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Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:235-244. [PMID: 38493063 DOI: 10.1016/j.joim.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Pain associated with cancer is one of the greatest causes of reduced quality of life in patients. Acupuncture is one of the treatments used to address this issue, with the great advantage of having little or no side effects, especially when compared with pharmacological pain-killers. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain. SEARCH STRATEGY Six electronic databases (PubMed, EBSCO, Cochrane Library, Scielo, b-On and Scopus) were searched for relevant articles about pain relief in cancer patients from their beginning until 2022 using MeSH terms such as "acupuncture," "electroacupuncture," "ear acupuncture," "acupuncture analgesia," ''oncological pain," and "cancer pain." INCLUSION CRITERIA Studies included were randomized controlled trials (RCTs) where acupuncture was compared with no treatment, placebo acupuncture or usual care. DATA EXTRACTION AND ANALYSIS Three independent reviewers participated in data extraction and evaluation of risk of bias, and a meta-analysis was conducted. The primary outcome was pain intensity, measured with the visual analog scale, numeric rating scale, or brief pain inventory. Secondary outcomes also assessed were quality of life, functionality, xerostomia, pain interference, and analgesic consumption. Results were expressed as standardized mean difference (SMD) with 95% confidence interval (CI). RESULTS Sixteen RCTs with a total of 1124 participants were included in the meta-analysis, with the majority of the studies presenting a low or unclear risk of bias. Acupuncture was more effective in reducing pain than no treatment (SMD = -0.90, 95 % CI [-1.68, -0.12]), sham acupuncture (SMD = -1.10, 95 % CI [-1.59, -0.61]) or usual care (SMD = -1.16, 95 % CI [-1.38, -0.93]). CONCLUSION The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer. Despite some limitations due to the low quality and small sample size of some included studies, as well as the different types and stages of cancer, acupuncture might provide an effective and safe treatment to reduce cancer pain. Please cite this article as: Faria M, Teixeira M, Pinto MJ, Sargento P. Efficacy of acupuncture on cancer pain: A systematic review and meta-analysis. J Integr Med. 2024; 22(3): 235-244.
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Affiliation(s)
- Miguel Faria
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; Clínica São João de Deus, 1700-048 Lisboa, Portugal.
| | - Mónica Teixeira
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; REQUIMTE/LAQV (Rede de Química e Tecnologia/Laboratório Associado para a Química Verde), Instituto Superior de Engenharia, Instituto Politécnico do Porto, 4051-401 Porto, Portugal
| | | | - Paulo Sargento
- Núcleo de Investigação em Ciências e Tecnologias da Saúde, Instituto Politécnico da Lusofonia, 1950-396 Lisboa, Portugal; Centro de Estudos Avançados em Direito "Francisco Suarez", 1749-024 Lisboa, Portugal
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Zhang J, Wu W, Ren Y, Yuan Y, Jia L. Electroacupuncture for the treatment of cancer pain: a systematic review and meta-analysis of randomized clinical trials. FRONTIERS IN PAIN RESEARCH 2023; 4:1186506. [PMID: 37255718 PMCID: PMC10225685 DOI: 10.3389/fpain.2023.1186506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objective This paper aims to review the current evidence on electroacupuncture as an effective and safe therapy for cancer pain management. Methods Five databases were searched from their inception through November 11, 2022. Only the randomized controlled trials that meet the eligibility criteria were finally included in the study. Literature screening and data extraction were performed independently by two reviewers, and RevMan 5.3 used for meta-analysis. Results A total of 17 RCTs met our inclusion criteria. We used 8 indicators to estimate the meta-analysis results, most of which proved statistically significant, including VAS scores, NRS scores, and KPS scores. To be specific, VAS scores (MD = -1.41, 95% CI: -2.42 to -0.41, P = 0.006) and NRS scores (MD = -1.19, 95% CI: -1.72 to -0.66, P < 0.0001) were significantly lower in the treatment group compared to the control group. The treatment group's KPS scores (MD = 5.48, 95% CI: 3.27 to 7.69, P < 0.00001) were higher than those of the control group. Also, in the treatment group, the number of burst pain (MD = -2.66, 95% CI: -3.32 to -1.99, P < 0.00001) and side effect rates (RR = 0.51, 95% CI: 0.39 to 0.67, P < 0.00001) greatly reduced, while the response rate (RR = 1.17, 95% CI: 1.09 to 1.26, P < 0.0001) significantly increased compared to the control group. Conclusion This study demonstrates the advantages of electroacupuncture in the treatment of cancer pain. Meanwhile, rigorous RCTs should be designed and conducted in the future to further demonstrate the exact efficacy of electroacupuncture. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022376148.
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Affiliation(s)
- Junning Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weizhen Wu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuehan Ren
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Liqun Jia
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
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Agrawal S, Szmit M, Wełna M, Rudnicki J, Agrawal A, Goździk W. Transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing inguinal hernia repair: protocol for a randomized controlled trial. Trials 2022; 23:1064. [PMID: 36581999 PMCID: PMC9801607 DOI: 10.1186/s13063-022-07019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) in the postoperative treatment of patients undergoing inguinal hernia repair compared with sham and no treatment group. METHODS This study is a protocol for a three-armed, single-blinded, placebo-controlled randomized controlled trial. Ninety participants scheduled for inguinal hernia repair will be randomly assigned to the TEAS group (n = 30), sham group (n = 30), and control group (n = 30). The TEAS group will receive treatment using four portable coin-sized electro-stimulators at both local and distal acupuncture points. The sham group will receive sham treatment with mock electrostimulation. The treatment groups will receive mixed frequency stimulation (alternating at 2 and 100 Hz every 3 s) in continuous mode for 30 min at intervals of 2 h for 24 h postoperatively. The control group will receive postoperative pain control using patient-controlled analgesia (PCA) device. The primary outcome is the total morphine dose received in the postoperative period (mg) using PCA 24 h after surgery. The number of PCA demands (i.e., times the button will be pressed) and delivered bolus doses, score on the Visual Analogue Scale, opioid-related side effects, the requirement for supplemental medications, score on the Hospital Anxiety and Depression Scale (HADS), and blood levels of stress hormones cortisol and prolactin. DISCUSSION The results of this trial will determine whether TEAS with intensified stimulation protocol is a safe and effective option for reducing analgesic consumption and postoperative pain. TRIAL REGISTRATION ISRCTN76428396. Registered on 05 October 2020. https://www.isrctn.com/ISRCTN76428396.
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Affiliation(s)
- Siddarth Agrawal
- grid.4495.c0000 0001 1090 049XDepartment of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland ,grid.4495.c0000 0001 1090 049XDepartment of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Szmit
- grid.4495.c0000 0001 1090 049XDepartment of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Wełna
- grid.4495.c0000 0001 1090 049XDepartment of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- grid.4495.c0000 0001 1090 049XDepartment of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Anil Agrawal
- grid.4495.c0000 0001 1090 049XSecond Department of General and Oncological Surgery, Wroclaw Medical University, Borowska 213 St, 50-556 Wroclaw, Poland
| | - Waldemar Goździk
- grid.4495.c0000 0001 1090 049XDepartment of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Xi Z, Wei X, Ye Z, Wang K, Zhou J. Acupuncture for adult lung cancer of patient-reported outcomes: A systematic review and meta-analysis. Front Oncol 2022; 12:921151. [PMID: 36119472 PMCID: PMC9479629 DOI: 10.3389/fonc.2022.921151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This systematic review and meta-analysis aims to assess the effects of acupuncture on patient-reported outcomes (PROs) in adults with lung cancer. Methods Electronic databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (CQVIP), Wanfang Data, SinoMed, and gray literatures were retrieved from inception to 1 July 2022 for randomized controlled trials (RCTs). Acupuncture was defined as an experimental intervention, and the patients of the control groups included either treatment including conventional therapy (usual care, sham/placebo acupuncture, pharmacotherapy including Western medicine and Chinese traditional medicine). PROs for this study were measured by seven scales of primary outcomes including the Karnofsky Performance Status (KPS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy-Lung, Functional Assessment of Cancer Therapy Lung Cancer Subscale, Leicester Cough Questionnaire (LCQ score), the Medical Outcomes Study (MOS) item short form health survey (SF-36), and the St George’s Respiratory Questionnaire, and 12 scales of secondary outcomes. Cochrane Collaboration’s tool was used to assess the risks of bias. Data were combined and analyzed with RevMan 5.4 and Stata/SE 16.0. Results We retrieved 3,002 lung cancer patients from 33 trials. KPS included with 1,000 patients showed that acupuncture could significantly improve the quality of life (QOL) compared with the control group regardless of different tumor–node–metastasis stages or the different stages of disease. The study showed that acupuncture significantly improved lung cancer–related symptoms in the QOL, pain, nausea and vomiting, insomnia, anxiety and depression, fatigue, and constipation compared with the control group. Eight RCTs reported the occurrence of adverse events, whereas four reported none and four RCTs reported that the events in the observation group were significantly less than those in the control group. Conclusion Acupuncture proved to be a promising intervention, both postoperatively and after chemotherapy, and should be recommended as a beneficial alternative strategy to promote PROs in lung cancer patients at all stages of application. Considering the low quality, we suggest more rigorous clinical trials of acupuncture for lung cancer in the future and more emphasis on the effect of acupuncture in patients with lung cancer on their PROs, mainly in the aspect of the QOL. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier [CRD42021274122].
