Abundant Heaven

Highlights

• Acupuncture may provide a safe and effective complementary/alternative treatment method.

• Review of RCTs assessing the effectiveness of acupuncture in manage myofascial pain was systematically conducted.

• Moderate quality evidence suggests that acupuncture is a safe and effective modality.

• Optimization of study designs and standardization of outcome measures are needed for future RCTs.

Abstract

Persistent head and neck myofascial pain is among the most frequently reported pain complaints featuring major variability in treatment approaches and perception of improvement. Acupuncture is one of the least invasive complimentary modalities that can optimize conventional treatment. The aim of this review was to determine the evidence for the effectiveness of acupuncture in the management of localized persistent myofascial head and neck pain. Only randomized controlled clinical trials (RCTs) were included. The search was conducted in PubMed, Ovid Medline, Embase, Google Scholar, and Cochrane Library in addition to manual search. The main outcome measure was the comparison of the mean pain intensity score on VAS between acupuncture and sham-needling/no intervention groups. Safety data and adherence rate were also investigated. Six RCTs were identified with variable risk of bias. All included studies reported reduction in VAS pain intensity scores in the groups receiving acupuncture when compared to sham needling/no intervention. Meta-analysis, using a weighted mean difference as the effect estimate, included only 4 RCTs, revealed a 19.04 point difference in pain intensity between acupuncture and sham-needling/no intervention (95 %CI: -29.13 to -8.95). High levels of safety were demonstrated by the low rates of side effects/withdrawal. Inconsistency in reporting of outcomes was a major limitation. In conclusion, moderate-quality evidence suggests that acupuncture may be an effective and safe method in relieving persistent head and neck myofascial pain. Optimizing study designs and standardizing outcome measures are needed for future RCTs.

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Keywords: Head and neck pain, Myofascial pain, Acupuncture, Randomized clinical trials

Abstract
IMPORTANCE: Up to 51%of patients with psoriasis report the use of complementary and alternative medicine (CAM) in their treatment regimen, although it is unclear which CAM therapies are effective for treatment of psoriasis.

OBJECTIVE: This review compiles the evidence on the efficacy of the most studied CAM modalities for treatment of patients with plaque psoriasis and discusses those therapies with the most robust available evidence.

EVIDENCE REVIEW: PubMed, Embase, and ClinicalTrials.gov searches (1950-2017) were used to identify all documented CAM psoriasis interventions in the literature. The criteria were further refined to focus on those treatments identified in the first step that had the highest level of evidence for plaque psoriasis with more than 1 randomized clinical trial supporting their use. This excluded therapies lacking randomized clinical trial (RCT) data or showing consistent inefficacy.

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FINDINGS: One meta-analysis of 13 RCTs examined the association of acupuncture with improvement in psoriasis and showed significant improvement with acupuncture compared with placebo.

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CONCLUSIONS AND RELEVANCE: The CAM therapies with the most robust evidence of efficacy for treatment of psoriasis are indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture. This review will aid practitioners in advising patients seeking unconventional approaches for treatment of psoriasis.

Abstract

Objective: Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery.

Methods: The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis.

Results: The acupuncture and control groups included 50,171 and 128,556 neck pain patients, respectively. A total of 50,161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to
gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group.

Conclusions: A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.

Keywords: acupuncture, epidemiology, musculoskeletal disorders, spinal neck pain

Abstract
Objective. Our aim was to assess the efficacy and safety of acupuncture for Obstructive sleep apnea (OSA) patients with various severities of the disorder.

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Methods.  Eight  databases  including  PubMed,  Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible  for  inclusion.  Studies  were  selected  for  inclusion,  and data were extracted by two authors independently.  The Cochrane Collaboration’s Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. 

Results.  Nine RCTs with 584 participants  were  included.  The  trials covered  acupuncture and electropuncture.  Acupuncture caused clinically significant reductions in apnea-hypopnea index (AHI)  (MD: -6.18;  95% CI:  -9.58  to  -2.78;  Z = 3:56,  P = 0:0004)  as  well  as  in Epworth Sleepiness Score (ESS) (MD: -2.84;  95%  CI:  -4.80  to  -0.16,  Z = 2:09,  P= 0:04).  AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z = 6:18, P < 0:00001) and severe OSA patients (MD:  -10.09;  95%  CI:  -12.47  to  -7.71;  Z = 8:31,  P < 0:00001).  ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z = 3:83, P= 0:0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z = 12:72, P < 0:00001). Besides, acupuncture had a beneficial effect on lowest oxygen saturation (LSaO2) (MD: 5.29; 95% CI: 2.61 to 7.97; Z = 3:86, P = 0:0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low.

Conclusions. Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.

Abstract

Anxiety disorders are one of the most common mental health concerns with a major contribution to the global burden of disease. When not treated, anxiety can be aggravated to more serious and complicated health problems. Pharmacology and psychotherapy stand for the conventional treatment for anxiety disorders but these present limited efficacy, especially in the case of chronic anxiety, with high relapse rates and often causing adverse side effects. Clinical research studies render acupuncture as a valid treatment therapy for anxiety disorders without significant adverse effects.

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The objective of this paper is to review the literature on the effectiveness of acupuncture and electroacupuncture for the treatment of patients with anxiety disorders in order to find strong scientific evidence for its regular practice in Western culture.

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The systematic review of the clinical research was focused on published clinical trials (controlled, randomized and non-randomized) regarding the treatment of anxiety with acupuncture. Only clinical trials where anxiety was treated as the therapeutic target, and not as a secondary measurement or being associated with other health condition or disease, were considered. Two authors extracted the data independently and exclusion and inclusion criteria were set. The search rendered 1135 papers addressing anxiety as a primary therapeutic target. After review, 13 papers were identified to match exclusion and inclusion criteria and were selected for this analysis. Methodology, design, and quality of the research were highly variable and are discussed and compared.

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Overall, there is good scientific evidence encouraging acupuncture therapy to treat anxiety disorders as it yields effective outcomes, with fewer side effects than conventional treatment. More research in this area is however needed.

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Keywords: Acupuncture, Electroacupuncture, Anxiety disorders, Anxiety, Systematic review

Abstract

Objective: This review aimed to examine the effectiveness of acupuncture for the treatment of diabetic retinopathy (DR).
 

Methods: Fourteen databases (5 English, 4 Chinese, and 5 Korean) were searched from their inception until May 20, 2020. Randomized controlled trials (RCTs) using acupuncture for DR treatment were included. The study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool version 2 (RoB 2.0) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to assess all the included RCTs.

Results: Of 864 citations, 6 RCTs met the inclusion criteria of our review. Four studies reported the beneficial  effects of acupuncture with standard medication or acupuncture alone compared with standard medication or no treatment on the effective rate. Only three studies showed that acupuncture combined with standard medications significantly improved visual acuity compared to standard medication alone. None of the studies reported on adverse events. The risk of bias of the included studies was judged to be of “some concern” and was marked with a moderate and low certainty of evidence in different outcomes.

Conclusion: Our results suggest the potential benefit of acupuncture in treating DR. Acupuncture in the form of combined therapy with standard medication or acupuncture alone may be more effective in the treatment of DR than standard medication alone. Further rigorous clinical trials are needed to confirm these findings.

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Keywords: Acupuncture, Diabetic, Diabetic complications, Retinopathy, Review, Traditional medicine

Abstract:

Objective. The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC).

Methods. A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3.
 

Results. (e merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p < 0.00001; MD� 0.84 [95% CI, 0.65 to 1.03]; I2 � 0%) and improving constipation symptoms (p � 0.03; SMD� −0.4 [95% CI, −0.78 to −0.03]; I2 � 74%), stool formation (p < 0.00001; MD� 0.24 [95% CI, 0.15 to 0.34]; I2 � 0%), quality of life (p < 0.00001; N� 1, MD� −0.33 [95% CI, −0.45 to −0.21]), and responder rates (p � 0.02; RR � 2.16; [95% CI, 1.1 to 4.24]; I2 � 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p � 0.44; RR � 1.18; [95% CI, 0.77 to 1.81]; I2 � 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p � 0.004; MD� 0.53 [95% CI, 0.17 to 0.88]; I2 � 88%) and improving patients’ quality of life (p < 0.00001; SMD� −0.73 [95% CI, −1.02 to −0.44]; I2 � 64%), with high heterogeneity. However, there were no significant differences in responder rate (p � 0.12; RR � 1.31; [95% CI, 0.94 to 1.82]; I2 � 53%), BSFS (p � 0.5; MD� 0.17 [95% CI, −0.33 to 0.68]; I2 � 93%), or CSS (p � 0.05; SMD� −0.62 [95% CI, −1.23 to −0.01]; I2 � 89%). Regarding safety evaluation, acupuncture was safer than medications (p < 0.0001; RR � 0.3; [95% CI, 0.18 to 0.52]; I2 � 30%).

Conclusions. Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

Abstract

Context. Non-pharmacological approaches are effective strategies for difficult to palliate breathlessness. Whilst acupuncture is effective for dyspnoea in early-stage COPD, little is known about its effects in patients with advanced (non-)malignant diseases.

Objectives. To identify and examine the evidence of acupuncture on breathlessness in advanced malignant and non-malignant diseases.

Methods. Systematic literature review of randomised controlled trials of acupuncture and acupressure searched in five databases. Included were adult participants with at least 25% having advanced diseases such as cancer or COPD with severe breathlessness. Primary outcome was severity of dyspnoea on visual analogue or Borg scale. Secondary outcomes included quality of life, function and acceptability. Data were pooled using a random effects model of standardised mean differences.
 

