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Anatomical Record (Hoboken, N.J. : 2007) Dec 2023Acupuncture, an important component of traditional Chinese medicine, has gained growing attention around the world in the past decades. Both manual and...
Acupuncture, an important component of traditional Chinese medicine, has gained growing attention around the world in the past decades. Both manual and electroacupuncture are commonly used in clinical practice, especially by patients with gastrointestinal disorders seeking symptoms control due to disease signs recurrence and/or lack of effective treatments. Currently, patients with functional gastrointestinal disorders, constipation, gastroesophageal reflux disease, inflammatory bowel disease, ileus, acute pancreatitis, and gastroparesis may benefit from acupuncture treatment, as clinically evident, and the most frequently used acupoints are chosen from the large intestine, stomach, bladder, and spleen meridian. The underlying mechanisms of acupuncture involve the neuromodulation, adjustment of gastrointestinal motility and visceral hypersensitivity, anti-inflammation, repairment of gut microbiota, and intestinal barrier. As methodology advanced, cumulative number of well-designed clinical trials has been established, which might help elevating clinicians and gastroenterologists' awareness and perception toward application of acupuncture for gastrointestinal diseases management.
Topics: Humans; Acute Disease; Pancreatitis; Gastrointestinal Diseases; Acupuncture Therapy; Acupuncture; Acupuncture Points
PubMed: 35148031
DOI: 10.1002/ar.24871 -
JAMA Network Open Nov 2023Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Pain is challenging for patients with advanced cancer. While recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown.
OBJECTIVE
To compare the effects of acupuncture and massage on musculoskeletal pain among patients with advanced cancer.
DESIGN, SETTING, AND PARTICIPANTS
A multicenter pragmatic randomized clinical trial was conducted at US cancer care centers consisting of a northeastern comprehensive cancer center and a southeastern cancer institute from September 19, 2019, through February 23, 2022. The principal investigator and study statisticians were blinded to treatment assignments. The duration of follow-up was 26 weeks. Intention-to-treat analyses were performed (linear mixed models). Participants included patients with advanced cancer with moderate to severe pain and clinician-estimated life expectancy of 6 months or more. Patient recruitment strategy was multipronged (eg, patient database queries, mailings, referrals, community outreach). Eligible patients had English or Spanish as their first language, were older than 18 years, and had a Karnofsky score greater than or equal to 60 (range, 0-100; higher scores indicating less functional impairment).
INTERVENTIONS
Weekly acupuncture or massage for 10 weeks with monthly booster sessions up to 26 weeks.
MAIN OUTCOMES AND MEASURES
The primary end point was the change in worst pain intensity score from baseline to 26 weeks. The secondary outcomes included fatigue, insomnia, and quality of life. The Brief Pain Inventory (range, 0-10; higher numbers indicate worse pain intensity or interference) was used to measure the primary outcome. The secondary outcomes included fatigue, insomnia, and quality of life.
RESULTS
A total of 298 participants were enrolled (mean [SD] age, 58.7 [14.1] years, 200 [67.1%] were women, 33 [11.1%] Black, 220 [74.1%] White, 46 [15.4%] Hispanic, and 78.5% with solid tumors). The mean (SD) baseline worst pain score was 6.9 (1.5). During 26 weeks, acupuncture reduced the worst pain score, with a mean change of -2.53 (95% CI, -2.92 to -2.15) points, and massage reduced the Brief Pain Inventory worst pain score, with a mean change of -3.01 (95% CI, -3.38 to -2.63) points; the between-group difference was not significant (-0.48; 95% CI, -0.98 to 0.03; P = .07). Both treatments also improved fatigue, insomnia, and quality of life without significant between-group differences. Adverse events were mild and included bruising (6.5% of patients receiving acupuncture) and transient soreness (15.1% patients receiving massage).
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial among patients with advanced cancer, both acupuncture and massage were associated with pain reduction and improved fatigue, insomnia, and quality of life over 26 weeks; however, there was no significant different between the treatments. More research is needed to evaluate how best to integrate these approaches into pain treatment to optimize symptom management for the growing population of people living with advanced cancer.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04095234.
