The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in England.
NICE guidelines are evidence-based recommendations for health and care in England.
They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings.
The guidelines help health and social care professionals to: prevent ill health, promote and protect good health, improve the quality of care and services, adapt and provide health and social care services.
Chronic pain is often difficult to treat and can have a significant impact on individuals and their families and carers. Chronic pain may affect between 30% and 50% of the population. Chronic primary pain is the pain with no clear underlying condition or impact of pain is out of proportion to any observable injury or disease.
NICE recommends acupuncture for chronic primary pain April 2021
Acupuncture for chronic primary pain
1.2.5Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, for people aged 16 years and over to manage chronic primary pain, but only if the course:
is delivered in a community setting and
is delivered by a band 7 (equivalent or lower) healthcare professional with appropriate training and
is made up of no more than 5 hours of healthcare professional time (the number and length of sessions can be adapted within these boundaries) or
is delivered by another healthcare professional with appropriate training and/or in another setting for equivalent or lower cost.
Why the committee made the recommendation
Many studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture. There was not enough evidence to determine longer-term benefits. The committee acknowledged the difficulty in blinding for sham procedures, but agreed that the benefit compared with a sham procedure indicated a specific treatment effect of acupuncture. There was a wide variation among the studies in the type and intensity of the intervention used, and the studies were from many different countries. The committee agreed that the type of acupuncture or dry needling should depend on the individual needs of the person with pain.
Two economic evaluations (1 in the UK) showed that acupuncture offered a good balance of benefits and costs for people with chronic neck pain. However, both studies had limitations; a notable limitation being that the costs of acupuncture seemed low. Threshold analysis based on these studies indicated the maximum number of hours of a band 6 and 7 healthcare professional's time that would make the intervention cost effective.
An original economic model was developed for this guideline, which compared acupuncture with no acupuncture. The model used data from studies with usual care comparisons, not comparisons with sham acupuncture, because the committee agreed that a usual care comparison in an economic model better reflects the real world benefit of the intervention. The model showed that acupuncture was likely to be cost effective. The committee considered the results to be robust, and agreed that the studies used in the model were representative of the whole evidence review. Acupuncture remained cost effective when the assumed benefits and costs were varied (sensitivity analysis).
Overall, the committee agreed that there was a large evidence base showing acupuncture to be clinically effective in the short term (3 months); the original economic modelling also showed it is likely to be cost effective. However, they were uncertain whether the beneficial effects would be sustained long term and were aware of the high resource impact of implementation. Taking these factors into account, the committee made a recommendation to consider acupuncture or dry needling for chronic primary pain, caveated by the factors likely to make the intervention cost effective. These were: only if delivered in the community, and with a maximum of 5 treatment hours (based on the average resource use in the trials in the model and on the threshold analysis), and from a band 7 (equivalent cost or lower) healthcare professional (based on the threshold analysis). It was agreed there may be different ways of delivering the service that enable acupuncture to be delivered for the same costs, which would equally be appropriate. The committee agreed that discontinuing before this total amount of course time would be an option if the person finds that the first few sessions are not effective.
No evidence was found to inform a recommendation for repeat courses of acupuncture. The committee agreed that further research would help to inform future practice (see the recommendation for research on repeat courses of acupuncture for chronic primary pain).