Meta-Analysis

Suhas Balakrishna et al. (2026) · Journal of lifestyle medicine

This systematic review and meta-analysis pooled 33 controlled studies with 2,651 adults to ask whether pelotherapy, the application of mineral-rich mud, peat or clay as packs, wraps or full baths, eases musculoskeletal disorders. These include osteoarthritis (joint cartilage wear), rheumatoid arthritis (an autoimmune joint disease), fibromyalgia (widespread pain) and chronic low back pain. Pelotherapy is a traditional naturopathic practice used in spas, balneological centres and clinics in at least 40 countries, and the authors set out to test it against modern standards: pre-registration, risk-of-bias rating and GRADE certainty scoring. The team searched eight databases and trial registers up to April 2026. Included trials enrolled adults with a confirmed musculoskeletal diagnosis, applied mud as the main treatment for 10 to 21 sessions over two to three weeks, and compared it with sham treatment, usual care, waiting lists or nothing. Pain was mostly rated on a 0-100 mm visual analogue scale or a 0-10 numeric scale, and function on questionnaires such as the WOMAC. Two reviewers worked independently and combined results with random-effects statistics. Pain dropped clearly after mud treatment (standardised mean difference -0.74, a moderate-to-large effect, roughly 18.5 mm on the 100 mm scale and above the 15 mm threshold for a meaningful change). The effect was still present at 3 months (-0.61) and at 6 months (-0.49, low certainty). Physical function (-0.69) and quality of life (+0.58 on SF-36) improved as well, with osteoarthritis trials using the WOMAC at -0.82 and rheumatoid arthritis trials using the HAQ at -0.58. Morning stiffness (-0.52) and C-reactive protein, a blood marker of inflammation (-0.44), fell modestly, while the erythrocyte sedimentation rate did not change significantly. Knee osteoarthritis showed the biggest benefit (-0.86), and Dead Sea mud the strongest peloid effect (-0.84). Serious adverse events were no more common than in controls (relative risk 0.98); about 6.5% of mud recipients had mild, short-lived skin redness, largely from heat. The authors note several limits: participants cannot be blinded to mud, peloid type, temperature and protocol varied widely, results differed between trials (I2 = 62% for pain), a correction for possible publication bias lowered the pain estimate to -0.66, most trials came from European spa settings, and safety beyond 12 months is unknown. They call for larger blinded trials with standardised peloids and longer follow-up, and frame pelotherapy as an adjunct to, not a replacement for, drug and physiotherapy care.

Sedighe Esmaeilzadeh et al. (2025) · Reproductive biology and endocrinology : RB&E

This systematic review and meta-analysis combined 17 randomized controlled trials (15 pooled, 996 women) to ask whether antioxidant supplements ease the pain of endometriosis, a chronic inflammatory condition in which tissue like the uterine lining grows outside the uterus. Oxidative stress (damage from unstable oxygen molecules called free radicals) is thought to feed the inflammation and pain, so antioxidants such as melatonin, vitamins C, D, and E, curcumin (from turmeric), garlic, silymarin (from milk thistle), and resveratrol have been tested. Results across individual trials have been inconsistent, and earlier reviews were narrower, so this one searched seven sources through January 2025 and graded the certainty of the evidence. Included trials enrolled women aged 18 to 49 with confirmed endometriosis, mostly in Iran, plus Egypt, Brazil, the United States, China, and Sweden. Women took an oral antioxidant or a comparator (placebo, standard care, or nothing) for 8 to 24 weeks. The review pooled three pain outcomes using standardized mean differences (a way to combine different pain scales into one measure): painful periods (dysmenorrhea), painful intercourse (dyspareunia), and chronic pelvic pain. Study quality was graded with Cochrane RoB 2, and evidence certainty with GRADE. For painful periods, 12 trials (706 women) showed lower pain with antioxidants (SMD -1.26; 95% CI -2.19 to -0.32, equal to about 3 points on a 0 to 10 scale), but results varied enormously between trials (I² = 90.1%), so the evidence was rated low certainty. Melatonin stood out (SMD -1.89; 95% CI -2.48 to -1.31), while vitamin D, vitamins C plus E, omega-3, resveratrol, and curcumin did not reach significance. Painful intercourse showed no significant effect (SMD -1.01; 95% CI -2.27 to 0.24). Chronic pelvic pain fell in the pooled analysis (SMD -1.07; 95% CI -1.71 to -0.42), but the evidence was very low certainty and the effect vanished when trials with conflicts of interest were removed. Single trials of garlic powder and silymarin reported lower pain, whereas curcumin did not. Only 7 of 17 trials had low risk of bias. The authors say the findings do not support routine antioxidant use for endometriosis pain, and describe melatonin as the most promising candidate for painful periods, pending confirmation. Limitations include very high heterogeneity, small trials, different antioxidants and doses, bigger effects in weaker studies, and little control of baseline vitamin levels or diet. The paper did not report adverse events. The garlic and silymarin findings come from single trials, and publication-bias testing found no small-study effects for chronic pelvic pain. The authors call for larger, standardized trials.