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Affiliation(s)
| | | | | | - Ke Wang
- *Correspondence: Ke Wang, ; Jia Zhou,
| | - Jia Zhou
- *Correspondence: Ke Wang, ; Jia Zhou,
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Lam WL, Wang J, Yeung WF, Cheung CW, Chan KKL, Ngan HYS, Wong CKH, Jiang F, Ma PWS, Leung TW, Leung WC, Liu TC, Chen H, Lao L. A combination of electroacupuncture and auricular acupuncture for postoperative pain after abdominal surgery for gynaecological diseases: A randomized controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154292. [PMID: 35797863 DOI: 10.1016/j.phymed.2022.154292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/04/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Postoperative pain following laparotomy for gynaecological diseases is a common problem that requires effective management to ensure patient satisfaction and recovery. Despite the wide use of acupuncture for pain management, knowledge of its efficacy in managing postoperative pain is limited. Previous literature used either acupuncture or auricular acupuncture alone. However, the combined use of acupuncture and auricular acupuncture have not been studied yet. PURPOSE This study examined the efficacy and feasibility of combined electroacupuncture and auricular acupuncture compared to a sham control in reducing pain during 5 days after a laparotomy for gynaecological diseases. This combined therapy was hypothesized to provide greater pain reduction than previous studies with less frequent treatment. STUDY DESIGN Randomized sham-controlled, patient- and- assessor-blinded trial. METHODS This trial recruited 72 patients scheduled for laparotomy in Hong Kong. Either acupuncture (n = 36) or non-invasive sham acupuncture (n = 36) was performed on the patients preoperatively (1 session) and postoperatively (once a day, up to 6 sessions). The primary outcome was pain at rest, measured using a numerical rating scale from postoperative days 0-5. Secondary outcomes such as analgesics consumption were also assessed. A data and safety monitoring board (DSMB) was established. RESULTS All 72 randomized patients were included in the analysis. The acupuncture group had a smaller pain score at rest at 22 hrs (mean = 2.6) than the sham control group (mean = 4.0) (Post hoc intention to treat analysis, Linear regression, mean difference = -1.4, 95% confidence interval = [-0.2] -2.7, p = 0.029). No statistically significant between-group difference was found in other outcomes. No serious adverse event was observed. CONCLUSION Perioperative acupuncture treatments are safe and feasible, but the efficacy of acupuncture is inconclusive.
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Affiliation(s)
- Wing Lok Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Jingxuan Wang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chi Wai Cheung
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China
| | - Karen Kar Loen Chan
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | | | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Fei Jiang
- Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, China
| | - Paulin Wai Sze Ma
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Tsin Wah Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong, China
| | - Wing Cheong Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong, China
| | - Tak Chiu Liu
- Department of Anaesthesiology, Kwong Wah Hospital, Hong Kong, China
| | - Haiyong Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.
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Zhang Y, Yang G, Wei J, Chen F, Zhang MZ, Mao S. Prospective comparison of acupuncture with sham acupuncture to determine impact on sedation and analgesia in mechanically ventilated critically ill patients (PASSION study): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059741. [PMID: 36041767 PMCID: PMC9438044 DOI: 10.1136/bmjopen-2021-059741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sedation and analgesia are recommended to be employed in the intensive care unit (ICU) to enhance patient comfort and safety, facilitate mechanical ventilation and reduce oxygen demands. However, the increasing evidence demonstrates that excessive sedation and analgesia might prolong mechanical ventilation and increase costs and mortality. Acupuncture is known to be able to attenuate pain, anxiety and agitation symptoms while avoiding excessive sedation and analgesia caused by drugs. Therefore, we present a protocol to investigate whether acupuncture, used for sedation and analgesia, can reduce the duration of mechanical ventilation, save medical resources and reduce the mortality of critically ill patients receiving mechanical ventilation. METHODS AND ANALYSIS Prospective, randomised controlled trial is conducted on 180 adult medical/surgical ICU patients with mechanical ventilation needing sedation at 3 ICUs between 03 November 2021 and 16 August 2023. Patients will be treated with analgesia and sedation to achieve desired target sedation levels (Richmond Agitation Sedation Score of -2 to 1). Enrolled patients will be randomly assigned in a ratio of 1:1:1 to receive deep needle insertion with combined manual and alternating-mode electrical stimulation on acupoints (AC group), superficial needle insertion without manual stimulation and electrical stimulation on non-acupoints (SAC group), or no acupuncture intervention (NAC group). The primary outcome is the duration of mechanical ventilation from randomisation until patients are free of mechanical ventilation (including non-invasive) without reinstitution for the following 48 hours. Secondary endpoints include the dose of administered sedatives and analgesic at comparable sedation levels throughout the study, ICU length of stay, hospital length of stay. Additional outcomes include the prevalence and days of delirium in ICU, mortality in ICU and within 28 days after randomisation, and the number of ventilator free days in 28 days. ETHICS AND DISSEMINATION This trial was approved by the ethics committee at Guangdong Provincial Hospital of Chinese Medicine. We will publish the study results. TRIAL REGISTRATION NUMBER ChiCTR2100052650.
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Affiliation(s)
- Yuzhuo Zhang
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guang Yang
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinyi Wei
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fangliang Chen
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min-Zhou Zhang
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Mao
- Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Peron R, Rampazo ÉP, Liebano RE. Traditional acupuncture and laser acupuncture in chronic nonspecific neck pain: study protocol for a randomized controlled trial. Trials 2022; 23:408. [PMID: 35578302 PMCID: PMC9109358 DOI: 10.1186/s13063-022-06349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/25/2022] [Indexed: 09/02/2023] Open
Abstract
Background Nonspecific neck pain is a multifactorial and very common condition in adult individuals, traditional acupuncture (TA) and laser acupuncture (LA) may be treatment options for certain individuals in such a condition. However, no reports were found in the literature comparing the effectiveness of TA and LA in cases of chronic nonspecific neck pain. Therefore, the aim of the present study is to investigate the effectiveness of TA and LA therapies in individuals with chronic nonspecific neck pain, noting which one is more efficient for this condition. The result of this research will have direct implications for pain management and, consequently, may benefit individuals suffering from nonspecific chronic neck pain. Methods/design This will be a controlled and randomized clinical trial. Eighty-four individuals will be recruited and distributed equally and randomly into 3 groups: TA (which will receive the acupuncture treatment with needles), LA (which will receive the laser acupuncture treatment), and Sham (who will receive the placebo intervention). The acupuncture points (Tianzhu, Fengchi, Jianjing, and Jianzhongshu) will be stimulated bilaterally. The primary outcome will be pain intensity, determined using the Numerical Rating Scale. The secondary outcomes will be pressure pain threshold, temporal summation of pain, conditioned pain modulation, use of analgesic medicines after treatment, and the global perceived effect scale. The assessments will be performed immediately before and after the treatment, which will be a single session, at the follow-up and 1 month after the end of the treatments; evaluation will be made of the pain intensity and the global perceived effect. Statistical analysis of the data obtained will consider a significance level of p < 0.05. Discussion This study will provide evidence concerning the effects of LA treatment, in comparison with TA and sham intervention, leading to benefits for individuals suffering from chronic nonspecific neck pain. Trial registration Brazilian Registry of Clinical Trials - ReBEC RBR-7vbw5gd. Date of registration: August 06th, 2021.
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Shah S, Godhardt L, Spofford C. Acupuncture and Postoperative Pain Reduction. Curr Pain Headache Rep 2022; 26:453-458. [PMID: 35482244 DOI: 10.1007/s11916-022-01048-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Acupuncture is an analgesic technique that has long been utilized in Eastern medicine. In recent times, various acupuncture techniques have been used in integrated pain management approaches in Western medicine. It has even been adopted as an analgesic method in surgical patients. Currently, no review exists regarding various acupuncture techniques used in perioperative pain management and data describing the utility of these techniques. This paper synthesizes the latest literature regarding the role of acupuncture in perioperative pain management. The authors sought to describe various acupuncture modalities used to help manage surgical pain and synthesize the current body of literature to help readers make informed judgements on the topic. RECENT FINDINGS Patients undergoing abdominal, spine/neuro, and gynecologic pelvic surgery generally benefit from acupuncture. Out of the various acupuncture techniques, electroacupuncture, transcutaneous electric acupoint stimulation, and traditional total body acupuncture seem to be most promising as adjuncts to multimodal perioperative analgesia. Benefits include improved analgesia and/or reduced narcotic requirements, decrease in PONV, and shorter time to return of bowel function. Acupuncture is a low-risk method that has the potential to enhance perioperative analgesia, decrease opioid requirement, and reduce unwanted side effects of anesthesia, surgery, and opioid administration such as nausea/vomiting. Given the variety of patient populations, various acupuncture techniques, and small patient populations for most current studies; it remains difficult to determine which acupuncture method would most benefit specific patients. Future studies with more robust sample sizes and prospective comparison on acupuncture technique would help better characterize acupuncture's role in perioperative pain management.
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Affiliation(s)
- Shivani Shah
- Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave; P347, Milwaukee, WI, 53226, USA
| | - Lisa Godhardt
- Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave; P347, Milwaukee, WI, 53226, USA
| | - Christina Spofford
- Department of Anesthesiology, Medical College of Wisconsin, 9200 W. Wisconsin Ave; P347, Milwaukee, WI, 53226, USA.
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Höxtermann MD, Haller H, Aboudamaah S, Bachemir A, Dobos G, Cramer H, Voiss P. Safety of acupuncture in oncology: A systematic review and meta-analysis of randomized controlled trials. Cancer 2022; 128:2159-2173. [PMID: 35262912 DOI: 10.1002/cncr.34165] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/06/2022] [Accepted: 02/09/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acupuncture is frequently used to treat the side effects of cancer treatment, but the safety of this intervention remains uncertain. The current meta-analysis was conducted to assess the safety of acupuncture in oncological patients. METHODS The PubMed, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from their inception to August 7, 2020. Randomized controlled trials in oncological patients comparing invasive acupuncture with sham acupuncture, treatment as usual (TAU), or any other active control were eligible. Two reviewers independently extracted data on study characteristics and adverse events (AEs). Risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS Of 4590 screened articles, 65 were included in the analyses. The authors observed that acupuncture was not associated an with increased risk of intervention-related AEs, nonserious AEs, serious AEs, or dropout because of AEs compared with sham acupuncture and an active control. Compared with TAU, acupuncture was not associated with an increased risk of intervention-related AEs, serious AEs, or drop out because of AEs but was associated with an increased risk for nonserious AEs (odds ratio, 3.94; 95% confidence interval, 1.16-13.35; P = .03). However, the increased risk of nonserious AEs compared with TAU was not robust against selection bias. The meta-analyses may have been biased because of the insufficient reporting of AEs in the original randomized controlled trials. CONCLUSIONS The current review indicates that acupuncture is as safe as sham acupuncture and active controls in oncological patients. The authors recommend researchers heed the CONSORT (Consolidated Standards of Reporting Trials) safety and harm extension for reporting to capture the side effects and better investigate the risk profile of acupuncture in oncology. LAY SUMMARY According to this analysis, acupuncture is a safe therapy for the treatment of patients with cancer. Acupuncture seems to be safe compared with sham acupuncture and active controls.
