (TE-5) and large intestine 11 triple energizer 5 (LI-11 TE-5).	The study demonstrated significant decreases in amplitude of EMG after acupuncture treatment in both the NPG (F1,112 = 26.82; P < .0001) and the control group (F1,112 = 21.69; P < .0001). For the NPG, the Numeric Rating Scale score (NRS) (F1,28 = 51.61; P < 0.0001) and pain area (F1,2 = 32.03; P < 0.0001) demonstrated significant effects post-treatment for both acupuncture and sham. The study found no difference between acupuncture and sham acupuncture treatment for NRS score (NPG: F1,28 = 0.95; P = .33), pain area (NPG: F1,28 = 1.97; P = 0.17), or EMG amplitude (NPG: F1,112 = 0.47; P = 0.49; HPG: F1,112 = 0.75; P = 0.38).	The study concluded that acupuncture at TE-5 and LI-11 TE-5 acupoints, or close to these points, helped improve neck pain. For both the NPG and control group, EMG demonstrated decreased hyperactivity of the upper trapezius muscle and increased resistance to muscle. The study noted that further studies are necessary.
Barreto and Svec (2019) ( 82 )	A review analyzed 25 RCTs regarding noninvasive nonpharmacologic treatments for chronic neck pain.	Combination exercise and low-level laser therapy both improved function and pain to a certain degree. Acupuncture provided some functional improvement but did not reduce pain when compared to sham acupuncture. The Alexander technique, a mind- body practice, also demonstrated some improvement in function. Massage did not improve function, and physical therapist-led relaxation techniques did not improve function or pain. All received a strength of recommendation (SOR) of B due to inconsistent or limited-quality evidence that is patient-oriented.	The review concluded that physicians should discuss these nonpharmacologic options with patients, and should consider including combination exercise, low-level laser therapy, acupuncture, and/or the Alexander technique as treatments of chronic neck pain.
Sun et al. (2019) ( 89 )	(ChiCTR1800016371) This article outlines the design and rationale of a randomized, controlled trial that intends to examine the safety and efficacy of needling at specific acupoints as a treatment of chronic neck pain. A total of 716 participants will be recruited and randomized into four groups: the highly sensitive acupoints group, low/non-sensitive acupoints group, sham acupuncture group, and the waiting-list control group.		The study was expected to end in December 2019.
Sun et al. (2019) ( 90 )	(ChiCTR1800016220) This article outlines the design and rationale of a case-control study that intends to analyze sensitization types and the distribution of sensitized points in neck pain patients. A total of 224 patients with neck pain and 224 healthy subjects (control) will be recruited. Measurements of pressure pain threshold, skin resistance, body surface temperature, and mechanical pain threshold will be taken at the fifteen most common acupoints associated with treating neck pain. These measurements will also be taken at the five body areas in which pain is most often experienced.		The results of the study will provide information regarding choosing the best acupuncture points for treating neck pain.
Eslamian et al. (2020) ( 84 )	(IRCT20100127003217N12) A randomized clinical trial investigated electroacupuncture and biofeedback along with conventional therapy in treating cervical myofascial pain syndrome (MPS). Fifty participants were recruited and randomized into either electroacupuncture or biofeedback group. The study set the primary outcome, measured through NDI, as a 20% reduction in dysfunction and neck pain at three months in comparison to the baseline measurement.	The study analyzed fifty patients (39 women, 11 men) with characteristics of a mean age ± SD of 39.0 ± 5.5 year and neck pain of 6.0 ± 2.2 weeks. Electroacupuncture and biofeedback group demonstrated significant improvement in all parameters except for the PPT of the paravertebral muscles and lower trapezius. The acupuncture group reached the primary outcome to a greater extend compared to the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio = 2 with 95% CI, 1.19 - 3.36; number needed to treat (NNT) = 2.5 with 95% CI, 1.54 - 6.58. Acupuncture showed greater clinical benefit compared to biofeedback as per the values of NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last treatment session until the 3 month follow-up (P < 0.05).	The study found both electroacupuncture and biofeedback therapies coupled with medication and exercises to be efficacious for myofascial neck pain. Intergroup differences demonstrated that for some parameters electroacupuncture was better than biofeedback. The study concluded that electroacupuncture appeared to be superior in treating cervical MPS.