Results. 12 studies with 597 patients (347 COPD, 190 advanced cancer) were included. For breathlessness severity significant differences were obtained in a meta-analysis (10 studies with 480 patients; SMD= -1.77 (95% CI -3.05,-0.49; p=0.007; I²= 90%)) and in a subgroup analysis of using sham acupuncture control groups and a treatment duration of at least three weeks (6 studies with 302 patients; SMD= -2.53 (95% CI -4.07,-0.99; p=0.001; I² =91%)). Exercise tolerance (6MWT) improved significantly in the acupuncture group (6 studies with 287 patients; SMD=0.93 (95% CI 0.27,1.59; p=0.006; I²= 85%)). In four of six studies quality of life improved in the acupuncture group.

Conclusion. Acupuncture improved breathlessness severity in patients with advanced diseases. The methodological heterogeneity, low power and potential morphine-sparing effects of acupuncture as add-on should be further addressed in future trials.

Key words: dyspnoea; acupuncture; advanced disease; systematic review; meta-analysi

Key Points:

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Question:  Is the use of acupuncture and acupressure associated with improved cancer pain management compared with sham intervention and/or analgesic therapy alone?
 

Findings:  In this systematic review of 17 randomized clinical trials and meta-analysis of 14 trials in the current English-language and Chinese-language literature, a significant association was found between real (compared with sham) acupuncture and reduced pain, and acupuncture combined with analgesic therapy was associated with decreased analgesic use. However, heterogeneity lowered the level of certainty of the evidence.

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Meaning:  This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

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Conclusions and Relevance:  This systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.

Abstract

Objectives

In cancer patients, chemotherapy-induced peripheral neuropathy (cipn) is a common complication, characterized by pain, loss of sensation, and numbness. Medical treatment for peripheral neuropathies has been shown to be ineffective for cipn. Acupuncture has been shown to be safe and effective in treating cancer-related symptoms and other peripheral neuropathies. For the present review, we aimed to evaluate the efficacy of acupuncture for the treatment of cipn.

Design

Comprehensive searches for relevant studies were conducted in Ovid embase, the Web of Science, Ovid medline, the Cochrane Central Register of Controlled Trials (central), cinahl (ebsco Information Services, Ipswich, MA, U.S.A.), and the ClinicalTrials.gov Web site. References from previous systematic reviews were also searched. Additional trials were found in the reference lists of relevant papers and in searches of Google Scholar and acupuncture-specific Web sites. Included studies were randomized controlled trials (rcts) of any type of acupuncture used to treat patients with cipn.

Results

Three clinical trials (203 participants) were included. Two studies found acupuncture to be effective in alleviating cipn pain and improving quality of life. One study found no benefit in improving neuropathic pain, symptoms, or quality of life. Study quality was variable and included a moderate overall risk of bias.

Conclusions

The evidence is insufficient to recommend acupuncture for the treatment or prevention of cipn. Further research is needed to evaluate the effects of acupuncture in the treatment of cipn. Given that acupuncture is considered safe and might provide relief for patients, it can be considered at the clinician’s discretion.

Keywords: Acupuncture, systematic reviews, chemotherapy-induced peripheral neuropathy, cipn, integrative oncology

Abstract

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Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with recurrent abdominal pain and altered defecation habits. We here attempted to determine the effect of acupuncture on IBS.

Methods.: Randomized controlled trials (RCTs) published in CNKI, VIP, Wanfang, PubMed, Cochrane Library, EMBASE, Web of science, and ClinicalTrials.gov till July 17, 2019 were
searched. Outcomes were total efficacy rates, overall IBS symptom scores, or global quality of life scores. Stan- dardized mean difference (SMD) with 95% confidence intervals (CI) and risk ratio (RR) with 95% CI were calculated for meta- analysis. 

Results:  We included 41 RCTs involving 3440 participants for analysis.  8 RCTs compared acupuncture with sham acupuncture, among which 3 trials confirmed the biological effects of acupuncture, especially in treating  abdominal  pain, discomfort, and stool frequency. No significant difference was found when acupuncture was compared with sham acupuncture, in terms of effects on IBS symptoms and quality of life (SMD 0.18, 95% CI 0.26∼0.63, P 0.42; SMD 0.10, 95% CI 0.31∼0.11, P 0.35), but the pooled efficacy rate data showed a better outcome for true acupuncture (RR 1.22, 95% CI 1.01∼1.47, P    0.04), which was not supported by sensitivity analysis. Acupuncture was more effective relative to western medicine in alleviating IBS symptoms (RR 1.17, 95% CI 1.12∼1.23, I2 0%, P 0.00001), whose effect might last 3 months. Besides, acupuncture as an adjunct to western medicine, Chinese medications, or tuina was superior over the single latter treatment (RR 1.68, 95% CI 1.18 to 2.40, P 0.004; 1.19, 1.03 to 1.36, P 0.02; 1.36, 1.08 to 1.72, P 0.009, respectively), with high heterogeneities.

Conclusions: Relative to sham controls, acupuncture showed no superiority for treating IBS, while the advantage over western medicine was be used as an adjunct in clinical settings to improve efficacy. Future high-quality and large-sample-size studies with adequate quantity-effect design need to be conducted.
 

Objective

To summarize the current evidence that evaluates the effectiveness of acupuncture for the treatment or prevention of migraine, tension-type headache, and chronic headache disorders.

Methods

Findings from selected systematic reviews and meta-analyses are summarized.

Results

Recently published systematic reviews and metaanalyses demonstrate that acupuncture is associated with improved clinical outcomes compared to routine care only, medical management, and sham acupuncture 2 months after randomization. The evidence in support of acupuncture’s comparative effectiveness at longer follow-up periods is mixed.  Cost effectiveness analyses conducted in the United Kingdom and Germany suggest that acupuncture is a cost-effective treatment option in those countries. There are few or no cost effectiveness studies of acupuncture in the United States.

Discussion

This brief review of the current, published evidence does not include a discussion of potential risks or adverse events associated with acupuncture. There is also the question of the extent to which placebo effects might contribute to acupuncture’s clinical effectiveness. From a purely comparative effectiveness perspective, however, the evidence from clinical trials and meta-analyses makes a compelling case in support of a potentially important role for acupuncture as part of a treatment plan for patients with migraine, tension-type headache, and several different types of chronic headache disorders.

Highlights:

• Endocannabinoid system (ECS) activation and acupuncture induce similar effects.

• ECS mediates multiple acupuncture’s effects, such as analgesia and neuroprotection.

• ECS is a novel and key participant in acupuncture’s multiple beneficial effects.

• Acupuncture may produce different beneficial effects via similar key pathways.

• •Findings may enable new techniques which increase the efficacy of acupuncture.

Abstract

Acupuncture and its modified forms have been used to treat multiple medical conditions, but whether the diverse effects of acupuncture are intrinsically linked at the cellular and molecular level and how they might be connected have yet to be determined. Recently, an emerging role for the endocannabinoid system (ECS) in the regulation of a variety of physiological/pathological conditions has been identified. Overlap between the biological and therapeutic effects induced by ECS activation and acupuncture has facilitated investigations into the participation of ECS in the acupuncture-induced beneficial effects, which have shed light on the idea that the ECS may be a primary mediator and regulatory factor of acupuncture’s beneficial effects. This review seeks to provide a comprehensive summary of the existing literature concerning the role of endocannabinoid signaling in the various effects of acupuncture, and suggests a novel notion that acupuncture may restore homeostasis under different pathological conditions by regulating similar networks of signaling pathways, resulting in the activation of different reaction cascades in specific tissues in response to pathological insults.

Keywords: Acupuncture, Endocannabinoid system, Analgesia, Neuroprotection

Abstract

Objective

To evaluate the effectiveness of acupuncture as monotherapy and as an alternative therapy in treating depression related
insomnia.

Data Source

Seven databases were searched starting from 1946 to March 30, 2016.

Study Eligibility Criteria

Randomized-controlled trials of adult subjects (18–75 y) who had depression-related insomnia and had received acupuncture.

Results

18 randomized-controlled clinical trials (RCTs) were introduced in this meta-analysis. The findings determined that the acupuncture treatment made significant improvements in PSQI score (MD = −2.37, 95% CI −3.52 to −1.21) compared with Western medicine.  Acupuncture combined with Western medicine had a better effect on improving sleep quality (MD = −2.63, 95% CI −4.40 to −0.86) compared with the treatment of Western medicine alone.  There was no statistical difference (MD = −2.76, 95% CI −7.65 to 2.12) between acupuncture treatment and Western medicine towards improving the HAMD score.  Acupuncture combined with Western medicine (MD = −5.46, CI −8.55 to −2.38) had more effect on improving depression degree compared with the Western medicine alone.

Conclusion

This systematic review indicates that acupuncture could be an alternative therapy to medication for treating depression-related insomnia.

Highlights
-  Acupuncture has a clinically relevant effect on chronic pain that persists over time
-  The effect of acupuncture cannot be explained only by placebo effects
-  Factors in addition to the specific effects of needling are important contributors
-  Referral for acupuncture treatment is a reasonable option for chronic pain patients

Abstract
Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions.We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data 
received for a total of 20,827 patients from 39 trials.Acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. We also found clear evidence  that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in  treatment effect at one year. In secondary analyses, we found no obvious association between trial  outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were 
associated with the type of control group, with smaller effects sizes for sham controlled trials 
that used a penetrating needle for sham, and for trials that had high intensity of intervention in  the control arm.We conclude that acupuncture  is effective for the treatment of chronic pain, with treatment effects persisting over time. While factors in addition to  the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain following acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominately by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.

Abstract

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Objectives: Vasomotor symptoms (VMSs) are the most common symptoms reported during menopause. Although hormone therapy is effective for reducing VMSs, its use is restricted in some women.  Many women with VMSs thus seek nonhormonal, nonpharmacologic treatment options such as acupuncture.

Design: An umbrella systematic review (SR) was conducted, supplemented by a search of published randomized controlled trials (RCTs), that assessed the effectiveness of acupuncture for VMSs, health-related quality of life (HRQOL), and adverse effects of treatment in perimenopausal or postmenopausal women. Metaanalyses were conducted using a random-effects model when data were sufficient.