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Affiliation(s)
- Melanie D Höxtermann
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Heidemarie Haller
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Shaimaa Aboudamaah
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Armin Bachemir
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Gustav Dobos
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Holger Cramer
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Petra Voiss
- Evangelical Clinics Essen-Mitte, Department of Internal and Integrative Medicine, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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11
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Park S, Lyu YR, Park SJ, Oh MS, Jung IC, Lee EJ. Electroacupuncture for post-thoracotomy pain: A systematic review and meta-analysis. PLoS One 2021; 16:e0254093. [PMID: 34234358 PMCID: PMC8263274 DOI: 10.1371/journal.pone.0254093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Thoracotomy is an invasive surgical procedure that produces intense postoperative pain. Electroacupuncture has been used to induce analgesia in various situations, including after surgery. The aim of the following systematic review and meta-analysis was to evaluate the effect of electroacupuncture on post-thoracotomy pain. Methods The studies for the systematic review were searched using the following 9 databases: PubMed, Cochrane Library, EMBASE, MEDLINE Complete, Google Scholar, China National Knowledge Infrastructure (CNKI), Korean Medical Database (KMBASE), Koreanstudies Information Service System (KISS), and OASIS, without language restriction. Randomized controlled trials (RCTs) that met the inclusion criteria were selected. The quality assessment was performed using the Cochrane risk-of-bias tool, and RevMan 5.3 was used for meta-analysis. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42019142157. Results Eleven randomized controlled trials were included in the systematic review. The meta-analysis was performed for two outcome measures: pain score 24 hours after surgery and total dose of opioid analgesics. A subgroup analysis was performed according to the control group: sham acupuncture and conventional analgesia group. Pain score 24 hours after surgery of electroacupuncture group showed a standard mean difference of -0.98 (95% CI: -1.62 to -0.35) compared to sham acupuncture. The standard mean difference was -0.94 (95% CI: -1.33 to -0.55) compared to conventional analgesia. The total dose of opioid analgesics of electroacupuncture group showed a standard mean difference values of -0.95 (95% CI: -1.42 to -0.47) compared to sham acupuncture. The standard mean difference was -1.96 (95% CI: -2.82 to -1.10) compared to conventional analgesia. Conclusion Current evidence suggests that electroacupuncture might provide useful pain relieving effect on post-thoracotomy patients. However, due to low quality and high heterogeneity of existing data, further rigorously designed studies should be performed to confirm the safety and efficacy.
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Affiliation(s)
- Sohyeon Park
- College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Yee Ran Lyu
- Clinical Trial Center, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
- Department of Korean Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - So Jung Park
- Clinical Trial Center, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
- Department of Korean Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Min Seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - In Chul Jung
- Clinical Trial Center, Dunsan Korean Medicine Hospital of Daejeon University, Daejeon, Republic of Korea
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- * E-mail: (ICJ); (E-JL)
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
- * E-mail: (ICJ); (E-JL)
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12
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Romero-Morales C, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, Calvo-Lobo C, Martínez-Jiménez EM, López-López D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon 2021; 67:101210. [PMID: 34099238 DOI: 10.1016/j.disamonth.2021.101210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Vanesa Abuín-Porras
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Eva María Martínez-Jiménez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.
| | - Emmanuel Navarro-Flores
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain.
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13
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Li Z, Feiyue Z, Gaofeng L. Traditional Chinese medicine and lung cancer--From theory to practice. Biomed Pharmacother 2021; 137:111381. [PMID: 33601147 DOI: 10.1016/j.biopha.2021.111381] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
With the continuous breakthroughs in molecular biology and biochemistry, we have constantly made great progress in the treatment of lung cancer. There is no doubt that standard treatment (such as surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy) has greatly improved the prognosis of lung cancer populations. In particular, the immunotherapy has brought more and more good news to countless lung cancer patients. In contrast to these standard treatments, traditional Chinese medicine (TCM) rarely has a profound and comprehensive overview in the field of lung cancer. This article will summarize the latest progress of TCM in lung cancer which is mainly non-small cell lung cancer (NSCLC) from theory to clinical practice, which would carry forward the sophisticated TCM and promote the development of modern medicine.
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Affiliation(s)
- Zhang Li
- Kunming Medical University, Kunming 650500, China; Department of Thoracic Tumor Surgery, Yunnan Cancer Center, Kunming 650118, China
| | - Zhang Feiyue
- Kunming Medical University, Kunming 650500, China; Department of Thoracic Tumor Surgery, Yunnan Cancer Center, Kunming 650118, China
| | - Li Gaofeng
- Department of Thoracic Tumor Surgery, Yunnan Cancer Center, Kunming 650118, China.
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14
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Szmit M, Agrawal S, Goździk W, Kübler A, Agrawal A, Pruchnicki P, Woźniak M, Nowak M, Bartoszewicz B, Rudnicki J. Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Analgesic Requirement in Patients Undergoing Inguinal Hernia Repair: A Randomized, Placebo-Controlled Study. J Clin Med 2021; 10:E146. [PMID: 33406735 PMCID: PMC7794768 DOI: 10.3390/jcm10010146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical stimulation (TEAS) on the postoperative patient-controlled analgesia (PCA) requirement for morphine, as well as side effects and recovery profile after inguinal hernia repair. Seventy-one subjects undergoing inguinal hernia repair with a standardized anesthetic technique were randomly assigned to one of three analgesic treatment regimens: PCA + TEAS (n = 24); PCA + sham-TEAS (no electrical stimulation) (n = 24), and PCA only (n = 23). The postoperative PCA requirement, pain scores, opioid-related side effects, and blood cortisol levels were recorded. TEAS treatment resulted in a twofold decrease in the analgesic requirement and decreased pain level reported by the patients. In addition, a significant reduction of cortisol level was reported in the TEAS group at 24 h postoperatively compared to the sham and control groups. We conclude that TEAS is a safe and effective option for reducing analgesic consumption and postoperative pain following inguinal hernia repair.
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Affiliation(s)
- Mateusz Szmit
- Department and Clinic of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (J.R.)
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Department of Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Waldemar Goździk
- Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Andrzej Kübler
- Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anil Agrawal
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Piotr Pruchnicki
- Department of Acoustics and Multimedia, Faculty of Electronics, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland;
| | - Marta Woźniak
- Department of Pathology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Matylda Nowak
- Department of Design, The Eugeniusz Geppert Academy of Art and Design, 50-416 Wroclaw, Poland;
| | - Bartłomiej Bartoszewicz
- Department of Econometrics and Operations Research, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland;
| | - Jerzy Rudnicki
- Department and Clinic of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.S.); (J.R.)
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15
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Chen J, Zhang Y, Li X, Wan Y, Ji X, Wang W, Kang X, Yan W, Fan Z. Efficacy of transcutaneous electrical acupoint stimulation combined with general anesthesia for sedation and postoperative analgesia in minimally invasive lung cancer surgery: A randomized, double-blind, placebo-controlled trial. Thorac Cancer 2020; 11:928-934. [PMID: 32062864 PMCID: PMC7113057 DOI: 10.1111/1759-7714.13343] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background Multimodal opioid‐sparing analgesia is a key component of an enhanced recovery pathway after surgery that aims to improve postoperative recovery. Transcutaneous electrical acupoint stimulation (TEAS) is assumed to alleviate pain and anxiety and to modify the autonomic nervous system. This study aimed to determine the efficacy of TEAS for sedation and postoperative analgesia in lung cancer patients undergoing thoracoscopic pulmonary resection. Methods A total of 80 patients were randomized into two groups: the TEAS group and the sham TEAS combined with general anesthesia group. Postoperative pain levels at six, 24, 48 hours, and one month after surgery were measured using the visual analogue scale (VAS). Bispectral index (BIS) score during the TEAS prior to anesthetic induction, Observer's Assessment of Alertness/Sedation (OAAS) score, sufentanil consumption during postoperative patient‐controlled intravenous analgesia (PCIA), number of total and effective attempts of PCIA pump use, and incidence of postoperative nausea and vomiting were recorded and analyzed statistically. Results Patients in the TEAS group had significantly lower VAS scores at six, 24, and 48 hours after surgery (P < 0.01); lower BIS scores at 10, 20, and 30 minutes before induction (P < 0.01); lower levels of postoperative sufentanil consumption; lower number of PCIA attempts and effective rates (P < 0.01); lower incidences of nausea at 0, six, 24, and 48 hours; and lower incidence of vomiting at 24 hours after surgery (P < 0.05). The postoperative OAAS scores were similar between the groups. Conclusions TEAS could be a feasible approach for sedation and postoperative analgesia in thoracoscopic pulmonary resection.
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Affiliation(s)
- Jiheng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yunxiao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - You Wan
- Neuroscience Research Institute and Department of Neurobiology, Peking University and Key Laboratory of Neuroscience of the Ministry of Education and the National Health Commission, Beijing, China
| | - Xinqiang Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Medical Record Statistics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Medical Record Statistics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaozheng Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Wanpu Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), The First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhiyi Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital and Institute, Beijing, China
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16
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Electroacupuncture Alleviates Pain-Related Emotion by Upregulating the Expression of NPS and Its Receptor NPSR in the Anterior Cingulate Cortex and Hypothalamus. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8630368. [PMID: 32104195 PMCID: PMC7035524 DOI: 10.1155/2020/8630368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
Objective Electroacupuncture (EA) is reported effective in alleviating pain-related emotion; however, the underlying mechanism of its effects still needs to be elucidated. The NPS-NPSR system has been validated for the involvement in the modulation of analgesia and emotional behavior. Here, we aimed to investigate the role of the NPS-NPSR system in the anterior cingulate cortex (ACC), hypothalamus, and central amygdala (CeA) in the use of EA to relieve affective pain modeled by complete Freund's adjuvant- (CFA-) evoked conditioned place aversion (C-CPA). Materials and Methods. CFA injection combined with a CPA paradigm was introduced to establish the C-CPA model, and the elevated O-maze (EOM) was used to test the behavioral changes after model establishment. We further explored the expression of NPS and NPSR at the protein and gene levels in the brain regions of interest by immunofluorescence staining and quantitative real-time PCR. Results We observed that EA stimulation delivered to the bilateral Zusanli (ST36) and Kunlun (BL60) acupoints remarkably inhibited sensory pain, pain-evoked place aversion, and anxiety-like behavior. The current study showed that EA significantly enhanced the protein expression of this peptide system in the ACC and hypothalamus, while the elevated expression of NPSR protein alone was just confined to the affected side in the CeA. Moreover, EA remarkably upregulated the mRNA expression of NPS in CeA, ACC, and hypothalamus and NPSR mRNA in the hypothalamus and CeA. Conclusions These data suggest the effectiveness of EA in alleviating affective pain, and these benefits may at least partially be attributable to the upregulation of the NPS-NPSR system in the ACC and hypothalamus.
