Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A GRADE-assessed Systematic Review and Meta-analysis

We searched MEDLINE, CENTRAL, Web of Science, EMBASE, CBM, CNKI, Wanfang database, J-stage, and CINII database for articles on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men up to November 2021. All studies on acupuncture treatment for men with CP/CPPS were searched until November 11, 2021. Higher-quality randomized controlled trials were eventually included, and the available results were graded in conjunction with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment. Acupuncture is an effective treatment for improving CP/CPPS symptoms, especially in terms of pain relief. Compared with sham acupuncture, acupuncture resulted in a significant reduction in the pain domain of National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and moderate relief in the urinary tract symptoms and quality of life domains of NIH-CPSI. Acupuncture may be more effective in reducing the total NIH-CPSI score and pain compared with pharmacotherapy. In terms of adverse effects, there is not much difference between acupuncture and sham acupuncture. Comprehensive acupuncture treatment should be considered for CP/CPPS patients based on individual symptoms. Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects 9–16% of adult men worldwide. This study aims to explore the efficacy and safety of acupuncture for CP/CPPS. Nine electronic databases were searched. Only randomized controlled trials were included. Two reviewers extracted data and assessed the risk of bias of trials using the revised Cochrane risk-of-bias (RoB 2.0) tool. Stata 17.0 was used to analyze the data. Twelve trials were included. The results of a meta-analysis showed that acupuncture had larger effect sizes (standardized mean difference [SMD] = –1.20, confidence interval or CI [–1.69, –0.71], acupuncture compared with sham acupuncture; SMD = –1.01, CI [–1.63, –0.38], acupuncture compared with medication; SMD = –0.91, CI [–1.29, –0.54], acupuncture plus medication compared with medication) in reducing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score. In decreasing NIH-CPSI pain domain score, acupuncture also led to larger effect sizes (SMD = –0.94, CI [–1.18, –0.70], acupuncture compared with sham acupuncture; SMD = –1.04, CI [–1.29, –0.79], acupuncture compared with medication; SMD = –0.85, CI [–1.23, –0.48], acupuncture p