Acupuncture to treat common reproductive health complaints: An overview of the evidence

Trends and Patterns in Traditional Chinese Medicine Use Among Chinese Population in Late Adulthood: An Eight-Year Repeated Panel Survey

Traditional Chinese medicine (TCM), originated from China, is different from Western medicine in theory and practice. This study aimed to document the longitudinal trends and the patterns by demographical characteristics in the prevalence of TCM among the middle-aged and elderly Chinese population. This study used nationally representative longitudinal survey data from the China Health and Retirement Longitudinal Study (CHARLS), covering approximately 20,000 individuals in each panel survey from 2011 to 2018. The questions regarding medication use in the questionnaire was used to identify the TCM users. The prevalence of using TCM for treating chronic diseases among the patients with chronic diseases stabilized between 2011 and 2018, while the prevalence of TCM use for any purpose among the overall population climbed from 19.03% (95% CI 18.37% to 19.69%) in 2011 to 23.91% (95% CI 23.23% to 24.60%) in 2015. Moreover, the prevalence of TCM use for nonchronic conditions among the overall population increased during the same period as well. The TCM users were more likely to be females and city dwellers. The increasing prevalence of TCM use for any purpose among the overall population reflects the increasing influence and potentials of TCM by year. With the expected rising demand in TCM for the following decades in China, more clinical trials on safety and healthcare policy regarding TCM are merited in the future.

Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial

BACKGROUND

Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect).

METHOD

This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects.

RESULTS

Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported.

CONCLUSION

This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect.

Database combinations to retrieve systematic reviews in overviews of reviews: a methodological study

Background

When conducting an Overviews of Reviews on health-related topics, it is unclear which combination of bibliographic databases authors should use for searching for SRs. Our goal was to determine which databases included the most systematic reviews and identify an optimal database combination for searching systematic reviews.

Methods

A set of 86 Overviews of Reviews with 1219 included systematic reviews was extracted from a previous study. Inclusion of the systematic reviews was assessed in MEDLINE, CINAHL, Embase, Epistemonikos, PsycINFO, and TRIP. The mean inclusion rate (% of included systematic reviews) and corresponding 95% confidence interval were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking.

Results

Inclusion of systematic reviews was higher in MEDLINE than in any other single database (mean inclusion rate 89.7%; 95% confidence interval [89.0–90.3%]). Combined with reference checking, this value increased to 93.7% [93.2–94.2%]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (99.2% [99.0–99.3%]). Stratification by Health Technology Assessment reports (97.7% [96.5–98.9%]) vs. Cochrane Overviews (100.0%) vs. non-Cochrane Overviews (99.3% [99.1–99.4%]) showed that inclusion was only slightly lower for Health Technology Assessment reports. However, MEDLINE, Epistemonikos, and reference checking remained the best combination. Among the 10/1219 systematic reviews not identified by this combination, five were published as websites rather than journals, two were included in CINAHL and Embase, and one was included in the database ERIC.

Conclusions

MEDLINE and Epistemonikos, complemented by reference checking of included studies, is the best database combination to identify systematic reviews on health-related topics.

Using Acupuncture in Labor Pain and Childbirth-Related Issues: A Narrative Review

BACKGROUND

Latent threats, such as prolonged labor duration and postpartum hemorrhage, endanger women and newborns during and post childbirth, which produce burdens on natal care and public health expenditures. Acupuncture, a traditional Chinese medical practice, has increasingly been used for labor delivery in various countries to cope with these problems.

METHOD

This narrative review searched 29 English and Chinese electronic databases. Thirty-one empirical studies, carried out in Asia, America, Africa, the Middle East, Europe, and Australia were reviewed according to inclusion and exclusion criteria.

RESULTS

Acupuncture is adopted with positive signs toward labor pain relief, delivery mode, labor duration, postpartum hemorrhage, APGAR score (an evaluation for a neonatal evaluation), and birth weight.

DISCUSSION

With support of earlier studies, the satisfactory effects of acupuncture on labor delivery reviewed in this research have been noted by obstetric researchers and scholars, physicians, nurses, and midwives.