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17
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Abstract
Scientific research into the effects and mechanisms of acupuncture for gastrointestinal diseases including inflammatory bowel disease has been rapidly growing in the past several decades. In this review, we discuss the history, theory, and methodology of acupuncture and review potentially beneficial mechanisms of action of acupuncture for managing inflammatory bowel disease. Acupuncture has been shown to decrease disease activity and inflammation via increase of vagal activity in inflammatory bowel disease. Acupuncture has demonstrated beneficial roles in the regulation of gut dysbiosis, intestinal barrier function, visceral hypersensitivity, gut motor dysfunction, depression/anxiety, and pain, all of which are factors that can significantly impact quality of life in patients with inflammatory bowel disease. A number of clinical trials have been performed to investigate the therapeutic effects of acupuncture in ulcerative colitis and Crohn's disease. Although the data from these trials are promising, more studies are needed given the heterogeneous and multifactorial aspects of inflammatory bowel disease. There is also an important need to standardize acupuncture methodology, study designs, and outcome measurements.
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Affiliation(s)
- Gengqing Song
- Department of Gastroenterology, Hepatology & Nutrition, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Claudio Fiocchi
- Department of Gastroenterology, Hepatology & Nutrition, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology & Nutrition, Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
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18
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Bae K, Kim E, Kong JS, Kim J, Park SJ, Jun HJ, Cho CK, Kim MK, Yoo HS. Integrative cancer treatment may have a survival benefit in patients with lung cancer: A retrospective cohort study from an integrative cancer center in Korea. Medicine (Baltimore) 2019; 98:e16048. [PMID: 31261510 PMCID: PMC6617466 DOI: 10.1097/md.0000000000016048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Integrative oncology is being increasingly adopted in mainstream cancer care to strengthen anticancer effects and to control cancer-related symptoms.The objective of this study is to identify the characteristics of patients with lung cancer treated at an integrative cancer center in Korea and to determine the effects of integrative cancer treatment (ICT) on survival outcome in traditional Korean medicine (TKM).We reviewed medical records for lung cancer patients who visited a single integrative clinical setting, East-West Cancer Center, between January 2014 and December 2015. We classified the patients into groups according to their ICT and whether or not they underwent anticancer traditional Korean Medicine treatment with a multiherbal formula containing Panax notoginseng Radix, Cordyceps militaris, P ginseng C.A.Mey., and Boswellia carterii BIRDWOOD (HangAmDan-B), with a herbal formula containing Rhus verniciflua Stoke, or with cultivated wild ginseng pharmacopuncture. A descriptive analysis of the characteristics and a survival analysis using the Kaplan-Meier curves with log rank test and a Cox proportional hazard model were performed.A total of 91 patients were included, and the majority had advanced-stage cancer. Of those patients, 45.1% were in the mono-TKM group and 39.6% were integrative group. Patients with advanced stage had significantly higher mortality than patients with early stage (crude hazard ratio [HR]: 4.41, 95% confidence interval [CI]: 1.56-12.5; adjusted HR: 6.31, 95% CI: 1.24-32.1). In the unadjusted model, for patients in the integrative group, the mortality rate was reduced by 50% compared to mono-TKM group with statistical significance. After adjusting confounders, the mortality rate of integrative group was reduced by 6% compared to mono-TKM group, suggesting positive effect on survival probability of integrative group.The results suggest that integration of TKM and conventional cancer treatment may have survival benefits in patients with lung cancer. Even though this study has limitations including heterogeneity between treatment groups, the study results suggest that ICT has positive effect on survival probability. To clarify the impacts of ICT for lung cancer and other cancers on survival outcome, further prospective study with a rigorous study design is required in multiclinical setting.
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Affiliation(s)
- Kyeore Bae
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
| | - Eunseok Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon
| | - Ji-Sook Kong
- Division of Cancer Epidemiology and Management, National Cancer Center, Ilsandong-gu, Goyang
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jeehye Kim
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
| | - So-jung Park
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
| | - Hyeong joon Jun
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
| | - Chong-kwan Cho
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Management, National Cancer Center, Ilsandong-gu, Goyang
| | - Hwa-Seung Yoo
- East-West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University
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19
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Capodice JL, Parkhomenko E, Tran TY, Thai J, Blum KA, Chandhoke RA, Gupta M. A Randomized, Double-Blind, Sham-Controlled Study Assessing Electroacupuncture for the Management of Postoperative Pain after Percutaneous Nephrolithotomy. J Endourol 2019; 33:194-200. [PMID: 30693806 DOI: 10.1089/end.2018.0665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for large renal calculi but postoperative (PO) pain remains a concern. Modifications of the PCNL technique and intraoperative and PO strategies have been tested to reduce pain. PO pain control reducing risk of long-term pain medication and narcotic use is of considerable importance. Acupuncture is a common medical procedure shown to alleviate PO pain. Some benefits are that it is nonpharmacologic, easy to administer, and safe. The purpose of this study was to evaluate the effects of electroacupuncture (EA) on PO pain in patients undergoing PCNL. MATERIALS AND METHODS This was a randomized, double-blind, sham-controlled study. The study was Institutional Review Board approved and performed under standard ethical guidelines. Fifty-one patients undergoing PCNL by a single surgeon were randomized to one of the three groups: true EA (n = 17), sham EA (SEA, n = 17), and no acupuncture (control, n = 17). The EA and SEA were performed by a single licensed acupuncturist <1 hour before operation. PCNL was performed without the use of intraoperative nerve block(s) or local anesthetic. Pain scores (visual analog scale [VAS]), narcotic use (morphine equivalents), and side effects were recorded at set intervals postoperatively. RESULTS Mean VAS scores for flank and abdomen pain were lower at all time periods in the EA compared with the SEA and control groups. Mean cumulative opioid usage was lower in the EA group immediately postoperatively compared with both SEA and control groups. Two patients in the EA group did not require any PO narcotics. No differences between groups were found for PO nausea and vomiting. No adverse effects of EA or SEA were noted. CONCLUSIONS EA significantly reduced PO pain and narcotic usage without any adverse effects after PCNL. This promising treatment for managing PO pain warrants further investigation.
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Affiliation(s)
- Jillian L Capodice
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Egor Parkhomenko
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Timothy Y Tran
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Julie Thai
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Kyle A Blum
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Ryan A Chandhoke
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Mantu Gupta
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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20
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Miller KR, Patel JN, Symanowski JT, Edelen CA, Walsh D. Acupuncture for Cancer Pain and Symptom Management in a Palliative Medicine Clinic. Am J Hosp Palliat Care 2018; 36:326-332. [PMID: 30286611 DOI: 10.1177/1049909118804464] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE: Studies suggest acupuncture improves cancer-related symptoms; however, it is unclear whether patient characteristics predict pain response. This study determined acupuncture's effect on cancer-related pain and identified variables associated with pain response. METHODS: A retrospective chart review included adult patients with cancer referred to palliative medicine and received acupuncture for pain management. Paired t tests compared differences in pain scores from pre- to postacupuncture. Clinically meaningful pain improvement was defined as ≥2-point reduction in pain score. Logistic regression was used to evaluate associations between patient characteristics and pain improvement. RESULTS: One hundred seventy acupuncture treatments from 68 individual patients were studied. Significant reductions in mean pain scores were observed after the first treatment (-1.9 ± 1.8; P < .001) and across all treatments (-1.7 ± 1.9; P < .001). Multivariable analysis demonstrated clinically meaningful pain improvement with higher baseline pain scores (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.44-2.22; P < .001) and stage III/IV disease (OR: 3.23, 95% CI: 1.11-9.40; P < .001). There were significant improvements in anxiety, depression, drowsiness, dyspnea, fatigue, nausea, and well-being after the first treatment and across all treatments ( P < .001). CONCLUSIONS: Acupuncture improved cancer-related pain and other symptoms. Those with higher baseline pain scores and advanced disease were more likely to achieve significant pain reduction. Improved depression and fatigue were closely related to pain reduction. Further studies are needed to confirm pain response variables, establish durability, and develop a personalized approach to acupuncture.
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Affiliation(s)
- Katherine R Miller
- 1 Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Jai N Patel
- 1 Department of Cancer Pharmacology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.,2 Section of Palliative Medicine, Department of Supportive Oncology, Atrium Health, Charlotte, NC, USA
| | - James T Symanowski
- 3 Department of Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Connie A Edelen
- 2 Section of Palliative Medicine, Department of Supportive Oncology, Atrium Health, Charlotte, NC, USA
| | - Declan Walsh
- 2 Section of Palliative Medicine, Department of Supportive Oncology, Atrium Health, Charlotte, NC, USA
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Dusek JA, Griffin KH, Finch MD, Rivard RL, Watson D. Cost Savings from Reducing Pain Through the Delivery of Integrative Medicine Program to Hospitalized Patients. J Altern Complement Med 2018; 24:557-563. [PMID: 29474095 PMCID: PMC6006422 DOI: 10.1089/acm.2017.0203] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES An important task facing hospitals is improving pain management without raising costs. Integrative medicine (IM), a promising nonpharmacologic pain management strategy, is yet to be examined for its cost implications in an inpatient setting. This institution has had an inpatient IM department for over a decade. The purpose was to examine the relationship between changes in patients' pain, as a result of receiving IM therapy, and total cost of care during an inpatient hospital admission. DESIGN In this retrospective analysis, data from an EPIC-based electronic health record (EHR) patient demographics, length of stay (LOS), and All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness measures were utilized. IM practitioners collected and entered patient-reported pain scores into the EHR. The authors regressed the demographic, change in pain, LOS, and APR-DRG variables with changes in pain on total cost for the hospital admission. To estimate cost savings to the hospital, they computed the average reduction in cost associated with reduction in pain by multiplying the coefficient for change in pain by average total cost. SETTING/LOCATION A large, tertiary care hospital in Minneapolis, MN. SUBJECTS Adult inpatient admissions, 2730, during the study period where patients received IM for pain and met eligibility criteria. INTERVENTION IM services provided to inpatients. OUTCOME MEASURES Change in pain on an 11-point numeric rating scale before and after initial IM sessions; total costs for hospital admissions. RESULTS Both LOS and age were found to increase cost, as did being white, male, married, and having APR-DRG severity coded as extreme. For patients receiving IM therapies, pain was reduced by an average of 2.05 points and this pain reduction was associated with a cost savings of $898 per hospital admission. CONCLUSIONS For patients receiving IM therapies, pain was significantly reduced and costs were lowered by about 4%.
