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Three Part Question

In [Adults with chronic lateral epicondylitis] does [acupuncture] improve [pain]

Clinical Scenario

A 40 year old patient has been suffering with lateral epicondylitis for several months. You normally treat this condition with a combination of manual therapy and electrotherapy but have been unimpressed with the results. A colleague mentions a recent outstanding success for the same condition using acupuncture. You wonder if there is any evidence for this.

Search Strategy

MEDLINE 1966-06/08, CINAHL 1982 –06/08, AMED 1985-06/08, SPORTDiscus 1830-06/08 and EMBASE 1996-06/08 via the OVID interface. Cochrane database June 2008 & PeDro June 2008
Search Terms:
Medline, CINAHL, AMED, EMBASE, SPORTSDiscus: [{exp acupuncture or acupuncture.mp) AND (exp tennis elbow or tennis elbow.mp. or lateral epicondylitis.mp.) AND(exp physical therapy or exp manual therapy or exp electrotherapy)

AMED and EMBASE add (exp physiotherapy)

In addition the PEDro database was also searched with search terms: [tennis elbow OR lateral epicondylitis AND acupuncture]

Search Outcome

There were 3 systematic reviews and 1 Cochrane review (amended in 2001) relevant to the 3 part question.

An RCT which compared manual acupuncture versus electroacupuncture was disregarded due to lack of control group

Comment(s)

All the review papers were unable to undertake data pooling or meta analysis due to methodological problems and different outcome measures in the RCTs. 3 review papers state that there is insufficient evidence to support or refute use of acupuncture for lateral epicondylitis. 1 review concludes that there is strong evidence for using acupuncture for this condition.

Clinical Bottom Line

There is contradictory evidence that acupuncture is significantly better than placebo in short term pain relief for chronic tennis elbow.