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Acupuncture in smoking cessation

Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms. White et al. conducted a review determining the effectiveness of acupuncture and the allied therapies of acupressure, laser therapy and electrostimulation, in smoking cessation in comparison with: (a) sham treatment, (b) other interventions, or (c) no intervention. A comprehensive literature search was conducted to identify all relevant clinical trials. Only randomized trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either sham treatment, another intervention or no intervention for smoking cessation were included in the review.

Data were extracted and analysed in a standardized manner. The authors assessed abstinence from smoking at the earliest time-point (before 6 weeks), at 6 months and at 1 year or more follow-ups in patients smoking at baseline. The authors used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing to smoke. The authors identified 22 studies. Acupuncture was not superior to sham acupuncture in smoking cessation at any time point. The odds ratio (OR) for early outcomes was 1.22 (95 per cent confidence interval 0.99 to 1.49); the OR after 6 months was 1.50 (95 per cent confidence interval 0.99 to 2.27) and after 12 months 1.08 (95 per cent confidence interval 0.77 to 1.52). Similarly, when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time-point. Acupuncture appeared to be superior to no intervention in the early results, but this difference was not sustained. The results with different acupuncture techniques did not show any one particular method (i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control intervention.

Based on the results of single studies, acupressure was found to be superior to advice; laser therapy and electrostimulation were not superior to sham forms of these therapies. The authors concluded that there was no clear evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation.

However, the fact that acupuncture is not more effective than placebo acupuncture for smoking cessation does not mean that it is entirely without effect. Acupuncture is associated with a sizeable placebo effect, which leads to immediate cessation in about 35 per cent of all patients. Thus, these placebo effects could be worth exploiting in clinical practice.

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