Yang Zhu et al. (2026) · PeerJ

This systematic review and meta-analysis pooled 22 randomized controlled trials with 375 mostly male participants to ask when, if at all, a single cold-water immersion (CWI) after exercise helps muscles recover. CWI means immersing the body, from navel depth up to the neck, in water of roughly 5 to 20 degrees C for about 6 to 20 minutes. Exercise-induced muscle damage (EIMD) is the loss of force, soreness and raised creatine kinase (CK, a blood marker leaking from stressed muscle cells) that follows hard or unaccustomed exercise, often with delayed onset muscle soreness (DOMS). Earlier reviews mixed time points, so this one separated results at 0, 24, 48 and 72 hours. The included trials enrolled healthy non-athletes and athletes aged about 16 to 49, who exercised with intervals, simulated matches, distance running or heavy eccentric lifting. After exercise, one group sat in cold water and the comparison group rested seated for a similar time. Researchers measured maximal voluntary isometric contraction (MVIC, the hardest possible static muscle squeeze), countermovement jump (CMJ, jump height as a gauge of explosive power), CK, and soreness on a visual analog scale (VAS, a line marked from no pain to worst pain). Maximal strength was unchanged by CWI (g = 0.08, 95% CI -0.11 to 0.26, p = 0.42; a negligible effect) at every time point. Jump performance was worse immediately afterward (g = -0.68, p = 0.01; a medium-sized drop) and showed no difference by 24 to 48 hours (g = 0.38 at 24 h, p = 0.06; g = 0.06 at 48 h, p = 0.68). CK looked lower after CWI (g = -0.43, p < 0.001; a small effect), but the result shrank to non-significance after correcting for likely missing small studies (g = -0.16, 95% CI -0.44 to 0.12; the original benefit was probably overestimated). Soreness was lower (g = -0.58, p = 0.006; a medium effect), though the trials disagreed widely (I² = 87%) and the certainty of evidence was rated very low. The evidence has clear limits: 362 of 375 participants were male, participants could not be blinded to cold water, several trials were tiny, and only one immersion with follow-up of 72 hours or less was studied. The authors suggest the soreness effect is the most plausible benefit and the temporary jump decrement is the main drawback. Repeated use during training and its effect on muscle adaptation were not examined, and they call for larger trials that include women and standardize temperature and duration.

Zheping Quan et al. (2026) · Frontiers in immunology

This systematic review and network meta-analysis of 16 randomized controlled trials (943 participants) explored which forms of exercise are linked to better outcomes in irritable bowel syndrome (IBS). IBS is a functional gut disorder, meaning the bowel looks normal on testing but causes recurring abdominal pain and altered bowel habits, and it often occurs alongside anxiety and depression. The authors framed the gut and brain as communicating through the brain-gut axis, with the immune system, intestinal barrier and gut microbiota also involved. A network meta-analysis is a statistical method that compares several treatments at once, even when some were never tested head to head, and ranks them using SUCRA, a percentage score where higher values mean a greater chance of being best. The included trials, published between 2004 and 2025, tested yoga, Pilates, Baduanjin (a traditional Chinese gentle movement routine), running and moderate-intensity aerobic exercise for 4 to 24 weeks. Participants were adults with constipation-predominant, diarrhea-predominant or mixed IBS, mostly in Asia, Europe and North America. Comparison groups received conventional treatment, dietary advice, probiotics or education. Researchers measured symptom severity with the IBS Symptom Severity Scale, quality of life with the IBS Quality of Life scale, and mood with anxiety and depression scores. Exercise improved several outcomes. Depression scores fell overall (SMD -0.56, a moderate-sized benefit), though heterogeneity was very high (I2 = 95%, meaning results varied widely between trials), and yoga alone was not significant. Anxiety dropped with yoga (SMD -1.82), Pilates (SMD -3.84) and aerobic exercise (SMD -6.31). Symptom severity improved with running (MD -72.68 points), Pilates (-71.32), aerobic exercise (-46.50) and Baduanjin (-16.94), with running ranked first (SUCRA 90.3%). Quality of life ranked Baduanjin first (99.9%) and yoga second (80.1%), while aerobic exercise showed no significant difference from conventional treatment. In subscale analyses, Pilates cut pain severity (MD -17.90) and aerobic exercise improved dysphoria, activity interference, body image, health worries and relationships, while yoga helped only bowel satisfaction and interference with life. Rankings differed by outcome, which the authors describe as functional specificity. The authors describe exercise as a safe, low-cost non-pharmacological option that may hold value in comprehensive IBS management, but the evidence carries clear limits. Heterogeneity was high, many trials did not clearly blind participants or assessors, and some effect sizes were unusually large, which the authors attribute to small samples. Study counts were reported inconsistently across sections, and safety was not analysed. Too few trials came from outside East Asia to judge differences across ethnic groups. The immune mechanisms remain unproven, and the authors call for trials that add immune markers, biomarkers and gut microbiome measures.

