Effect of acupuncture on somatic symptom disorder: a systematic review and meta-analysis

Feixue Zhao¹Weiming Wang²Xinyao Feng¹Jinyu Li¹Weijuan Gang²Xiang-Hong Jing²Huan Chen^2*Ying Liang^1*

• ¹Peking University Sixth Hospital, Beijing, China
• ²China Academy of Chinese Medical Sciences, Beijing, China

Objective: The rising prevalence of somatic symptom disorder (SSD) lacks specific treatment options. While acupuncture shows promise for mental health, its efficacy for SSD remains unclear. This systematic review and meta-analysis aims to clarify the evidence on acupuncture's effectiveness for SSD.Methods: Eight databases including PubMed, Embase, Cochrane Library, Web of Science (WoS), China National Knowledge Internet (CNKI), etc. were searched from the inception to 15th March 2024. Randomized controlled trials (RCTs) that assessed the effect of acupuncture used alone or in combination with other therapies for SSD were included. Two independent reviewers performed study screening and data extraction. Risk of bias of included studies were assessed using Cochrane Risk-of-Bias (RoB) tool version 2. Meta-analysis was conducted where applicable.Results: Out of 9526 articles, 5 studies with 376 patients were selected. Four of the studies showed the pooled estimates of mean difference in the change of HAMA scores between acupuncture plus paroxetine or duloxetine group and medication alone group were statistically significantly at week 4 (-1.94, 95%CI -3.71 to -0.17; p=0.03) with borderline significance at week 6/8(-3.17, 95%CI -6.38 to 0.04; p=0.05) from baseline. The pooled mean difference in change of NRS score was not statistically significant between acupuncture plus duloxetine group and duloxetine alone group at week 2(-1.25, 95% CI -3.03 to 0.53; p=0.17), 4(-0.96; 95%CI -2.30 to 0.38; p=0.16) and 6/8 p=0.33) from baseline. Adverse event rates were comparable between acupuncture plus SSRI/SNRI and SSRI/SNRI alone, except in the comparison of floating acupuncture with placebo versus simulated floating acupuncture with duloxetine. All studies exhibited bias concerns or high risk of bias. Certainty of all outcomes were judged to be low or very low by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.Conclusions: Our findings indicated potential added benefits of acupuncture combined with SSRI/SNRI for SSD-related anxiety, though effects on pain were inconsistent. High-quality RCTs with larger sample sizes are required to confirm acupuncture's efficacy and safety for SSD.Systematic registration: This work was registered in the PROSPERO database (registration number: CRD42024537063).