Author (Year)	Groups Studied and Intervention	Results and Findings	Conclusions
Calamita et al. 2018[@145444]	15 healthy patients and 15 patients with nonspecific neck pain, 1 session of acupuncture and 1 session of sham acupuncture. EMG signal of the upper trapezius was measured before and after acupuncture sessions.	Decreased EMG amplitude in both healthy and nonspecific neck pain patient groups. Numerical pain score improved among patients with nonspecific neck pain after acupuncture and sham acupuncture sessions. No difference was found between acupuncture and sham acupuncture treatments in regards to the numerical pain score. No systemic adverse effects were observed.	Acupuncture resulted in resistance to muscle fatigue and decrease of muscle activity as measured by EMG and was well tolerated. Pain improved with both acupuncture and sham acupuncture. Further investigation is warranted.
Cao et al. 2020[@145445]	18 patients, including 12 females, with chronic low back pain. Subjects received 6 treatments of video-guided acupuncture imagery treatment (VGAIT) over 4 weeks. Results were compared with a previous trial involving real acupuncture and sham acupuncture in chronic low back pain patients (n = 50, 31 females).	The three treatments studied (VGAIT, real, and sham acupuncture) resulted in decreased pain severity as measured by chronic low back pain severity score. No statistical difference in pain relief was found between VGAIT, real acupuncture, or sham acupuncture. No systemic adverse effects were noted.	VGAIT provided pain relief and shows promise. No control was used, the results should be viewed as preliminary.
Cerezo-Tellaz et al. 2016[@145433]	130 adult patients with nonspecific neck pain, with active myofascial trigger points in their cervical muscles. One group (n = 65) received deep dry needling (DDN) plus stretching while the second group (n = 65) received stretching only.	Subjective pain intensity significantly decreased in both trial groups after treatment. At a 6-month follow-up, the DDN trial group had neck disability index score reported (2.48 vs. 1.60). No adverse effects were observed.	Dry deep needling and muscle stretching alone relieved subjective pain in chronic neck pain patients. More studies are warranted.
Chi et al. 2016[@145492]	Single center study. 60 adults, including 55 females, with diagnosed and self-perceived chronic neck pain were followed for 5 months. 30 patients received dry cupping therapy while 30 control patients received rest only. Cupping therapy was administered at 3 acupuncture points (SI 15, GB 21, and LI 15) over 20 minutes.	Skin surface temperature (SST), blood pressure, and pain intensity was measured and compared to baseline. SST was elevated at each site in the cupping group. Neck pain intensity decreased more in the cupping group (baseline of 9.7 decreased by 6.1). Blood pressure differences were not significant, however systolic blood pressure was reduced in the cupping group (117.7 mmHg to 111.8 mmHg). No study participant reported adverse effects in the treatment regions.	Subjective neck pain relief was observed after treatment with cupping performed at traditional acupuncture sites. An analgesic effect is possible with no known adverse effects. Further studies on long-term effects of cupping are recommended.
Cho et al. 2013[@145431]	Multicenter study with 130 adults suffering from nonspecific chronic low back pain. Participants received either real acupuncture or sham acupuncture for 6 weeks with 2 treatments performed each week. The primary outcome was visual analogue score (VAS) for bothersomeness for chronic low back pain.	116 patients maintained follow-up over a 6-month period. Mean VAS decreased by 3.36 points in the real acupuncture group, compared with 2.27 in the sham control group. Adverse effects were monitored, and 16 participants reported minor to moderate events related to treatment. No systemic or serious adverse effects were reported.	Real acupuncture reduced chronic low back pain bothersomeness and pain intensity better than sham acupuncture. Adverse effects were minor, such as worsened low back pain, pain, or bruising, and did not last greater than 1 week. The physicians who administered the acupuncture were not blinded.