Farag et al. (2020) ( 86 )	(CRD42016042956) A systemic review and meta-analysis examined six RCTs regarding the efficacy of acupuncture in treating localized unremitting myofascial pain of the head and neck. The study’s main outcome measurement was the mean pain severity score (VAS) for acupuncture versus sham-needling or no intervention groups.	There was a decrease in VAS scores for acupuncture groups compared to sham needling or no intervention groups in all six studies. The meta-analysis included only four of the RCTs and showed acupuncture’s pain intensity score 19.04 points less than sham-needling/no intervention’s score (95% CI: -29.13 to -8.95).	The findings propose that acupuncture may be safe and efficacious for decreasing unremitting myofascial pain of the head and neck. Additional studies with a more standardized design are needed in order to provide further compelling evidence.
Kim et al. (2019) (85)	(KCT0002320) An RCT examined the safety and efficacy of thread-embedding acupuncture (TEA) using polydioxanone along with conventional care for patients with chronic nonspecific neck pain (CNP) versus treatment with only conventional care. A total of 106 CNP participants were randomized to either the TEA plus usual care (TU) group or the usual care (UC) group.	NPDS scores significantly improved in the TU group compared with the UC group (adjusted group difference, week 5: 13.74 [95% confidence interval: 7.57 - 19.90]; p < 0.0001 and week 9: 17.46 [11.15 - 23.76]; p < 0.0001). For the TU group at weeks 5 and 9, the fraction of patients with a lower NPDS score of ‡11.5 points (minimal CID) was significantly higher compared to the UC group. For both groups at weeks 5 and 9, the study showed significant differences on the HADS, EQ-5D, and PGIC, but not for the PPTs at the three measured sites.	The findings of the study indicated TEA, along with conventional care, to be safe and effective in treating CNP.
Pan et al. (2018) ( 92 )	A systemic review and meta-analysis analyzed thirty-five studies regarding acupuncture as a clinical treatment for osteoporosis. The RCTs compared warm acupuncture, needling or electroacupuncture to Western medicine in treating osteoporosis.	Compared with Western medicine, warm acupuncture increased the level of serum calcium (MD = 0.18, 95% CI = 0.13, 0.24, P < 0.00001) and estradiol (SMD = 0.65, 95% CI = 0.32, 0.98, P = 0.0001), the bone mineral density of lumar* (SMD = 0.93, 95% CI = 0.65, 1.21, P < 0.00001) and femur (MD = 0.11, 95% CI = 0.05, 0.16, P = 0.0002), relieved pain (MD = =1.64, 95% CI = -2.69, -0.59, P = 0.002), and decreased the level of serum alkaline phosphatase (MD = -7.8, 95% CI = -14.17, -0.84, P = 0.03). Compared with Western medicine, electroacupuncture increased the level of serum calcium (MD = -0.12, 95% CI = -0.16, -0.09, P < 0.00001), relieve pain (MD = -1.32, 95% CI = -2.15, -0.48, P = 0.002), and decreased the level of serum alkaline phosphatase (MD = -3.63, 95% CI = -6.60, -0.66, P = 0.02). The review found, in comparison with Western medicine, needling relieved pain (MD = -2.27, 95% CI = -3.11, -1.43, P < 0.00001).	The review found acupuncture to be efficacious in treating osteoporosis. Warm acupuncture appeared to be superior compared to electroacupuncture and needling in treating osteoporosis in comparison to Western medicine. The study concluded that additional clinical trials are needed.
