acupuncture for smoking cessation

7/29/2019 Acupuncture for Smoking Cessation

1/17

Acupuncture for smoking cessationWhite AR, Rampes H, Ernst E

Cover sheet - Background - Methods- Results-Discussion - References - Tables & Graphs

A substantive amendment to this systematic review was last made on 17 June 1999.

Cochrane reviews are regularly checked and updated if necessary.

Background and objectives: Acupuncture is promoted as a treatment for smoking

cessation, and is believed to reduce withdrawal symptoms. The objective of this review is

to determine the effectiveness of acupuncture in smoking cessation in comparison with:

a) sham acupuncture

b) other interventions

c) no intervention.

Search strategy: We searched the Cochrane Tobacco Addiction Group trials register,

Medline, Psyclit, Dissertation Abstracts, Health Planning and Administration, Social

SciSearch, Smoking & Health, Embase, Biological Abstracts and DRUG.

Selection criteria: Randomised trials comparing a form of acupuncture with either sham

acupuncture, another intervention or no intervention for smoking cessation.

Data collection and analysis: We extracted data in duplicate on the type of subjects, the

nature of the acupuncture and control procedures, the outcome measures, method of

randomisation, and completeness of follow-up.

We assessed abstinence from smoking at the earliest time-point (before 6 weeks), at six

months and at one year follow-up in patients smoking at baseline. We used the mostrigorous definition of abstinence for each trial, and biochemically validated rates if

available. Those lost to follow-up were counted as continuing to smoke. Where

appropriate, we performed meta-analysis using a fixed effects model.

Main results: We identified 18 publications involving 20 comparisons. Acupuncture was

not superior to sham acupuncture in smoking cessation at any time point. The odds ratio

(OR) for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49); the OR after 6

months was 1.38 (95% confidence interval 0.90 to 2.11) and after 12 months 1.02 (95%

confidence interval 0.72 to 1.43).

Similarly, when acupuncture was compared with other anti-smoking interventions, there

were no differences in outcome at any time point. Acupuncture appeared to be superior to

no intervention in the early results, but this difference was not sustained.

The results with different acupuncture techniques do not show any one particular method

(i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control

intervention.

Reviewers' conclusions: There is no clear evidence that acupuncture is effective for

smoking cessation.

BackgroundAcupuncture has been used in the treatment of nicotine dependence in the West since anincidental observation in Hong Kong (Wen 1973). Opium smokers who had been givenelectroacupuncture for pain relief claimed that their opiate withdrawal symptoms were less


2/17

severe than they expected. Uncontrolled studies have suggested that acupuncture might alsoreduce the symptoms of nicotine withdrawal and some remarkably high rates of initial successhave been claimed. For example Fuller claimed that 95% of 194 subjects were not smokingafter three treatments in one week, falling to 34% after twelve months (Fuller 1982). Choyclaimed 88% success in a large study of 514 subjects but did not state the long-term results(Choy 1983). Clearly only randomised controlled studies can determine whether this is morethan a placebo effect.Several literature reviews of controlled trials of acupuncture for smoking cessation have beenpublished yet the conclusions are not uniform. Vincent & Richardson found that acupunctureappeared to be as effective as other methods in the initial stages of nicotine withdrawal.However there was uncertainty as to what the actual stimulation contributed and whetheracupuncture helped prevent relapse (Vincent 1987). Schwartz found no evidence of a specificeffect (Schwartz 1988). Brewington et al (Brewington 1994) concluded that acupuncture mightbe of limited assistance in withdrawal.Ter Riet (Ter Riet 1990) performed a criteria-based systematic review of randomised controlledtrials and found that the better the quality of the study the more likely it was to be negative. Heconcluded that on balance there was no evidence that acupuncture was efficacious in the

treatment of nicotine addiction. Lewith criticised this review and argued that trials in which thecontrols received needling in inappropriate sites were likely to underestimate the effects ofacupuncture: the control procedure was not inactive since needling random sites could triggerthe release of endorphins (Lewith 1995). He concluded that acupuncture is as good as nicotinereplacement therapy.Law & Tang performed a limited meta-analysis of the Medline-listed trials, concluding thatacupuncture had "little or no effect" (Law 1995). Ashenden & Silagy (1997) included 10 studiesin a systematic review looking at the long-term success of acupuncture in smoking cessation: 9of the studies could be combined in a meta-analysis which concluded that, while acupunctureappears to be promising, there was insufficient evidence to recommend it as an effective form oftherapy.We undertook a new review and meta-analysis in order to evaluate the short and long-term

outcome of acupuncture for smoking cessation.

ObjectivesTo evaluate whether acupuncturea) has a specific effect in smoking cessation beyond placebo effectsb) is more effective than other interventions for smoking cessationc) is more effective than no treatment for smoking cessation

Criteria for considering studies for this review

Types of participants

Tobacco smokers aged over 18 years who wished to stop smoking.