De Meulemeester et al. 2017[@145436]	42 female office-worker participants with existing myofascial neck/shoulder pain. Randomly assigned to dry needling (DN) group or the manual pressure (MP) control group. Evaluated with Neck Disability Index (NDS), a numeric rating scale, pressure pain threshold, and muscle characteristics before and after treatment.	No significant differences were found between DN and MP. Symptoms and rating scales improved in both groups after 4 treatments performed over 3 months. No adverse effects were reported.	DN was found to be no more effective than manual pressure. Reduced long term and short-term disability was found in both groups.
Eslamian et al. 2020[@145401]	Patients between 25-55 of both sexes (n = 50, 39 women and 11 men); diagnosed with myofascial pain syndrome (MPS). Treatment group (n = 25) exposed to electroacupuncture. Control group (n = 25) exposed to visual electromyography and biofeedback. Pain severity based on VAS and functional status assessed with the NDI. Inclinometer and algometer used to measure range of motion and pressure pain threshold.	All parameters improved significantly in both groups, except for pressure pain threshold of lower trapezius and paravertebral muscles. Outcomes improved significantly in acupuncture (20 subjects) versus biofeedback (10 subjects) (rate ratio=2, CI of 1.19-3.36). Intervention lasted 3 months.	Both electroacupuncture and biofeedback were effective in reducing pain severity and neck disability. Electroacupuncture performed better in some parameters and shows promise in the treatment of myofascial pain syndromes of the neck and upper back.
Foster et al. 2016[@145446]	Two phase study assessing acupuncture in the treatment of chronic low back pain in pregnant women in the UK. Phase I consisted of a questionnaire survey, interview of patients and providers, to assess feasibility of study. Phase II consisted of a single-center randomized controlled trial (n = 125) comparing real acupuncture (n = 42) versus sham acupuncture (n = 42) versus standard care alone (n = 41). Both acupuncture groups received standard care for chronic low back pain (education and physical therapy). Acupuncture (real and sham) regimen consisted of 6 to 8 treatments.	Phase I results showed that 24% of physical therapists administered acupuncture. Women reported no concerns with exploring acupuncture as a treatment of chronic low back pain. Phase II patient reported that outcomes (pain, function, and quality of life) improved with acupuncture overall at the 8-week follow-up. Mean score differences were adjusted for baseline scores and baseline covariates obtained through regression. No severe adverse events were reported. All participants resumed treatment after any hospitalization or medical intervention not related to the study. No neonatal adverse effects were reported. Minor side effects reported include bleeding at the site of acupuncture (21% of true acupuncture, 0.5% in non-penetrating acupuncture arm). 86% of the women were still pregnant at the end of the 8-week follow-up.	Pain reduction and functionality improvement were achieved with true acupuncture and non-penetrative acupuncture.
Ho et al. 2017[@145429]	Patient and assessor-blind, sham-controlled single center trial. Patients ages 18-65 (n = 154) were assigned to receive abdominal (n = 77) or non-penetrating sham (n = 77) acupuncture. Each group received treatments in six sessions by Registered Chinese Medicine Practitioners. Mean improvement in neck pain disability scores (Northwick Park Neck Pain Questionnaire) and quality of life were obtained. The abdominal acupuncture group had additional follow-up at 14 weeks.	True abdominal acupuncture group exhibited greater improvement in neck pain and disability scores at both 2- and 6-week periods (mean difference -5.75 at 2 weeks; -8.65 at 6 weeks). Patients in the true abdominal acupuncture group also reported greater improvement in pain intensity and quality-of-life measures than those in the sham control group. There were no severe adverse effects. 11 participants in the true abdominal acupuncture group reported transient bruises that did not persist or require treatment.	Abdominal acupuncture resulted in greater decrease in neck pain and disability as compared with sham non-penetrative acupuncture. Further multicenter studies on abdominal acupuncture are needed, however abdominal acupuncture appears to be an effective treatment of neck pain.