Results: Three SRs and four new RCTs were identified that met eligibility criteria. Meta-analyses of this study revealed statistically significant standardized mean differences (SMDs) associated with acupuncture compared with no acupuncture at reducing VMS frequency (SMD -0.66, 95% confidence interval [CI] -1.06 to -0.26, I2 = 61.7%, 5 trials) and VMS severity (SMD -0.49, 95% CI -0.85 to -0.13, I2 = 18.1%, 4 trials) and improving HRQOL outcomes (SMD -0.93, 95% CI -1.20 to -0.67, I2 = 0.0%, 3 trials). SMDs were smaller or not statistically significant when acupuncture was compared with sham acupuncture.

Conclusions: Evidence from RCTs supports the use of acupuncture as an adjunctive or stand alone treatment for reducing VMSs and improving HRQOL outcomes, with the caveat that observed clinical benefit associated with acupuncture may be due, in part, or in whole to nonspecific effects. The safety of acupuncture in the treatment of VMSs has not been rigorously examined, but there is no clear signal for a significant potential for harm.

Keywords: vasomotor symptoms, hot flashes, health-related quality of life, acupuncture, nonpharmacologic treatment

Abstract

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Note: 'Dry Needling' is an alternate term for 'acupuncture' i.e. the use of filiform needles inserted into the tissues of the body to achieve a therapeutic effect
 

OBJECTIVES: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA).

MATERIALS AND METHODS: In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months.

RESULTS: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months.

DISCUSSION: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA.

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LEVEL OF EVIDENCE: Level 1b-therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).

Abstract

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Background: Because acupuncture may modulate the immune system, it has been proposed as a useful treatment for patients with allergic rhinitis (AR). Here, we assessed the evidence for the clinical efficacy of acupuncture for the management of AR patients by performing a systematic review and meta-analysis of the published literatures.

Methods: By searching PubMed, EMBASE, the Cochrane clinical trials database, and the China National Knowledge Infrastructure from 1980 through July 11, 2013, we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety.

Results: Thirteen full papers that met our inclusion criteria were included, and a total of 2365 participants, including 1126 as treatment group and 1239 as control group, were enrolled. Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores (weighted mean difference [WMD]: 4.42, 95% confidence interval [CI]: 8.42 to 0.43, p 0.03), medication scores (WMD: 1.39, 95% CI: 2.18 to 0.61, p .0005), and serum IgE (WMD: 75.00, 95% CI: 91.17 to 58.83, p  0.00001). Data relating to Rhinitis Quality of Life Questionnaire (RQLQ) and 36-Item Short-Form (SF-36) component score in included studies were analyzed, which ultimately point to the efficacy of acupuncture treatment in improving quality of life in AR patients. No fatal events were reported in any of the included studies, and no serious systemic reaction, which needed treatment in the hospital, was related to the acupuncture treatment.

Conclusion: Our meta-analysis suggests that that acupuncture could be a safe and valid treatment option for AR patients.

Abstract

Background and Objectives: Opioid use disorder (OUD) is a chronic disease with significant personal, societal, and public health consequences. Even for the minority who receive the most effective evidence-based treatments, morbidity, and mortality remain significant. These facts, along with the recovery movement calling for individualized, holistic, culturally sensitive care, have led to the exploration of adjunctive interventions including acupuncture. Despite hundreds of international trials, however, there is a lack of consensus regarding its efficacy in OUD due in large part to methodological issues of trials to date. In response to these issues, the National Acupuncture Detoxification Association (NADA) developed an operationalized manual auricular acupuncture protocol that has since become the most widely used in the US. This systematic review is the first to focus explicitly on randomized trials utilizing the NADA protocol as a complementary intervention to address OUD.

Methods: The methods utilized to identify studies for inclusion are based on a 2009 protocol developed by the Cochrane Collaboration.

Results: Four trials met inclusion criteria. Despite methodological issues, results indicate that while the NADA protocol may not be effective in reducing acute opiate craving or withdrawal, it may be effectively utilized as an adjunctive treatment to increase treatment retention and decrease methadone detoxification and maintenance dosages in OUD.

Conclusion and Scientific Significance: Incorporation of the NADA protocol into existing evidence-based treatment approaches may facilitate recovery and, through its impact on treatment retention and completion, indirectly impact morbidity, and mortality in individuals with OUD. Given the limitations of the current review, conclusions are tentative and directions for future research are discussed.

Abstract

Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network,including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbicneo-cortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker pat-terns of brain responses were detected in areas similar to those stated above. The activation and deacti-vation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain. 

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Perspective: This article facilitates a better understanding of acupuncture needle stimulation and its effects on specific activity changes in different brain regions as well as its relationship to the mul-tiple dimensions of pain. Future studies can build on this meta-analysis and will help to elucidate the clinically relevant therapeutic effects of acupuncture.

Key words: Acupuncture, analgesia, functional magnetic resonance imaging (fMRI), meta-analysis, pain

Abstract

Background:

Acupuncture is often used for migraine prevention but its effectiveness is still controversial. We present an update of our Cochrane review from 2009.

Objectives:

To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than sham (placebo) acupuncture; and c) as effective as prophylactic treatment with drugs in reducing headache frequency in adults with episodic migraine.

Search methods:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL: 2016, issue 1); MEDLINE (via Ovid, 2008 to January 2016); Ovid EMBASE (2008 to January 2016); and Ovid AMED (1985 to January 2016). We checked PubMed for recent publications to April 2016. We searched the World Health Organization (WHO) Clinical Trials Registry Platform to February 2016 for ongoing and unpublished trials.

Selection criteria:

We included randomized trials at least eight weeks in duration that compared an acupuncture intervention with a no-acupuncture control (no prophylactic treatment or routine care only), a sham-acupuncture intervention, or prophylactic drug in participants with episodic migraine.

Data collection and analysis:

Two reviewers checked eligibility; extracted information on participants, interventions, methods and results, and assessed risk of bias and quality of the acupuncture intervention. The primary outcome was migraine frequency (preferably migraine days, attacks or headache days if migraine days not measured/reported) after treatment and at follow-up. The secondary outcome was response (at least 50% frequency reduction). Safety outcomes were number of participants dropping out due to adverse effects and number of participants reporting at least one adverse effect. We calculated pooled effect size estimates using a fixed-effect model. We assessed the evidence using GRADE and created ’Summary of findings’ tables.

Main results:

Twenty-two trials including 4985 participants in total (median 71, range 30 to 1715) met our updated selection criteria. We excluded five previously included trials from this update because they included people who had had migraine for less than 12 months, and included five new trials. Five trials had a no-acupuncture control group (either treatment of attacks only or non-regulated routine care), 15 a sham-acupuncture control group, and five a comparator group receiving prophylactic drug treatment. In comparisons with no-acupuncture control groups and groups receiving prophylactic drug treatment, there was risk of performance and detection bias as blinding was not possible. Overall the quality of the evidence was moderate.

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Authors’ conclusions:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

Abstract

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Objective: Despite the recent re-emergence of the process of cupping by athletes, supporting evidence for its efficacy and safety remains scarce. This systematic review aims to summarize the evidence of clinical trials on cupping for athletes.

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Methods: SCOPUS, Cochrane Library, PubMed, AMED, and CNKI databases were searched from their inception to December 10, 2016. Randomized controlled trials on cupping therapy with no restriction regarding the technique, or cointerventions, were included, if they measured the effects of cupping compared with any other intervention on health and performance outcomes in professionals, semi-professionals, and leisure athletes. Data extraction and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted independently by two pairs of reviewers.

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Results: Eleven trials with n = 498 participants from China, the United States, Greece, Iran, and the United Arab Emirates were included, reporting effects on different populations, including soccer, football, and handball players, swimmers, gymnasts, and track and field athletes of both amateur and professional nature. Cupping was applied between 1 and 20 times, in daily or weekly intervals, alone or in combination with, for example, acupuncture. Outcomes varied greatly from symptom intensity, recovery measures, functional measures, serum markers, and experimental outcomes. Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups. The majority of trials had an unclear or high risk of bias. None of the studies reported safety.

Conclusions: No explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.

Abstract

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Background: Instrument-assisted soft tissue mobilization (IASTM) is an emerging intervention in physical therapy. With the increasing prevalence of pain and disability associated with musculoskeletal impairments, it is essential to identify the most effective treatment strategies.

Objective: To systematically examine evidence on the effectiveness of IASTM, compared to other interventions on patients with pain and disability resulting from musculoskeletal impairments.

Methods: Numerous databases were searched using the terms Instrument Assisted Soft Tissue, Pain, Function, Graston, and soft tissue mobilization (STM). Inclusion criteria included: randomized clinical trials on patients with musculoskeletal impairments, STM had to be a treatment intervention, performed on human subjects, and had to capture a measure of pain or function. Articles were excluded if they were not published in English or if the subjects were of the pediatric or geriatric populations. Included articles were appraised using the Physiotherapy Evidence Database (PEDro) scale.

Results: Seven studies met the inclusion criteria. All seven articles scored a minimum 4/10 on the PEDro scale. The studies involved treatment of numerous anatomical locations and the majority of the studies demonstrated significant improvements in pain and/or range of motion when compared to control or other conservative treatment groups.

Conclusions: These outcomes support the idea that IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and improvement of flexibility of underlying tissue. It is suggested that IASTM is an effective treatment intervention for reducing pain and improving function in less than a three-month period.