CONCLUSION

This review recommends the use of acupuncture in obstetric profession with respect to maternal-related healthcare.

Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study)

OBJECTIVE

To investigate the efficacy of a standardised brief acupuncture approach for women with moderate-to-severe menopausal symptoms.

DESIGN

Randomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded.

SETTING

Nine Danish primary care practices.

PARTICIPANTS

70 women with moderate-to-severe menopausal symptoms and nine general practitioners with accredited education in acupuncture.

INTERVENTION

The acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks.

MAIN OUTCOME MEASURES

Outcomes were the differences between the randomisation groups in changes to mean scores using the scales in the MenoScores Questionnaire, measured from baseline to week 6. The primary outcome was the hot flushes scale; the secondary outcomes were the other scales in the questionnaire. All analyses were based on intention-to-treat analysis.

RESULTS

36 participants received the intervention, and 34 participants were in the control group. Four participants dropped out before week 6. The acupuncture intervention significantly decreased hot flushes: Δ -1.6 (95% CI [-2.3 to -0.8]; p<0.0001), day-and-night sweats: Δ -1.2 (95% CI [-2.0 to -0.4]; p=0.0056), general sweating: Δ -0.9(95% CI [-1.6 to -0.2]; p=0.0086), menopausal-specific sleeping problems: Δ -1.8 (95% CI [-2.7 to -1.0]; p<0.0001), emotional symptoms: Δ -3.4 (95% CI [-5.3 to -1.4]; p=0.0008), physical symptoms: Δ -1.7 (95% CI [-3 to -0.4]; p=0.010) and skin and hair symptoms: Δ -1.5 (95% CI [-2.5 to -0.6]; p=0.0021) compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported.

CONCLUSIONS

The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported.

TRIAL REGISTRATION NUMBER

NCT02746497; Results.

Menopausal Hot Flashes: A Concise Review

Hot flashes (HFs), defined as transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1-5 min, constitute one of the most common symptoms of menopause among women though only a few seek treatment for these. The basis of HFs lies in abnormal hypothalamic thermoregulatory control resulting in abnormal vasodilatory response to minor elevations of core body temperature. Recent data suggest an important role for calcitonin gene-related peptide, hypothalamic kisspeptin, neurokinin B and dynorphin signal system, serotonin, norepinephrine in causation of HFs in addition to estrogen deficiency which plays a cardinal role. The mainstay of treatment includes hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors in addition to lifestyle modification. In this review, we address common issues related to menopause HFs and suggest a stepwise approach to their management.

Acupuncture and women's health: an overview of the role of acupuncture and its clinical management in women's reproductive health

BACKGROUND

Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years.

OBJECTIVE

This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health.

METHODS

A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary.

RESULTS

For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed.

CONCLUSION

There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.

Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview

Background: Acupuncture is being used increasingly to treat gynecologic and obstetric disorders. Objective: The aim of this review was to determine the efficacy and safety of acupuncture for treating pelvic and low-back pain during pregnancy, pain during labor, primary dysmenorrhea, and menopausal symptoms. Design: This is an overview of systematic reviews (SRs) and randomized controlled trials (RCTs). Search strategy: A literature search was conducted, in July 2010, in MEDLINE,® the Cochrane Database of Systematic Reviews, CENTRAL, the Database of Abstracts of Reviews of Effects, and Tripdatabase. Selection criteria: Published SRs and RCTs found during the literature search were included as well as RCTs that were published after completion of the literature search. Analysis: Data from SRs and RCTs that provided quantitative information were pooled. Results: Eight SRs and nine RCTs were included. One SR and 4 RCTs showed that acupuncture reduced pelvic and low-back pain, compared to physiotherapy or usual prenatal care. Results were contradictory when interventions were compared with sham acupuncture. With respect to reduction of pain during labor, two SRs showed no differences between acupuncture and sham acupuncture. None of the three SRs included on primary dysmenorrhea produced conclusive results. Two SRs of studies on menopausal symptoms showed no differences between acupuncture and sham acupuncture. A meta-analysis of three additional RCTs identified a favorable effect of acupuncture for reducing frequency and intensity of hot flashes. Adverse effects were mild and infrequent. Conclusions: Evidence for the efficacy of needle acupuncture for treating the disorders evaluated remains inconclusive. The intervention showed promising results for reducing pelvic and back pain during pregnancy and climacteric vasomotor symptoms, although well-designed studies are needed to make the results more precise and reliable.