Topics: Female; Humans; Male; Middle Aged; Acupuncture Therapy; Fatigue; Massage; Musculoskeletal Pain; Neoplasms; Quality of Life; Sleep Initiation and Maintenance Disorders; Adult; Aged
PubMed: 37962891
DOI: 10.1001/jamanetworkopen.2023.42482 -
Advances in Clinical and Experimental... Sep 2023Transcutaneous electrical acupoint stimulation (TEAS) is an emerging therapeutic approach that combines the effects of transcutaneous electrical nerve stimulation (TENS)... (Review)
Review
Transcutaneous electrical acupoint stimulation (TEAS) is an emerging therapeutic approach that combines the effects of transcutaneous electrical nerve stimulation (TENS) with acupuncture point stimulation. Due to its noninvasive nature, it possesses relative advantages over traditional acupuncture and needle-based electrostimulation. Despite the large number of randomized clinical trials (RCTs) describing the effectiveness of TEAS in different applications, its role and mechanism are still not fully understood. The aim of this study was to systematically compare and summarize the latest studies examining a variety of TEAS applications in clinical practice. Databases, including Medline (PubMed), Cochrane Library and Google Scholar were searched without any time restrictions (as of March 2021). The analysis was performed according to the Cochrane Collaboration criteria. Out of 637 studies, only 22 RCTs were selected. Nine studies evaluated the impact of TEAS on nausea and vomiting (NV), showing beneficial effects compared to standard therapy. Eight RCTs examined the effectiveness of TEAS in pain management, reporting pain alleviation described using the visual analog scale (VAS) and lowering of total opioid doses. Improvement of postoperative recovery, in vitro fertilization and pregnancy outcomes, as well as display of cardioprotective properties were found to positively correlate with TEAS. As a noninvasive modality with advantages over classical acupuncture and needle-based electrostimulation, TEAS may be a valuable tool in clinical practice, particularly for pain and NV management. However, considering the methodological quality of the RCTs, rigorous large-scale clinical trials are required to evaluate the clinical utility of this method.
Topics: Pregnancy; Female; Humans; Transcutaneous Electric Nerve Stimulation; Acupuncture Points; Pain Management; Vomiting; Nausea; Pain
PubMed: 37026972
DOI: 10.17219/acem/159703 -
JAMA Network Open Sep 2023When sham acupuncture is set as a control in evaluating acupuncture, the sham needling technique is usually different from acupuncture. However, the sham procedure is... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
When sham acupuncture is set as a control in evaluating acupuncture, the sham needling technique is usually different from acupuncture. However, the sham procedure is conducted either at the same points that are used for the acupuncture group or at nonindicated points.
OBJECTIVE
To assess whether the outcome of sham acupuncture varies according to the needling points in sham-controlled trials of acupuncture for chronic nonspecific low back pain (CLBP) as an example.
DATA SOURCES
Searches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Allied and Complementary Medicine Database were conducted on February 12, 2023.
STUDY SELECTION
Randomized clinical trials (RCTs) assessing the outcomes of acupuncture in sham acupuncture-controlled or waiting list-controlled trials on CLBP were included.
DATA EXTRACTION AND SYNTHESIS
Two researchers independently extracted data on study characteristics and outcomes and assessed quality. Sham acupuncture was classified according to whether it was conducted at the same acupuncture points used in the acupuncture group, referred to as sham acupuncture therapy (verum) (SATV) or at different points, referred to as sham acupuncture therapy (sham) (SATS). Clinical similarity, transitivity, and consistency tests were conducted, followed by a random-effects frequentist network meta-analysis (NMA).
MAIN OUTCOMES AND MEASURES
The primary outcome was pain, and the secondary outcome was back-specific function. The first assessment after the end of treatment was chosen for analysis. Effect sizes are reported as standardized mean differences (SMD) with 95% CIs. The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence for findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS
Ten RCTs involving 4379 participants were included. In comparison with SATS, acupuncture was significantly associated with improvements in both pain (SMD, -0.33; 95% CI, -0.52 to -0.15) and function outcomes (SMD, -0.13; 95% CI, -0.25 to -0.02); however, there were no differences between acupuncture and SATV. In comparison with SATS, SATV was significantly associated with better pain (SMD, -0.45; 95% CI, -0.88 to -0.03) and function outcomes (SMD, -0.30; 95% CI, -0.56 to -0.05). The risk of bias that could affect the interpretation of the results was usually low, and the certainty of evidence was moderate to low.
CONCLUSIONS AND RELEVANCE
In this NMA, sham acupuncture needling at the same points as those in acupuncture was not a true placebo control for assessing the efficacy of acupuncture for CLBP and might underestimate the outcome of acupuncture in clinical settings.
Topics: Humans; Low Back Pain; Network Meta-Analysis; Acupuncture Therapy; Vascular Surgical Procedures; Databases, Factual
PubMed: 37672270
DOI: 10.1001/jamanetworkopen.2023.32452 -
Zhongguo Zhen Jiu = Chinese Acupuncture... Oct 2023Acupoint is the basis of acupuncture. To elaborate the theory of acupuncture, the structure and function of acupoint should be clarified in advance. By exploring the...