Keywords: Instrument assisted, Soft tissue, Mobilization, Pain, Function, Musculoskeletal

Abstract

Acupuncture is potentially beneficial for post-stroke rehabilitation and is considered a promising preventive strategy for stroke. Electroacupuncture pretreatment or treatment after ischemic stroke by using appropriate electroacupuncture parameters generates neuroprotective and neuroregenerative effects that increase cerebral blood flow, regulate oxidative stress, attenuate glutamate excitotoxicity, maintain bloodbrain barrier integrity, inhibit apoptosis, increase growth factor production, and induce cerebral ischemic tolerance.

Key Words: acupuncture; neuroprotection; neuroregeneration

Abstract

Acupuncture is a therapeutic technique and part of traditional Chinese medicine (TCM). Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature,muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. This review focused on the central mechanism of acupuncture in modulating various autonomic responses, which might provide neurobiological foundations for acupuncture effects.

Abstract

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This review reports on recent findings concerning the effects of acupuncture and electroacupuncture (EA) on stem cell mobilization and differentiation, in particular with regard to neurogenesis. Traditional Chinese acupuncture has a history of over 2,500 years and is becoming more popular worldwide. Evidence has demonstrated that acupuncture may be of benefit in stroke rehabilitation, parkinsonism, dementia, and depression. This article reviews recent studies concerning the effects of acupuncture/EA on stem cell mobilization and on progenitor cell proliferation in the CNS. The reviewed evidence indicates that acupuncture/EA has beneficial effects in several neurodegenerative diseases, and it may prove to be a nondrug method for mobilizing stem cells in the CNS.

Key words: Neurodegenerative diseases; Neurogenesis; Acupuncture; Electroacupuncture (EA)

Abstract

Carpal tunnel syndrome is the most common entrapment neuropathy, affecting the median nerve at the wrist.  Acupuncture is a minimally-invasive and conservative therapeutic option, and while rooted in a complex practice ritual, acupuncture overlaps significantly with many conventional peripherally-focused neuromodulatory therapies. However, the neurophysiological mechanisms by which acupuncture impacts accepted subjective/psychological and objective/physiological outcomes are not well understood. 

Eligible patients (n = 80, 65 female, age: 49.3  8.6 years) were enrolled and randomized into three intervention arms: (i) verum electro-acupuncture ‘local’ to the more affected hand; (ii) verum electro-acupuncture at ‘distal’ body sites, near the ankle contralesional to the more affected hand; and (iii) local sham electro acupuncture using non-penetrating placebo needles.  Acupuncture therapy was provided for 16 sessions over 8 weeks. Boston Carpal Tunnel Syndrome Questionnaire assessed pain and paraesthesia symptoms at baseline, following therapy and at 3-month follow-up.  Nerve conduction studies assessing median nerve sensory latency and brain imaging data were acquired at baseline and following therapy.  Functional magnetic resonance imaging assessed somatotopy in the primary somatosensory cortex using vibrotactile stimulation over three digits (2, 3 and 5).  While all three acupuncture interventions reduced symptom severity, verum (local and distal) acupuncture was superior to sham in producing improvements in neurophysiological outcomes, both local to the wrist (i.e. median sensory nerve conduction latency) and in the brain (i.e. digit 2/3 cortical separation distance).  Moreover, greater improvement in second/third interdigit cortical separation distance following verum acupuncture predicted sustained improvements in symptom severity at 3-month follow-up.  We further explored potential differential mechanisms of local versus distal acupuncture using diffusion tensor imaging of white matter microstructure adjacent to the primary somatosensory cortex. 

Compared to healthy adults (n = 34, 28 female, 49.7  9.9 years old), patients with carpal tunnel syndrome demonstrated increased fractional anisotropy in several regions and, for these regions we found that improvement in median nerve latency was associated with reduction of fractional anisotropy near (i) contralesional hand area following verum, but not sham, acupuncture; (ii) ipsilesional hand area following local, but not distal or sham, acupuncture; and (iii) ipsilesional leg area following distal, but not local or sham, acupuncture.  As these primary somatosensory cortex subregions are distinctly targeted by local versus distal acupuncture electrostimulation, acupuncture at local versus distal sites may improve median nerve function at the wrist by somatotopically distinct neuroplasticity in the primary somatosensory cortex following therapy.  Our study further suggests that improvements in primary somatosensory cortex somatotopy can predict long-term clinical outcomes for carpal tunnel syndrome.

Abstract

Introduction: Hypertension is an important risk factor of cardiovascular disease (CVD), which is associated with premature death, myocardial infarction, stroke, peripheral vascular disease, and renal disease. The goal of the present study was to use a randomized controlled clinical trial to explore and compare the effectiveness of abdominal and auricular acupuncture on blood pressure in 440 subjects with and without obesity.

Methods: Four hundred participants were recruited and randomized to one of four groups: cases and controls receiving auricular acupuncture (204 subjects) and cases and controls receiving abdominal electro-acupuncture (196 subjects). Blood pressure and anthropometric parameters were measured before and after the intervention period. In order to match the initial diet of the groups, participants were required to follow an isocaloric diet for two weeks before the trial, and a low-calorie diet for 6 weeks during the intervention period.

Results: We observed a significant time dependent improvement in the systolic blood pressure measurements in the abdominal intervention group, although this improvement was more pronounce in the first period of study. Of note, in the auricular intervention group, a significant increasing in the level of SBP was detected. Importantly no statistically significant changes were found in the corresponding sham groups.

Conclusions: Our findings demonstrated that abdominal electro-acupuncture for 6 weeks reduced both systolic and diastolic blood pressure and auricular acupuncture had a short-term adverse effect on both SBP and DBP.

Keywords:  Acupuncture, Hypertension, Cardiovascular Disease

Abstract

Acupuncture (ACU) is becoming a more common practice among hypertensive individuals. However, the reported therapeutic effects of ACU in lowering brachial blood pressure (BP) are ambiguous. Therefore, evaluating more sensitive markers of arterial functioning might unveil the protective effects of ACU on hypertension. We examined the effects of an 8-week ACU therapy intervention on vascular hemodynamics and stiffness in middle-age hypertensive individuals. Participants were randomly assigned to either ACU (n = 23) or a control group (n = 22). Brachial and aortic BP, wave reflection (AIx) and arterial stiffness (SI) were measured before and after 8 weeks. There was a significant group x time interaction (P < 0.05) for brachial and aortic BP, AIx and SI which significantly decreased (P < 0.05) following ACU but not after control. ACU led to reductions in brachial and aortic BP, wave reflection and arterial stiffness in middle-age hypertensive individuals. ACU might be effective in the prevention and treatment of hypertension.

Keywords:  Acupuncture, Vascular hemodynamic, Arterial stiffness, Wave reflection

Abstract:

Background: Seasonal allergic rhinitis (SAR) is a common disease that has detrimental effects on the quality of life (QoL) of affected individuals. Approximately 18% of patients try to alleviate their symptoms through acupuncture. The ACUSAR (ACUpuncture in Seasonal Allergic Rhinitis) study (ClinicalTrials.gov registration no. NCT00610584) assessed the impact of acupuncture on SAR, showing significant improvements in rhinitis-specific QoL (RQoL) and in rescue medication (RM) use.

Objective: A secondary analysis of SAR patients’ use of antihistamine.

Methods: Patients were randomised into three study groups: acupuncture plus RM, sham acupuncture plus RM, and RM alone. The patients documented their medication use before and during the intervention period (8weeks). The main outcome was the number of days with antihistamine use. Statistical analyses were conducted using parametric and non-parametric tests. The robustness of the results was tested by sensitivity analyses using non-parametric bootstrapping.

Results: The data from 414 patients were analysed. The acupuncture group used antihistamines significantly less often compared with the other groups (acupuncture vs sham acupuncture: mean difference −4.49 days, p=0.01; acupuncture vs RM: mean difference −9.15 days, p<0.001). Approximately 38% of the acupuncture group did not use any antihistamine in contrast to only 16% in the RM group. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms, unlike the other groups.

Conclusions: Acupuncture appeared to significantly reduce the number of days of antihistamine use while improving RQoL and SAR symptoms; it can therefore be considered a valuable, additional treatment option for patients with SAR.

Diseases and disorders that can be treated with acupuncture: 

The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials reported in the recent literature can be classified into four categories as shown below.

1. Diseases, symptoms or conditions for which acupuncture has been proved— through controlled trials—to be an effective treatment.

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2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed.

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3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult.

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4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment.

ABSTRACT:

Objectives: Acupuncture is characterized as an alternative or complementary medicine with a low complication rate and minimal side effects. There is a lack of robust evidence that shows acupuncture is an effective treatment for chronic pain. The purpose of this study was to determine which (if any) characteristics can predict successful response to acupuncture in chronic pain patients treated at military treatment facilities.

Methods: Data from 222 patients who received treatment for a chronic pain condition were collected from 2 medical centers. The patients underwent at least 4 acupuncture treatments and had an average pain score of 4 or higher on a 0- to 10-point numerical rating scale or visual analog scale in the week before treatment initiation. A successful outcome was defined to be a 2-point or greater reduction on the numerical rating scale or visual analog scale 12 weeks postinitial treatment.

Results: The overall treatment success rate was 42.3%. Multivariate logistic regression found a higher baseline pain rating and the use of stimulation needles to be associated with a positive outcome (odds ratio [OR]= 1.26; 95% confidence interval [CI], 1.03-1.55; P= 0.02 and OR= 2.73; 95% CI, 1.39-5.32; P= 0.03, respectively). Only the presence of one or more psychological comorbidities was found to be associated with treatment failure (OR= 0.67; 95% CI, 0.49-0.92; P= 0.01).

Discussion: The use of electrical stimulation and higher baseline pain score were associated with a positive treatment outcome, while the presence of a psychological comorbidity diminished the likelihood of treatment success. Practitioners should consider using electrical stimulation more frequently, and addressing psychopathology before or concurrent to treatment, when initiating acupuncture.