Seo et al. (2017) ( 83 )	A systemic review and meta-analysis of 16 RCTs examined the safety and efficacy of acupuncture and electroacupuncture in treating chronic neck pain. The review included 9 acupuncture studies and 7 electroacupuncture studies. The studies included in the review had treatment groups with or without active control, and control groups that received typical intervention options, medication or physical therapy.	There was not a significant difference in pain between the acupuncture group and the active control group (SMD 0.24, 95% CI -0.27 - 0.75), disability (SMD 0.51, 95% CI -0.01 - 1.02), or quality of life (SMD -0.37, 95% CI -1.09 - 0.35). Acupuncture added into the control group demonstrated greater pain relief in the studies with unclear allocation concealment (SMD -1.78, 95% CI -2.08 - - 1.48). However, when acupuncture was added into the control group in studies with good allocation concealment there was not significant pain relief (SMD - 0.07, 95% CI -0.26 - 0.12). The electroacupuncture vs. the control or electroacupuncture plus the active control demonstrated significant pain relief, however, the findings had a low level of evidence.	Acupuncture and conventional therapy demonstrated similar effects for pain relief and disability. Pain relief was better when acupuncture was added onto conventional therapy, and electroacupuncture lessened pain to a greater degree. Additional studies are needed as forming a conclusion was challenging due to the risk of bias and unreliability of the studies.
Chen et al. (2019) ( 93 )	(Only abstract available for review in English) A literature analysis examined the quality of randomized controlled trails for acupuncture as a treatment of chronic neck pain per the (CONSORT) and (STRICTA). The analysis examined both English and Chinese articles that were published between the dates of January 2008 to January 2018. The analysis included a total of 29 Chinese articles and 10 English articles.	The analysis found that Chinese literature is better at included acupuncture details than English literature. Regarding addressing trial design, English literature is better compared to Chinese literature.	The analysis concluded that both literature types needed to improve trial design in order to have a higher quality of reporting clinical evidence.
Li et al. (2017) ( 79 )	(Only abstract available for review in English) A study analyzed fast acupuncture versus retaining acupuncture in the treatment of the cervical type of cervical spondylosis. The study randomized 60 participants into either the fast acupuncture group or the retaining needle group.	For both groups, the NPQ score decreased after treatment (both P < 0.01), and the fast acupuncture group had greater improvement (P < 0.01). For both groups, all components of the SF-MPQ were lower compared to the pre-treatment scores (all P < 0.01). The fast acupuncture group had better results regarding PRI sensation and PRI total score (both P < 0.05). Post-treatment, the PRI feeling score, VAS score, and PPI score were not significantly different between the two groups (all P > 0.05). With the fast acupuncture group’s total effective rate being 83.3% (25/30), there was not a significant difference from the 76.7% (23/30) of the retaining needle group (P > 0.05).	The study concluded that both fast and retaining needle acupuncture were efficacious in improving the symptoms of cervical type of cervical spondylosis. The study found fast acupuncture to be better than retaining needle acupuncture.
Fejer et al. (2006) ( 5 )	A systematic review examined fifty-six studies regarding the global prevalence of neck pain and differences in methods among the studies. The review investigated the MED- LINE, EMBASE, CINAHL, OSH- ROM, PsycINFO databases, and citation lists of related articles. Point, week, month, 6 months, year, and lifetime were the prevalence periods used to determine mean prevalence measurements. The quality of the studies did not influence the prevalence measurements.	Women described more neck pain compared to men in every prevalence period except for lifetime. Scandinavia appeared to have more neck pain compared to the remainder of Europe and Asia for the prevalence period of one year.	The review concluded that neck pain is a prevalent symptom and standardization of design is needed in subsequent studies.
