Is Acupuncture Effective in Moderating the Cardiovascular System's Stress Response? A Systematic Review of the Literature
By Alison Tattersfield
The UK’s Health and Safety Executive recently launched Management Standards for Stress, setting out employers’ responsibility to address the condition in the work-place. Cardiovascular disorders can result from long-term stress as recognised by the World Health Organisation. Acupuncture is a widely used complementary medicine and it has been suggested that it might help to prevent disease. So it follows that acupuncture could contribute to stress management in organisations. Therefore this systematic review analyses methodological quality and treatment adequacy of clinical trials, to determine the level of evidence of acupuncture’s efficacy in moderating the cardiovascular stress response in healthy individuals.
Following an initial literature review, there is discussion about stress and the cardiovascular system from Western and Chinese medicine perspectives. Benefits and drawbacks of systematic reviews previously suggested by authors, together with their solutions are highlighted. Published guidelines are used in this work and its strengths and weaknesses outlined. Five randomised controlled trials (RCTs) met the inclusion criteria. Four were rated as low quality, showing positive results and one was rated high quality but with a negative effect.
It was therefore concluded, from the included trials, that there is conflicting evidence of acupuncture’s efficacy in relation to the research question. Poor methodology in trials is often mentioned as limiting evidence of acupuncture’s efficacy. However, whereas calls have been made to increase their quality, a debate is highlighted concerning appropriateness of even using explanatory trials for complementary medicine as they are primarily designed to assess biomedicine’s specific effects. These are difficult to segregate in complex interventions and recommendations are cited for the use of well-designed, pragmatic trials in acupuncture research so that its full, holistic effects as observed in routine practice can be captured.