Effects of acupuncture on the symptoms of anxiety and depression caused by premenstrual dysphoric disorder

OBJECTIVE

The objective of this investigation was to evaluate the effects of acupuncture and sham acupuncture on the symptoms of anxiety and depression brought on by premenstrual dysphoric disorder (PMDD).

METHODS

In a single-blind randomised clinical trial, 30 volunteers with PMDD were assigned alternately to group 1 (acupuncture) or group 2 (sham acupuncture), and completed an evaluation of symptoms of anxiety and depression using the Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) Rating Scales. The procedure was performed twice a week for two menstrual cycles, for a total of 16 attendances for each participant.

RESULTS

Before the intervention the mean HAM-A and HAM-D scores did not differ between groups. Following the intervention symptoms of anxiety and depression were reduced in both groups; however, the improvement was significant in group 1 compared to group 2, as shown by a mean reduction in HAM-A scores of 58.9% in group 1 and 21.2% in group 2 (p<0.001). The reduction in the mean HAM-D scores was 52.0% in group 1 and 19.6% in group 2, resulting in a significant difference (p=0.012).

CONCLUSIONS

The results suggest that acupuncture could be another treatment option for PMDD patients.

Does Traditional Chinese Medicine pattern affect acupoint specific effect? Analysis of data from a multicenter, randomized, controlled trial for primary dysmenorrhea

OBJECTIVES

This study assessed the importance of the Traditional Chinese Medicine (TCM) pattern on an acupoint-specific effect.

DESIGN

This was a TCM pattern subdivision analysis of the first intervention data from a multicenter, randomized, controlled trial (ISRCTN24863192) (the main trial).

SETTINGS

The main trial recruited participants from six hospitals in three provinces in China.

SUBJECTS

Five hundred and one (501) participants diagnosed with primary dysmenorrhea (PD) were enrolled in the main trial.

INTERVENTIONS

The main trial randomly and equally divided participants into three treatment groups with bilateral electroacupuncture at three sites, respectively: Sanyinjiao (SP6), Xuanzhong (GB39), and an adjacent nonacupoint. Participants were diagnosed with TCM patterns before the treatment. The intervention was carried out when the visual analogue scale (VAS) score of participant's menstrual pain was ≥ 40 mm on the first day of menstruation and lasted for 30 minutes.

OUTCOME MEASURES

The immediate improvement of pain was measured with a 100-mm VAS before the intervention, at 5 minutes, 10 minutes, and 30 minutes during the intervention, and at 30 minutes after the completion of this intervention.

RESULTS

Three (3) TCM patterns (n=320) were eligible for analysis, including Cold and Dampness Stagnation pattern (n=184), Qi and Blood Stagnation pattern (n=84), and Qi and Blood Deficiency pattern (n=52). In Cold and Dampness Stagnation pattern, the SP6 group had a significant reduction in VAS scores compared with the GB39 group (mean difference -7.6 mm) and the nonacupoint group (mean difference -8.2 mm), respectively. There was no difference between the latter two groups. There were no group differences in VAS scores in the other two patterns.

CONCLUSIONS

It suggested that TCM pattern might affect acupoint specific effect on the immediate pain relief obtained for participants with PD.

Exploring practice characteristics and research priorities of practitioners of traditional acupuncture in China and the EU-A survey

ETHNOPHARMACOLOGICAL RELEVANCE

Acupuncture practice is based on the theoretical, historical and philosophical principles, which are part of Chinese medicine. Traditional acupuncture practitioners assess their patients' conditions using Chinese medicine diagnostic techniques, which determine clinical care and treatment. Little is known about differences in the perceptions of research evidence among practitioners in the European Union (EU) and China, given the diversity of acupuncture practice.