Xinrong Chen et al. (2024) · BMC medicine

This systematic review and network meta-analysis explored which kinds of breathing support, given while people with chronic obstructive pulmonary disease (COPD) do supervised exercise training, help most. COPD is a long-term lung disease that limits airflow and makes exercise uncomfortable, so many patients struggle to exercise hard enough to benefit from pulmonary rehabilitation. The authors compared six approaches: conventional oxygen through a nasal tube or mask, high-flow nasal cannula (HFNC, which delivers warmed, humidified air at high flow), noninvasive positive pressure ventilation (NPPV, a mask that pushes air in to ease breathing effort), nighttime NPPV, heliox (a helium-oxygen mix), and plain air. The protocol was registered with PROSPERO. The team searched five databases through December 2023 and included 35 randomized trials with 1321 patients from 19 countries. All had stable, severe COPD (GOLD stage III or IV), with average ages from 59 to 76 and mostly men. Programs ran 6 to 12 weeks, with two to three sessions weekly of 30 to 45 minutes. A network meta-analysis lets treatments be ranked even when they were not directly compared. Outcomes included the 6-minute walk test (distance covered in 6 minutes), peak work rate, endurance time, breathlessness on the Borg scale, oxygen uptake, and quality of life. NPPV performed best. Compared with plain air, NPPV improved walk distance (SMD 0.36, where SMD is a standardized effect size), peak work rate (0.69) and peak oxygen uptake (0.75), and it was the only option to do so on those measures. Versus oxygen, NPPV also improved walk distance (0.44) and peak work rate (0.56). It also lowered blood lactate and improved tidal volume and minute ventilation. For endurance time, both NPPV (0.38) and oxygen (0.31) beat air, and HFNC ranked highest. Breathlessness dropped more with NPPV (-0.47), HFNC (-0.46) and oxygen (-0.36) than with air. No therapy changed quality of life significantly, heliox showed no benefit, and nighttime NPPV did not reach significance. The evidence quality ranged from critically low to moderate. The authors suggest that NPPV is the most promising option for stable severe COPD during pulmonary rehabilitation exercise, while noting that results apply only to GOLD stage III or IV disease. They state limitations including small, varied trials, few direct comparisons, high risk of bias in many studies, and unclear best device settings. They call for larger trials that also examine safety, feasibility, cost and personalization. The authors add that the analysis used change from baseline to limit differences between groups, and that the lack of direct comparisons between some therapies weakens confidence in the rankings.

Luis González-Gómez et al. (2025) · European journal of pain (London, England)

This systematic review and meta-analysis asked a practical question for people with chronic low back pain (CLBP, pain lasting more than three months): if you had to choose between exercise therapy and hands-on manual therapy alone, which works better? Clinical guidelines actually recommend combining both approaches with psychological support, but in real clinics, people often receive just one or the other, so the researchers pooled every trial that tested exercise against manual therapy head-to-head, without either being combined with the other. After a comprehensive search of five research databases, the researchers found six qualifying randomized trials, covering 743 people with CLBP total, published between 2007 and 2022. The exercise treatments ranged from general aerobic and strengthening exercise to specific 'motor control' exercises that retrain deep core muscles; the manual therapies ranged from joint mobilization and massage to formal osteopathic and chiropractic spinal manipulation. The researchers combined the trial results statistically and also checked whether results changed depending on how long people had been followed up, and whether patient characteristics like age or sex explained some of the differences. Overall, there was no clear winner. For pain relief, exercise and manual therapy performed about the same across all six trials, though when two trials involving chiropractic or osteopathic-style manipulation were set aside, manual therapy showed a small edge in the first three months. For disability (how much back pain limits a person's daily activities), the two treatments were also similar in the short and medium term, but exercise therapy showed a small advantage after six months or longer. Neither treatment stood out for physical function, based on the two trials that measured it. Notably, trials with more women in them tended to show exercise working somewhat better for disability but manual therapy working somewhat better for pain, and older participants tended to respond somewhat better to exercise for pain — though these are patterns across studies, not conclusions about any one person. The researchers rate the overall quality of this evidence as very low, mainly because there are still very few well-designed trials that isolate exercise from manual therapy without mixing the two, and the studies used inconsistent doses and often didn't fully describe what patients actually received. Their bottom line is that picking exercise or manual therapy alone is not clearly better-supported than the other, and that combining exercise, manual therapy, and psychological support, as major clinical guidelines already recommend, remains the better-evidenced path rather than choosing one alone.