Kim et al. 2019[@145435]	Single-center, assessor blinded, two-armed trial with 106 adults suffering from chronic neck pain. Trial patients (n = 51) received thread-embedding acupuncture (TEA) with polydioxanone in conjunction with usual care (UC). Control group received usual care only. TEA treatments were given once a week for a 4-week period with usual care as needed. The primary outcome measured was neck pain and disability scale (NPDS) score. Patients were assessed at 0,3,5, and 9 weeks.	The TEA treatment group showed significant improvement in NPDS at week 5 (13.74) and at week 9 (17.46) than the UC control group. 12 patients reported adverse effects that occurred during the 191 TEA treatment sessions. These included stiffness (22.6%), bruising (8%), irritation (8%), skin flare (4%), pruritus (1%). No severe adverse events were reported.	TEA therapy resulted in significant improvements in NPDS scores. Psychological distress and quality of life improvements were also observed. Although some patients reported mild adverse effects related to treatments, TEA is a promising therapy for chronic nonspecific neck pain.
Nasb et al. 2020[@145493]	Pilot trial with 24 adult patients possessing trigger points and nonspecific neck pain. Randomly assigned to a cupping therapy group, ischemic compression therapy group, and a combination therapy group. Pressure pain threshold, neck range of motion, and neck disability index were assessed.	All treatment groups experienced improvement in neck disability index, pressure pain threshold, and neck range of motion. No significant difference was observed between dry cupping and ischemic compression, although the combination therapy achieved the most improvement.	A larger RCT on the efficacy of dry cupping and ischemic compression is indicated. No adverse effects were observed.
Norrbrink et al. 2011[@145443]	Pilot trial with 30 adult patients, with neuropathic pain following a spinal cord injury, assigned to acupuncture group (n = 15) or massage group (n = 15). Both groups received treatments twice weekly for 6 weeks. Patients received follow-up at end of treatments and 2 months later. Ratings of present pain, general pain, pain unpleasantness, and coping were monitored. Ratings were obtained using the multidimensional pain inventory and the patient global impression of change scale.	Pain ratings improved significantly at the end of treatment after acupuncture as compared with baseline. Ratings of pain interference on the multidimensional pain inventory improved after massage. No significant improvements were found after the 2-month follow-up, however 6 acupuncture patients reported subjective improvement. Few side effects were reported, and no subjects dropped out due to adverse effects.	It is possible that acupuncture may improve neck pain after spinal cord injuries. Larger trials are warranted to examine this issue.
Que et al. 2013[@145441] Protocol	Protocol for a double blinded, parallel group, placebo-controlled trial comparing active acupuncture with sham acupuncture. 456 adult patients diagnosed with cervical spondylosis and suffering from neck pain. Patients will be treated 5 times a week for 2 weeks. Northwick Pain Neck Pain Questionaire (NPQ), Short-Form 36 (SF-36), and McGill pain scale will be used. Patients will be followed up at 4,8, and 12 weeks after intervention.	-	-
Schiller et al. 2016[@145442]	Sham controlled trial. 53 adult patients (87% female) with osteoporosis, received 10 sessions of acupuncture over a period of 5 weeks. Pain score (VAS) and quality of life score (QUALEFFO-41) were recorded.	Pain reduced by 61%, by the end of the study, in the true acupuncture group. Pain reduced by 49% in the control sham group. Serious side effects did not occur during the study.	Both true and sham acupuncture were effective in producing pain relief in osteoporosis patients. True acupuncture had longer lasting effects. No adverse effects were reported. Larger sample sizes are warranted.
Shin et al. 2013[@145430]	Multicenter study with 58 adult patients with acute low back pain, with severe functional disability, assigned to motion style acupuncture treatment or conventional diclofenac injection. Improvement in lower back pain was assessed using 10-point numerical score. Patients were assessed at 2,4, and 24 weeks after treatment.	Numerical rating scale decreased by 3.12 in the acupuncture group while the disability score decreased by 32.95%. The differences with the diclofenac group were statistically different at the 2 and 4 week assessments. No adverse effects were reported.	Motion style acupuncture is an effective method for initial pain relief in acute lower back pain. Adverse effects were not reported.