Types of intervention

Any treatment involving needle puncture of areas of the body described by the studys author asacupuncture points. This includes points on the ear, face and body. Needles usually remain inposition for the duration of a treatment session (often lasting 15 - 20 minutes). Studies in whichan electrical stimulation was applied to the needles, known as electroacupuncture, were alsoincluded.Alternatively, or in addition, to the above needling, specially designed indwelling needles maybe inserted, usually in ear points, and held in position with surgical tape for several days.Patients are instructed to press the indwelling needles when they become aware of withdrawalsymptoms. As alternatives to indwelling needles, either small seeds may be attached to the earwith adhesive tape, or a surgical suture may be inserted and knotted with a bead attached.Such studies were also included in the review.


3/17

Types of outcome measures

Only complete abstinence from smoking was considered. The review has not been limited tostudies where the outcome was confirmed biochemically (see 'Methodological quality'). Wherenecessary the published data have been recalculated on an intention-to-treat basis i.e. countingall drop-outs as smokers.

Data have been extracted (where they are presented in the report) on early outcome (i.e. firstmeasure after the treatment, but in any case less than 6 weeks) and after 6 and 12 months.Sustained smoking cessation was chosen in preference to point prevalence where these figureswere available.

Types of studies

All randomised controlled trials comparing acupuncture with either sham acupuncture, anotherintervention or no treatment, for smoking cessation.

Search strategy for identification of studiesSee: Collaborative Review Group search strategy

All publications containing the terms "smoking" and "acupuncture" were identified usingcomputerised searches of MEDLINE, PSYCLIT, DISSERTATION ABSTRACTS, HEALTHPLANNING & ADMINISTRATION, SOCIAL SCISEARCH, SMOKING & HEALTH, EMBASE,BIOLOGICAL ABSTRACTS and DRUG (a database maintained by the Alcohol and other DrugsCouncil of Australia). In addition, relevant references were obtained from published reviews,clinical trials and conference abstracts, as well as smoking and health bulletins andbibliographies.

Methods of the reviewData for smoking cessation rates early after treatment (the first recorded, but less than 6 weeks)and at 6 and 12 months were extracted from the reports by ARW and HR independently.Disagreements were resolved by discussion. The reviewers were not blinded. Where possible,authors were contacted to provide missing data.Subjects lost to follow-up were regarded as having continued smoking.The three time-points were selected in an attempt to identify separately the possible effects ofacupuncture on a) cessation in the acute withdrawal period, and b) sustained abstinence.When more than one control group was used, 2 comparisons were performed, one using thedata most favorable to acupuncture and the other using the data least favorable. This situationoccurred with Circo 1985and Cottreaux 1983. However, data from control groups werecombined in the subsequent comparison of different methods of acupuncture.Data on withdrawal symptoms were not extracted; very few studies used withdrawal symptomsas an endpoint.

Repeated comparisons were made between acupuncture and different control procedures (i.e.sham acupuncture, other active treatment control, and no intervention) and between differenttechniques of acupuncture. In each case a weighted estimate of the OR (with a positiveoutcome shown as >1) was calculated using the fixed effects model.Confidence intervals were set at 95%.

Description of studiesSee: Table of included studies, Table of excluded studies18 reports were found of studies which qualified for inclusion in the review. However, Martin(1981) and Parker (1977) both reported parallel studies, i.e. two groups with different treatmentprocedures, each with its own control group. Therefore, data from each of these groups havebeen entered separately, giving a total of 20 controlled studies for analysis (see Table ofIncluded Studies).


4/17

Initial group sizes for the study by Martin (1981) were not available in the published report andwere obtained from the authors. Results for the different arms of the study by Clavel (1990)were obtained from the authors.The studies varied considerably in methodology as well as the technique of acupuncture used.

Methodological qualitySee: Table of included studiesWe assessed four dimensions of study design which may lead to bias in studies of smokingcessation: a) reporting of method of randomisation and allocation concealment b) blinding ofsubjects to treatment status c) verification of cessation d) duration of outcome.a) Randomisation and concealmentOnly one report included sufficient details to be certain whether correct method of randomisationwith adequate concealment was used (White 1998). Martin (1981) and Lagrue (1977)randomised subjects in groups in order to prevent individuals who were receiving differentprocedures from mixing together and attempting to guess their group allocation. Labadie (1983)randomised subjects by alternation; and Steiner (1982) used a matched pairs design. None ofthese methods is regarded as true randomisation.

