REVIEW ARTICLE Review article: Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis Andrew L JAN , 1 Emogene S ALDRIDGE, 1 Ian R ROGERS, 1,2 Eric J VISSER, 3 Max K BULSARA 4 and Richard C NIEMTZOW 5 1 Emergency Department, St John of God Murdoch Hospital, Perth, Western Australia, Australia, 2 The University of Notre Dame Australia, Fremantle, Western Australia, Australia, 3 Chronic Pain Education and Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia, 4 Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia, and 5 United States Air Force Acupuncture and Integrative Medicine Center, Joint Base Andrews, Maryland, USA Abstract Acupuncture might offer a novel approach to improve ED pain man- agement. Our primary aim was to assess the efficacy of acupuncture in the emergency setting while second- ary objectives were to explore its suitability through its side-effect pro- file, patient satisfaction, cost, admin- istration time and points used. Seven databases and Google Scholar were searched up to 31 July 2016 using MeSH descriptors for three over- arching themes concerning acupunc- ture, pain management and emergency medicine. Meta-analysis was performed on randomised trials for three comparator groups: acu- puncture versus sham, acupuncture versus standard analgesia care and acupuncture-as-an-adjunct to stand- ard care, to calculate the standar- dised mean difference and weighted mean difference for pain scores out of 10. Data for secondary outcomes was extracted from both randomised and observational studies. Nineteen randomised controlled trials and 11 uncontrolled observational stud- ies totaling 3169 patients were retrieved after exclusions. Meta- analyses were performed on data from 14 randomised controlled trials representing 1210 patients. The three resulting comparator groups (as above) resulted in standardised mean differences of 1.08, 0.02 and 1.68, and weighted mean differences of 1.60, -0.04 and 2.84, respectively (all positive figures favour acupunc- ture). Where measured, acupuncture appears to be associated with improved patient satisfaction, lower cost and a low adverse effects pro- file. The data available were inade- quate to ascertain the effect of acupuncture on analgesia use. Signif- icant study bias was found, espe- cially with respect to practitioner and patient blinding. We conclude that for some acute pain conditions in the ED, acupuncture was clini- cally effective compared to sham and non-inferior to conventional therapy. As an adjunct, limited data was found indicating superiority to standard analgesia care. Further studies will elucidate the most appropriate acupuncture training and techniques, use as an adjunct and the clinical situations in which they can be best applied. Key words: acupuncture, emergency medicine, meta-analysis, pain man- agement, systematic review. Background Pain is the primary reason for patients attending the ED in the Western world, with up to three quarters reporting pain. 1–4 Despite this, pain is often poorly managed and undertreated. 5,6 In the emer- gency setting, analgesia should ideally be evidence-based, safe, simple to administer, rapidly effec- tive, titratable and cost-effective, with minimal adverse effects. 7 In the ED, acute pain is often mana- ged with opioids and NSAIDs. 8 These have acknowledged adverse effects in both the short and long term. 7,9,10 Correspondence: Dr Andrew L Jan, Emergency Department, St John of God Murdoch Hospital, 100 Murdoch Drive, Murdoch, WA 6150, Australia. Email: drandrewjan@gmail.com Andrew L Jan, MBBS, FACEM, BA, FAMAC, MPhil, Emergency Physician, Staff Spe- cialist, PhD Candidate; Emogene S Aldridge, BHlthSc, Academic Support Officer; Ian R Rogers, MBBS, FACEM, Professor; Eric J Visser, MBBS, FANZCA, FFPMANZCA, Professor/Churack Chair; Max K Bulsara, PhD, MSc, BSc, Professor; Richard C Niemtzow, MD, PhD, MPH, Director. Accepted 13 June 2017 Key findings • Acupuncture appears to pro- vide effective analgesia for some acute pain conditions in the ED. • It is non-inferior to selected analgesia medications. • There is insufficient evidence as yet to show that acupunc- ture reduces analgesic medica- tion usage. • The most appropriate techni- ques to use and the clinical situations in which to apply them, require further research. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine Emergency Medicine Australasia (2017) doi: 10.1111/1742-6723.12832