Effective Positive effect Acupuncture seems to be at least as effective as conventional preventative medication for migraine and is safe, long lasting, and cost-effective (citing Witt et al 2008) (Da Silva 2015 - Narrative review of large high quality RCTs)(40) Acupuncture reduces migraine frequency.

Acupuncture superior to sham and may be as effective as prophylactic drugs; subgroup analysis showed larger effect size when 16 or more treatments given (Z = 4.06) compared to 12 treatments or less (Z = 2.32); Moderate quality evidence (Linde 2016 - Cochrane SR of 22 RCTs of at least 8 weeks duration)(41) Acupuncture superior to sham in effectiveness and reduced risk of recurrence; Moderate to high quality evidence (Yang 2016 - SR of 10 RCTs)(42).

Allergic rhinitis Effective Unclear Acupuncture could be a safe and valid treatment for allergic rhinitis; Moderate quality evidence (Feng 2015 - SR of 13 RCTs)(54) High quality evidence of efficacy and effectiveness (Taw 2015 - SR of 2 large multi-centre RCTs, 3 acupuncture vs medication RCTs and 1 cost-effectiveness study)(15) OHNSF clinical practice guideline: Option 5: Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy; Aggregate evidence quality - Grade B (Seidman 2015)(37) Acupuncture is cost-effective for allergic rhinitis (Kim 2012, Witt 2010)(75, 76) SAR - Acupuncture significantly superior to rescue medication in QALY gained, but may cost more short term (Reinhold 2013)(77, 78)

Anxiety Potential positive effect Acupuncture has ‘potential use’ (Bazzan 2014 - Narrative review)(79) Positive and statistically significant effects; Moderate to high quality evidence (Goyata 2016 - Integrative review of 19 studies including 6 RCTs; 11 high quality studies; 5 moderate)(80) 

Temperomandibular pain Potential positive effect One new RCT: Acupuncture was equivalent to occlusal splint in pain intensity and range of mouth opening (Grillo 2015 - RCT acupuncture vs occlusal splint, n = 40)(85).

Insomnia Potential positive effect Acupuncture may be superior to medication. Acupuncture for insomnia is potentially mediated by norepinephrine, melatonin, gamma-aminobutyric acid, and beta-endorphin; insufficient evidence (Zhao 2013 - book chapter)(90) Acupuncture statistically superior to sham (3 studies) and medication (27 studies); low quality evidence (Shergis 2016 - SR)(91)

Chronic low back pain High quality evidence for acupuncture; moderate quality evidence for acupressure (Wellington 2014 – SR of noninvasive interventions)(48) Acupuncture alone or as an adjunct to usual care provided short-term improvement in pain and function; low to high quality evidence; ‘should be advocated in routine clinical practice’ (Liu 2015 - Overview of 16 SRs)(49) Moderate quality evidence for pain and function (Chou 2016 [AHRQ Comparative Effectiveness review])(45) Upgrade to positive

Acute low back pain Acupuncture superior to NSAIDS for improving symptoms; acupuncture superior to sham for pain but not function (Lee 2013 - SR of 11 RCTs)(47) Low quality evidence for pain and function (Chou 2016 - AHRQ Comparative Effectiveness review)(45) Upgrade to potential positive

Low back pain Acute low back pain Chronic low back pain Taylor 2014 (51): Cost effective for chronic low back pain Andronis 2016 (50): Likely to be cost effective Chronic and acute low back pain need to be differentiated in SRs Lee 2013 (SR of 11 RCTs; 5 low risk of bias, 6 high)(47): Acupuncture superior to NSAIDS for improving symptoms; acupuncture superior to sham for pain but not function; Chou 2016 [AHRQ Comparative Effectiveness review])(45): Low quality evidence for pain and function Upgrade to potential positive Lam 2013 (32 RCTs; 25 in MA)(46): Acupuncture may be effective for pain and functional limitation in chronic non-specific low back pain: Evidence Level 1 Wellington 2014 (SR of non-invasive interventions)(48): High quality evidence for acupuncture; moderate quality evidence for acupressure Liu 2015 (Overview of 16 SRs)(49): Acupuncture alone or as an adjunct to usual care provided short-term improvement in pain and function; low to high quality evidence; ‘should be advocated in routine clinical practice’ Chou 2016 [AHRQ Comparative Effectiveness review])(45): Moderate quality evidence for pain and function Nahin 2016 (4 RCTs; Excluded studies not performed in USA or by US researchers)(195): Acupuncture superior to usual care; Acupuncture superior to sham in 1 RCT, but not superior in 2 RCTs 

