Acupuncture for osteoarthritis in the UK: A turning point for NICE?

IntroductionThe UK National Institute for Health and Care Excellence (NICE) guidelines specifically recommend against the use of acupuncture for osteoarthritis. This article aims to explore the evidence base, to link this with the decisions made by guideline development group in 2014 and to consider the legacy of this thinking in respect of subsequent guidelines and future research possibilities.MethodsA review of systematic reviews, meta-analyses and recent randomized controlled trials on acupuncture and osteoarthritis was carried out through the Cochrane Library and a PubMed search covering the period January 2013-March 2016. The comments from stakeholders and developers about the 2014 draft NICE guideline for osteoarthritis, published at the time on the NICE website, were qualitatively analysed.ResultsResults from the 2014 NICE guideline review were in accord with other systematic reviews: acupuncture shows a small superiority over sham and a moderate to large benefit compared with usual care. According to answers given by the guideline development group to stakeholder comments, the decision to determine clinical effectiveness from sham comparison data appears to be based on a desire to avoid ethical problems in promoting therapies whose effects may derive largely from placebo. Most guideline-endorsed treatments were not updated in this review, hence stakeholder suggestions that acupuncture was subject to higher acceptance thresholds could not be tested.ConclusionsConclusions and recommendations about acupuncture arising from systematic reviews and clinical guidelines may differ according to the belief systems of the authors. Whichever interpretive model is used it should be applied evenly across all interventions under consideration.