Table 4.

Acupuncture RCTs for acute pain: inpatient, surgery, ICU, and ED

Authors/year	Modality/Kind of Study/n	Setting and Types of Pain	Intervention and Comparators	Results
Zheng et al. 2012 [65]	Acupuncture or EAS Exploratory study n = 45	ICU Pain of intubated patients (under mechanical ventilation)	UC n = 15 UC plus acupuncture n = 15 (v24, Yin tang) de qi and 6 hours UC plus EAS n = 15 (GV 24, Yintang); 30 minutes on and off / 6 hours	EAS markedly reduced dosage of sedative drug (midazolam) needed for pain/discomfort of mechanical intubation.
Murugesan et al. 2017 [66]	Acupuncture Double-blind RCT n = 157	Outpatient, acute dental pain, irreversible pulpitis, tooth extraction	Acupuncture needles 15–20 minutes Classical acupuncture+ placebo tablet (n = 53) Sham acupuncture+ placebo tablet (n = 52) Sham acupuncture+ ibuprofen (n = 52) VAS before and after tx: 15, 20. 45, and 60 minutes Follow-up: 12, 24, and 48 hours	Acupuncture+ placebo tablet showed statistically significant lower pain values, no difference between either sham arm including with ibuprofen. acupuncture+ placebo tablet higher % no pain on follow-up= statistically significant to comparison groups.
Cohen et al. 2017 [56]	Acupuncture Equivalence, noninferiority RCT n = 528	Multicenter ED Acute LBP n = 270 Migraine n = 92 Ankle sprain n = 166	Prescribed acupuncture protocol per clinical condition Acupuncture alone (n = 177) Acupuncture+ pharm (n = 178) Pharm alone (n = 173) Pharm: Diazepam 5 mg, Hartmann’s solution, paracetamol 1 g, paracetamol 500 mg+ codeine 30 mg, tramadol 40–100 mg, dextropropoxyphene 32.5 mg+ paracetamol 325 g, ibuprofen 400 mg, diclofenac 50 mg, indomethacin 100 mg as needed. After 1 hour, second line: morphine 2.5-mg intravenous boluses, chlorpromazine 25 mg in 1,000 mL normal saline. VNRS Scale T0 and at every hour until discharge; functionality by Oswestry Low Back Disability Questionnaire, 24-Hour Migraine Quality of Life Questionnaire, or Patients Global Assessment of Ankle Injury Scale at T48 Acceptability T1, T48; health resource use, length of stay, readmission rate, additional analgesia.	Acupuncture analgesia comparable to pharm for acute back pain and ankle sprain. Three arms similarly effective at reducing pain at T1 but less than 40% of participants had reduction of pain of 2 points or more at T1 where more than 80% had pain of 4 or more. By T48, 61% of acupuncture alone, 57% combined, and 52% of pharm alone were definitely willing to repeat tx. Mild AE in each arm. Safe and acceptable.
AminiSaman et al. 2018 [67]	Double-blind RCT n = 60	OR: spinal anesthesia for trans-urethral lithotripsy surgery	TENS (n = 30) electrodes applied to GV channel at point between lumbar 3–4 and lumbar 5–S1 (extra point: M-BW-25: Shiqizhuixia) vs control of no intervention (n = 30)	Intervention reduced pain of spinal anesthesia; duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group.
AminiSaman et al. 2018 [68]	TENS at acupuncture points RCT n = 50	ICU Pain of intubated patients (under mechanical ventilation)	Li 4 and St 36 bi 30 min, 4×/24 hours vs sham (same device, not activated)	Reduction in pain and analgesic and sedation medication.
Fox et al. 2018 [69]	Ear acupuncture n = 30	ED Acute LBP	Ear acupuncture (n = 15) Standard care (n = 15)	Acupuncture was feasible and effective in reducing pain intensity; comparable outcomes in “get up and go test”
Beltaief et al. 2018 [58]	Acupuncture n = 115	ED Acute renal colic	Acupuncture (n = 54) vs titrated morphine (n = 61)	Time to 50% pain reduction: acupuncture (14 minutes) vs morphine (28 minutes). Acupuncture associated with much faster and deeper analgesic effect. Acupuncture had better tolerance profile than titrated morphine.
Crawford et al. 2019 [70]	Ear acupuncture BFA n = 233	Lower-extremity surgery acute pain	Modified BFA (n = 81) (right ear including cingulate gyrus, thalamus, omega 2, shen-men, and point zero) Sham acupuncture (n = 74) [ASP needles at ear upper limb ear points] Usual care (n = 78)	Overall pain levels unchanged at any time point; modified BFA does not change pain, opioid use, or quality of life in those with lower-extremity surgery.
Liu et al. 2019 [71]	Nonpharmacologic interventions n = 182	Primarily pediatric and adolescent athletes: Acute sprains Elective surgery Appendectomy or extremity surgery	Acupuncture with e-stim vs no tx (n = 72) Hypnosis vs no hypnosis (n = 50) Imagery relaxation vs no intervention (n = 60) 15- to 30-minute txs	Acupuncture, hypnosis, and relaxation beneficial. Acupuncture with e-stim improved pain relief for athlete sprains.
Schiff et al. 2019 [72]	Nonpharmacologic n = 1127	Perioperative pain, nausea, anxiety	SOC+ acupuncture or reflexology or guided imagery (n = 916) SOC (n = 211) (do not give n for each intervention group)	SOC insufficient; acupuncture better than reflexology for nausea; otherwise, all therapies provided equal advantage to SOC for pain and anxiety.
Jan et al. 2020 [73]	BFA n = 90	ED acute abdominal, low back pain, or limb trauma.	SAC (n = 30) BFA+ SAC= Adj-BFA (n = 30) Sham+ SAC= Adj Sham (n = 30) Intervention provided by nurses, nurse practitioners, physicians, trainees	No significant differences across groups. BFA cannot be recommended for acute pain in ED. (BFA is an abbreviated form of acupuncture.)
Skonnord et al. 2020 [74]	Abbreviated, short, single tx of “Western medical” acupuncture protocol plus movement: n = 167 Acupuncture = 86	Acute nonspecific LBP; 11 primary care settings	n = 171 2 lumbar (right) hand points strong de qi; then patient mobilization movements 2 minutes, then 6 needles at Huatuojiaji L2–L4 segments to de qi (tx time 8–9 minutes) plus usual care vs SOC: advice regarding activity and medications (paracetamol and/or ibuprofen), and information on sick leave (Norwegian national guidelines).	No difference in pain relief across groups. UC time to recovery = 14 days. Acupuncture care plus UC time to recovery = 9 days. Though an abbreviated tx, meets 3-day threshold of clinical relevance, but authors inexplicably conclude it is not clinically relevant.

Adj = adjunct; AE= adverse event; EAS = electroacupuncture stimulation (e-stim on needles inserted at acupoints; e-stim  = electrical stimulation; nonpharm = nonpharmacologic; OR = operating room; pharm = pharmaceutical; SAC = standard analgesic care; SOC = standard of care; TENS = transcutaneous electrical nerve stimulation; tx = treatment; UC = usual care; VAS = visual analog scale; VNRS = verbal numerical rating scale.