Acupuncture vs NRT

Inspired by Dai et al 2021.[1]

Photo by David Yanutama on Unsplash.

NRT – nicotine replacement therapy
NMA – network meta-analysis

key to acronyms

I wonder how many former smokers have relapsed after that last penalty on Sunday night? I cannot imagine many England football fans resorted to acupuncture after the disappointment of losing on penalties in the Euro 2020 final.

Rather like Italy’s performance, this paper is not particularly inspiring, but it is the first paper on the subject to use NMA, and so deserves a mention here.

The paper is titled as a comparison between acupuncture and NRT for smoking cessation, and they included 23 studies (RCTs) with a total of 6 different treatment arms (ie 6 different categories of interventions) with a total of 2706 patients. Whilst the search included NRT, they only included trials of NRT where it was compared with an acupuncture intervention.

Here is a list of the different acupuncture interventions:

AT – acupuncture therapy
AA – auricular acupressure
APAA – acupuncture plus auricular acupressure
SAT – sham acupuncture therapy
SAA – sham auricular acupressure

There were 5 of the 23 trials that included NRT, but these were large trials including over half the total number of patients (1588), so the comparison of acupuncture techniques with NRT is well represented in statistical terms.

Auricular acupressure may be the best intervention

There were no statistically significant differences between the groups apart from AA being superior to SAA in long-term abstinence rates.

Despite the lack of statistically significant differences between interventions, AA and APAA came out on top of the probability rankings in the NMA.

The fact that AA seems to be part of the more successful approaches is consistent with a comment Adrian White made to me after the 2014 Cochrane review that he led. He said that auricular acupressure seemed to be superior to auricular acupuncture for smoking cessation in the short-term.[2] He seemed a little concerned by these results, but I was not, because my experience of these techniques suggested that acupressure with ear seeds was always felt strongly, whereas indwelling needles could sometimes be entirely without sensation.

The take home message for me is to continue using ear seeds rather than indwelling needles for most applications in which they are indicated, apart from post-operative pain,[3] and possibly pre-operative anxiety.[4]


1          Dai R, Cao Y, Zhang H, et al. Comparison between Acupuncture and Nicotine Replacement Therapies for Smoking Cessation Based on Randomized Controlled Trials: A Systematic Review and Bayesian Network Meta-Analysis. Evid-Based Complement Altern Med ECAM Published Online First: 2021. doi:10.1155/2021/9997516

2          White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev 2014;1:CD000009. doi:10.1002/14651858.CD000009.pub4

3          Usichenko TI, Lehmann C, Ernst E. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia 2008;63:1343–8. doi:10.1111/j.1365-2044.2008.05632.x

4          Dietzel J, Cummings M, Hua K, et al. Auricular Acupuncture for Preoperative Anxiety—Protocol of Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicines 2020;7:73. doi:10.3390/medicines7120073

Declaration of interests MC