Open Access Highly Accessed Research article

Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials

Marcus Gadau18, Wing-Fai Yeung2, Hua Liu3, Chris Zaslawski48, Yuan-Sheng Tan58, Fu-Chun Wang68, Sergio Bangrazi78, Ka-Fai Chung2, Zhao-Xiang Bian1 and Shi-Ping Zhang18*

Author Affiliations

1 School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, SAR, China

2 Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China

3 Department of Neurology, the Second Clinical Medical College of North Sichuan Medical College, Nanchong, China

4 College of Traditional Chinese Medicine, University of Technology Sydney, Sydney, Australia

5 World Federation of Acupuncture and Moxibustion Societies, Beijing, China

6 Changchun University of Traditional Chinese Medicine, Jilin, China

7 Instituto Paracelso, Roma, Italy

8 From the Tennis Elbow Acupuncture International Study-China, Hong Kong, Australia and Italy (TEA-IS-CHAI) group

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BMC Complementary and Alternative Medicine 2014, 14:136  doi:10.1186/1472-6882-14-136

Published: 12 April 2014



Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.


Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.


All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone.


Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.

Epicondylitis; Tennis elbow; Randomized Controlled Trials (RCTs); STRICTA; PRISMA; Cochrane risk of bias tool; Chinese literature