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Affiliation(s)
- Jeffery A Dusek
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Kristen H Griffin
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Michael D Finch
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
| | - Rachael L Rivard
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - David Watson
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
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Lam WL, Yeung WF, Wong MK, Cheung CW, Chan KKL, Ngan HYS, Wong CKH, Chen HY, Lao L. Combined electroacupuncture and auricular acupuncture for postoperative pain after abdominal surgery for gynecological diseases: study protocol for a randomized controlled trial. Trials 2018; 19:8. [PMID: 29301556 PMCID: PMC5755011 DOI: 10.1186/s13063-017-2359-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/28/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Postoperative pain is a major complaint following abdominal surgery for gynecological diseases. Effective postoperative pain control after abdominal surgery is particularly important for patient recovery, mobility, and satisfaction. Acupuncture has been commonly used for pain management. However, its efficacy in postoperative pain control is inconclusive and health economic evaluation is limited. METHODS A randomized, sham-controlled, patient- and- assessor-blind trial is designed to evaluate the efficacy and safety of acupuncture in managing postoperative pain following abdominal surgery of gynecological diseases. Patients who are eligible for laparotomy with a midline incision for gynecological neoplasia, including ovarian mass, uterine mass, and cervical lesions, will be recruited. Seventy-two participants will be randomly allocated to an acupuncture or non-invasive sham control in a 1:1 ratio. Treatment will be done within 2 h before operation, upon arrival to the ward and once daily for 5 days. The Pain Numerical Rating Scale (NRS) on the first 5 days during hospitalization will be the primary outcome and will be analyzed using the area-under-the-curve (AUC) method. The secondary outcome measures include frequency of rescue analgesic use during hospital stay, cumulative morphine consumption; quality of recovery as measured by time to recovery variables and the Quality of Recovery-9 (QoR-9); quality of life as measured by the Short Form-6 dimension (SF-6D) and EuroQol-5 Dimension-5 Level (EQ-5D-5 L). The incremental cost-effectiveness ratio of acupuncture vs sham acupuncture will be calculated. DISCUSSION This study protocol provides an example of integrative medicine practice in a hospital setting for the management of postoperative pain using acupuncture treatment. The acupuncture treatment protocol, if proven to be effective, can be implemented in routine settings to play a role in postoperative pain management for patients who have undergone abdominal surgery for gynecological diseases. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02851186 . Registered on 19 July 2016.
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Affiliation(s)
- Wing Lok Lam
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Wing Fai Yeung
- School of Nursing, the Hong Kong Polytechnic University, Kowloon, Hong Kong, Special Administrative Region of China
| | - Mei Kuen Wong
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Chi Wai Cheung
- Department of Anesthesiology, The University of Hong Kong, 4/F, K Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Karen Kar Loen Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Hextan Yuen Sheung Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, 6/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Hai Yong Chen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, Special Administrative Region of China
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Lee S, Nam D, Kwon M, Park WS, Park SJ. Electroacupuncture to alleviate postoperative pain after a laparoscopic appendectomy: study protocol for a three-arm, randomised, controlled trial. BMJ Open 2017; 7:e015286. [PMID: 28780543 PMCID: PMC5724078 DOI: 10.1136/bmjopen-2016-015286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the efficacy and safety of electroacupuncture (EA) for postoperative pain after laparoscopic appendectomy compared with sham electroacupuncture (SEA) and no acupuncture treatment. METHODS AND ANALYSIS This study is a protocol for a three-arm, randomised, patient-assessor-blinded (to the type of acupuncture treatment), controlled, parallel trial. 138 participants diagnosed with appendicitis and scheduled for laparoscopic appendectomy will be randomly assigned to the EA group (n=46), SEA group (n=46) or control group (n=46). The EA group will receive acupuncture treatment at both regional and distal acupuncture points with electrostimulation. The SEA group will receive sham acupuncture treatment with mock electrostimulation. Both EA and SEA groups will receive a total of four treatments 1 hour preoperative, 1 hour postoperative and during the morning and afternoon the day after surgery with the same routine postoperative pain control. The control group will receive only routine postoperative pain control. The primary outcome is the 11-point Pain Intensity Numerical Rating Scale (PI-NRS) at 24 hours after surgery. The secondary outcomes are the PI-NRS, analgesic consumption, opioid-related side effects, time to first passing flatus, quality of life and adverse events evaluated 6, 12, 24 and 36 hours and 7 days after surgery. ETHICS AND DISSEMINATION The study was planned in accordance with the Helsinki Declaration and the Korean Good Clinical Practice Guidelines to protect the participants and was approved by the institutional review board (IRB) of Kyung Hee University Medical Center (KMC IRB-1427-02). The results will be disseminated in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER Clinical Research Information Service (KCT0001328).
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Affiliation(s)
- Seunghoon Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, South Korea
| | - Dongwoo Nam
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, South Korea
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Minsoo Kwon
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, South Korea
| | - Won Seo Park
- Department of Surgery, Kyung Hee University Hospital, Seoul, South Korea
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Sun Jin Park
- Department of Surgery, Kyung Hee University Hospital, Seoul, South Korea
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
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Momtazi AA, Askari-Khorasgani O, Abdollahi E, Sadeghi-Aliabadi H, Mortazaeinezhad F, Sahebkar A. Phytochemical Analysis and Cytotoxicity Evaluation of Kelussia odoratissima Mozaff. J Acupunct Meridian Stud 2017; 10:180-186. [PMID: 28712477 DOI: 10.1016/j.jams.2017.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kelussia odoratissima Mozaff. (Apiaceae) is an edible, indigenous, and ethnomedicinal plant that grows only in Iran. Although antioxidant and anti-inflammatory properties of K. odoratissima have been reported, cytotoxic activity of this plant has not been investigated previously. OBJECTIVE This study aims to evaluate the cytotoxicity of K. odoratissima leaf extract against a panel of human cancer cell lines. A secondary aim was to perform a phytochemical analysis of the plant's leaf oil. METHODS To extract the plant oil, dried leaves were subjected to hydrodistillation using a Clevenger-type apparatus for up to 3 hours. For the phytochemical analysis, essential oil was subjected to gas chromatography/mass spectrometry. Plant extraction was performed by macerating leaf powder of K. odoratissima (50 g) in 70% methanol (500 mL) at room temperature (25-28°C) for 24 hours. To perform cytotoxicity assays, methanolic extract of K. odoratissima was tested against a panel of cell lines including MDA-MB468 (human breast cancer cell line), K562 (human leukemia cell line), SKOV3 (human ovarian cancer cell line), Y79 (human eye cancer cell line), A549 (lung cancer cell line), and HEK 293 (normal human embryonic kidney cell line). RESULTS Gas chromatography/mass spectrometry analysis revealed that sesquiterpens are dominant volatile components of the plant, followed by phthalides comprising 3-butyldine phthalide and 3-n-butyl phthalide, the latter compound being the major component of the leaf oil (25.1%). The leaf extract showed selective and dose-dependent cytotoxicity against MDA-MB468, K562, SKOV3, Y79, and A549 cancer cell lines with IC50 values (concentration that inhibits cell growth by 50%) of 85 μg/mL, 70 μg/mL, 120 μg/mL, 82 μg/mL, and145 μg/mL, respectively. CONCLUSIONS The present results suggest a direct cytotoxic activity of K. odoratissima leaf extract against human cancer cell lines. This activity of K. odoratissima may find application in combination with traditional herbal medicines to develop a new anticancer pharmacopuncture therapy.
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Affiliation(s)
- Amir Abbas Momtazi
- Nanotechnology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Omid Askari-Khorasgani
- Nanotechnology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran; Department of Horticultural sciences, Faculty of Agriculture and Natural Resources, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Elham Abdollahi
- Department of Medical Immunology and Allergy, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hojjat Sadeghi-Aliabadi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forough Mortazaeinezhad
- Department of Horticultural sciences, Faculty of Agriculture and Natural Resources, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Amirhossein Sahebkar
- Neurogenic inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Sham Electroacupuncture Methods in Randomized Controlled Trials. Sci Rep 2017; 7:40837. [PMID: 28106094 PMCID: PMC5247761 DOI: 10.1038/srep40837] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Sham electroacupuncture (EA) control is commonly used to evaluate the specific effects of EA in randomized-controlled trials (RCTs). However, establishing an inert and concealable sham EA control remains methodologically challenging. Here, we aimed to systematically investigate the sham EA methods. Eight electronic databases were searched from their inception to April 2015. Ten out of the 17 sham EA methods were identified from 94 RCTs involving 6134 participants according to three aspects: needle location, depth of needle insertion and electrical stimulation. The top three most frequently used types were sham EA type A, type L and type O ordinally. Only 24 out of the 94 trials reported credibility tests in six types of sham EA methods and the results were mainly as follows: sham EA type A (10/24), type B (5/24) and type Q (5/24). Compared with sham EA controls, EA therapy in 56.2% trials reported the specific effects, of which the highest positive rate was observed in type N (3/4), type F (5/7), type D (4/6) and type M (2/3). In conclusion, several sham EA types were identified as a promising candidate for further application in RCTs. Nonetheless, more evidence for inert and concealable sham EA control methods is needed.
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Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. THE JOURNAL OF PAIN 2016; 17:131-57. [PMID: 26827847 DOI: 10.1016/j.jpain.2015.12.008] [Citation(s) in RCA: 1558] [Impact Index Per Article: 194.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief. Many preoperative, intraoperative, and postoperative interventions and management strategies are available for reducing and managing postoperative pain. The American Pain Society, with input from the American Society of Anesthesiologists, commissioned an interdisciplinary expert panel to develop a clinical practice guideline to promote evidence-based, effective, and safer postoperative pain management in children and adults. The guideline was subsequently approved by the American Society for Regional Anesthesia. As part of the guideline development process, a systematic review was commissioned on various aspects related to various interventions and management strategies for postoperative pain. After a review of the evidence, the expert panel formulated recommendations that addressed various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. The recommendations are based on the underlying premise that optimal management begins in the preoperative period with an assessment of the patient and development of a plan of care tailored to the individual and the surgical procedure involved. The panel found that evidence supports the use of multimodal regimens in many situations, although the exact components of effective multimodal care will vary depending on the patient, setting, and surgical procedure. Although these guidelines are based on a systematic review of the evidence on management of postoperative pain, the panel identified numerous research gaps. Of 32 recommendations, 4 were assessed as being supported by high-quality evidence, and 11 (in the areas of patient education and perioperative planning, patient assessment, organizational structures and policies, and transitioning to outpatient care) were made on the basis of low-quality evidence. PERSPECTIVE This guideline, on the basis of a systematic review of the evidence on postoperative pain management, provides recommendations developed by a multidisciplinary expert panel. Safe and effective postoperative pain management should be on the basis of a plan of care tailored to the individual and the surgical procedure involved, and multimodal regimens are recommended in many situations.
