Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis

This innovative bibliometric study performed a comprehensive mapping of clinical guidelines recommending acupuncture, revealing surprising data on the acceptance of this therapy by conventional medicine. The investigators initially identified 96 health conditions for which systematic reviews had found positive evidence or positive trends for acupuncture efficacy, published between 1996 and 2017.

Using an innovative search methodology based on "snowballing" (following links between publications), the authors overcame the limitations of traditional databases, which often do not index treatment guidelines with acupuncture-related terms. This creative approach was necessary because many guidelines are published in non-academic formats such as medical society websites and government reports.

The results were notable: 1,311 publications containing treatment guidelines that recommend acupuncture were identified, covering the period from 1991 to 2017. These guidelines yielded a total of 2,189 positive recommendations for the use of acupuncture across 204 different health problems. Of the recommendations, 1,486 pertained to 107 pain indications and 703 to 97 non-pain indications.

The temporal analysis revealed an important pattern: the growth of recommendations closely tracked the increase in positive evidence from scientific reviews. The number of guidelines reached 50 annual publications in 2005 and 100 in 2009, demonstrating a clear correlation between the emergence of scientific evidence and its incorporation into recommended clinical practices. Approximately 87% of the recommendations corresponded to the 96 conditions initially identified as having positive evidence.

The sources of the recommendations were diverse and reputable, including national departments of health, ministries of health, state health departments, reimbursement systems, national guideline groups, national and international expert groups, insurance companies, and specialty medical organizations. Geographically, the recommendations were especially abundant in North America, Europe, and Australasia.

The study challenges previous perceptions about the limited acceptance of acupuncture by conventional medicine. A previous 2012 search had found only 14 publications recommending acupuncture for 10 different conditions, in dramatic contrast to the current findings. This discrepancy suggests that there is significant unawareness — in both the medical community and the acupuncture community — about the actual extent of official recommendations.

The clinical implications are substantial. The study shows that medical authorities around the world already recognize acupuncture as a valid therapeutic option for a wide range of conditions, based on emerging scientific evidence. However, a critical gap in implementation is identified: many guidelines were apparently developed without adequate consultation with acupuncture specialists, resulting in lack of knowledge and inadequate implementation by professionals in the field.

The study has important limitations, including language restrictions (English focus), possible inaccessibility of publications in other languages, and financial limitations that prevented access to some paywalled publications. In addition, the authors did not appraise the quality of the evidence used in the guidelines or the strength of the recommendations, aspects that will be addressed in future work.