Headache (frequent episodic or chronic tension-type) Not reviewed Potential positive effect Acupuncture is cost effective for headache (Kim 2012)(76) A potentially important role for acupuncture as part of a treatment plan for migraine, tension-type headache, and several different types of chronic headache disorders. Cost-effective in Germany and UK (Coeytaux 2016 - Brief review of selected SRs and MAs)(44) Acupuncture can reduce workplace headache pain intensity, frequency and related disability; low quality evidence (Lardon 2016 - SR of 15 RCTs)(124) Effective for frequent episodic or chronic tension-type headaches; Moderate or low quality evidence (Linde 2016 - Cochrane SR of 12 RCTs)(43) Acupuncture has been included in the NICE guidelines for headache since 2012(38) 

Menopausal hot flushes Acupuncture improves hot flash frequency and severity, menopause-related symptoms, and QoL (vasomotor domain) in natural menopause (Chiu 2015 - MA of 12 studies; 2 high quality studies, 8 moderate and 2 low)(136) Promising results; low quality evidence (Selva Ovid 2013 (Review of 8 SRs and 9 RCTs))(93) Acupuncture superior to wait-list or no treatment; low quality evidence Acupuncture superior to sham in reducing severity but not frequency; very low quality evidence Acupuncture inferior to hormone therapy in QoL and frequency; no difference in severity; low quality evidence (Dodin 2013 - Cochrane SR of 16 RCTs)(137)

Perimenopausal and postmenopausal sleep disturbance Significant reduction in sleep disturbance which appears to be associated with changes in serum estradiol, FSH and LH; acupuncture recommended as adjunctive therapy in improving sleep disturbances in perimenopausal and postmenopausal women (Chiu 2016 - SR of 34 studies; 4 high quality)(138) Improved sleep quality; limited evidence; moderate to high quality evidence (Bezarra 2015 - SR of 7 RCTs; 4 high quality; no studies with high risk of bias)(139) 

Carpal tunnel syndrome Evidence of no effect Acupuncture superior to ibuprofen in function and symptoms (Hadianfard et al 2015 - RCT comparing acupuncture plus night wrist splints with ibuprofen plus night wrist splints, n=50)(167)

Lateral elbow pain Acupuncture superior to sham; moderate quality evidence (Gadau 2014 - SR of 19 RCTs)(173) Insufficient evidence: low to very low quality evidence (Tang 2015 - SR of 4 RCTs)(174)

Neck pain Acupuncture plus usual medical care is cost-effective for neck pain and its associated disorders (NAD) (Van der Velde 2015 – SR of 6 studies)(175) Acupuncture superior to sham acupuncture or inactive treatment (at completion of treatment and short-term follow-up) for pain relief; Moderate quality evidence (Trinh 2016 - Cochrane update with 27 RCTS)(176) Limited evidence of effectiveness; low quality evidence (Moon 2014 – 6 RCTs on whiplash associated disorder [WAD])(177) 

Shoulder pain For non-operative treatment options at an early stage of Shoulder Impingement Syndrome (SIS), exercise combined with therapies such as kinesio taping, specific exercises, and acupuncture should be considered as the first line choices (2 included high quality acupuncture studies) (Dong 2015 - SR and network MA)(178) 

Asthma  Acupuncture may improve peak expiratory flow or peak expiratory flow variability in children; low quality evidence (Liu 2015 – SR of 7 RCTs)(179) Acupoint herbal patches superior to sham in improving FEV1 and asthma symptoms; low quality evidence (Lee 2016 – SR & MA of 16 RCTs)(180) Acupuncture improved FEV1, FEV1/FVC, IL and IgE (moderate quality evidence), but not ECP (Su 2016 - SR & MA of 8 RCTs)(18)

Acute ankle sprain in adults Park 2013 (SR of 17 RCTs; 2 high quality, 15 low quality)(193): Acupuncture superior to various controls in relieving pain, facilitating return to normal activity, and promoting QoL based on subgroup analysis of 2 high quality studies

Lumbar spinal stenosis Kim 2013 (SR of 6 RCTs, 6 controlled trials) (194): Acupuncture superior to controls in pain intensity, functional improvements and QoL; Low quality evidence

Neck pain Van der Velde 2015 (SR of 6 studies)(175): Acupuncture plus usual medical care is costeffective for neck pain and its associated disorders (NAD) Trinh 2016 (Cochrane update with 27 RCTS)(176): Acupuncture superior to sham acupuncture or inactive treatment (at completion of treatment and short-term follow-up) for pain relief; Moderate quality evidence 