In view of the lack of information on methods of randomisation, we did not assign a formalquality score to the studies.b) BlindingA study was adjudged to be single-blind if it involved some form of sham therapy that wasdesigned to be indistinguishable to the participant, even if the word 'blind' was not specificallymentioned by the author. Single-blinded studies appear in the comparisons 'Acupuncture vssham acupuncture'.Achieving full double-blinding is problematic in acupuncture studies. One trial (Lagrue, 1977)achieved blinding of the therapist by training a novice to use the two interventions withoutknowing which was genuine.Even if subjects are blinded, they may be influenced by the interaction with the practitioner. Toavoid this, minimal or standardised interaction between therapist and patient is a recognisedmethod of reducing bias in acupuncture research. This procedure was adopted in 4 studies(Gilbey 1977, He 1997, Lamontagne 1980 and White 1998).c) Outcome measure verificationSmoking cessation was verified by biochemical testing in four of the trials: Clavel 1985 andWhite 1998used a carbon monoxide meter, He 1997 measured serum cotinine, and Waite 1998measured urinary cotinine concentrations.d) Duration of smoking cessationSince sustained cessation is the prime object of anti-smoking programmes, cessation at 12months is considered the most important outcome. However, only 5 of the 16 studies measuredoutcomes at 12 months.

Results List of comparisons

Acupuncture was not superior to sham acupuncture in smoking cessation at any time pointconsidered in this review. The OR for early outcomes was 1.22 (95% CI 0.99 to 1.49); the ORafter 6 months was 1.38 (95% CI 0.90 to 2.11) and after 12 months 1.02 (95% CI 0.72 to 1.43).Similarly, when acupuncture was compared with other anti-smoking interventions, there were nodifferences in outcome at any time point. The respective ORs for early outcomes were 0.80(95% CI 0.62 to 1.02) using the least favourable data, and 1.05 (95% CI 0.82 to 1.35) using themost favourable data. After 6 months the OR was 1.11 (95% CI 0.63 to 1.94) and after 12months the OR was 0.87 (95% CI 0.61 to 1.24) or, with the least favourable data, 0.76 (95% CI0.54 to 1.08).Acupuncture was only compared with no intervention in 3 studies. Acupuncture appeared to besuperior to no intervention in the early results (OR 5.88, 95% CI 2.66 to 13.01), but there was no


5/17

difference at 6 months (OR 0.99, 95% CI 0.30 to 3.24). The result at 12 months is dependent ononly one study, OR 2.44 (95% CI 1.15 to 5.20).The results with different techniques did not show any one particular method (i.e. auricularacupuncture or non-auricular acupuncture) to be superior to control intervention at any time-point.The sensitivity of the results to study quality was not tested because of the problems inassigning formal quality scores to this set of studies.

DiscussionAcupuncture was not shown to be superior to sham acupuncture or any other intervention insmoking cessation. The studies included in this review are subject to a number of biases. Inparticular, the majority of studies neither reported how randomisation was performed nor verifiedsmoking cessation biochemically. However such biases might be expected to exaggerate theeffects of acupuncture rather than underestimate them.The comparisons of acupuncture and sham acupuncture reveal three studies with results thatare strongly positive and clearly different from all other results (He 1997, Lacroix 1977, Waite

1998). No explanation for this difference can be identified in the study by Lacroix. The study byHe 1997, however, involved a combination of acupuncture approaches, with bodyelectroacupuncture, ear acupuncture and prolonged ear acupressure. The study by Waite 1998involved ear acupuncture and prolonged ear acupressure. It is possible that acupuncturestimulation that is both intensive and continuous may have an effect which is not seen with morelimited treatment, and this deserves further research.It appears that acupuncture, like some other interventions, may be better than doing nothing inorder to aid smoking cessation. However, this conclusion is based on only 3 studies, and theeffect appears not to be sustained.This negative conclusion limits rather than prohibits further investigation of the place ofacupuncture in withdrawal from habituating substances. It should be emphasised that the initialobservation of an effect of acupuncture in dependency was in patients who were in the acutestage of opiate withdrawal (Wen 1973) . Changes in opioid peptides accompanied theseobservations (Clement-Jones 1979). Animal experiments have also suggested that acupuncturemight have a place in the acute withdrawal syndrome (Cheng 1980, Choy 1978, Han 1993, Ng1975). It would seem important to study the possible effect of acupuncture in the acute stages ofnicotine withdrawal. Clavel 1990 made an attempt to measure withdrawal symptoms but lessthan a quarter of the subjects completed the questionnaires. White 1998 measured withdrawalsymptoms in those who were successful in stopping smoking and found no effect ofacupuncture compared with sham. The effect of prolonged ear acupressure on withdrawalsymptoms remains untested.

Reviewers' conclusions

Implications for practice

There is no evidence for the specific effectiveness of acupuncture in smoking cessation greaterthan a placebo effect.

Implications for research

Future research should concentrate on using adequate stimulation. Investigations should alsoconsider whether acupuncture may lead to a reduction of nicotine withdrawal symptoms.