Acupoint is the basis of acupuncture. To elaborate the theory of acupuncture, the structure and function of acupoint should be clarified in advance. By exploring the discussion upon the classification, distribution and structure of acupoint in (), (on meridian points and extra points), (on convergence of joints) and (on three-dimensional structure of acupoint) are extracted. Based on whether located on the fixed sites, acupoints are classified into meridian points and extra points, while the meridian points are divided into 4 categories, i.e , , and . The convergence of joints illustrates the principal rule of acupoint distribution. The density of the major and key acupoints is proportional to the size and the complexity of function of joints. Acupoint is recognized as a three-dimensional structure in consideration of its external distribution on the body surface and the substances inside the body, which can be explored and examined. In addition, the relationship between meridian points and extra points, the significance of meridian points in different conditions, and the approaches to acupoint study are deeply discussed and analyzed. The crucial problems and the way for solving them are proposed for the future study to provide the references to the inheritance and innovation of acupuncture.
Topics: Acupuncture Points; Meridians; Acupuncture Therapy; Acupuncture
PubMed: 37802528
DOI: 10.13703/j.0255-2930.20230227-0002 -
JAMA Network Open Nov 2023Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple,... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety.
OBJECTIVE
To estimate the efficacy and safety of auricular acupuncture as a treatment for depression.
DESIGN, SETTING, AND PARTICIPANTS
This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted.
INTERVENTION
Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group's treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group's acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points.
MAIN OUTCOMES AND MEASURES
The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score < 5) at 4 weeks, 6 weeks, and 3 months); and adverse events.
RESULTS
A total of 304 participants were screened, and 74 participants (62 women [84%]; median [IQR] age, 29 [23-27] years) were included in the intention-to-treat analysis, with 37 participants randomized to each group (SA and NSA). A total of 47 participants (64%) were followed-up through 3 months. The results showed no statistically significant difference in depressive recovery between the groups at 3 months (14 of 24 participants in the SA group [58%] vs 10 of 23 participants in the NSA group [43%]; risk ratio [RR], 1.34; 95% CI, 0.76-2.45; P = .38). The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at 6 weeks) with no statistically significant differences. However, a statistically significant difference was observed in symptom remission at 3 months (11 of 24 participants in the SA group [46%] vs 3 of 23 participants in the NSA group [13%]; RR, 1.99; 95% CI, 1.16-3.34; P = .02) in favor of SA. There were no significant differences in adverse event rates between the groups, evidencing the intervention's safety. Most participants reported mild pain at the needle application site (33 patients [94%] in the SA group vs 32 patients [91%] in the NSA group). Five participants dropped out of the study due to adverse events.
CONCLUSIONS AND RELEVANCE
The results of this randomized clinical trial suggest that SA over 6 weeks is safe. Although there was no statistically significant difference between groups for the primary efficacy outcome, patients receiving SA did experience greater symptom remission at 3 months. A larger sample size and longer intervention are needed to further evaluate the efficacy of SA for depression.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05855421.
Topics: Adult; Humans; Female; Acupuncture, Ear; Depression; Acupuncture Therapy; Brazil; Depressive Disorder
PubMed: 38032640
DOI: 10.1001/jamanetworkopen.2023.45138 -
JAMA Network Open Jan 2024Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.
OBJECTIVE
To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.
INTERVENTIONS
Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) or sham acupuncture (SA) groups. Both groups underwent language training and conventional treatments.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the aphasia quotient (AQ) of the Western Aphasia Battery (WAB) and scores on the Chinese Functional Communication Profile (CFCP) at 6 weeks. Secondary outcomes included WAB subitems, Boston Diagnostic Aphasia Examination, National Institutes of Health Stroke Scale, Stroke-Specific Quality of Life Scale, Stroke and Aphasia Quality of Life Scale-39, and Health Scale of Traditional Chinese Medicine scores at 6 weeks and 6 months after onset. All statistical analyses were performed according to the intention-to-treat principle.
RESULTS
Among 252 randomized patients (198 men [78.6%]; mean [SD] age, 60.7 [7.5] years), 231 were included in the modified intention-to-treat analysis (115 in the MA group and 116 in the SA group). Compared with the SA group, the MA group had significant increases in AQ (difference, 7.99 points; 95% CI, 3.42-12.55 points; P = .001) and CFCP (difference, 23.51 points; 95% CI, 11.10-35.93 points; P < .001) scores at week 6 and showed significant improvements in AQ (difference, 10.34; 95% CI, 5.75-14.93; P < .001) and CFCP (difference, 27.43; 95% CI, 14.75-40.10; P < .001) scores at the end of follow-up.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, patients with poststroke motor aphasia who received 6 weeks of MA compared with those who received SA demonstrated statistically significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months after onset.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR1900026740.