Neil P Roberts et al. (2019) · European journal of psychotraumatology

This systematic review and meta-analysis explored which early psychological treatments, started within three months of a traumatic event, reduce post-traumatic stress symptoms. Post-traumatic stress disorder (PTSD) involves intrusive memories, avoidance and heightened alertness that persist after trauma, and acute stress disorder (ASD) is a similar early reaction in the first month. The authors updated an earlier 2009 review, pooled 61 randomized controlled trials, and prepared it as part of the International Society for Traumatic Stress Studies treatment guidelines. Trials were split into three groups: help offered to everyone exposed to a trauma, help for people already showing symptoms, and help for people diagnosed with ASD or PTSD. Included trials tested a wide range of approaches, including trauma-focused cognitive behavioural therapy (CBT-T, which uses written, imagined or real-life exposure to the trauma), cognitive therapy without exposure, brief EMDR (eye movement desensitization and reprocessing, a therapy in which a person recalls a trauma while following guided eye movements), cognitive processing therapy, internet-based self-help and stepped collaborative care. Most participants were adults recruited after accidents, assaults, injury or intensive care. Symptom severity was compared using standardized mean differences (SMD, where negative favors treatment), and the authors rated evidence quality with GRADE. For people not screened for symptoms, no intervention was clinically better than usual care. For people with symptoms, CBT-T outperformed waitlist (SMD -0.63) and supportive counselling (SMD -0.61) after treatment, and the gap was larger in diagnosed ASD or PTSD (SMD -0.89 and -0.75). Cognitive therapy versus waitlist reached SMD -0.68, and brief EMDR reached SMD -2.50, though that result came from four small trials with only 84 participants and very low quality evidence. CBT-T and cognitive therapy performed similarly (SMD -0.19). Benefits were less consistent at 7 to 12 months, and cognitive processing therapy showed no effect in two trials. The authors judged the CBT-T, cognitive therapy and EMDR findings clinically important, whereas significant effects for collaborative care, brief dyadic therapy and a self-guided internet program in unscreened individuals were not judged clinically important. Most ratings were low or very low quality, and few trials reported adverse events. The authors suggest that CBT-T, cognitive therapy and brief EMDR are supported for symptomatic people and that routine intervention for everyone exposed is not supported. They note limits: diverse studies, many small trials, high attrition, inconsistent follow-up and thin safety data. They also caution that the large EMDR effect rests on very few participants, that pooled estimates are uncertain because most GRADE ratings were low or very low, and that non-publication of negative results cannot be excluded.

Veerle Oosterbaan et al. (2019) · European journal of psychotraumatology

This systematic review and meta-analysis explored whether psychological help offered within 3 months of a sexual assault can reduce or prevent posttraumatic stress disorder (PTSD), a condition in which distressing memories, avoidance and heightened alertness persist after trauma. The authors searched six databases for studies from 1980 to April 2018, and excluded psychological debriefing because earlier work found it harmful. They report that this narrow question had not been reviewed before. Seven studies with 350 participants met the criteria and tested five different early interventions, a small evidence base that the authors describe as diverse in design and timing. The included studies were mostly of women in high-income countries, with average ages of 22 to 34, recruited through hospitals, forensic examinations or counselling centres. Interventions ranged from a single 9- or 17-minute educational video to a 113-minute EMDR session (eye movement desensitization and reprocessing, in which a person recalls a trauma while following guided eye movements), a modified prolonged exposure session (structured, repeated recalling of the trauma), cognitive restructuring with relaxation, and six weeks of cognitive processing therapy. Two authors independently screened studies and rated risk of bias; four studies compared with standard care were pooled. Pooling four studies, early intervention did not clearly reduce PTSD severity at 1 to 6 weeks (g = -0.28, 95% CI -0.57 to 0.02; g is a standardized effect size, where negative favors intervention), though all four leaned that way. At 2 to 12 months, a small effect just reached significance (g = -0.23, 95% CI -0.46 to 0.00), with no measured heterogeneity. Two studies that compared PTSD diagnoses found no difference between groups. Safety data were thin: only two studies reported adverse events, and none used an active strategy to detect harm, though author contact turned up no serious events. All seven studies were judged at high risk of bias, and true randomization occurred in only two of the five studies that compared treatment groups, which the authors link to a high risk of selection bias. The authors suggest that early interventions may lead to lasting reductions in PTSD severity after sexual assault, but state that definite conclusions about safety, efficacy and PTSD prevention are impossible with so few, heterogeneous, high-risk-of-bias studies. They also note that the studies used older PTSD definitions from DSM-III-R and DSM-IV. They call for trials that actively track harm, report PTSD diagnoses as well as symptom scores, compare early with later treatment, and consider cost and access for survivors.

Hong Xu et al. (2024) · Menopause (New York, N.Y.)