Potential conflict of interestAW and EE are authors of a trial included in this review.


6/17

AcknowledgementsWe are grateful to Ruth Ashenden and Chris Silagy for kindly giving us access to their ownreview of acupuncture in smoking cessation as the basis for much of the present review.We are grateful to Prof P Waite of the University of New South Wales, Australia for providingfurther data for the study by Martin and Waite (1981); and to Dr F Clavel of the Unite deRecherche en Epidemiologie des Cancers, Villejuif France for providing data for the studyClavel (1990).

ReferencesReferences to studies included in this reviewCirco 1985 (published data only)

Circo A, Tosto A, Raciti S, Cardillo R, Gulizia M, Oliveri M et al. Primi risultati di un

ambulatori antifumo [First results of an anti smoke outpatient unit: Comparison among

three methods]. Riv Cardiol Prev Riabil 1985;3:147-51.

Clavel 1985 (published data only)

Clavel F, Benhamou S, Company-Huertas A, Flamant R. Helping people to stop

smoking: randomised comparison of groups being treated with acupuncture and nicotine

gum with control group. BMJ 1985;291:1538-1539

Clavel 1990 (published and unpublished data)

Clavel F, Paoletti C, Benhamou S. A randomised 2x2 factorial design to evaluate

different smoking cessation methods. Rev Epidm et Sant Publ 1992;40:187-190Clavel

F, Paoletti C. Une tude de diffrents programmes de dsintoxication tabagique portant

sur prs de 1000 volontaires recruts dans la population gnrale : rsultats 1 mois. Rev

Epidm et Sant Publ 1990;38:133-138Clavel-Chapelon F, Paoletti C, Benhamou S.

Smoking cessation rates 4 years after treatment by nicotine gum and acupuncture.

Preventive Medicine 1997;26:25-28

Clavel 1990 +NG (published data only)Cottraux 1983 (published data only)

Cottraux JA, Harf R, Boissel J-P, Schbath J, Bouvard M, Gillet J. Smoking cessation with

behaviour therapy or acupuncture - a controlled study. Behav Res Ther 1983;21(4):417-

424

Gilbey 1977 (published data only)

Gilbey V, Neumann B. Auricular acupuncture for smoking withdrawal. Am J Acup

1977;5:239-247Gillams 1984 (published data only)

Gillams J, Lewith GT, Machin D. Acupuncture and group therapy in stopping smoking.

Practitioner 1984;228:341-344

He 1997 (published data only)

He D, Berg JE, Hostmark AT. Effects of acupuncture on smoking cessation or reduction

for motivated smokers. Prev Med 1997;26:208-214

Labadie 1983 (published data only)

Labadie JC, Dones JP, Gachie JP, Frour P, Perchoc S, Huynh Van Thao JP.

Dsintoxication tabagique: acupuncture et traitement mdical. Gaz Md de France1983;90:2741-2747

Lacroix 1977 (published data only)


7/17

Lacroix JC, Besancon F. Le sevrage du tabac. Efficacit de l'acupuncture dans un essai

comparatif. Ann Md Interne 1977;128:405-408

Lagrue 1977 (published data only)

Lagrue G, Poupy JL, Grillot A, Ansquer JC. Acupuncture anti-tabagique. Resultats a

court terme d'une etude comparative menee a double insu. Nouv Presse Med 1977;9:966Lamontagne 1980 (published data only)

Lamontagne Y, Annable L, Gagnon MA. Acupuncture for smokers: lack of long-term

therapeutic effect in a controlled study. Can Med Assoc J 1980;5:787-790

Leung 1991 (published data only)

Leung JP. Smoking cessation by auricular acupuncture and behavioral therapy.

Psychologia 1991;34:177-187

Martin 1981a (published data only)

Martin GP, Waite PME. The efficacy of acupuncture as an aid to stopping smoking. NZ

Med J 1981;93:421-423Martin 1981b (published data only)

Martin GP, Waite PME. The efficacy of acupuncture as an aid to stopping smoking. NZ

Med J 1981;93:421-423

Parker 1977a (published data only)

Parker LN, Mok MS. The use of acupuncture for smoking withdrawal. Am J Acup

1977;5:363-366

Parker 1977b (published data only)

Parker LN, Mok MS. The use of acupuncture for smoking withdrawal. Am J Acup

1977;5:363-366Steiner 1982 (published data only)

Steiner RP, Hay DL, Davis AW. Acupuncture therapy for the treatment of tobacco

smoking addiction. Am J Chin Med 1982;10:107-121

Vandevenne 1985 (published data only)

Vandevenne A, Rempp M, Burghard G. Etude de l'action spcifique de l'acupuncture

dans la cure de sevrage tabagique. Sem Hp Paris 1985;61:2155-2160

Waite 1998 (published data only)