Lorenc et al. (2018) ( 94 )	A scoping review of systematic reviews examined the safety, efficacy, and cost-effectiveness of complementary medicine for treating musculoskeletal and mental health conditions. The review included 84 musculoskeletal systematic reviews and 27 mental health systematic reviews; only one of the reviews specifically addressed the musculoskeletal-mental health comorbidity.	Specifically regarding acupuncture, the systematic reviews provided fair/good quality evidence in a medium/large population for acupuncture treating low back pain, osteoarthritis, neck pain, myofascial trigger point pain. Acupuncture demonstrated safety in treating these conditions except there was some reported evidence of harm in acupuncture used in treating osteoarthritis. The review reported some evidence of acupuncture being an economical treatment option for low back pain.	The review concluded that yoga, mindfulness, and tai chi are the focuses of research regarding complementary medicine for musculoskeletal and mental health conditions; and additional better quality RCTs regarding comorbidity are needed.
Furlan et al. (2010) ( 75 )	A systematic review of 265 RCTs and 5 non-RCTs regarding complementary and alternative medicine (CAM) therapies analyzed the efficacy, harms, and cost-effectiveness of acupuncture, massage, spinal manipulation, and mobilization in treating pain of the back, neck, and/or thoracic region. We will specifically address the findings of the acupuncture analysis. The review examined MEDLINE, cochrane central, cochrane database of systematic reviews, CINAHL, and EMBASE for literature published up to 2010. Additionally, the review searched for literature not yet published and reference lists from related articles.	In treating chronic nonspecific low back pain, acupuncture showed significantly reduced pain intensity compared to placebo, but only right after treatment. (VAS: -0.59, 95 percent CI: -0.93, -0.25). The review did not find a difference between acupuncture and placebo regarding intake of pain medication, overall improvement in chronic nonspecific low back pain, or post-treatment disability. Regarding decreasing chronic non-specific neck pain immediately post-treatment, acupuncture and sham-acupuncture did not differ (VAS: ­ 0.24, 95 percent CI: -1.20, 0.73). Compared to no treatment, acupuncture improved pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately post-treatment. Overall, the studies that involved sham-acupuncture more likely had statistically insignificant results versus studies which involved placebos such as laser therapy or medications. Studies produced less consistent results when compared to other treatments such as mobilization. When compared to conventional treatment or no treatment, acupuncture was more economical for treating chronic back pain.	The general conclusion of entire review was that CAM treatments appeared to be the most beneficial immediately or sooner after the conclusion of treatment. Additional better quality studies are needed in order to formulate decisive conclusions.
Liang et al. (2012) ( 88 )	(ChiCTR-TRC-00000184) This article outlines the design and rationale of a randomized controlled trial that aims to evaluate acupuncture as a treatment for neck pain in the setting of cervical spondylosis. A total of 945 patients will be randomized to either the optimized acupuncture therapy group, shallow acupuncture, or sham acupuncture group. The intervention will last up to 4 weeks with 2 - 3 treatment sessions per week; a total of 8 - 10 sessions. The primary outcome measurement is the NPQ. The secondary outcome measurements are the MPQ and SF-36. Assessments will occur at baseline, at the conclusion of treatment, and at one month and three months post-treatment.		This article was published in 2012; and the published outcome of the study is not available per the Chinese Clinical Trial Registry.
Nasb et al. (2020) ( 70 )	(ChiCTR800014723) A randomized pilot trial examined the effectiveness of ischemic compression therapy, dry cupping, and the combination of the two therapies in treating trigger points (TPs) associated with neck pain. The study randomized 24 patients to either receive ischemic compression therapy, dry cupping, or both. The outcome measurements included PPT, neck ROM, NDI; assessments were made at pre-treatment and at four weeks post-treatment.	All three groups demonstrated significant improvement the NDI, PPT, and neck ROM in comparison to the pre-treatment results (P < 0.05). The study did not find major difference between ischemic compression and dry cupping. The combination of the two treatment methods demonstrated more rapid and greater improvement (P < 0.05).	Based on the findings, ischemic compression and dry cupping may have individual efficacy in treating TPs. The combination of the two appears to be a more superior treatment option for TPs. The study recommends conducting a RCT.