Efficacy of acupuncture on acute pharynx infections: A systematic review and meta-analysis

This study represents the first comprehensive meta-analysis on acupuncture for acute pharyngeal infections, analyzing 19 randomized controlled trials with 1,701 patients. Acute pharyngeal infections are extremely common, affecting more than 2% of adults and 5% of children each year, causing significant impact on public health and productivity. Conventional treatment is based primarily on antibiotics, which can cause adverse effects and contribute to bacterial resistance. The methodology was rigorous, following PRISMA guidelines and including searches across multiple databases through October 2022.

Inclusion criteria were randomized controlled trials comparing acupuncture (manual, electroacupuncture, bloodletting, or auriculotherapy) with antibiotics or sham acupuncture in patients with acute pharyngitis. Study quality was assessed using Cochrane tools, with only one study showing high risk of bias. Primary results demonstrated significant superiority of acupuncture over antibiotics in the clinical response rate (OR=4.18), indicating that patients treated with acupuncture had more than four times the likelihood of improvement. Secondary outcomes showed that acupuncture significantly reduced visual analog scale pain scores (g=1.30), decreased sore throat duration (g=-3.25), and improved inflammatory markers, including leukocyte count (g=0.42).

Notably, no adverse events were reported in the acupuncture groups, whereas antibiotics caused nausea, vomiting, skin rash, and allergic reactions. Subgroup analysis revealed that auriculotherapy and bloodletting were more effective than manual acupuncture for pain relief. The most used points were He Gu (LI-4), Qu Chi (LI-11), and Shao Shang (LU-11), belonging to the Large Intestine and Lung meridians, traditionally associated with the treatment of respiratory conditions. The proposed mechanism involves modulation of the neuro-immune system, with acupuncture regulating M1/M2 macrophages, NK cell activity, mast cell degranulation, and release of anti-inflammatory mediators.

Acupuncture also appears to inhibit pro-inflammatory neuropeptides such as substance P and CGRP. The clinical implications are significant, suggesting that acupuncture can be considered a first-line treatment for acute pharyngitis, especially given its superior safety profile. This is particularly relevant in the current context of antimicrobial resistance and the need for alternatives to antibiotics. Limitations include clinical heterogeneity in acupuncture protocols, small sample sizes in some studies, and the difficulty of blinding due to the nature of the intervention.

Only two studies used sham acupuncture as a control, limiting the assessment of placebo effect. Methodologic quality varied, with many studies not adequately describing randomization and allocation concealment.