Key Words: acupuncture, complementary and alternative medicine, military medicine

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Excerpt from Discussion:
"The use of acupuncture in the military is gaining in popularity and acceptance. This is partly the result of increasing opioid use and the subsequent abuse and addiction potential that has gained National attention.20,21 Military Medicine has been working to change its culture since 2010, when the Pain Management Task Force issued recommendations to explore alternative treatments such as acupuncture, meditation, and biofeedback.6 In particular, the military has embraced a particular form of acupuncture entitled “Battlefield Acupuncture” whereby 5 specific acupoints are placed in the ear.22,23 Our population is also unique in that it represents a young, very active, generally healthy group who often face physical and psychosocial stressors that may be different, and perhaps more pronounced, than a civilian cohort. In addition, medications typically used to treat chronic pain such as adjuvants and particularly opioids, are often discouraged in this population due to their potential for cognitive effects and, for opioids, physical dependence, and addiction. Therefore, there has been a strong emphasis on the use of complementary and alternative treatments in the military health care system."

ABSTRACT:

Although it is widely used, the mechanisms and effects of acupuncture on pain are not completely understood. Recently, increased nitric oxide (NO) synthase activity has been found in meridians and acupoints. Because NO is a key regulator of local circulation, and because change in circulation can affect the development and persistence of pain, we propose that acupuncture might regulate NO levels. We studied the effects of acupuncture on local NO levels and circulation in a randomized, double-blind, crossover study with 20 volunteers, each of whom underwent one session each of real and noninvasive sham acupuncture in a single hand and forearm with a 1-wk interval between treatments. NO concentration in the plasma from the acupunctured arm was significantly increased by 2.8 ± 1.5 μmol/L at 5 min and 2.5 ± 1.4 μmol/L at 60 min after acupuncture. Blood flow in palmar subcutaneous tissue of the acupunctured arm also increased, and this correlated with the NO increase. These changes were not observed in noninvasive sham-acupunctured hands and forearms. In conclusion, acupuncture increases the NO level in treated regions and thereby increases local circulation. These regulatory effects might contribute to pain relief provided by acupuncture.

Highlights

• Acupuncture has a clinically relevant effect on chronic pain that persists over time

• The effect of acupuncture cannot be explained only by placebo effects

• Factors in addition to the specific effects of needling are important contributors

• Referral for acupuncture treatment is a reasonable option for chronic pain patients

Abstract

Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions.We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm.We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. While factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain following acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominately by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.

Perspective

Acupuncture is effective for the treatment of chronic musculosketal, headache and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.

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Keywords: Acupuncture, chronic pain, meta-analysis, osteoarthritis, back pain, neck pain, migraine, tension-type headaches, shoulder pain

ABSTRACT:

Electroacupuncture (EA) performed in rats and humans using limb acupuncture sites, LI-4 and LI-11, and GV-14 and GV-20 (humans) and Bai-hui (rats) increased functional connectivity between the anterior hypothalamus and the amygdala and mobilized mesenchymal stem cells (MSCs) into the systemic circulation. In human subjects, the source of the MSC was found to be primarily adipose tissue, whereas in rodents the tissue sources were considered more heterogeneous. Pharmacological disinhibition of rat hypothalamus enhanced sympathetic nervous system (SNS) activation and similarly resulted in a release of MSC into the circulation. EA-mediated SNS activation was further supported by browning of white adipose tissue in rats. EA treatment of rats undergoing partial rupture of the Achilles tendon resulted in reduced mechanical hyperalgesia, increased serum interleukin-10 levels and tendon remodeling, effects blocked in propranolol-treated rodents. To distinguish the afferent role of the peripheral nervous system, phosphoinositide-interacting regulator of transient receptor potential channels (Pirt)-GCaMP3 (genetically encoded calcium sensor) mice were treated with EA acupuncture points, ST-36 and LIV-3, and GV-14 and Bai-hui and resulted in a rapid activation of primary sensory neurons. EA activated sensory ganglia and SNS centers to mediate the release of MSC that can enhance tissue repair, increase anti-inflammatory cytokine production and provide pronounced analgesic relief.

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Significance Statement:
In this study we show how the use of electroacupuncure at specific points stimulates mesenchymal stem cell (MSC) release into pe‐ ripheral blood through the activa‐ tion of the nervous system.  Electroacupuncture could be used to aid tissue repair through increasing the levels of circulating MSC. Moreover, MSC can be harvested directly from the blood of electroacupuncture‐treated humans and animals and expanded ex‐vivo. Thus, electroacupuncture may be a low‐ cost, low‐risk method for MSC harvest for autologous stem cell therapy.

ABSTRACT:

Introduction:
Acupuncture is used to modulate the physical well-being of athletes in Asian countries. However, there is little information on the immediate effects of acupuncture treatment on physiological or psychological responses to exercise.

Purpose: The purpose of this study was to examine the effect of acupuncture treatment on the physical well-being of elite female soccer players during a competition period.

Methods: Subjects were divided into two groups: those who received acupuncture treatment (18.1
2.3 yr [
SD], N  9) and a control group (17.7
2.8 yr, N  12). In the treatment group, acupuncture stimulus was applied at LI 4 (Goukoku), ST 36 (Ashi-sanri) for 20 min, and ST 6 (Kyosya), LU 6 (Ko-sai) points for 15 min 4 h after the game every night during the competition period. The measured parameters included salivary secretory immunoglobulin A (SIgA) level, cortisol level in saliva, subjective rating of physical well-being, and profile of mood states (POMS).

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Results: The following were the main results: 1) Exercise-induced decrease of salivary SIgA and increase of salivary cortisol were inhibited by acupuncture. 2) Acupuncture improved subjective rating of muscle tension and fatigue. 3) The POMS score was modulated by acupuncture.

Conclusion: These results support the effectiveness of acupuncture for physical and mental well-being of athletes.

Key Words: SALIVA, IgA, CORTISOL, POMS

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Highlighted from article: 
"Experiments show that acupuncture treatment produces various effects including alleviation of muscle tension, improvement of local blood flow, increase of pain threshold, and modulation of autonomic nervous system. In fact, acupuncture has been used for treatment of injury, reduction of fatigue, and management of physical condition in athletic fields."

ABSTRACT:

Muscle pain is a common medical problem that is difficult to treat. One nonpharmacological treatment used is acupuncture, a procedure in which fine needles are inserted into body points with the intent of relieving pain and other symptoms. Here we investigated the effects of manual acupuncture (MA) on modulating macrophage phenotype and interleukin-10 (IL-10) concentrations in animals with muscle inflammation. Carrageenan, injected in the gastrocnemius muscle of mice, induces an inflammatory response characterized by mechanical hyperalgesia and edema. The inflammation is initially a neutrophilic infiltration that converts to a macrophage-dominated inflammation by 48 h. MA of the Sanyinjiao or Spleen 6 (SP6) acupoint reduces nociceptive behaviors, heat, and mechanical hyperalgesia and enhanced escape/avoidance and the accompanying edema. SP6 MA increased muscle IL-10 levels and was ineffective in reducing pain behaviors and edema in IL-10 knockout (IL-10−/−) mice. Repeated daily treatments with SP6 MA induced a phenotypic switch of muscle macrophages with reduced M1 macrophages (pro-inflammatory cells) and an increase of M2 macrophages (anti-inflammatory cells and important IL-10 source). These findings provide new evidence that MA produces a phenotypic switch in macrophages and increases IL-10 concentrations in muscle to reduce pain and inflammation.

Keywords: Acupuncture, SP6, Nociception, Inflammation, Pain, Hyperalgesia, Edema, Muscle, IL-10 cytokine, Macrophage 

Highlights

In this study, we evaluated the regulatory role of acupuncture in airway inflammation and the hypothalamic-pituitary-adrenal (HPA) axis activity in OVA-induced murine asthma model. Our results demonstrated that acupuncture was effective in suppression of AHR, inhibition of total leukocyte, neutrophil, lymphocyte and eosinophil counts in BALF. Acupuncture also attenuated airway inflammation and TNF-α, IL-1β, IL-5 and eotaxin secretion in serum. The HPA axis activity was regulated by acupucnture, which included promotion of adrenocorticotropic hormone and cortisol secretion in the plasma. Our findings may provide support to better understand the contribution of acupuncture to the regulation of airway inflammation and HPA axis activity in asthma.

ABSTRACT

Asthma is a complex inflammatory disease of the airways and acupuncture is one of the effective therapies widely used to treat asthma in China. The aim of the study was to evaluate the regulatory role of acupuncture in airway inflammation and the hypothalamic-pituitary-adrenal (HPA) axis activity in OVA-induced murine asthma model. Our results demonstrated that acupuncture was effective in suppression of AHR, inhibition of total leukocyte, neutrophil, lymphocyte and eosinophil counts in BALF, attenuation of airway inflammation and TNF-α, IL-1β, IL-5 and eotaxin secretion. Furthermore, the HPA axis activity was also regulated by acupuncture, which included promotion of adrenocorticotropic hormone and cortisol secretion in the plasma. Our findings revealed that acupuncture could attenuate airway inflammation and regulate HPA axis and immunologic function in the OVA-induced murine asthma model, which may provide support to better understand the contribution of acupuncture to the regulation of airway inflammation and HPA axis activity in asthma.

Keywords: Acupuncture, Asthma, Inflammation, Immunologic function, HPA axis

ABSTRACT:

This study was to examine the influences of manual acupuncture (MA) and electrical heat corresponding to reinforcing methods on nitric oxide (NO) release over the skin regions in humans. A device with collecting solution was taped to the skin surface along pericardium (PC) or lung (LU) meridian. Acupuncture needles were gently inserted into PC 4 with reinforcing stimulation (low force/rate) for 20 minutes in the MA group. LU11 on the finger was heated (43-44°C) by electrical heat for 20 minutes. Biocapture was consecutively conducted for two 20-minute intervals during and after each treatment. Total nitrite and nitrate (NO) in the collecting samples were quantified using chemiluminescence in blinded fashion. Baseline Nitric oxide levels are higher and tended to be higher over PC and LU acupoints during the 1st biocapture.  Nitric oxide levels over PC regions were consistently increased by MA during both intervals.  Nitric oxide concentrations over LU acupoints were increased and tended to be increased by electrical heat in the 1st and 2nd biocapture. The results suggest that reinforcing MA and electrical heat induce NO released from the local skin regions with higher levels at acupoints, which improve local circulation and contribute to the beneficial effects of the therapies.

