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Research Question

  1. What are the efficacy and safety of needle acupuncture, as an adjunctive or monotherapy, in addressing PTSD symptoms, health-related quality of life, functional status, depression and anxiety symptoms, sleep quality, and adverse events in adults with PTSD compared with treatment as usual, active treatments, sham acupuncture, waitlists, or no treatment?

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials (RCTs) of needle acupuncture — used adjunctively or as monotherapy — to provide estimates of its efficacy and safety for treating adults diagnosed with posttraumatic stress disorder (PTSD).

Outcomes of interest included PTSD symptoms (primary outcome), health-related quality of life, functional status, anxiety and depression symptoms, sleep quality, and adverse events. Meta-analyses were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.

Seven studies with 709 total participants were included. We identified potential benefits of acupuncture for PTSD and depression symptoms compared with control groups in the months following treatment, although the quality of the evidence underpinning these estimates is limited. Few minor adverse events and no serious adverse events were reported, but safety assessments were limited. Additional well-designed, rigorous, and large RCTs have the potential to further develop the evidence base to provide more-conclusive evidence.

Key Findings

The Available Evidence in Support of Acupuncture for PTSD Is Limited

  • We found statistically significant effects in favor of acupuncture (as adjunctive or monotherapy) versus any comparator for PTSD symptoms at postintervention and between one and six months follow-up, as well as for depressive symptoms at follow-up. However, the number of available studies is small, and the quality of evidence is low to very low.
  • Safety data suggested that acupuncture is not associated with any serious adverse events, although some participants reported mild adverse events due to needling procedures. However, adverse events were not systematically collected in most studies.
  • We did not identify any evidence to suggest that results differ by type of acupuncture, co-intervention status, or comparator, although these analyses are limited by the small number of identified RCTs and lack of direct comparisons.

Recommendations

  • Additional well-designed, rigorous, and large RCTs are needed to provide more-conclusive evidence on acupuncture for treating adults with PTSD.
  • Future RCTs should investigate specific PTSD symptom clusters (in addition to overall PTSD symptoms) to clarify whether any of the symptom clusters specifically are sources of any potential patient improvements.
  • Future RCTs should include sham comparators to account for possible nonspecific effects.
  • Given the potentially chronic nature of PTSD, researchers should seek to measure outcomes at long-term follow-ups.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Methodology

  • Appendix B

    Cochrane Risk of Bias Criteria

  • Appendix C

    Excluded Full-Text Articles

  • Appendix D

    Included Studies

  • Appendix E

    Evidence Table of Included Studies

  • Appendix F

    Sensitivity Analyses

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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