Effectiveness of pharmacopuncture for cervical spondylosis: A systematic review and meta-analysis

Introduction: The aim of this systematic review was to assess the evidence from randomized controlled trials (RCTs) on the effectiveness and safety of pharmacopuncture in cervical spondylosis patients. Methods: Seven databases were searched, including Chinese and Korean databases, through to January 2018. Eligible trials were those with intervention groups receiving pharmacopuncture for cervical spondylosis and control groups receiving other conventional treatments including acupuncture. Outcome measures included pain, disability, quality of life, and adverse events (AEs). For statistical pooling, the mean difference (MD) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Twenty RCTs were selected. Eight trials on pharmacopuncture as a single treatment reported significant pain decrease in patients with cervical spondylosis compared to acupuncture (MD -1.79, 95% CI -2.39, -1.19). Add-on pharmacopuncture treatment also showed significant effects in alleviating pain compared to the control (MD -1.79, 95% CI -2.24, -1.34). Add-on pharmacopuncture treatment significantly increased quality of life compared to the control, as shown with SF-36 scores (MD 18.31, 95% CI 13.33, 23.29). However, all analysis results were assessed to be low or very low quality evidence due to considerably high heterogeneity and high risk of bias. In addition, solid conclusions on safety could not be drawn as few studies reported on AEs related with pharmacopuncture. Conclusions: Pharmacopuncture, both as a sole intervention and as an add-on treatment, was found to decrease pain in patients with cervical spondylosis. These results, however, should be interpreted with caution as the quality of evidence was found to be low.