Waite NR, Clough JB. A single-blind, placebo-controlled trial of a simple acupuncture

treatment in the cessation of smoking. British J. of General Practice. 1998;48:1487-90

White 1998 (published data only)

White AR, Resch K-L, Ernst E. Randomized trial of acupuncture for nicotine withdrawal

symptoms. Arch. Intern. Med. 1998;158:2251-55

* indicates the major publication for the studyReferences to studies excluded from this reviewBoureau, 1978

Boureau F, Willer J-C. Desintoxification tabagique par l'acupuncture: essai negative de

blocage par la naloxone. La Nouvelle Presse medicale. 1978;7(6):1401

MacHovec 1978MacHovec FJ, Man SC. Acupuncture and hypnosis compared: fifty-eight cases. Am J

Clin Hypnosis 1978;21(1):45-47


8/17

Man 1975

Man SC. A preliminary clinical study of smoking treated by stitch-auriculo-acupuncture.

Proceedings of the Third World Symposium on Acupuncture and Chinese Medicine, New

York, USA March 1975

Additional referencesAshenden 1997

Ashenden R, Silagy CA, Lodge M, Fowler G. A meta-analysis of the effectiveness of

acupuncture in smoking cessation. Drug Alcohol Rev 1997;16:33-40.

Brewington 1994

Brewington V, Smith M, Lipton D. Acupuncture as a detoxification treatment: an

analysis of controlled research. J Subst Abuse Treatment 1994;11(4):289-307

Cheng 1980

Cheng RS, Pomeranz B, Yu G. Electroacupuncture treatment of morphine-dependent

mice reduces signs of withdrawal, without showing cross-tolerance. Eur J Pharmacol

1980;68:477-481

Choy 1978

Choy YM, Tso WW, Fung KP, Leung KC, Tsang YF, Lee CY et al. Suppression of

narcotic withdrawals and plasma ACTH by auricular electroacupuncture. Biochem

Biophys Res Comm 1978;82:305-309

Choy 1983

Choy DS, Lutzker L, Meltzer L. Effective treatment for smoking cessation. Am J Med

1983;75:1033-6

Clement-Jones 1979

Clement-Jones V, McLoughlin L, Lowry PJ, et al. Acupuncture in heroin addicts:

changes in met-enkephalin and beta-endorphin in blood and cerebrospinal fluid. Lancet

1979; 2:380-383

Fuller 1982

Fuller JA. Smoking withdrawal and acupuncture. Med J Aust 1982;1:28-29

Han 1993

Han JS, Zhang RL. Suppression of morphine abstinence syndrome by body

electroacupuncture of different frequencies in rats. Drug Alcohol Depend 1993;31:169-

175

Law 1995

Law M, Tang JL. An analysis of the effectiveness of interventions intended to help

people stop smoking. Arch Intern Med 1995;155:1933-1941

Lewith 1995

Lewith GT. The treatment of tobacco addiction. Comp Ther Med 1995;3:142-145

Ng 1975

Ng LKY, Douthitt TC, Thoa NB, Albert CA. Modification of morphine-withdrawal

syndrome in rats following transauricular stimulation: an experimental paradigm for

auricular acupuncture. Biological Psychiatry 1975;10:575-580

Schwartz 1988


9/17

Schwartz JL. Evaluation of acupuncture as a treatment for smoking. Am J Acupuncture

1988;16:135-142

Ter Riet 1990

Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of

acupuncture on addiction. Br J Gen Pract 1990;40:379-382Vincent 1987

Vincent CA, Richardson PH. Acupuncture for some common disorders: a review of

evaluative research. J R Coll Gen Pract 1987;37:77-81

Wen 1973

Wen HL, Cheung SYC. Treatment of drug addiction by acupuncture and electrical

stimulation. Asian Med J 1973;9:138-141

Cover sheet

Acupuncture for smoking cessationReviewer(s) White AR, Rampes H, Ernst E

Date of most recent amendment 13 July 1999

Date of most recent substantiveamendment

17 June 1999

Contact address

Dr Adrian White MA BM BChResearch FellowDepartment of ComplementaryMedicineUniversity of Exeter

25 Victoria Park RoadExeterUKEX2 4NTTelephone: +44 1392 424839Facsimile: +44 1392 424989E-mail: [email protected]

Cochrane Library number CD000009

Editorial groupCochrane Tobacco AddictionGroup

Editorial group code HM-TOBACCO

This review should be cited as :White AR, Rampes H, Ernst E. Acupuncture for smoking cessation (Cochrane Review). In: TheCochrane Library, Issue 4, 1999. Oxford: Update Software.