Sun et al. 2019[@145440] Planned	Protocol for a multicenter trial that will feature 716 adult patients with chronic neck pain. Acupuncture will be applied to sensitive acupoints. Participants assigned to one of 4 groups (highly sensitive acupoints group, low/non-sensitive acupoints group, sham acupuncture group, and waiting list-control group). Patients evaluated before treatment, after treatment, and at 4, 8, 12, 16, 20 weeks.	Primary outcome is the VAS while the secondary outcome is the NPQ and McGill pain questionnaire. Adverse effects will be recorded.	-
Sun et al. 2019[@145494] Planned	Protocol for a multicenter observational study that will feature 224 adult patients with chronic neck pain. Study will attempt types of sensitization and the distribution of sensitized points. Body surface temperature, mechanical pain threshold, pressure pain threshold, and skin resistance will be assessed at 15 acupoints.	Acupoint sensitization will be determined using odds ratio between neck pain patients and healthy controls and acupoint sensitization rate of all patients.	-
Vas et al. 2012[@145434]	Multicenter trial that evaluated the efficacy of acupuncture in 275 patients with acute low back pain. Patients assigned to either conventional treatment alone or conventional treatment plus true acupuncture, sham acupuncture, or placebo acupuncture. Roland Morris Disability Questionnaire (RMDQ) score was scored, and patients were followed up at 3, 12, and 48 weeks.	RMDQ score reduced by 35% or more after 2 weeks of treatment. All modalities of acupuncture treatment resulted in greater pain reduction than conventional treatment alone. There was no significant difference between sham acupuncture and true acupuncture. No serious adverse effects reported. 12 patients (4.4%) had possible adverse effects including epigastralgias and nausea. 8 patients (3.9%) reported pain after the treatment session.	True acupuncture and sham acupuncture were effective in reducing pain and disability in patients with acute low back pain. No serious adverse effects were reported however minor discomfort was observed in a small number of patients (3.9%).
Wand et al. 2013[@145495]	Cross-over experiment in 25 adult patients with chronic low back pain. Compared effects of acupuncture with sensory discrimination training component against acupuncture without. Patients rated pain intensity using a numerical rating scale. Treatments were given during two phases.	The average reported pain intensity was less in the sensory discrimination group (2.8) than the acupuncture alone group (3.6). Adverse effects were not considered.	Patients subjectively reported less pain when given acupuncture with sensory discrimination training than with acupuncture alone. Acupuncture may favorably influence pain through improvement of self-perception.
Weiß et al. 2013[@145432]	143 adult patients with chronic low back pain (67% men). Assigned to 2 groups: acupuncture plus standard rehabilitation and standard rehabilitation only. Short-Form Health Survey-36 (SF-36) used to measure outcomes (physical functioning, general health, vitality, quality of life, and pain).	Acupuncture treatment group reported better quality of life outcomes than control group. Pain outcomes improved compared with control group.	Acupuncture was accepted by study participants as a viable treatment option and showed better improvement in subjective pain symptoms and quality of life outcomes than standard rehabilitation alone. There were no major adverse effects reported.
Yang et al. 2017[@145439] Protocol	Protocol for five-arm, parallel, single-blinded, sham-controlled trial. 175 adult patients with chronic neck pain. Groups will include traditional acupuncture, shallow-puncture, non-acupoint acupuncture, non-acupoint shallow-puncture, and sham acupuncture. Sessions will last 20 minutes and will be carried out twice a week for 5 weeks.	NPQ and Short Form McGill Pain Questionnaire (SF-MPQ-2) will be used to measure outcomes. Safety will be evaluated at each treatment period.	Intent is to measure efficacy of traditional acupuncture vs placebo.