Knee osteoarthritis pain Corbett 2013 (Network meta-analysis - 152 studies on 22 interventions: 12 RCTs included in network MA)(52): Acupuncture was equal to balneotherapy and superior to sham acupuncture, muscle-strengthening exercise, Tai Chi, weight loss, standard care and aerobic exercise (in ranked order). Acupuncture superior to standard care and muscle-strengthening exercises in sub-analysis of moderate to high quality studies Nahin 2016 (4 RCTs; Excluded studies not performed in USA or by US researchers)(195): Acupuncture superior to attention control or usual care in 3/4 studies; Acupuncture superior to sham in 2/4 studies

Sciatica Lewis 2015 (Network MA of 21 interventions)(196): Acupuncture 2nd out of 21 interventions for global effect and pain intensity Qin 2015 (SR & MA of 11 RCTs; 10 acupuncture vs medications; 1 acupuncture vs sham)(197): Acupuncture may be superior to drugs and may enhance the effect of drugs for patients with sciatica; low quality evidence Ji 2015 (SR of 12 RCTs)(198): Acupuncture superior to conventional Western medicine in outcomes effectiveness, pain intensity and pain threshold; low quality evidence Acupuncture 2nd out of 21 interventions for global effect and pain intensity

Potential positive

Shoulder pain: Shoulder impingement syndrome (SIS) Dong 2015 (SR and network MA; 2 high quality acupuncture studies)(178): For non-operative treatment options at an early stage of SIS, exercise combined with therapies such as kinesio taping, specific exercises, and acupuncture should be considered as the first-line choices, whereas pulsed electromagnetic field therapy, localized corticosteroid injection, diacutaneous fibrolysis, and ultrasound therapy may be considered as the second-line treatment choices; however, low-level laser therapy and the localized injection of NSAIDs are not recommended 

Anxiety Bazzan 2014 (Narrative review)(79): Acupuncture has ‘potential use’ Goyata 2016 (Integrative review of 19 studies including 6 RCTs; 11 high quality studies; 5 moderate)(80): Positive and statistically significant effects; Moderate to high quality evidence 

Insomnia Zhao 2013 (SR)(90): Acupuncture may be superior to medication. Acupuncture for insomnia is potentially mediated by norepinephrine, melatonin, gamma-aminobutyric acid, and betaendorphin; Insufficient evidence Shergis 2016 (SR of 30 studies)(91): Acupuncture statistically superior to sham (3 studies) and medication (27 studies); low quality evidence

Back or pelvic pain during pregnancy Selva Olid 2013 (Review of 8 SRs and 9 RCTs)(93): Promising results; low quality evidence Close 2014 (SR of 8 RCTs on CAM; 2 acupuncture RCTs with low risk of bias)(94): Clinically important and statistically significant changes Liddle 2015 (Cochrane SR: Comparison of interventions 26 RCTs – 7 acupuncture RCTs)(95): Moderate quality evidence showed that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic or lumbo-pelvic pain.

Acupuncture superior to exercise for reducing evening pelvic pain; Both acupuncture and exercise were superior to usual care; Insufficient evidence Potential positive Dysmenorrhoea Chen et al, 2013 (MA of 3 acupuncture and 4 acupressure RCTs)(202): Acupuncture is effective and acupressure may be effective for pain relief; acupuncture trials had low to moderate risk of bias; acupressure trials high risk of bias Xu 2014 (MA of 20 RCTs of acupoint stimulation)(183): Acupoint stimulation superior to controls for pain relief; low to moderate quality evidence Abaraogu 2015 (SR of 8 RCTs and MA of 4 RCTs)(184): Acupuncture and acupressure vs placebo, waitlist or medication reduced pain intensity, while acupuncture also improved physical and mental aspects of QoL; moderate quality evidence Smith 2016 (Cochrane update)(185): Insufficient evidence; low to very low quality evidence Kim 2012(76): Acupuncture is cost effective for dysmenorrhoea, allergic rhinitis, osteoarthritis & headache 

Menopausal hot flushes Chiu 2015 (MA of 12 studies; 2 high quality, 8 moderate and 2 low)(136): Acupuncture improves hot flash frequency and severity, menopause-related symptoms, and QoL (vasomotor domain) in natural menopause Selva Ovid 2013 (Review of 8 SRs and 9 RCTs) (93): Promising results; low quality evidence Dodin 2013 (Cochrane SR of 16 RCTs)(137): Acupuncture superior to wait-list or no treatment; low quality evidence Acupuncture superior to sham in reducing severity but not frequency; very low quality evidence Acupuncture inferior to hormone therapy in QoL and frequency; no difference in severity; low quality evidence Chen 2016 (SR of 12 RCTs) (152): Seems to be effective; insufficient evidence; low quality evidence