ABSTRACT:

Recent clinical trial studies have demonstrated that the effects of acupuncture on pain improvement are small and no difference between acupoints and non-points. Whether acupuncture needles must be inserted in specific points depends on whether acupoint specificity exists that is still not resolved, and is now urgent. Previous anatomical studies have demonstrated that acupoints exist higher number of nerve fibers/trunks, blood vessels, hair follicles, and sweat glands as well as density of the gap junction. Recent evidence shows that nitric oxide (NO) level is elevated in the acupoints/ meridians and is associated with an enhanced expression of NO synthase endowed with transient receptor potential vanilloid type-1. There is growing evidence from international groups showing that acupuncture induces NO-mediated vasodilatation, which increases local blood flow and allows for a flush of algesic or sensitizing substances, leading to pain relief. Previous studies, using a novel biocapture system, have demonstrated that NOx– (total nitrite and nitrate) and cyclic guanosine monophosphate (cGMP) concentrations are consistently increased over skin acupoints compared to non-meridian control regions (NMCR) in humans. Dermal microdialysis in humans showed that NO-cGMP releases in the subcutaneous tissue of acupoint are higher than those in NMCR and increased by electroacupuncture (EA). Recent studies have demonstrated that low-frequency electrical stimulation and manual acupuncture with low stimulating force and rate produce an elevation of NO release predominantly over acupoints. In contrast, NO levels over the areas of the skin regions are moderately reduced by high-frequency EA stimulation. The results from anatomical and biochemical studies consistently show that acupoints exist higher levels of NO signaling molecules, and stimulus-evoked NO release is also with a higher level at acupoints. Results suggest that NO signaling molecules contribute to the specificity of acupoints, and selecting well-trained acupuncturetists for using correct acupoints and appropriate parameters should improve acupuncture clinical trial studies.

Keywords: acupoint, nitric oxide, electroacupuncture, manual acupuncture, reinforcement methods 

Abstract

Alzheimer’s disease is the most common type of dementia in the aging population worldwide. The etiology and treatment of Alzheimer’s disease are still not very clear. Finding a new treatment is urgent due to the increasing population aging. Acupuncture has been practicing in China for more than 3000 years and reported to be beneficial in treating cognitive impairment of Alzheimer’s disease. This paper reviews the recent development on the effect of acupuncture on Alzheimer’s disease in animal-based researches. It is suggested that acupuncture improves cognitive function of Alzheimer’s disease by regulating glucose metabolism, enhancing neurotransmission as well as reducing oxidative stress, Aβ protein deposition, and neuronal apoptosis. However, it is still difficult to clarify which specific signaling pathway contributes to the acupuncture effect. Better designed studies are recommended to investigate the effects of acupuncture on Alzheimer’s disease.

Objective

To determine the effects of electroacupuncture (EA) at Zusanli (ST36) on colonic motility and neuronal nitric oxide synthase (nNOS) expression in rats with neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI).

Setting

Second School of Clinical Medical, Nanjing University of Chinese Medicine, Jiangsu, China.

Methods

We divided 30 adult Sprague–Dawley rats into a sham group (10 rats), a model group (SCI alone, 10 rats) and a EA group (SCI+EA at ST36, 10 rats). Defecation time was recorded as the time from activated carbon administration (on day 15) to evacuation of the first black stool. Immunohistochemical, real-time PCR and western blot analyses were performed to assess changes in nNOS-immunoreactive cells, and nNOS messenger RNA (mRNA) and protein, respectively, after 14 experimental days.

Results

Defecation time was lower in the EA group than in the model group (P<0.01). On immunohistochemical analysis, nNOS was localized in the myenteric plexus of the colon. The number of nNOS-immunoreactive cells and the intensity of nNOS staining were greater in the model group than in the sham group and lesser in the EA group than in the model group. Consistent with the immunohistochemical findings, nNOS mRNA and protein expression was higher in the model group than in the sham group and lower in the EA group than in the model group (P<0.05 for both).

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Conclusion

Increased colonic nNOS expression can induce/aggravate NBD in SCI rats. EA at ST36 ameliorated NBD, possibly by downregulating colonic nNOS expression.

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Keywords: acupoint, nitric oxide, electroacupuncture, manual acupuncture, reinforcement methods 

ABSTRACT:

There is a growing interest in integrative medical treatments such as acupuncture on hypertension although therapy to control high blood pressure (BP) is available. We have demonstrated in a series of experimental investigations the mechanisms and actions of acupuncture and electro acupuncture (EA) in models of elevated BP associated with reflex induced sympathoexcitation [1-4]. These studies suggest that bilateral EA at select acupoints PC5- 6 and ST36-37, in contrast to EA at LI6-7 and GB37-39, inhibits sympathetically-mediated reflex responses lowering BP through cardiovascular regions in the brain and specific neurotransmitter systems. The experimental findings provided guidance in designing the clinical study to proof the overall hypothesis that weekly EA at PC5-6+ST36-37 but not LI6-7+GB37-39 acupoints for 8 weeks decreases BP for a prolonged period of time in patients with mild to moderate hypertension. We have used 24 h ambulatory blood pressure measurements to monitor EAinhibition of peak and average systolic and diastolic BP (SBP and DBP) and to identify high and low responders to EA. In a cross-over and double blinded design, we have shown that EA application to acupoints PC5-6+ST36-37 for 8 weeks reduces peak and average SBP by 8 and 6 mm Hg in the overall group. Of interest, in high responders EA decreases peak and average SBP by 16 and 11 mm Hg. Following 8 weeks of EA treatment, sympathetic activity reduces and therefore ultimately norepinephrine, reninaldosterone-system. In a subgroup of patients, we observed a long-lasting blood pressure lowering acupuncture effect for at least an additional four weeks after the end of EA treatment.

ABSTRACT:
We attempted to investigate cardioprotection of electroacupuncture (EA) for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6), Ximen (PC4), Shenting (GV24), and Baihui (GV20) acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. 

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Conclusion:
Overall, the findings from this trial suggest that EA plays an important role of cardioprotective effect and is useful in reducing the occurrence of complications and also in improving the quality of life in patients after heart valve replacement with CPB at the early days after operation which potentially benefits patients to recovery after surgery

ABSTRACT:

Objective: Acupuncture is a therapeutic treatment defined as the insertion of needles into the body at specific points (i.e., acupoints). The acupuncture sensation of Deqi is an important component of acupuncture, but the functional brain responses of Deqi have not been entirely supported by the results of functional magnetic resonance imaging (fMRI) studies. The aims of this study were to test the conditions that would generate a Deqi sensation and to investigate the effect of Deqi and the response of acupuncture at different depths and intensities on brain fMRI blood oxygen level-dependent (BOLD) signals. Design/setting: Healthy subjects (n = 16) completed two resting-state fMRI (rs-fMRI) scans, once during shallow needling (2 mm) and once during deep needling (10–20 mm) pseudorandomly, at the acupoint BL40. Results: When undergoing shallow needling, 16 subjects had a mild stabbing pain sensation, and no one had a composite Deqi sensation; when undergoing deep needling, 14 subjects had a composite Deqi sensation, and only 2 subjects had a sharp pain feeling. Composite deep needling of Deqi sensation modulated neural activity at multiple levels of the brain and cerebellum, decreased functional connectivity in the default mode networks (DMN) and the pain matrix networks, and increased connectivity in the right posterior cerebellar lobe, left parahippocampal gyrus, thalamus, and supplementary motor area (P < 0.05, false discovery rate [FDR] < 0.05). When subjects underwent shallow needling, the brain network increased functional connectivity in the right side (precentral gyrus, superior frontal gyrus, cerebellar tonsil) and both side thalami; moreover, the right side of the medial prefrontal cortex had a decreased functional connection (P < 0.05, FDR < 0.05).

Conclusions: The hemodynamic response of deep needling of Deqi sensation hypothesis whereby deep needing could affect a variety of deep tissues and never fibers was supported as acupuncture modulates the limbic-paralimbic-neocortical network to produce its Deqi effects. The similarity of LPNN and DMN suggests that deep needing may mobilize an important intrinsic brain network for its multiplemodulation effects.

ABSTRACT:

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Objective: Our study aimed to investigate the feasibility and effectiveness of preoperative electroacupuncture (EA), delivered 24 hours before surgery, on postoperative nausea and vomiting (PONV) and postoperative pain in patients undergoing gynecologic laparoscopic surgery.

Methods: In this randomized controlled trial, 40 patients scheduled for elective gynecologic laparoscopic surgery, were randomly assigned to the usual care (UC) group and the EA group (n=20 each). Both groups received the routine treatment consisting of intravenous Dexamethasone (5 mg) after induction of anesthesia and intravenous Tropisetron(5 mg) before the end of the operation. Those in the EA group received EA at bilateral Neiguan (PC6) and Zusanli (ST36) within 24 hours prior to the surgery. The incidence and severity of PONV and pain were recorded at 6hours, 12hours, and 24 hours after the operation. Time to first flatus passage was also recorded. Bonferroni-corrected independent sample t-tests were used to analyse the data.