Topics: United States; Adult; Male; Humans; Middle Aged; Aphasia, Broca; Quality of Life; Acupuncture Therapy; Communication; Stroke
PubMed: 38252438
DOI: 10.1001/jamanetworkopen.2023.52580 -
Neurogastroenterology and Motility Nov 2023Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory... (Review)
Review
BACKGROUND/PURPOSE
Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory function. Symptoms may vary depending on the organ affected and can be debilitating. Treatment usually involves diet and lifestyle changes. Pharmacotherapy is limited in effectiveness with various side effects. Transcutaneous electrical stimulation (TES), a noninvasive, needleless technique that provides electrical stimulation using cutaneous non-needle electrodes, has become increasingly popular. It has been shown to be beneficial in treating GI motility disorders.
METHODS
This review paper navigates through the different TES techniques, including transcutaneous peripheral nerve (vagal/sacral/tibial nerves) electrical stimulation, transcutaneous electrical acustimulation (stimulation via acupuncture point), transcutaneous interferential current therapy, and transcutaneous electrical nerve stimulation.
KEY RESULTS
As we delve deeper, we explore the promising effects of TES on dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, postoperative ileus, constipation, and irritable bowel syndrome. The literature at hand speaks volumes about the therapeutic prowess of this noninvasive technique.
CONCLUSION & INFERENCES
The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders.
Topics: Humans; Transcutaneous Electric Nerve Stimulation; Gastrointestinal Diseases; Constipation; Gastrointestinal Motility
PubMed: 37288650
DOI: 10.1111/nmo.14618 -
BMJ (Clinical Research Ed.) Dec 2023We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We explored the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD).
DESIGN
Systematic review and network meta-analysis of randomised clinical trials (RCTs).
DATA SOURCES
MEDLINE, EMBASE, CINAHL, CENTRAL, and SCOPUS were searched to May 2021, and again in January 2023.
STUDY SELECTION
Interventional RCTs that enrolled patients presenting with chronic pain associated with TMD.
DATA EXTRACTION AND SYNTHESIS
Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We captured all reported patient-important outcomes, including pain relief, physical functioning, emotional functioning, role functioning, social functioning, sleep quality, and adverse events. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence and categorise interventions from most to least beneficial.
RESULTS
233 trials proved eligible for review, of which 153-enrolling 8713 participants and exploring 59 interventions or combinations of interventions-were included in network meta-analyses. All subsequent effects refer to comparisons with placebo or sham procedures. Effects on pain for eight interventions were supported by high to moderate certainty evidence. The three therapies probably most effective for pain relief were cognitive behavioural therapy (CBT) augmented with biofeedback or relaxation therapy (risk difference (RD) for achieving the minimally important difference (MID) in pain relief of 1 cm on a 10 cm visual analogue scale: 36% (95% CI 33 to 39)), therapist-assisted jaw mobilisation (RD 36% (95% CI 31 to 40)), and manual trigger point therapy (RD 32% (29 to 34)). Five interventions were less effective, yet more effective than placebo, showing RDs ranging between 23% and 30%: CBT, supervised postural exercise, supervised jaw exercise and stretching, supervised jaw exercise and stretching with manual trigger point therapy, and usual care (such as home exercises, self stretching, reassurance).Moderate certainty evidence showed four interventions probably improved physical functioning: supervised jaw exercise and stretching (RD for achieving the MID of 5 points on the short form-36 physical component summary score: 43% (95% CI 33 to 51)), manipulation (RD 43% (25 to 56)), acupuncture (RD 42% (33 to 50)), and supervised jaw exercise and mobilisation (RD 36% (19 to 51)). The evidence for pain relief or physical functioning among other interventions, and all evidence for adverse events, was low or very low certainty.
CONCLUSION
When restricted to moderate or high certainty evidence, interventions that promote coping and encourage movement and activity were found to be most effective for reducing chronic TMD pain.
REGISTRATION
PROSPERO (CRD42021258567).
Topics: Humans; Chronic Pain; Network Meta-Analysis; Exercise Therapy; Cognitive Behavioral Therapy; Physical Therapy Modalities; Randomized Controlled Trials as Topic
PubMed: 38101924
DOI: 10.1136/bmj-2023-076226