Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis

BACKGROUND:Shoulder pain is a common complication of stroke.Bee venom acupuncture(BVA)is increasingly used in the treatment of post-stroke shoulder pain.OBJECTIVE:To summarize and evaluate evidence on the effectiveness of BVA in relieving shoulder pain after stroke.SEARCH STRATEGY:Nine databases,namely MEDLINE,EMBASE,the Cochrane Library,the China National Knowledge Infrastructure(CNKI),the Japan Science and Technology Information Aggregator,Electronic(J-STAGE),and four Korean medical databases,namely,the National Assembly Library,the Research Information Service System,the National Discovery for Science Leaders,and OASIS,were searched from their inception through August 2014 without language restrictions.INCLUSION CRITERIA:Randomized controlled trials(RCTs)were included if BVA was used at acupoints as the sole treatment,or as an adjunct to other treatments,for shoulder pain after stroke.DATA EXTRACTION AND ANALYSIS:Two review authors independently selected trials for inclusion,assessed methodological quality and extracted data.RESULTS:A total of 138 potentially relevant articles were identifi ed,4 of which were RCTs that met our inclusion criteria.The quality of studies included was generally low,and a preponderance of positive results was demonstrated.All four trials reported favorable effects of BVA on shoulder pain after stroke.Two RCTs assessing the effects of BVA on post-stroke shoulder pain,as opposed to saline injections,were included in the meta-analysis.Pain was signifi cantly lower for BVA than for saline injections(standardized mean difference on 10-cm visual analog scale:1.46 cm,95%CI=0.30–2.62,P=0.02,n=86)CONCLUSION:This review provided evidence suggesting that BVA is effective in relieving shoulder pain after stroke.However,further studies are needed to confi rm the role of BVA in alleviating post-stroke shoulder pain.Future studies should be conducted with large samples and rigorous study designs.