Sources of support

Extramural sources of support to the review

NHS Anglia and Oxford Region Research and Development Programme, England UK

NHS Research and Development National Cancer Programme, England UKIntramural sources of support to the review

University of Exeter UK

KeywordsACUPUNCTURE-THERAPY; SMOKING-CESSATION; TREATMENT-OUTCOME; TIME-FACTORS; ODDS-RATIO; RANDOMIZED-CONTROLLED-TRIALS; RANDOM-ALLOCATION;


10/17

PUBLICATION-BIAS; NICOTINE / therapeutic-use; COMPARATIVE-STUDY; SAMPLE-SIZE;PLACEBO-EFFECT; SUBSTANCE-WITHDRAWAL-SYNDROME / therapy; HUMAN

Tables & Graphs

MetaView graphs List of comparisons

Table of included studies

Table of excluded studies

List of comparisonsFig 01 ACUPUNCTURE VS SHAM ACUPUNCTURE

01.01.00 Early

01.02.00 6 months

01.03.00 12 months

Fig 02 ACUPUNCTURE VS OTHER INTERVENTION CONTROLS

02.01.00 Early

02.02.00 6 months

02.03.00 12 months

Fig 03 ACUPUNCTURE VS NO TREATMENT CONTROLS

03.01.00 Early

03.02.00 6 months

03.03.00 12 months

Fig 04 COMPARISON OF DIFFERENT TECHNIQUES

04.01.00 Non-auricular points vs all controls (early)

04.02.00 Non-auricular acupuncture vs all controls (6 months)

04.03.00 Non-auricular acupuncture vs all controls (12 months)

04.04.00 Auricular acupuncture vs all controls (early)

04.05.00 Auricular acupuncture vs all controls (6 months)

04.06.00 Auricular acupuncture vs all controls (12 months)

Tables of other dataTables of other data are not available for this review

Table of included studies

St Method Participants Interventions Outcomes Notes
http://clibdata/mv000825.mvdhttp://clibdata/images/CD000009-01-01.gifhttp://clibdata/images/CD000009-01-02.gifhttp://clibdata/images/CD000009-01-03.gifhttp://clibdata/images/CD000009-02-01.gifhttp://clibdata/images/CD000009-02-02.gifhttp://clibdata/images/CD000009-02-03.gifhttp://clibdata/images/CD000009-03-01.gifhttp://clibdata/images/CD000009-03-02.gifhttp://clibdata/images/CD000009-03-03.gifhttp://clibdata/images/CD000009-04-01.gifhttp://clibdata/images/CD000009-04-02.gifhttp://clibdata/images/CD000009-04-03.gifhttp://clibdata/images/CD000009-04-04.gifhttp://clibdata/images/CD000009-04-05.gifhttp://clibdata/images/CD000009-04-06.gifhttp://clibdata/mv000825.mvdhttp://clibdata/images/CD000009-01-01.gifhttp://clibdata/images/CD000009-01-02.gifhttp://clibdata/images/CD000009-01-03.gifhttp://clibdata/images/CD000009-02-01.gifhttp://clibdata/images/CD000009-02-02.gifhttp://clibdata/images/CD000009-02-03.gifhttp://clibdata/images/CD000009-03-01.gifhttp://clibdata/images/CD000009-03-02.gifhttp://clibdata/images/CD000009-03-03.gifhttp://clibdata/images/CD000009-04-01.gifhttp://clibdata/images/CD000009-04-02.gifhttp://clibdata/images/CD000009-04-03.gifhttp://clibdata/images/CD000009-04-04.gifhttp://clibdata/images/CD000009-04-05.gifhttp://clibdata/images/CD000009-04-06.gif


11/17

udy

Circo

1985

Country: ItalyRecruitment:from patients

withcardiovasculardisorders,method ofrecruitmentunclearRandomisation method: notstated

90 adults, noinclusion orexclusion criteria

reported

All participantsreceivedcounselling in

addition to:a) illustrationmaterialb) medicaltreatmentcombining vitaminswith herbal extract(Hawthorn), for 30daysc) acupuncture to 9ear points ('Nogier'anti-smoking) given

6 hours afterstopping smoking;repeated after 4days and a further 7days; combinedwith 3 indwellingneedles for 15 days

Reportedcessation, time-point unspecified

(we assume end-of-treatment)Validation: none

Clavel1985

Country:FranceRecruitment:Communityvolunteers,

peradvertisementRandomisation method: notstated

651 adultssmoking >5cigs/day

a) facialacupuncture, singlesessionb) nicotine gumc) cigarette case

with lock controlledby time-switchAll groups alsoreceived 3 one-hoursessions of grouptherapy in firstmonth

Sustainedcessation at oneand 13 monthsValidation: noneat one month; at

13 months,expired air COconcentration wastested in half ofthose claimingsuccess

Clavel1990

Country:FranceRecruitment:Communityvolunteersresponding tocirculatedleafletRandomisation method: notstated2x2 factorialdesign