Results: In the first 6 hours after surgery, 15% and 20% of the patients experienced postoperative nausea in the EA and the UC groups, respectively. The incidences of postoperative vomiting were 5% for the EA group and 20% for the UC group. PONV reduced to zero over 12 hours in both groups and there was no statistically significant difference in PONV between the two groups at any time point. The EA group rated their postoperative pain statistically significantly lower than the UC group did at 6 hours postoperative (EA: 1.9 ± 0.8; UC: 2.9 ± 0.9, p = 0.001).The two groups did not differ in pain at 12 and 24 hours. The EA group had a shorter time to pass first flatus than the UC group did (EA: 20.3 hours ± 6.1; UC: 26.4 ± 5.2, p = 0.002). The common EA related adverse effects were minor, and did not require medical attention. The patients tolerated the EA treatment well.

Conclusion: It is feasible and safe to deliver one-session EA treatment within 24 hours preoperatively to preempt postoperative pain. One-session preoperative EA may also accelerate motility of the gastrointestinal track. Properly powered studies are needed to further test the effectiveness of preoperative EA on PONV.

Key words: Electroacupuncture; Postoperative nausea and vomiting; Gynecologic laparoscopic surgery

ABSTRACT:
Paresthesia is defined as an alteration in local sensibility, associated with numbness,
tingling, or unpleasant sensations caused by nerve lesions or irritation. It can be temporary or permanent. The treatment protocol for facial paresthesia is primarily based on the use of drugs and implant removal, which may not be completely effective or may require other risk exposure when there is no spontaneous regression. However, other therapeutic modalities such as acupuncture can be used. The aim of this study is to report a case of a patient with paresthesia of the inferior alveolar nerve and pain caused by an implant surgery performed 2 years earlier. The patient received acupuncture treatment during 4 months of weekly sessions. Six points were used: Large Intestine (LI4), Large Intestine (LI11), Stomach (ST36), Liver (LR3), Extra Head and Neck (E-HN-18), and Stomach (ST5). The visual analog scale was used before and after each session for the analysis of paresthesia and pain, together with assessment of the paresthesia by delimitation of the desensitized region of the skin and presented discomfort. Pain remission and reduction in the size of the paresthesia area occurred after four sessions.

ABSTRACT:

Background:  Patients with allergic rhinitis (AR) increasingly use complementary medicine. The aim of this study was to determine whether traditional Chinese therapy is efficacious in patients suffering from seasonal AR.

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Methods:  Fifty-two patients between the ages of 20 and 58 who had typical symptoms of seasonal AR were assigned randomly and in a blinded fashion to (i) an active treatment group which received a semi-standardized treatment of acupuncture and Chinese herbal medicine, and (ii) a control group which received acupuncture applied to non-acupuncture points in addition to a non-specific Chinese herbal formula. All patients received acupuncture treatment once per week and the respective Chinese herbal formula as a decoction three times daily for a total of 6 weeks. Assessments were performed before, during, and 1 week after treatment. The change in severity of hay fever symptoms was the primary outcome measured on a visual analogue scale (VAS).
 

Results:  Compared with patients in the control group, patients in the active treatment group showed a significant after-treatment improvement on the VAS (P = 0.006) and Rhinitis Quality of Life Questionnaire (P = 0.015). Improvement on the Global Assessment of Change Scale was noted in 85% of active treatment group participants vs 40% in the control group (P = 0.048). No differences between the two groups could be detected with the Allergic Rhinitis Symptom Questionnaire. Both treatments were well-tolerated.

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Conclusions:  The results of this study suggest that traditional Chinese therapy may be an efficacious and safe treatment option for patients with seasonal AR.

ABSTRACT:

We previously showed that a yin meridian of the upper limb decreased electromyographic activity (root mean square) and muscle strength ipsilateral and contralateral to the side of stimulation. Here, we tested the upper trapezius (UT) muscle response after stimulation of a yang meridian of the upper limb, the small intestine (SI). Thirty-eight healthy volunteers were randomized into the following groups: UT muscle (SI14), distant of the UT muscle (SI8), without stimulation (CG), and sham (R3). An acupuncturist certificated by the Brazilian Society of Physical Therapists and Acupuncturists performed the needle insertion. Each volunteer received only one stimulation to the right upper limb. The evaluation occurred before, 5 minutes after, and 20 minutes after needle withdrawal. The root mean square activity increased on the right side in the UT muscle for the SI8 and SI14 groups (F3,37 = 4.67; p < 0.025) at the 20-minute evaluation. The most vigorous response occurred on the contralateral side because the effects were maintained for 5 minutes after withdrawal (F3,37 = 4.52; p < 0.025). Both groups showed an increase in the UT muscle strength at the 20-minute evaluation (F3,37 = 3.41; p < 0.025). The CG and R3 groups did not show any changes. Our data indicate that SI a yang meridian increases the UT muscle response.

Keywords: acupuncture, electromyography, muscle activation, strength

ABSTRACT:

The present study was to examine the distribution of transient receptor potential vanilloid type-1 (TRPV1) receptor immunoreactivity in the acupuncture points (acupoint), and determine the influences of electroacupuncture (EA) stimulation on TRPV1 expression. EA stimulation of BL 40 was conducted in two sessions of 20 min separated by an 80 min interval in anesthetized rats. Sections of skin containing BL 40, and its non-meridian control were examined by immunolabeling with antibodies directed against TRPV1. Without EA, the number of subepidermal nerve fibers expressing TRPV1 was higher in the acupoint than in non-acupoint control skin (p < 0.01). The subepidermal nerve fibers showed the colocalization of TRPV1 with peripherine, a marker for the C-fibers and A-d fibers. The expression of TRPV1 in nerve fibers is significantly increased by EA stimulation in acupoints (p < 0.01). However the upregulation in the non acupoint meridian and the non-meridian control skin was short of statistical significance. Double immunostaining of TRPV1 and neuronal nitric oxide synthase (nNOS) revealed their co-localization in both the subepidermal nerve fibers and in the dermal connective tissue cells. These results show that a high expression of TRPV1 endowed with nNOS in subepidermal nerve fibers exists in the acupoints and the expression is increased by EA. We conclude that the higher expression of TRPV1 in the subepidermal nerve fibers and its upregulation after EA stimulation may play a key role in mediating the transduction of EA signals to the CNS, and its expression in the subepidermal connective tissue cells may play a role in conducting the local effect of the EA.

ABSTRACT:

A hydro-mechanic model was put forward to study the fundamental nature of acupuncture meridians. The basic state of low hydraulic resistance was tested on humans and mini pigs using three methods. The first, a modified Guyton’s method, proved that there was lower hydraulic resistance on meridians compared with nonmeridians. The second scanning method involved a single pressure transducer that can find the lowest resistance point in tissue, and the third method used two transducers and provided a more stable measurement. Using the latter method, low hydraulic resistance points were found very close to low impedance points along meridians. The transmission of artificial interstitial fluid pressure waves was measured to examine their connection to the low resistance points, with the result that a good connection between the points was confirmed. This means the points form channels along the meridians that we refer to as low hydraulic resistance channels. The channel was imaged through isotopic tracing and a migration of isotope 99mTe could be found along the channel. The layer of the channel was detected by injecting Alcian blue and the track was found beneath the skin. All of the above experiments suggest the existence of a new type of channel in living tissues that has not yet been described in modern science, but coincides quite well with the Qi channel theory of traditional Chinese medicine.

Overview:

Acupuncture is an ancient healing art that has been practiced continuously for thousands of years in East Asia, has spread throughout the world during the 20th century, and nevertheless remains difficult to define. In 1960s Communist China, acupuncture underwent a transformation that standardized its practice under the influence of Western medicine, while maintaining some of its distinct elements such as the insertion of acupuncture needles at discrete body locations known as ‘‘acupuncture points.’’ The result, ‘‘Traditional Chinese Medicine’’ or TCM style acupuncture, is now the dominant model in both China and the rest of the world, and is the official core curriculum taught at the majority of U.S. acupuncture schools.

However, the modernization of TCM left out some important aspects of ‘‘Classical’’ Chinese medicine that nevertheless survived in marginalized styles of acupuncture that were orally transmitted through family lineages. These ‘‘pre-TCM’’ acupuncture styles, along with Japanese, Korean, and Vietnamese traditions that developed from the classics, began spreading in the West before the Chinese cultural revolution and became established, first in Europe and then in the United States, through apprenticeships, select programs, and continuing education opportunities.

In this article, we propose that some components of acupuncture missing from the TCM model are related to important 21st century advances in physiology and medicine, including systems biology, cross-system integration, matrix biology, and mechanotherapeutics. We further propose that understanding physiologic mechanisms underlying these ‘‘lost’’ components of acupuncture may yield important insights that could benefit medicine as a whole. It is important to clarify that this commentary does not seek to advocate a dogmatic fixation with ancient ideas for the sake of tradition. Rather, the overarching purpose is to emphasize the potential loss of valuable experience and information in the process of acculturation and modernization.

ABSTRACT:

The anatomical basis for the concept of meridians in traditional Chinese medicine (TCM) has not been resolved. This paper reviews the evidence supporting a relationship between acupuncture points/meridians and fascia. The reviewed evidence supports the view that the human body's fascia network may be the physical substrate represented by the meridians of TCM. Specifically, this hypothesis is supported by anatomical observations of body scan data demonstrating that the fascia network resembles the theoretical meridian system in salient ways, as well as physiological, histological, and clinical observations. This view represents a theoretical basis and means for applying modern biomedical research to examining TCM principles and therapies, and it favors a holistic approach to diagnosis and treatment.

ABSTRACT:

There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time after acupuncture, using a large individual patient data set from high-quality randomized trials of acupuncture for chronic pain. The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. We used meta-analytic techniques to determine the trajectory of posttreatment pain scores. Data on longer term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a nonsignificant 0.011 SD per 3 months (95% confidence interval: -0.014 to 0.037, P = 0.4) after treatment ended. The central estimate suggests that approximately 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months (95% confidence interval: 0.000-0.050, P = 0.050), suggesting approximately a 50% diminution at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not seem to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.

