Please cite this paper as: Cho S‐H, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta‐analysis. BJOG 2010;117:907–920.Background  Acupuncture is frequently used for pain relief in labour, but the evidence is not clear.Objectives  To critically evaluate the evidence for or against acupuncture for labour pain management.Search strategy  Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched.Selection criteria  All randomised controlled trials (RCTs) involving women receiving acupuncture alone, or as an adjunct to conventional analgesia, for pain relief in labour were considered.Data collection and analysis  Pain intensity on a 100‐mm visual analogue scale (VAS; 0, no pain; 100, worst pain) and use of other analgesic methods were used as primary outcomes, and for statistical pooling. Maternal/fetal outcomes were secondary outcomes, and adverse events were also recorded. Risk of bias was assessed regarding randomisation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.Main results  Ten RCTs involving 2038 women were included. VAS for pain intensity data were available in seven studies; the meta‐analysis shows that acupuncture was not superior to minimal acupuncture at 1 hour (pooled mean difference −8.02; 95% CI −21.88, 5.84; I² = 94%) and at 2 hours (−10.15; 95% CI −23.18, 2.87; I² = 92%). Patients reported significantly reduced pain by 4 and 6% during electroacupuncture (EA) treatment at 15 (−4.09; 95% CI −8.05, −0.12) and 30 minutes (−5.94; 95% CI −9.83, −2.06), compared with placebo EA, but the effect was not maintained afterwards. Compared with no intervention, acupuncture reduced pain by only 11% for the first 30 minutes (−10.56; 95% CI −16.08, −5.03). In trials where acupuncture was compared with conventional analgesia, women receiving acupuncture required less meperidine (pooled risk ratio 0.20; 95% CI 0.12, 0.33) and other analgesic methods (0.75; 95% CI 0.66, 0.85). No acupuncture‐related adverse events were reported. Most trials did not blind participants, care providers and/or evaluators.Author’s conclusions  The evidence from RCTs does not support the use of acupuncture for controlling labour pain. The primary studies are diverse and often flawed. Further research seems warranted.

The aim of this study was to critically assess whether acupuncture therapy reduces vasomotor menopausal symptoms and to evaluate the adverse effects of acupuncture therapy on the basis of the results of randomized controlled trials (RCTs). Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs in which acupuncture was used to reduce vasomotor menopausal symptoms before July 2008. There were no language restrictions. The methodological quality of the eligible studies was assessed using the categories provided by the Menstrual Disorders and Subfertility Review Group. Eleven studies, which included a total of 764 individual cases, were systematically reviewed. The methodological quality of the trials varied substantially. Six trials compared acupuncture treatment to sham or placebo acupuncture. Only one study using a nonpenetrating placebo needle found a significant difference in the severity outcomes of hot flashes between groups (mean difference, 0.48; 95% CI, 0.05-0.91). Five studies reported a reduced frequency of hot flashes within groups; however, none found a significant difference between groups. An analysis of the outcomes of the trials that compared acupuncture with hormone therapy or oryzanol for reducing vasomotor symptoms showed that acupuncture was superior. Three RCTs reported minimal acupuncture-related adverse events. There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture for reducing menopausal hot flashes. Some studies have shown that acupuncture therapies are better than hormone therapy for reducing vasomotor symptoms. However, the number of RCTs compared with a nonpenetrating placebo control needle or hormone therapy was too small, and the methodological quality of some of the RCTs was poor. Further evaluation of the effects of acupuncture on vasomotor menopausal symptoms based on a well-controlled placebo trial is therefore warranted.