Perimenopausal and postmenopausal sleep disturbance Chiu 2016 (SR of 34 RCTs; 4 high quality)(138): Significant reduction in sleep disturbance which appears to be associated with changes in serum estradiol, FSH and LH; acupuncture recommended as adjunctive therapy in improving sleep disturbances in perimenopausal and postmenopausal women Bezerra 2015 (SR of 7 RCTs; 4 high quality; no studies with high risk of bias)(139): Improved sleep quality; limited evidence; moderate to high quality evidence 

Headache Kim 2012(76): Acupuncture is cost effective for dysmenorrhoea, allergic rhinitis, osteoarthritis & headache Coeytaux 2016 (Brief review of selected SRs and MAs)(44): A potentially important role for acupuncture as part of a treatment plan for migraine, tension-type headache, and several different types of chronic headache disorders. Cost-effective in Germany and UK Lardon 2016 (SR of 15 RCTs)(124): Acupuncture can reduce workplace headache pain intensity, frequency and related disability; low quality evidence 

Migraines (Da Silva 2015 - Narrative review of large high quality RCTs)(40): Acupuncture seems to be at least as effective as conventional preventative medication for migraine and is safe, long lasting, and cost-effective Linde 2016 (Cochrane SR of 22 RCTs of at least 8 weeks duration)(41): Acupuncture reduces migraine frequency. Acupuncture superior to sham and may be as effective as prophylactic drugs; subgroup analysis showed larger effect size when 16 or more treatments given (Z = 4.06) compared to 12 treatments or less (Z = 2.32); Moderate quality evidence Yang 2016 (SR of 10 RCTs)(42): Acupuncture superior to sham in effectiveness and reduced risk of recurrence; Moderate to high quality evidence Moderate to high quality evidence, safe and cost-effective (including Cochrane update); 16 or more treatments more effective than 12 treatments or less - Positive Tension-type headache Linde 2016 (Cochrane SR of 12 RCTs)(43): Effective for frequent episodic or chronic tensiontype headaches; Moderate or low quality evidence

Allergic rhinitis Feng 2015 (SR of 13 RCTs)(54): Significant improvements in nasal symptoms scores and RQLQ; Moderate quality evidence Taw 2015 (SR of 2 large multi-centre RCTs, 3 acupuncture vs medication RCTs and 1 costeffectiveness study)(15): High quality evidence of efficacy and effectiveness Seidman 2015 (OHNSF clinical practice guideline)(37): Option 5: Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in non-pharmacologic therapy; Aggregate evidence quality - Grade B McDonald 2016 (High quality RCT)(32): PAR - Significant improvements in symptoms, QoL, and reductions in total IgE and dust mite specific IgE and Substance P; high quality evidence Xue 2015 (High quality RCT)(222): SAR - Significant improvement in symptoms; high quality evidence Kim 2012(76): Acupuncture is cost effective for dysmenorrhoea, allergic rhinitis, osteoarthritis & headache Reinhold 2103(77): SAR - Acupuncture significantly superior to rescue medication in QALY gained, but may cost more short term 

Headache Kim 2012 (Cost effectiveness analysis)(76): Acupuncture is cost effective for dysmenorrhoea, allergic rhinitis, osteoarthritis & headache. Coeytaux 2016 (Brief review of selected SRs and MAs)(44): A potentially important role for acupuncture as part of a treatment plan for migraine, tension-type headache, and several different types of chronic headache disorders. Cost-effective in Germany and UK. A potentially important role for acupuncture’ as part of a treatment plan for migraine, tension-type headache, and several different types of chronic headache disorders. Cost effective Low back pain Taylor 2014 (Cost effectiveness analysis/MA)(51): Cost effective for chronic low back pain. Andronis 2016 (SR of 33 studdies)(50): Likely to be cost effective. Moderate to high quality evidence Cost effective, safe. Migraine Da Silva 2015 (Narrative review of large high quality RCTs)(40): Acupuncture seems to be at least as effective as conventional preventative medication for migraine and is safe, long lasting, and costeffective. Moderate to high quality evidence, safe and cost-effective (including Cochrane update); 16 or more treatments more effective than 12 treatments or less.