996 adults over 18,smoking >10cigs/day

a) facialacupuncture, withgenuine or placebonicotine gumb) shamacupuncture (wrongpoints), withgenuine or placebonicotine gumBoth given on days0, 7 and 28

Sustainedabstinence at 1and 13 months,and after 4 years'Need forcigarette'estimated weeklyfor 1 monthValidation: nil

Later results werereported as Clavel1990; long-termfollow-up asClavel 1997Analysis: forcomparison ofacupuncture vsshamacupuncture, armswith placebo gumentered in thisstudy and armswith nicotine gumin Clavel 1990+NG

The comparison ofacupuncture vnicotine gum wasperformed


12/17

between 'genuineacupuncture andplacebo gum'group and 'shamacupuncture andgenuine gum'group

Clavel1990+NG

See Clavel1990Used to enterresults ofAcupunctureplus nicotinegum vs Shamacupunctureplus nicotinegum

Cottraux

1983

Country:FranceRecruitment:Communityvolunteersresponding toTV and radioadvertsRandomisation method: notstated

558 Frenchcitizens, aged 18-50, smoking >10cigs/day for 2years

a) behaviourtherapy, weekly for3 weeksb) facialacupuncture, 3weekly sessionsc) placebo capsulesprescribed at 2consultationsd) waiting-listcontrol (assessedat 12 months only)

Sustainedabstinence at 2weeks, and 3, 6, 9and 12 months.Validation: none

Gilbey1977

Country:CanadaRecruitment:Communityvolunteersresponding tonewspaperadvertsRandomisation method: notstated

92 subjects aged30-39 who smoked>15 cigs/day for 3years

a) indwelling needlein active auricularpoint ('Lung') for 1weekb) indwelling needlein inactive auricularpoint ('Kidney') for 1week

Sustainedabstinence at 1week, 1 monthand 3 monthsValidation: none

Some authorsregard 'Kidney'point (used as acontrol) as aneffective treatmentfor dependency

Gillams

1984

Country: UKRecruitment:volunteersresponding toposter inhealth centreRandomisation: sealedenvelopes

81 adults smoking>50 cigs/week for5 years

a) indwelling needlein active auricularpoint ('Lung') for 4weeksb) indwelling needlein inactive auricularpoint (as far from'Lung' as possible)for 4 weeksc) group therapysessions, one hour/

week for 4 weeks

Sustainedabstinence at 4weeks, 3 months,and 6 monthsValidation: none

He

Country:Norway

46 adults smokingfor at least 5 years,

Both groupsreceived a

Abstinence at 1week after the last

Standardisedinteraction


13/17

1997

Recruitment:employeesrecruitedthroughinternaladvertisementthroughoccupationalhealth serviceRandomisation: drawing lotswithreplacement

daily average of10-30 cigarettes inthe last year; noother form oftreatment forsmoking cessation:no currentacupunctureExclusions:diabetes, coronaryheart disease,pregnancy, breast-feeding

combination ofbodyelectroacupuncture,ear acupunctureand earacupressure:a) using genuinepoints described forsmoking cessationb) using shampoints described fortreatingmusculoskeletalconditions6 treatments over 3weeksManual and

electricalstimulation were thesame in the 2groupsIn addition, 6 plantseeds were placedon either a) 'correct'or b) 'incorrect'points in the ear,according to group,and retained inplace with adhesive

tape: subjects wereinstructed to presson each seed 100times on 4occasions each day

acupuncturetreatment (pointprevalence)Validation:cessationconfirmed byserum cotinineand thiocyanateconcentrations.(Serumconcentrations offibrinogen andlipid peroxidewere alsomeasured)Daily cigaretteconsumption,

taste for tobaccoand desire tosmoke wereassessed byquestionnaire

Labadie

1983

Country:FranceRecruitment:Communityvolunteersattending anti-

smoking clinicRandomisation: byalternation

130 smokers(criteria notspecified)

a) acupuncture toauricular and bodypoints; not statedwhether repeatedb) medicaltreatment (advice

plusbenzodiazepine,lobeline and a'detoxicant')Both groupsfollowed up weeklyfor 1 month,fortnightly for 3months, monthly fora year

Abstinence andreduction ofsmoking at 8weeks and 1 year.Validation: none

La

croix

19

Country:

FranceRecruitment:not statedRandomisatio

117 smokers

(criteria notspecified)

a) facial

acupuncture,bilateral, weekly for3 weeksb) sham

Abstinence at 3

weeksValidation: none


14/17


15/17

Martin1981b

Country: NewZealandRecruitment:CommunityvolunteersRandomisation: in groups,method notstated