This meta-analysis pooled 11 randomized trials testing whether mind-body exercise programs, including tai chi, yoga, Pilates, qigong, and mindfulness-based stress reduction (MBSR, an 8-week meditation and gentle-movement program), help women going through perimenopause or postmenopause, a life stage marked by declining estrogen that can weaken bones, disrupt sleep, and affect mood. These practices pair physical movement with controlled breathing and present-moment attention, offering a non-drug alternative for women wary of hormone therapy's cancer-risk profile. The review combined 11 trials from six countries, involving just over 1,000 women, comparing mind-body exercise groups against women who continued their normal daily activities without a structured exercise program. The trials varied widely, from 6-week programs to a full year, and used five different practices, so results were combined statistically using methods that account for this variety. Across the pooled data, mind-body exercise meaningfully helped on every measure studied: bone density improved (drawing on Pilates and tai chi trials), sleep quality improved (drawing on Pilates, yoga, qigong, and MBSR trials), and both anxiety and depression symptoms dropped substantially (also drawing on that same four-practice group), while fatigue eased too. The anxiety and depression improvements were the largest effects seen, though the studies contributing to them varied considerably in their findings (a statistical marker called heterogeneity was high), meaning some trials showed much bigger benefits than others. Taken together, the findings support mind-body exercise as a safe, reasonable option for managing the physical and emotional challenges of the menopause transition, giving women another evidence-based choice beyond hormone therapy. Because the analysis pooled several different practices together rather than testing each one separately with its own effect size, it shows that mind-body exercise as a category helps, without pinpointing exactly how much benefit comes from any one specific practice like yoga versus tai chi. The individual trials were also generally small and only partially blinded, since exercise programs are hard to disguise from participants.

Jihye Seo et al. (2020) · Medicine

This systematic review and meta-analysis pooled 14 randomized controlled trials (1,215 women, mostly from China with one from Japan) exploring whether Dangguijagyag-san (DJS) - a traditional East Asian herbal formula also called Danggui Shaoyao San - helps primary dysmenorrhea (PD), the cramping menstrual pain that occurs without an underlying pelvic disease. PD is common, estimated to affect 16-91% of women of reproductive age, and is driven by elevated uterine prostaglandins causing muscle spasm; standard NSAID and hormonal treatments carry gastrointestinal and other side-effect risks, which is part of why researchers keep examining herbal alternatives. The review followed a pre-registered protocol and searched eight medical databases through April 2019. The included trials compared DJS - most often prepared as a decoction (a boiled herbal liquid), given over roughly three menstrual cycles - against NSAIDs (5 trials), a placebo (1 trial), other herbal formulas (6 trials), or NSAIDs with moxibustion added to DJS (2 trials). The main outcome tracked was the total effective rate, a practitioner-judged measure of symptom improvement, alongside pain scores on a visual analogue scale in some trials. Pooled results favored DJS across every comparison. Against NSAIDs, DJS produced a higher effective rate (relative risk 1.16, meaning about 16% more improvement events, 95% confidence interval 1.08-1.24, with no meaningful variation between trials). Against placebo, DJS reduced pain scores and cut how often women needed rescue pain medication during their period. Against other herbal formulas, DJS again showed a higher effective rate (RR 1.24), an advantage that held up most consistently when DJS was prepared as a decoction rather than a granule or capsule. Adding moxibustion (heated-herb therapy at acupuncture points) to DJS outperformed NSAIDs alone (RR 1.47). Side effects were reported in only a handful of trials and were mostly mild digestive complaints, less frequent in the DJS groups than the NSAID groups. The review's authors rated the overall certainty of this evidence as moderate to low: most trials did not clearly describe how they randomized or concealed group assignment, could not blind participants to which herbal or drug treatment they were taking, and were often small (many under 100 participants), all conducted in East Asia. The findings do not establish how DJS performs in other populations or over longer treatment periods, and the authors call for larger, more rigorously designed trials to confirm the effect.

