Acupuncture and related interventions for smoking cessation

This Cochrane systematic review represents the most comprehensive analysis ever conducted on acupuncture and related therapies for smoking cessation, including 38 randomized controlled trials with thousands of participants across four decades of research. The objective was to determine whether acupuncture, acupressure, laser therapy, and electrostimulation are effective in helping smokers quit, comparing them with no treatment, sham treatments, or other established interventions. The methodology followed rigorous Cochrane standards, searching international and Chinese databases through 2013, including only randomized controlled trials that assessed complete tobacco abstinence. The investigators analyzed short-term effects (up to 6 weeks) and long-term effects (6 months to 1 year) separately, using intention-to-treat analyses in which participants lost to follow-up were considered smokers.

The results showed mixed evidence. For acupuncture versus sham acupuncture, there was evidence of a modest short-term effect (RR 1.22, 95% CI 1.08-1.38) based on 16 studies with 2,588 participants, but this benefit was not sustained in the long term (RR 1.10, 95% CI 0.86-1.40) in an analysis of 9 studies with 1,892 participants. When compared with a waiting list or no intervention, three studies did not demonstrate clear evidence of benefit from acupuncture for long-term abstinence. Acupuncture was shown to be less effective than nicotine replacement therapy in two large studies.

For acupressure, limited evidence suggested superiority over sham acupressure in the short term (RR 2.54, 95% CI 1.27-5.08), but no studies assessed long-term effects. Continuous auricular stimulation showed a positive short-term effect (RR 1.69, 95% CI 1.32-2.16) but not long term. Laser therapy yielded inconsistent results, while electrostimulation did not demonstrate effectiveness compared with sham treatment. The clinical implications suggest that, although these therapies may have some effect during the acute abstinence period, there is no consistent, bias-free evidence of sustained benefit at 6 months or beyond.

The quality of evidence was limited by methodological risk of bias, heterogeneity across studies, and evidence of publication bias. The authors conclude that acupuncture and related therapies may be considered safe adjuncts when applied correctly, but are likely less effective than interventions with established evidence such as nicotine replacement therapy and structured behavioral support.