Abstract:

Obesity often results when regular caloric intake exceeds the energy expenditure. Hypothalamus is the center that regulates feeding and energy balance inside the body, especially the lateral hypothalamic area (LHA) and ventromedial nucleus (VMN). Acupuncture-moxibustion has achieved significant progress in treating simple obesity, and the relevant studies have revealed the central action mechanism underlying the treatment. By reviewing the literatures associated with the mechanism studies on acupuncture-moxibustion for simple obesity, this article is going to provide clinical and scientific guidance for the treatment of simple obesity with acupuncture-moxibustion.

Keywords: Acupuncture Therapy; Moxibustion Therapy; Acupuncture-moxibustion Therapy; Obesity; Hypothalamus

Abstract

OBJECTIVES: Although acupuncture therapy has demonstrated itself to be effective in several clinical areas, the underlying mechanisms of acupuncture in general and the analgesic effect in particular are, however, still not clearly delineated. We, therefore, have studied acupuncture analgesic effect through fMRI and proposed a hypothesis, based on the obtained result, which will enlighten the central role of the brain in acupuncture therapy.

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METHODS: The proposed model, termed as a broad sense hypothalamus-pituitary-adrenal (BS-HPA) axis, was based on our observed neuroimaging results. The model incorporates the stress-induced HPA axis model together with neuro-immune interaction including the cholinergic anti-inflammatory model.

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RESULTS: The obtained results coupled with accumulating evidence suggest that the central nervous system is essential for the processing of these effects via its modulation of the autonomic nervous system, neuroimmune system and hormonal regulation.

CONCLUSIONS: Based on our fMRI study, it appears that understanding the effects of acupuncture within a neuroscience-based framework is vital. Further, we have proposed the broad sense-HPA axis hypothesis which incorporates the experimental results.

IMPORTANCE:

Chronic pain management is a growing challenge for both primary care physicians and specialists.  Many of the pharmacologic agents commonly used to manage chronic pain, such as nonsteroidal antiinflammatory drugs (NSAIDs), have the potential for serious toxicity, including gastrointestinal bleeding and renal failure.  In addition, recent decades have seen a large increase in the use of long-acting opiates for ongoing pain management. Yet, the long-term efficacy of these agents is poorly documented, and there is significant potential for addiction and abuse.  Clearly, additional strategies are needed for managing chronic pain, especially behavioral and low-risk interventions with the potential to reduce or even eliminate the need for ongoing pain medication.

OBJECTIVE:

To investigate whether reductions in pain among participants receiving TCM can be explained by increased use of pain medications, or whether use of pain medications also declined in this group.

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DESIGN, SETTING, AND PARTICIPANTS:

One hundred sixty-eight participants with TMD were treated with TCM or enhanced self-care according to a stepped-care design. Those for whom self-care failed were sequentially randomized to further self-care or TCM. This report includes 111 participants during their first 16 TCM visits. The initial 8 visits occurred more than once a week; participants and practitioners determined the frequency of subsequent visits.

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Outcome measures:  Average pain (visual analog scale, range 0-10) and morphine and aspirin dose equivalents.

Results:

The sample was 87% women and the average age was 44 ± 13 years. Average pain of narcotics users (n = 21) improved by 2.73 units over 16 visits (p < 0.001). Overall narcotics use trended downward until visit 11 (-3.27 doses/ week, p = 0.156), and then trended upward until week 16 (+4.29 doses/week, p = 0.264). Among those using narcotics, use of nonsteroidal anti-inflammatory drugs (NSAIDs) declined linearly over visits 1–16 (-1.94 doses/week, p = 0.002). Among the top quartile of NSAID-only users (n = 22), average pain decreased linearly over 16 visits (-1.52 units, p = 0.036). Overall NSAID doses/week declined between visits 1 and 7 (-9.95 doses/week, p < 0.001) and then remained stable through 16 visits. NSAID use also declined among the third quartile (n = 23) and remained low and stable among the lower half (sorted by total intake) of NSAID users.

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Conclusions:

Among the heaviest NSAID users, we observed a short-term reduction in NSAID use that was sustained as TCM visits became less frequent. There was no indication that pain reduction during TCM treatment was influenced by drug use.

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ABSTRACT:

Background: There has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.

Aim: Our aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.

Methods and results: We synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p < 0.001) and usual care (p < 0.001) for all conditions. Using network meta-analyses, we compared acupuncture with other physical therapies for osteoarthritis of the knee. In both an analysis of all available evidence and an analysis of a subset of better-quality trials, using aggregate-level data, we found acupuncture to be one of the more effective therapies. We developed new Bayesian methods for analysing multiple individual patient-level data sets to evaluate heterogeneous continuous outcomes. An accompanying cost-effectiveness analysis found transcutaneous electrical nerve stimulation (TENS) to be cost-effective for osteoarthritis at a threshold of £20,000 per quality-adjusted life-year when all trials were synthesised. When the analysis was restricted to trials of higher quality with adequate allocation concealment, acupuncture was cost-effective. In a RCT of acupuncture or counselling compared with usual care for depression, in which half the patients were also experiencing comorbid pain, we found acupuncture and counselling to be clinically effective and acupuncture to be cost-effective. For patients in whom acupuncture is inappropriate or unavailable, counselling is cost-effective.

Conclusion: We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.

The History, Mechanism, and Clinical Application of Auricular Therapy in Traditional Chinese Medicine

Overview:

Auricular therapy includes acupuncture, electroacupuncture, acupressure, lasering, cauterization, moxibustion, and bloodletting in the auricle. For 2500 years, people have employed auricular therapy for treating diseases, but the methods have been limited to bloodletting and cauterization. Only after 1957, the international scientific community became aware that the map of the ear resembles an inverted fetus, its introduction has led to auricular acupuncture (AA) becoming a more systemic approach, and, following the identification and standardization of more precise points, AA has been employed in clinical applications. The mechanisms of AA are considered to have a close relationship with the autonomic nervous system, the neuroendocrine system, neuroimmunological factors, neuroinflammation, and neural reflex, as well as antioxidation.  Auricular therapy has been applied, for example, for pain relief, for the treatment of epilepsy, anxiety, and obesity, and for improving sleep quality.However, the mechanisms and evidence for auricular therapy warrant further study.

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The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial

IMPORTANCE:

The long-term prophylactic effects of acupuncture for migraine are uncertain.

OBJECTIVE:

To investigate the long-term effects of true acupuncture compared with sham acupuncture and being placed in a waiting-list control group for migraine prophylaxis.
 

DESIGN, SETTING, AND PARTICIPANTS:

This was a 24-week randomized clinical trial (4 weeks of treatment followed by 20 weeks of follow-up). Participants were randomly assigned to true acupuncture, sham acupuncture, or a waiting-list control group. The trial was conducted from October 2012 to September 2014 in outpatient settings at 3 clinical sites in China. A total of 249 participants 18 to 65 years old with migraine without aura based on the criteria of the International Headache Society, with migraine occurring 2 to 8 times per month.

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ABSTRACT:

Purpose: Auricular acupuncture treatments are becoming increasingly available within military treatment facilities, resulting in an expansion of nonpharmacologic treatment options available to veterans with posttraumatic stress disorder (PTSD). This study aimed to explore the self-reported benefits of auricular acupuncture treatments for veterans living with PTSD.

Design: A qualitative research methodology, thematic content analysis, was used to analyze data.

Method: Seventeen active duty veterans with PTSD provided written comments to describe their experiences and perceptions after receiving a standardized auricular acupuncture regimen for a 3-week period as part of a pilot feasibility study.

Findings: A variety of symptoms experienced by veterans with PTSD were improved after receiving auricular acupuncture treatments. Additionally, veterans with PTSD were extremely receptive to auricular acupuncture treatments. Four themes emerged from the data: (1) improved sleep quality, (2) increased relaxation, (3) decreased pain, and (4) veterans liked/loved the auricular acupuncture treatments.

Conclusions: Veterans with PTSD reported numerous benefits following auricular acupuncture treatments. These treatments may facilitate healing and recovery for veterans with combat-related PTSD, although further investigations are warranted into the mechanisms of action for auricular acupuncture in this population.

Keywords: posttraumatic stress disorder; auricular acupuncture; Veterans

ABSTRACT:

Objective: Sleep disturbance is a major consequence of hot flashes among breast cancer survivors. This study evaluated the effects of electro-acupuncture (EA) versus gabapentin (GP) for sleep disturbances among breast cancer survivors experiencing daily hot flashes.

Methods: We analyzed data from a randomized controlled trial involving 58 breast cancer survivors experiencing bothersome hot flashes at least two times per day. Participants were randomly assigned to receive 8 weeks of EA or daily GP (total dose of 900 mg/d). The primary outcome was change in the total Pittsburgh Sleep Quality Index (PSQI) score between groups at week 8. Secondary outcomes include specific PSQI domains.

Results: By the end of treatment at week 8, the mean reduction in PSQI total score was significantly greater in the EA group than the GP group (-2.6 vs -0.8, P = 0.044). The EA also had improved sleep latency (-0.5 vs 0.1, P = 0.041) and sleep efficiency (-0.6 vs 0.0, P = 0.05) compared with the GP group. By week 8, the EA group had improved sleep duration, less sleep disturbance, shorter sleep latency, decreased daytime dysfunction, improved sleep efficiency, and better sleep quality (P < 0.05 for all) compared with baseline, whereas the GP group improved in duration and sleep quality only (P < 0.05).

Conclusions: Among women experiencing hot flashes, the effects of EA are comparable with GP for improving sleep quality, specifically in the areas of sleep latency and efficiency. Larger randomized controlled trials with longer follow-ups are needed to confirm this preliminary finding.