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Analgesic Neural Circuits Are Activated by Electroacupuncture at Two Sets of Acupoints. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:3840202. [PMID: 27429635 PMCID: PMC4939346 DOI: 10.1155/2016/3840202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 11/17/2022]
Abstract
To investigate analgesic neural circuits activated by electroacupuncture (EA) at different sets of acupoints in the brain, goats were stimulated by EA at set of Baihui-Santai acupoints or set of Housanli acupoints for 30 min. The pain threshold was measured using the potassium iontophoresis method. The levels of c-Fos were determined with Streptavidin-Biotin Complex immunohistochemistry. The results showed pain threshold induced by EA at set of Baihui-Santai acupoints was 44.74% ± 4.56% higher than that by EA at set of Housanli acupoints (32.64% ± 5.04%). Compared with blank control, EA at two sets of acupoints increased c-Fos expression in the medial septal nucleus (MSN), the arcuate nucleus (ARC), the nucleus amygdala basalis (AB), the lateral habenula nucleus (HL), the ventrolateral periaqueductal grey (vlPAG), the locus coeruleus (LC), the nucleus raphe magnus (NRM), the pituitary gland, and spinal cord dorsal horn (SDH). Compared with EA at set of Housanli points, EA at set of Baihui-Santai points induced increased c-Fos expression in AB but decrease in MSN, the paraventricular nucleus of the hypothalamus, HL, and SDH. It suggests that ARC-PAG-NRM/LC-SDH and the hypothalamus-pituitary may be the common activated neural pathways taking part in EA-induced analgesia at the two sets of acupoints.
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Chao MT, Chang A, Reddy S, Harrison JD, Acquah J, Toveg M, Santana T, Hecht FM. Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness-implementation study. JOURNAL OF INTEGRATIVE MEDICINE 2016; 14:228-38. [PMID: 27181130 PMCID: PMC5050044 DOI: 10.1016/s2095-4964(16)60252-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Effective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials (RCTs) support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown. METHODS/DESIGN In partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco's Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to: (1) assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and (2) evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a two-month pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders. DISCUSSION Effectiveness research in "real-world" practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide clinical acupuncture services and maintain a rigorous research design, practice-based trials of acupuncture require careful planning and attention to setting-specific, contextual factors. TRIAL REGISTRATION This trial has been registered in ClinicalTrials.gov. The identifier is NCT01988194, registered on November 5, 2013.
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Affiliation(s)
- Maria T. Chao
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
- Division of General Internal Medicine at the Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Chang
- Departments of Anesthesiology and Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Sanjay Reddy
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - James D. Harrison
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joseph Acquah
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Miria Toveg
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Trilce Santana
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Frederick M. Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
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Janakiraman N, Johnson M. Ethanol Extracts of Selected Cyathea Species Decreased Cell Viability and Inhibited Growth in MCF 7 Cell Line Cultures. J Acupunct Meridian Stud 2016; 9:151-5. [PMID: 27342889 DOI: 10.1016/j.jams.2016.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/30/2022] Open
Abstract
Cancer is the cause of more than 6 million deaths worldwide every year. For centuries, medicinal plants have been used in the treatment of cancer. Chemotherapy, radiotherapy, surgery and acupuncture point stimulation are also used to treat cancer. The present study was intended to reveal the cytotoxic and anticancer potential of selected Cyathea species and to highlight their importance in the pharmaceutical industry for the development of cost-effective drugs. Cytotoxic studies using brine shrimp lethality bioassays and MCF 7 cell line cultures were carried out. Compared to petroleum ether, chloroform and acetone extracts, the ethanol extracts of selected Cyathea species were found to be more effective against brine shrimps. The ethanol extracts were further subjected to 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell proliferation assays. A decrease in cell viability and an increase in growth inhibition were observed for the MCF 7 cell line. The maximum percentage of cell inhibition was observed in Cyathea crinit, followed by Cyathea nilgirensis and Cyathea gigantea. The results of the present study suggest that Cyathea species are an effective source of cytotoxic compounds.
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Affiliation(s)
- Narayanan Janakiraman
- Centre for Plant Biotechnology, Department of Botany, St. Xavier's College (Autonomous), Palayamkottai, Tamil Nadu, India
| | - Marimuthu Johnson
- Centre for Plant Biotechnology, Department of Botany, St. Xavier's College (Autonomous), Palayamkottai, Tamil Nadu, India.
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Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC. Effects of Acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy on Symptom Management and Quality of Life for Cancer Patients: A Meta-Analysis. J Pain Symptom Manage 2016; 51:728-747. [PMID: 26880252 DOI: 10.1016/j.jpainsymman.2015.11.027] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Most cancer patients suffer from both the disease itself and symptoms induced by conventional treatment. Available literature on the clinical effects on cancer patients of acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy (TCM-FEMT) reports controversial results. OBJECTIVES The primary objective of this meta-analysis was to evaluate the effect of acupuncture, Tuina, Tai Chi, Qigong, and TCM-FEMT on various symptoms and quality of life (QOL) in patients with cancer; risk of bias for the selected trials also was assessed. METHODS Studies were identified by searching electronic databases (MEDLINE via both PubMed and Ovid, Cochrane Central, China National Knowledge Infrastructure, Chinese Scientific Journal Database, China Biology Medicine, and Wanfang Database). All randomized controlled trials (RCTs) using acupuncture, Tuina, Tai Chi, Qigong, or TCM-FEMT published before October 2, 2014, were selected, regardless of whether the article was published in Chinese or English. RESULTS We identified 67 RCTs (5465 patients) that met our inclusion criteria to perform this meta-analysis. Analysis results showed that a significant combined effect was observed for QOL change in patients with terminal cancer in favor of acupuncture and Tuina (Cohen's d: 0.21-4.55, P < 0.05), whereas Tai Chi and Qigong had no effect on QOL of breast cancer survivors (P > 0.05). The meta-analysis also demonstrated that acupuncture produced small-to-large effects on adverse symptoms including pain, fatigue, sleep disturbance, and some gastrointestinal discomfort; however, no significant effect was found on the frequency of hot flashes (Cohen's d = -0.02; 95% CI = -1.49 to 1.45; P = 0.97; I(2) = 36%) and mood distress (P > 0.05). Tuina relieved gastrointestinal discomfort. TCM-FEMT lowered depression level. Tai Chi improved vital capacity of breast cancer patients. High risk of bias was present in 74.63% of the selected RCTs. Major sources of risk of bias were lack of blinding, allocation concealment, and incomplete outcome data. CONCLUSION Taken together, although there are some clear limitations regarding the body of research reviewed in this study, a tentative conclusion can be reached that acupuncture, Tuina, Tai Chi, Qigong, or TCM-FEMT represent beneficial adjunctive therapies. Future study reporting in this field should be improved regarding both method and content of interventions and research methods.
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Affiliation(s)
- Wei-Wei Tao
- College of Nursing, Dalian Medical University, Dalian, People's Republic of China.
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, People's Republic of China
| | - Xiao-Mei Tao
- Beijing Shijitan Hospital, Beijing, People's Republic of China
| | - Ping Jiang
- Graduate School, Dalian Medical University, Dalian, People's Republic of China.
| | - Li-Yan Sha
- College of Nursing, Dalian Medical University, Dalian, People's Republic of China
| | - Xian-Ce Sun
- College of Public Health, Dalian Medical University, Dalian, People's Republic of China
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Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:2126416. [PMID: 27073400 PMCID: PMC4814664 DOI: 10.1155/2016/2126416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 01/07/2023]
Abstract
The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.
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The Efficacy of Acupuncture in Post-Operative Pain Management: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0150367. [PMID: 26959661 PMCID: PMC4784927 DOI: 10.1371/journal.pone.0150367] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/12/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Postoperative pain resulting from surgical trauma is a significant challenge for healthcare providers. Opioid analgesics are commonly used to treat postoperative pain; however, these drugs are associated with a number of undesirable side effects. OBJECTIVE This systematic review and meta-analysis evaluated the effectiveness of acupuncture and acupuncture-related techniques in treating postoperative pain. DATA SOURCE MEDLINE, Cochrane Library, and EMBASE databases were searched until Sep 30, 2014. STUDY ELIGIBILITY CRITERIA Randomized controlled trials of adult subjects (≥ 18 years) who had undergone surgery and who had received acupuncture, electroacupuncture, or acupoint electrical stimulation for managing acute post-operative pain were included. RESULTS We found that patients treated with acupuncture or related techniques had less pain and used less opioid analgesics on Day 1 after surgery compared with those treated with control (P < 0.001). Sensitivity analysis using the leave-one-out approach indicated the findings are reliable and are not dependent on any one study. In addition, no publication bias was detected. Subgroup analysis indicated that conventional acupuncture and transcutaneous electric acupoint stimulation (TEAS) were associated with less postoperative pain one day following surgery than control treatment, while electroacupuncture was similar to control (P = 0.116). TEAS was associated with significantly greater reduction in opioid analgesic use on Day 1 post surgery than control (P < 0.001); however conventional acupuncture and electroacupuncture showed no benefit in reducing opioid analgesic use compared with control (P ≥ 0.142). CONCLUSION Our findings indicate that certain modes of acupuncture improved postoperative pain on the first day after surgery and reduced opioid use. Our findings support the use of acupuncture as adjuvant therapy in treating postoperative pain.