Dilara Onan et al. (2025) · Journal of oral & facial pain and headache

Chronic tension-type headache (CTTH) -- headaches on 15 or more days a month for at least three months -- is thought to involve tight, tender muscles in the head, neck, and face, though scientists are not fully certain why it happens. This systematic review and meta-analysis pulled together randomized trials testing physiotherapy-style treatments -- things like massage, exercise, acupuncture, and relaxation training -- to see whether they actually ease CTTH symptoms. The researchers followed a pre-registered research plan and searched two major databases through mid-2024, aiming to answer a focused question: do these hands-on and movement-based approaches beat sham treatment, no treatment, or medication alone? Two physiotherapist researchers with PhD degrees independently screened 237 studies and settled on nine randomized trials -- ranging from 25 to 169 patients each, mostly women, treated for 3 to 12 weeks. The approaches tested included trigger point massage, electroacupuncture, relaxation with muscle-tension biofeedback, yoga, and neck-and-shoulder strengthening exercises, among others. Seven of the nine trials had comparable enough data to combine mathematically (meta-analysis), and each study's methodological rigor was scored using a standard 11-item checklist. When the researchers pooled the numbers, physiotherapy approaches meaningfully reduced headache intensity compared to control (a large, statistically significant effect), cut the number of headache days per month by more than one day on average, and shortened how long headaches lasted -- all statistically significant improvements. A fourth measure, day-to-day headache impact on daily life, trended in favor of physiotherapy but did not reach statistical significance. Looking at individual studies: electroacupuncture beat sham treatment for headache intensity; combining a hands-on release technique with ibuprofen worked better than ibuprofen alone; and yoga added to standard medical care outperformed medical care by itself on several measures. Importantly, though, the researchers rated their overall confidence in these pooled results as low to very low -- the studies were small, methods varied a lot between them, and most carried some risk of bias. No serious side effects were reported in any trial. The takeaway is cautiously encouraging: physiotherapy-based approaches -- especially those combining exercise, hands-on techniques, or relaxation training with standard care -- show a real signal for easing CTTH symptoms, and they appear safe. But because the underlying evidence is still thin and inconsistent, these findings should not be read as proof that any one specific technique is the best choice. The authors call for larger, more consistently designed trials before physiotherapy can be confidently recommended as a primary CTTH treatment, though the current evidence supports trying it as a reasonable, low-risk complement to standard care.

Zhiyong Long et al. (2023) · Frontiers in immunology

Whether the plant compounds often discussed for rheumatoid arthritis — turmeric, green tea, pomegranate, garlic — actually do anything is the question this meta-analysis set out to answer. This review gathered every randomized trial it could find on the question: 47 trials, nearly 3,900 people, fifteen different plant polyphenols, from Iran, China, Korea, Egypt, Japan, Brazil, India and the United States. The clearest picture came from two of them. The first is total glucosides of paeony, an extract of Chinese peony root that is a licensed prescription medicine in China. Twenty-three trials tested it — always added to standard RA drugs like methotrexate, never instead of them. Disease activity scores came down, and so did CRP, ESR and rheumatoid factor, the blood markers doctors track. The most interesting result: people taking it reported *fewer* side effects than people on the standard drugs alone. That fits how it is used clinically — it appears to soften the toll the conventional drugs take on the liver and stomach. The second is curcumin, the yellow compound in turmeric. Five trials, and the same direction: lower disease activity, lower inflammatory markers, no extra side effects. Green tea polyphenols looked promising across two trials. Saffron did not show a clear effect. Everything else — pomegranate, garlic, resveratrol, sesame, cinnamon, ginger, kudzu, cranberry, olive oil, quercetin — rests on one or two small trials apiece, which is encouraging but not yet evidence that bears weight. The honest caveat, which the authors state plainly themselves: the trials disagreed with each other a great deal, most were small, and when the researchers sliced the data by dose and duration some of the headline benefits faded. Nearly all of these were add-on studies. Nobody tested a polyphenol against methotrexate, so the evidence says nothing about replacing a prescribed medication. What it does support is turmeric and peony extract as the best-evidenced candidates, studied as additions to existing treatment rather than replacements for it.

Shuang Liang et al. (2024) · BMJ open

This systematic review and meta-analysis pooled 8 randomized controlled trials with 463 participants (229 receiving acupuncture, 234 receiving a comparator) to test acupuncture for atopic dermatitis — also called atopic eczema — a chronic, relapsing inflammatory skin condition marked by itch (pruritus), dryness and rash. The most frequently needled points were LI11 (Quchi), ST36 (Zusanli) and SP10 (Xuehai), acupoints from Traditional Chinese Medicine's meridian system traditionally used to clear heat, calm itch and support immune balance; here they were tested against blank controls, sham (non-penetrating) acupuncture, or standard medicines like antihistamines and topical steroids. Across the eight trials — two from Germany, two from South Korea and four from China — treatment took two main forms: manual acupuncture (5 trials, mostly needling LI11, ST36 and SP10 for 15-30 minutes, one to seven times weekly over 10 days to 5 weeks) and fire acupuncture, where a heated needle is briefly inserted (3 trials, mainly paired with standard medicine). Two trials added retained press-tack needles at LI11 and the ear point Shenmen. Severity was tracked with the SCORAD index (combining physician and patient ratings) and the EASI (physician-only); itch with a 0-100 visual analogue scale (VAS); and quality of life with the DLQI questionnaire. Acupuncture significantly lowered SCORAD scores compared with control (MD=-10.61, 95% CI -17.77 to -3.45, p=0.004 — a drop large enough to clear the 8.7-point threshold doctors consider clinically noticeable). It cut itch scores even more clearly (VAS MD=-14.71, 95% CI -18.20 to -11.22, p<0.00001 — also above its meaningful-change threshold) and improved DLQI quality-of-life scores (MD=-2.37, p<0.0001), though that change fell short of the threshold considered clinically important. The EASI score, which relies only on a physician's rating rather than patient-reported itch and sleep, showed no significant group difference (p=0.08), and neither did blood IgE levels (p=0.07). Compared specifically with sham (fake-point) acupuncture rather than no treatment, real acupuncture still won out on SCORAD (p<0.00001) — evidence the effect is not just expectation or attention. Only mild, short-lived side effects were reported (bruising, limb numbness, mild stomach upset), and no serious harms occurred in any of the five trials that tracked safety. In atopic dermatitis, these results suggest acupuncture — especially manual or fire acupuncture at LI11, ST36 and SP10 — may help as an add-on to standard treatment, with itch relief the most consistent benefit and a good safety record. The review authors caution that only 8 small trials (463 people total) were available, most had weaknesses like unclear allocation concealment or blinding, and results varied a great deal between studies. Larger, more rigorously blinded multicentre trials are needed before acupuncture earns a stronger recommendation than a promising adjunct therapy.

