Effects from acupuncture in treating anxiety: integrative review

Anxiety is a very common health problem today, characterized by unpleasant feelings of restlessness, tension, and apprehension that tend to become chronic. This condition can appear in different clinical situations, such as generalized anxiety disorder, panic syndrome, post-traumatic stress disorder, phobias, and obsessive-compulsive disorder, and is related to other diseases such as cardiac problems, gastrointestinal problems, and asthma. The high prevalence of anxiety in the general population, especially its tendency to chronicity and the social and individual costs involved, has made the search for effective and safe treatments essential. Conventional treatments include mainly anxiolytic medications, such as benzodiazepines, which are widely prescribed worldwide, but present important concerns related to physical, chemical, and psychological dependence, mainly when used for prolonged periods or in inadequate doses.

The present study aimed to evaluate the scientific evidence available in the literature on the effects of acupuncture in the treatment of anxiety and to analyze the methodological quality of this research. The researchers performed an integrative literature review, which is an evidence-based research method that allows the incorporation of scientific knowledge into clinical practice. The search was conducted in five important scientific databases between April and June 2014, including studies published between 2001 and 2014. They used specific keywords such as anxiety, acupuncture, and acupuncture therapy, strategically combined to ensure a broad search of primary studies.

Articles in Portuguese, English, and Spanish that answered the research question and were electronically available were included.

The results showed that, of 514 articles initially found, 19 were included in the final analysis after rigorous application of the selection criteria. The majority of studies were conducted in the United States, followed by Brazil, with representation also from other countries such as Canada, the United Kingdom, Australia, Sweden, Turkey, Austria, and Israel. Among the studies analyzed, 11 presented a strong level of scientific evidence, of which six were randomized controlled clinical trials. When these six studies were evaluated for methodological quality using a specific scale for acupuncture research, five were classified as of reasonable quality and one as of low quality.

The number of participants in the studies ranged from 29 to 120 people, and validated instruments were used to measure anxiety. The results demonstrated positive and statistically significant effects of the use of acupuncture for the treatment of people with anxiety, with significant improvements compared with conventional treatments.

The clinical implications of these findings are promising for both patients and health professionals. Acupuncture was shown to be a safe and effective therapeutic alternative, without the side effects associated with traditional anxiolytic medications, such as dependence or drowsiness. For patients, this means a treatment option that can be used alone or in combination with other therapies, offering relief from anxious symptoms without the risks of conventional medications. The World Health Organization had already recognized acupuncture since 2002 as effective for the treatment of various health problems, including psychological and emotional disorders, validating its use in different age groups and levels of health care.

In Brazil, acupuncture was included in the National Policy on Integrative and Complementary Practices (PNPIC) of the Unified Health System (SUS) in 2006, and nursing professionals have been able to practice it as a specialty since 2008, which expands access to this therapy.

Despite the encouraging results, the study has some important limitations that must be considered. The main limitation refers to the methodological quality of the research analyzed, with problems such as small samples, lack of standardization in treatment protocols, diversity of instruments to assess anxiety, and absence of a gold standard in treatments. Some studies had deficiencies in randomization, blinding of participants, and clear definition of the number of sessions and duration of treatment. Another limitation was the restriction of the search to articles in only three languages, which may have excluded important studies published in Eastern countries where acupuncture is a traditional medical practice.

The authors conclude that, although acupuncture appears to be a promising treatment for anxiety, there is a need to improve the methodological quality of research in this area, with studies of greater scientific rigor, larger samples, and more standardized protocols, so that more precise and safe clinical guidelines can be established for the use of this therapy in the treatment of anxiety.