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Chiu H, Hsieh Y, Tsai P. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12457] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 02/06/2023]
Affiliation(s)
- H.Y. Chiu
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - Y.J. Hsieh
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
| | - P.S. Tsai
- School of Nursing; College of Nursing; Taipei Medical University; Taipei Taiwan
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Nutrition, exercise, and complementary medicine: potential role in mesothelioma? CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0133-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ben-Arye E, Samuels N. Patient-centered care in lung cancer: exploring the next milestones. Transl Lung Cancer Res 2015; 4:630-4. [PMID: 26629435 DOI: 10.3978/j.issn.2218-6751.2015.03.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In this editorial, the authors comment on a recently published review paper by Molassiotis et al. on the developments made over the past 40 years in supportive care for patients with lung cancer. During this period, a paradigm shift promoting patient-centered care (PCC) has led to an important change in the approach of supportive cancer care, from a purely disease-centered approach, measuring survival-related outcomes, to recognizing the importance of quality of life outcomes as well. This change of understanding in supportive and palliative care for patients with lung cancer can be further advanced through the understanding that there is a need to address bio-psycho-spiritual concerns and health belief models, within the context of the family socio-cultural environment, for both patients and their caregivers. There is also a need to address the psycho-spiritual effects of cancer on those health care professionals treating patients with lung cancer, in order to reduce compassion fatigue and increase resilience. Future directions for supportive care for patients with lung cancer may include the development of a patient-tailored treatment approach, assisted by the integration of a multidisciplinary team of health care providers and evidence-based complementary medicine practices, within conventional supportive care practice.
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Affiliation(s)
- Eran Ben-Arye
- 1 Integrative Oncology Program, The Oncology Service and Lin Medical center, Clalit Health Services, Haifa and Western Galilee District, Israel ; 2 Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa and Western Galilee District, Israel ; 3 Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Noah Samuels
- 1 Integrative Oncology Program, The Oncology Service and Lin Medical center, Clalit Health Services, Haifa and Western Galilee District, Israel ; 2 Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel and Clalit Health Services, Haifa and Western Galilee District, Israel ; 3 Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
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Comachio J, Oliveira Magalhães M, Nogueira Burke T, Vidal Ramos LA, Peixoto Leão Almeida G, Silva APMCC, Ferreira de Meneses SR, Costa-Frutuoso JR, Santos Miotto Amorim C, Pasqual Marques A. Efficacy of acupuncture and electroacupuncture in patients with nonspecific low back pain: study protocol for a randomized controlled trial. Trials 2015; 16:469. [PMID: 26472590 PMCID: PMC4608106 DOI: 10.1186/s13063-015-0850-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/03/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Previous studies have shown that acupuncture and electroacupuncture (EA) are effective in the treatment of patients with low back pain. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effect of acupuncture and electroacupuncture in the treatment of pain and disability in patients with chronic nonspecific low back pain. METHODS/DESIGN The study design is a randomized controlled trial. Patients with nonspecific chronic low back pain of more than three months duration are recruited at Rehabilitation Center of Taboao da Serra - SP (Brazil). After examination, sixty-six patients will be randomized into one of two groups: acupuncture group (AG) (n = 33) and electroacupuncture group (EG) (n = 33). Interventions will last one hour, and will happen twice a week for 6 weeks. The primary clinical outcomes will be pain intensity as measured and functional disability. SECONDARY OUTCOMES quality of pain, quality of life. perception of the overall effect, depressive state, flexibility and kinesiophobia. All the outcomes will be assessed will be assessed at baseline, at treatment end, and three months after treatment end. Significance level will be determined at the 5 % level. Results of this trial will help clarify the value of acupuncture and electroacupuncture as a treatment for chronic low back pain and if they are different. DISCUSSION Results of this trial will help clarify the value of acupuncture needling and electroacupuncture stimulation of specific points on the body as a treatment for chronic low back pain. TRIAL REGISTRATION Clinicaltrials.gov: NCT02039037 . Register October 30, 2013.
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Affiliation(s)
- Josielli Comachio
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Mauricio Oliveira Magalhães
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Thomaz Nogueira Burke
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | | | | | - Ana Paula M C C Silva
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Sarah Rúbia Ferreira de Meneses
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Jecilene Rosana Costa-Frutuoso
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Cinthia Santos Miotto Amorim
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
| | - Amélia Pasqual Marques
- Department of Physical Therapy, Communication Science & Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil.
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Electroacupuncture for postoperative pain and gastrointestinal motility after laparoscopic appendectomy (AcuLap): study protocol for a randomized controlled trial. Trials 2015; 16:461. [PMID: 26466590 PMCID: PMC4606555 DOI: 10.1186/s13063-015-0981-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/28/2015] [Indexed: 01/26/2023] Open
Abstract
Background Acupuncture is a widely serviced complementary medicine. Although acupuncture is suggested for managing postoperative ileus and pain, supporting evidence is weak. The AcuLap trial is designed to provide high-level evidence regarding whether or not electroacupuncture is effective in promoting gastrointestinal motility and controlling pain after laparoscopic surgery. Methods/design This study is a prospective randomized controlled trial with a three-arm, parallel-group structure evaluating the efficacy of electroacupuncture for gastrointestinal motility and postoperative pain after laparoscopic appendectomy. Patients with appendicitis undergoing laparoscopic surgery are included and randomized into three groups: 1) electroacupuncture group, 2) sham acupuncture group, and 3) control group. Patients receive 1) acupuncture with electrostimulation or 2) fake electroacupuncture with sham device twice a day or 3) no acupuncture after laparoscopic appendectomy. The primary outcome is time to first passing flatus after operation. Secondary outcomes include postoperative pain, analgesics, nausea/vomiting, bowel motility, time to tolerable diet, complications, hospital stay, readmission rates, time to recovery, quality of life, medical costs, and protocol failure rate. Patients and hospital staff (physicians and nurses) are blinded to which group the patient is assigned, electroacupuncture or sham acupuncture. Data analysis personnel are blinded to group assignment among all three groups. Estimated sample size to detect a minimum difference of time to first flatus with 80 % power, 5 % significance, and 10 % drop rate is 29 × 3 groups = 87 patients. Analysis will be performed according to the intention-to-treat principle. Discussion The AcuLap trial will provide evidence on the merits and/or demerits of electroacupuncture for bowel motility recovery and pain relief after laparoscopic appendectomy. Trial registration The trial was registered in Clinical Research Information Service (CRiS), Republic of Korea (KCT0001486) on 14 May 2015.
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Liu XL, Tan JY, Molassiotis A, Suen LKP, Shi Y. Acupuncture-Point Stimulation for Postoperative Pain Control: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:657809. [PMID: 26568767 PMCID: PMC4620376 DOI: 10.1155/2015/657809] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/19/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of Acupuncture-point stimulation (APS) in postoperative pain control compared with sham/placebo acupuncture or standard treatments (usual care or no treatment). Only randomized controlled trials (RCTs) were included. Meta-analysis results indicated that APS interventions improved VAS scores significantly and also reduced total morphine consumption. No serious APS-related adverse effects (AEs) were reported. There is Level I evidence for the effectiveness of body points plaster therapy and Level II evidence for body points electroacupuncture (EA), body points acupressure, body points APS for abdominal surgery patients, auricular points seed embedding, manual auricular acupuncture, and auricular EA. We obtained Level III evidence for body points APS in patients who underwent cardiac surgery and cesarean section and for auricular-point stimulation in patients who underwent abdominal surgery. There is insufficient evidence to conclude that APS is an effective postoperative pain therapy in surgical patients, although the evidence does support the conclusion that APS can reduce analgesic requirements without AEs. The best level of evidence was not adequate in most subgroups. Some limitations of this study may have affected the results, possibly leading to an overestimation of APS effects.
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Affiliation(s)
- Xian-Liang Liu
- 10th People's Hospital of Tongji University, 301 Yanchang Road, Shanghai 200072, China
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 1100 Nudgee Road, Banyo, Brisbane, QLD 4014, Australia
- School of Nursing, Jinggangshan University, 28 Xueyuan Road, Ji'an 343009, China
| | - Jing-Yu Tan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lorna K. P. Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Yan Shi
- 10th People's Hospital of Tongji University, 301 Yanchang Road, Shanghai 200072, China
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Jun MH, Kim YM, Kim JU. Modern acupuncture-like stimulation methods: a literature review. Integr Med Res 2015; 4:195-219. [PMID: 28664127 PMCID: PMC5481834 DOI: 10.1016/j.imr.2015.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/18/2022] Open
Abstract
Acupuncture therapy has been proved to be effective for diverse diseases, symptoms, and conditions in numerous clinical trials. The growing popularity of acupuncture therapy has triggered the development of modern acupuncture-like stimulation devices (ASDs), which are equivalent or superior to manual acupuncture with respect to safety, decreased risk of infection, and facilitation of clinical trials. Here, we aim to summarize the research on modern ASDs, with a focus on featured devices undergoing active research and their effectiveness and target symptoms, along with annual publication rates. We searched the popular electronic databases Medline, PubMed, the Cochrane Library, and Web of Science, and analyzed English-language studies on humans. Thereby, a total of 728 studies were identified, of which 195 studies met our inclusion criteria. Electrical stimulators were found to be the earliest and most widely studied devices (133 articles), followed by laser (44 articles), magnetic (16 articles), and ultrasound (2 articles) stimulators. A total of 114 studies used randomized controlled trials, and 109 studies reported therapeutic benefits. The majority of the studies (32%) focused on analgesia and pain-relief effects, followed by effects on brain activity (16%). All types of the reviewed ASDs were associated with increasing annual publication trends; specifically, the annual growth in publications regarding noninvasive stimulation methods was more rapid than that regarding invasive methods. Based on this observation, we anticipate that the noninvasive or minimally invasive ASDs will become more popular in acupuncture therapy.
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Affiliation(s)
| | | | - Jaeuk U. Kim
- Corresponding author. KM Fundamental Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdaero, Yuseong-Gu, Deajeon 305-811, Korea.
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Kang HJ, Yoon JW, Park JH, Cho CK, Yoo HS. Cancer pain control for advanced cancer patients by using autonomic nerve pharmacopuncture. J Pharmacopuncture 2015; 17:62-9. [PMID: 25780711 PMCID: PMC4332014 DOI: 10.3831/kpi.2014.17.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022] Open
Abstract
Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP) treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP) along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae) to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases) with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12 ─ 20 mL injection) of each patient’s dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS) for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain.