Liuting Zeng et al. (2022) · Frontiers in immunology

This systematic review and meta-analysis pooled 31 randomized controlled trials (34 study records, roughly 1,583 participants) exploring curcumin and Curcuma longa (turmeric) extract across 10 autoimmune diseases — conditions where the immune system mistakenly attacks the body's own tissue. Autoimmune disease covers more than 120 named conditions; this review focused on ankylosing spondylitis, Behçet's disease, Crohn's disease, multiple sclerosis, oral lichen planus, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, Takayasu arteritis, and ulcerative colitis. Curcumin is the main active compound in turmeric, long used in Chinese medicine, and is studied here for its ability to regulate immune cells and reduce inflammation. Researchers searched English and Chinese databases plus the Cochrane Library and ClinicalTrials.gov through February 2022, screening 2,991 records down to 31 RCTs that tested curcumin or Curcuma longa extract against placebo or usual care. Trial count per disease varied widely: 9 RCTs for ulcerative colitis and 6 for oral lichen planus, but only 1 each for ankylosing spondylitis, Behçet's disease, and Takayasu arteritis. Doses ranged from 60 mg to 6,000 mg daily, taken orally, or in some trials applied as a gel, mouthwash, or enema, for 2 to 96 weeks. Disease activity was tracked with condition-specific scales (PASI for psoriasis, DAS28 for rheumatoid arthritis, EDSS for multiple sclerosis, and others) alongside blood markers like ESR and CRP. Where enough trials existed to combine statistically, curcumin performed well. In psoriasis, it roughly tripled the rate of major skin-clearance (PASI75: RR=3.01, p=0.008—meaning patients getting curcumin were about three times as likely to see substantial improvement). In ulcerative colitis, it raised clinical remission more than twofold (RR=2.28, p=0.0005) and lowered inflammatory markers ESR and CRP. In rheumatoid arthritis, it reduced the DAS28 disease-activity score (WMD=-1.10, p=0.0002—a clinically noticeable drop in joint disease activity), though results varied considerably between the five trials. Oral lichen planus, despite being studied in six trials, did not show a significant benefit on its pooled lesion-severity score (p=0.17). None of the pooled analyses found more side effects with curcumin than with placebo. The other six diseases each had just one or two small trials reporting improvement, too few to combine or confirm. These findings support curcumin as a reasonably safe adjunct for psoriasis, ulcerative colitis, and rheumatoid arthritis specifically, where the evidence is strongest and most consistent; for the seven other diseases, results are preliminary and should not yet guide treatment decisions. Curcumin's poor absorption from the gut remains a practical obstacle to reliable dosing. The authors call for larger, multi-center trials, especially for the thinly studied conditions, before broader clinical recommendations can be made.

Min He et al. (2022) · European journal of medical research

This systematic review and meta-analysis combined 30 randomised controlled trials with 4,413 participants to test whether acupuncture helps allergic rhinitis — the sneezing, congestion and runny nose caused by an allergic reaction in the lining of the nose. What sets it apart is that the authors then stress-tested their own findings using trial sequential analysis, a method that asks whether enough participants have been studied for a pooled result to be trusted rather than treated as a chance finding. Trials came mostly from China (22 of 30), with others from Germany, Australia, South Korea and Sweden, ranging from 24 to 981 participants and lasting between two and twelve weeks. Three needling approaches were used: standard needle acupuncture, electroacupuncture, and warm needling, in which mugwort is burned on the needle to heat it. Acupuncture was compared against no treatment, against sham needling at non-acupuncture points, and against antihistamines including cetirizine and loratadine. Symptoms were scored with the Total Nasal Symptom Score and quality of life with the Rhinoconjunctivitis Quality of Life Questionnaire. Against no treatment, acupuncture improved both nasal symptoms and quality of life in adults. Against sham needling it also came out ahead, improving nasal symptoms (mean difference -0.60, 95% CI -1.16 to -0.04, from 489 participants) and quality of life (mean difference -8.47, 95% CI -14.91 to -2.03, from 248 participants) — both statistically significant, since neither confidence interval crosses zero. Against cetirizine or loratadine no clear difference appeared, suggesting acupuncture performs about as well as standard antihistamines. But the trial sequential analysis failed to confirm any of these results, meaning the pooled evidence has not yet accumulated enough participants to be considered reliable. Effects in children and adolescents could not be determined at all. The honest summary is a promising signal that has not yet been confirmed. Performance and attrition bias were serious in most of the included trials, and the authors' own robustness check contradicted their own positive findings. For an adult who would rather not take daily antihistamines, acupuncture is a defensible option on current evidence; it is not yet a demonstrated one. Larger and better-conducted trials, especially in children, are what would settle the question.