128 smokers(unspecified)

a) indwellingneedles to effectiveauricular points('Lung' and'hunger') for 3weeksb) indwellingneedles toineffective auricularpoints ('elbow' and'eye') for 3 weeks

Abstinence andreduction incigaretteconsumption at 3weeks, 3 monthsand 6 monthsValidation: nil

Some authorswould consider'elbow' and 'eye'points (used ascontrols) aspossibly effective,since innervatedby the vagusnerve

Parker1977a

Country: USARecruitment:Vounteersfrom hospitalemployeesRandomisatio

n method: notstated


a) indwellingneedles placed ineffective auricularpoints ('Shemmen'and 'Lung')b) indwelling

needles placed inpoints consideredinactive ('Shoulder'and 'Eye')Needles replaced inboth groups twiceweekly for 3 weeks

Abstinence andreduction inconsumption at 6weeksValidation: none

Some authorswould not agreethat 'shoulder' and'eye' points are'inactive'

Parker1977

b

Country: USARecruitment:Vounteersfrom hospitalemployees

Randomisation method: notstated


a) electricalstimulation toeffective auricularpoints ('Shemmen'and 'Lung')

b) electricalstimulation to pointsconsidered inactive('Shoulder' and'Eye')Both groups treatedfor 20 minutes twiceweekly for 3 weeks

Abstinence andreduction inconsumption at 6weeksValidation: none

Some authorswould not agreethat 'shoulder' and'eye' points are'inactive'

Steiner

1982

Country: USARecruitment:Communityvolunteersresponding tonewspaperand radioadvertsRandomisation: matchedpairs, one ofeach pairrandomlyassigned,method not

stated

32 subjects over21, smoking over20 cigs/day for 2consecutive years,not pregnant andnot on chronic painmedication ormood-alteringdrugsSelected from 82volunteers,matched accordingto age, sex, andcigaretteconsumption

a) acupuncture togenuine body andear points; needlesensation achieved.

b) shamacupuncture tonearby areaswithout needlingsensationBoth interventionsgiven twice weeklyfor 2 weeks

Abstinence andcigaretteconsumption at 4weeksValidation: none

Subjects were notadvised to stopsmoking at anyparticular time, butto 'follow yourmotivation andappetite to thebest of your ability'

Vand

Country:France

200 self-referredsmokers, no

a) acupuncture to 3auricular and 2

Abstinence (point-prevalence) at 6


16/17

evenne1985

Recruitment:volunteersattending anti-smoking clinicRandomisation: randomnumber table(not stated tobe concealed)

criteria stated body pointsb) shamacupuncture tonearby areasboth interventionsgiven on days 1, 4,10 and 20

weeks, 6 monthsand 1 year

Waite

1998

Country: UKRecruitment:communityvolunteersrecruited byadvertisements in on-linenews pages,

posters inhospital andword ofmouth.Randomisation method: notstated.Stratified bygender

78 adults over 18years old whowere smoking atleast 10 cigarettesa day.Exclusions: cardiacpacemaker,previous

acupuncture

Both groupsreceived one 20-minute session ofacupuncture withelectricalstimulation followedby placement of aseed on the needle

site held in placewith adhesive tape.Participants wereinstructed to keepthe seed in place aslong as they foundit helpful and pressit when theyexperienced thedesire to smokePoints used were:a) active group,

lung point in earb) control group,medial aspect ofthe patella, not onrecognisedacupuncture point

Cessation at 6months (pointprevalence)Validation: urinarycotinine

White

1998

Country: UKRecruitment:communityvolunteersfrom mediainvitationRandomisation method:sealed opaqueenvelopes,openedimmediatelybeforeintervention

76 adults over 21years smoking atleast 15 cigarettesdailyExclusions:previousacupuncture,pregnancy, breast-feeding, cardiacpacemaker, knownbleeding tendency

a) acupuncture withelectricalstimulation to lungpoint in both earsb) shamacupunctureconsisting of eitherneedle or carbonpad placed over themastoid boneattached to sham(inactivated)stimulatorInterventions weregiven on day 1, 3and 7 of the

smoking cessation

Sustainedcessation at 2weeksValidation:expired air carbonmonoxideconcentrationWithdrawalsymptomsassessed byVisual AnalogueScale

Credibility ofinterventionstested byquestionnaireStandardised,minimal interactionby acupuncturistAll counselling byblinded nurse


17/17

Table of excluded studies

Study Reason for exclusion

Boureau, 1978

This study compared 2 groups who both received identical acupuncture following aninjection: one group were injected with saline, the other with naloxone. Therefore, 2

hypotheses are tested simultaneously: does acupuncure help smoking cessation byreleasing endogenous opioid peptides?

MacHovec

1978

This study does not specify that the subjects were randomised

Man1975

Subjects were allocated by place of residence, not randomly

The Cochrane Library

acupuncture for smoking cessation

Documents