Acupuncture, transcutaneous electrical nerve stimulation, and laser therapy in chronic pain.

OBJECTIVE: The purpose of this review was to determine how effective acupuncture, transcutaneous electrical nerve stimulation, acupuncture-like transcutaneous nerve stimulation, laser therapy, electrical nerve stimulation, and neuroreflexotherapy are in the management of chronic pain. METHODOLOGY: The literature search identified six systematic reviews of the literature and four randomized controlled trials to provide evidence for this review. RESULTS: The systematic reviews included different methodologies and heterogeneity of study groups, but studies were generally of poor methodology. Although sham acupuncture may have analgesic effects, it was used as a control in many studies. CONCLUSIONS: In general, the evidence was contradictory or inadequate, reflecting poor study methodologies. No positive conclusion could be reached for acupuncture, transcutaneous electrical nerve stimulation, acupuncture-like transcutaneous nerve stimulation, laser therapy, or neuroreflexotherapy. A single randomized controlled trial provided limited evidence (level 3) that electrical nerve stimulation is effective for pain relief in myofascial pain syndrome for up to 4 weeks, but further study in humans is needed. Future randomized controlled trials and systematic reviews should include subgroup analyses of sham acupuncture and inert placebos as controls.