Ping-Tao Tseng et al. (2023) · Advances in nutrition (Bethesda, Md.)

This network meta-analysis pooled 40 randomized controlled trials with 6,616 migraine sufferers to answer a question few doctors are asked but many patients wonder: can fish-oil omega-3s genuinely compete with prescription drugs for preventing migraines? Migraine affects roughly one in ten people worldwide, and standard preventive medications work for only 40–50% of those who try them, often with side effects that drive people to quit. Network meta-analysis is a technique that connects every studied treatment through shared comparison arms — here, 40 trials from the United States, Iran, Brazil, France, Norway and beyond, covering omega-3 supplements (EPA and DHA, the two main long-chain omega-3 fatty acids) alongside FDA-approved preventives like topiramate, valproate, amitriptyline, and propranolol. Participants averaged 35 years old and 79% were women, matching migraine's real-world demographics. Treatments ran 8 to 16 weeks, with migraine frequency and dropout rates as the primary measuring sticks. High-dose EPA/DHA ranked first in the entire network on every efficacy measure. It cut migraine frequency more than any drug (standardized mean difference −1.36 versus placebo, 95% CI −2.32 to −0.39 — a large effect) and reduced attack severity even more decisively (SMD −2.23, 95% CI −3.17 to −1.30). Just as important, people stuck with it: dropout was identical to placebo (odds ratio 1.00), while every prescription preventive in the network lost more patients along the way. The trade-off for honesty: the omega-3 trials were smaller than the drug trials, and the confidence intervals around these estimates are wide. This analysis moves high-dose omega-3 supplementation from "can't hurt" folk advice to a first-line candidate with top-of-network evidence, most relevant where preventive-drug side effects have been limiting. The benefit tracked the high-dose regimens, not the small amounts found in a typical daily fish-oil capsule.

Yincong Xu et al. (2020) · The Journal of international medical research

Painful periods are one of the most common health complaints among women of reproductive age — affecting anywhere from 16% to 91% — and the standard treatment, anti-inflammatory painkillers like ibuprofen, fails for roughly one in four women. This 2020 meta-analysis pooled the randomized trial evidence for three familiar kitchen herbs: cinnamon, fennel and ginger. In Traditional Chinese Medicine, menstrual pain is understood as cold dampness stagnating in the channels serving the uterus, and all three herbs are classically used to warm the meridians (the body's energy channels) and disperse that cold. The researchers combed four major research databases for randomized controlled trials — the strongest single-study design — where women with primary dysmenorrhea (period pain without an underlying pelvic condition) received one of the herbs or a placebo. Nine trials qualified, covering 647 women, most of them students aged 15 to 25. Seven of the nine trials rated as high quality on standard scoring. The herbs worked. Ginger showed the strongest effect, lowering pain scores by nearly 3 points on a 10-point scale compared with placebo (WMD = 2.902, p < 0.001 — a difference women would clearly feel). Cinnamon lowered pain by about 1.8 points (WMD = 1.815) and was the only herb that also shortened how long the pain lasted (by about 16 minutes per episode, WMD = 16.200). Fennel helped more modestly (WMD = 0.528, p = 0.011). The benefit held when only the highest-quality trials were analyzed, and earlier research has found ginger comparable to ibuprofen and mefenamic acid for this purpose. These effects have a known biological basis: compounds in these herbs (eugenol, gingerols) reduce prostaglandins — the chemicals that trigger the intense uterine cramping behind period pain. Typical study dosages were practical: ginger 250-500 mg capsules three times daily during the first 3-5 days of the period, and cinnamon around 1-3 grams daily for 3 days. The honest caveats: all nine trials were conducted in Iran, samples were small, and results varied considerably between studies — so larger, more diverse trials are needed before firm clinical recommendations. Still, for a low-cost, low-risk option with a plausible mechanism, this is among the better-supported uses of herbal medicine for a specific condition.