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Affiliation(s)
- Hwi-Joong Kang
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Jung-Won Yoon
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Ji-Hye Park
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Chong-Kwan Cho
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Hwa-Seung Yoo
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
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Zhang Q, Gao Z, Wang H, Ma L, Guo F, Zhong H, Xiong L, Wang Q. The effect of pre-treatment with transcutaneous electrical acupoint stimulation on the quality of recovery after ambulatory breast surgery: a prospective, randomised controlled trial. Anaesthesia 2014; 69:832-9. [PMID: 24865978 DOI: 10.1111/anae.12639] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
Electroacupuncture has been demonstrated to be effective at alleviating pain and postoperative side-effects. Our aim was to investigate whether transcutaneous electric acupoint stimulation, a low-skill alternative to needle-based electroacupuncture, could improve the quality of recovery after ambulatory surgery. Seventy-two women scheduled for cosmetic breast surgery were randomly allocated to transcutaneous electric acupoint stimulation or sham groups. Patients in the transcutaneous electric acupoint stimulation group received 30 min of electrical stimulation at three acupoints located on the hand and forearm before the induction of general anaesthesia. We found significant mean (SD) differences between the transcutaneous electric acupoint stimulation and sham groups in the mean (SD) length of recovery room stay (35.6 (12.9) min vs 48.3 (16.3) min, p = 0.01), time to removal of the laryngeal mask airway (10.2 (2.5) min vs 17.8 (4.4) min, p = 0.01), and time to reorientation of the patient (14.6 (3.2) min vs 26.5 (5.0) min, p = 0.01). Further, postoperative pain scores and the incidence of side-effects were all lower in the transcutaneous electric acupoint stimulation group. In conclusion, transcutaneous electric acupoint stimulation can significantly improve the quality of recovery and decrease the incidence of anaesthesia-related side-effects for patients undergoing ambulatory surgery.
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Affiliation(s)
- Q Zhang
- Department of Anaesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China; Department of Anaesthesiology, Shaanxi Provincial Maternal and Child Health Hospital, Xi'an, Shaanxi, China
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Wang H, Xie Y, Zhang Q, Xu N, Zhong H, Dong H, Liu L, Jiang T, Wang Q, Xiong L. Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial. Br J Anaesth 2014; 112:1075-82. [PMID: 24576720 DOI: 10.1093/bja/aeu001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint stimulation (TEAS) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects. METHODS Sixty patients undergoing sinusotomy were randomly assigned to TEAS or control group. TEAS consisted of 30 min of stimulation (6-9 mA, 2/10 Hz) on the Hegu (LI4), Neiguan (PC6), and Zusanli (ST36) before anaesthesia. The patients in the control group had the electrodes applied, but received no stimulation. Bispectral index was used to monitor the depth of anaesthesia. Perioperative haemodynamics were recorded, and peripheral blood samples were collected to measure the levels of mediators of surgical stress. The primary end point was intraoperative remifentanil consumption and the secondary endpoints were recovery quality and anaesthesia-related side-effects. RESULTS Patients in the TEAS group required 39% less remifentanil during surgery than controls [0.0907 (SD 0.026) μg kg(-1) min(-1) vs 0.051 (0.018) μg kg(-1) min(-1)]. There were no differences in intra-operative haemodynamics or surgical stress between groups. However, the time to extubation and recall in the control group was 16.8 (6.8) min and 23.0 (5.0) min, respectively, significantly longer than that in the TEAS group (P<0.01). TEAS also decreased the incidence of dizziness and pruritus within the first 24 h after surgery (P<0.01). CONCLUSION The use of TEAS significantly reduced intra-operative remifentanil consumption and alleviated postoperative side-effects in patients undergoing sinusotomy. CLINICAL TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (NCT01700855).
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Affiliation(s)
- H Wang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - Y Xie
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - Q Zhang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - N Xu
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - H Zhong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - H Dong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - L Liu
- Department of Anesthesiology, School of Medicine, Stony Brook University, New York, NY 11794-8480, USA
| | - T Jiang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - Q Wang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
| | - L Xiong
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 Shaanxi Province, People's Republic of China
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Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Greenlee H, Pietanza MC, Cassileth BR. Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e420S-e436S. [PMID: 23649450 DOI: 10.1378/chest.12-2364] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Physicians are often asked about complementary therapies by patients with cancer, and data show that the interest in and use of these therapies among patients with cancer is common. Therefore, it is important to assess the current evidence base on the benefits and risks of complementary therapies (modalities not historically used in modern Western medicine). METHODS A systematic literature review was carried out and recommendations were made according to the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines development methodology. RESULTS A large number of randomized controlled trials, systematic reviews, and meta-analyses, as well as a number of prospective cohort studies, met the predetermined inclusion criteria. These trials addressed many different issues pertaining to patients with lung cancer, such as symptoms of anxiety, mood disturbance, pain, quality of life, and treatment-related side effects. The available data cover a variety of interventions, including acupuncture, nutrition, mind-body therapies, exercise, and massage. The body of evidence supports a series of recommendations. An evidenced-based approach to modern cancer care should integrate complementary therapies with standard cancer therapies such as surgery, radiation, chemotherapy, and best supportive care measures. CONCLUSIONS Several complementary therapy modalities can be helpful in improving the overall care of patients with lung cancer.
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Affiliation(s)
- Gary E Deng
- Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Sarah M Rausch
- University of Florida College of Medicine, Jacksonville, FL
| | | | | | - Nagi B Kumar
- Moffitt Cancer Center and Research Institute, Tampa, FL
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Abstract
Cancer pain is one of most prevalent symptoms in patients with cancer. Acupuncture and related techniques have been suggested for the management of cancer pain. The National Comprehensive Cancer Network guidelines for adult cancer pain recommends acupuncture, as one of several integrative interventions, in conjunction with pharmacologic intervention as needed. This review presents the latest available evidence regarding the use of acupuncture for cancer pain. It also provides "actionable" acupuncture protocols for specific cancer pain conditions and related symptoms in order to provide more clinically relevant solutions for clinicians and cancer patients with pain. These conditions include postoperative cancer pain, postoperative nausea and vomiting, postsurgical gastroparesis syndrome, opioid-induced constipation, opioid-induced pruritus, chemotherapy-induced neuropathy, aromatase inhibitor-associated joint pain, and neck dissection-related pain and dysfunction.
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Affiliation(s)
- Weidong Lu
- Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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Azad A, John T. Do randomized acupuncture studies in patients with cancer need a sham acupuncture control arm? J Clin Oncol 2013; 31:2057-8. [PMID: 23610109 DOI: 10.1200/jco.2012.47.8750] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, Palmer JL, Cohen L. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol 2013; 31:952-60. [PMID: 23341529 DOI: 10.1200/jco.2012.43.5818] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many cancer centers offer acupuncture services. To date, a comprehensive systematic review of acupuncture in cancer care has not been conducted. The purpose of this review was to evaluate the efficacy of acupuncture for symptom management in patients with cancer. METHODS Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 for prospective randomized clinical trials (RCT) evaluating acupuncture for symptom management in cancer care. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. Outcomes by symptom were designated as positive, negative, or unclear. RESULTS A total of 2,151 publications were screened. Of those, 41 RCTs involving eight symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance) met all inclusion criteria. One positive trial of acupuncture for chemotherapy-induced nausea and vomiting had low ROB. Of the remaining studies, eight had unclear ROB (four positive, three negative, and one with unclear outcomes). Thirty-three studies had high ROB (19 positive, 11 negative, and three with both positive and negative outcomes depending on the symptom). CONCLUSION Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.
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Affiliation(s)
- M Kay Garcia
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0462, Houston, TX 77030, USA
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Leung L. Neurophysiological Basis of Acupuncture-induced Analgesia—An Updated Review. J Acupunct Meridian Stud 2012; 5:261-70. [DOI: 10.1016/j.jams.2012.07.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 11/28/2011] [Indexed: 12/12/2022] Open
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D'Alessandro E, de Brito C, Cecatto R, Saul M, Atta JA, Lin CA. Evaluation of acupuncture for cancer symptoms in a cancer institute in Brazil. Acupunct Med 2012; 31:23-6. [PMID: 23117345 DOI: 10.1136/acupmed-2012-010206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acupuncture has been progressively included in the practice of mainstream medicine in recent decades. The State of Sao Paulo Cancer Institute is a public hospital established in 2008 and its acupuncture service follows the experience and model of several oncology centres in the USA, aiming to optimise the treatment of symptoms such as postoperative pain, oncological pain, neuropathic pain, nausea, vomiting, xerostomia and fatigue induced by chemotherapy. This paper describes the population given acupuncture treatment and the effects of the intervention on symptom management. METHODS One hundred and eighty-three patients from our service were enrolled in the study. Baseline and final symptom intensity was recorded using a visual analogue score (VAS) ranging from 0 to 10 cm, with a higher score meaning higher symptom intensity. RESULTS Fifty-four (29.50%) were receiving active treatment with chemotherapy and/or radiotherapy, 29 (15.85%) were receiving hormone therapy and 100 (54.65%) were considered to be in remission. The main symptoms were: oncological pain in 44 (24.04%), chemotoxicity in 34 (18.6%), lumbar pain in 53 (28.96%) and chronic postoperative pain in 54 (28.4%). The mean (SD) initial symptom score was 7.04 (1.8), which was reduced to 2.56 (2.75) after treatment (p<0.001), an improvement of 63.6% in control of the symptoms. Further analysis of the data showed that the effect was similar in different indications for acupuncture treatment. CONCLUSIONS Use of acupuncture may have improved symptom control in patients enrolled in this study.
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Affiliation(s)
- Eduardo D'Alessandro
- Department of Internal Medicine, Sao Paulo State Institute of Cancer, São Paulo, SP 05403-000, Brazil.
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Utilization of and Attitudes towards Traditional Chinese Medicine Therapies in a Chinese Cancer Hospital: A Survey of Patients and Physicians. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:504507. [PMID: 23093982 PMCID: PMC3475319 DOI: 10.1155/2012/504507] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/10/2012] [Indexed: 02/07/2023]
Abstract
Background. In China, the use of traditional Chinese medicine (TCM) is very popular, but little is known about how it is integrated with conventional cancer care. We conducted parallel surveys of patients and physicians on TCM utilization. Methods. Two hundred forty-five patients and 72 allopathic physicians at the Fudan University Shanghai Cancer Center completed questions on their use of and attitude towards TCM. Results. Patient mean age was 51, with 60% female. Eighty-three percent of patients had used TCM. Use was greatest for Chinese herbal medicine (CHM; 55.8%). Only 1.3% of patients used acupuncture and 6.8% Qi Gong or Tai Qi. Sixty-three percent of patients notified their oncologist about TCM use. The most common reason for use was to improve immune function. CHM was often used with a goal of treating cancer (66.4%), a use that 57% of physicians agreed with. Physicians were most concerned with interference with treatment, lack of evidence, and safety. Ninety percent of physicians have prescribed herbs and 87.5% have used TCM themselves. Conclusion. The use of TCM by Chinese cancer patients is exceptionally high, and physicians are generally well informed and supportive of patients' use. Botanical agents are much more commonly used than acupuncture or movement-based therapies.
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