MATERIAL AND METHODS

This study explored differences between practitioners of traditional acupuncture regarding perceived need for research evidence and prioritisation for future clinical trials, based on their practice within the EU and China. A convenience sample of acupuncturists in the EU (contacted by their professional organisation) and China (from geographically dispersed hospitals) were invited to participate in a survey, which was conducted during 2010/2011. Data collected included: practitioners' demographic details, country of training, practice setting, acupuncture techniques, perceived adverse event reporting, diagnostic methods, conditions commonly treated, conditions perceived as needing more evidence and practitioner perceptions of conditions which could demonstrate benefit if investigated in clinical trials.

RESULTS

From 1126 survey responses, 1020 (559 EU, 461 China) could be included in the analysis for direct comparison. A response rate for the EU could not be calculated but for China was 98%. Pain was the most frequently reported commonly treated condition by EU acupuncturists and neurological conditions (mainly stroke) for Chinese practitioners. The top reported priorities for research were obstetrics/gynaecological conditions in the EU and neurological problems in China.

CONCLUSION

The survey identified differences in practice and training between acupuncturists in China and the EU and between EU member states. These differences may inform prioritisation of health conditions for future trials. Innovative research methods are recommended to incorporate the complexity and plurality of acupuncture practice and theory. Creation of collaborative networks is crucial in overcoming these differences to facilitate international, multi-centre clinical trials.

Acupuncture might have contributed to improving amenorrhoea in a top athlete

A 26-year-old top female athlete (height 157 cm), who took part in competitive sport similar to middle- and long-distance running, became amenorrhoeic in February 2009. In late May 2009, athletic amenorrhoea was diagnosed and a norgestrel-ethinyl estradiol combination (norgestrel 0.5 mg and ethinyl estradiol 0.05 mg three times daily) was prescribed for 2 weeks. She experienced menstrual bleeding on one occasion for 4 days in mid-June before becoming amenorrhoeic again. The athlete visited our centre to try acupuncture treatment. Forty-six acupuncture sessions were given between 1 October 2009 and 2 November 2010. Acupuncture point selection was based on classical acupuncture medicine and included points long used for gynaecological disorders in Japan--namely, CV6, CV12, LR3, LR14, BL17, BL18, BL23, SP6 and SP10. On 7 May 2010, owing to lack of regular normal vaginal bleeding, she again consulted her gynaecologist and was prescribed the same hormone preparation as used previously. She took it for 2 weeks in conjunction with acupuncture treatment. From July, the amount and duration of menstrual flow increased at regular intervals. Throughout July, a biphasic pattern in basal body temperature (BBT) was gradually established. In conclusion, the single hormone replacement therapy in May 2009 without acupuncture treatment was not effective for the amenorrhoea, nor was the single acupuncture treatment between October 2009 and May 2010. However, after hormone replacement therapy was started in May 2010 in conjunction with regular acupuncture treatment, menstrual blood flow restarted and BBT moved close to the biphasic pattern.

The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews

Acupuncture is increasingly popular for the treatment of many medical complaints, including gynaecologic conditions. The aim of this study was to summarise the evidence from systematic reviews (SRs) and meta-analyses assessing the efficacy of acupuncture in treating common gynaecologic conditions. Six electronic databases, including two major English-language databases (PubMed and the Cochrane Library) and four Korean databases, were systematically searched for SRs and meta-analyses concerned with acupuncture and common gynaecologic diseases. The following English search terms were used: (gynaecologic disease in MeSH terms) AND (acupuncture or acup*) AND (systematic review OR meta-analysis). In addition, three Korean traditional medicine journals (The Journal of the Korean Acupuncture and Moxibustion Society, The Journal of Korean Oriental Medicine and The Journal of Oriental Obstetrics and Gynaecology) were searched. The quality of the included studies was assessed using the Overview Quality Assessment Questionnaire. Of the 55 potentially relevant studies that were found, 16 SRs were included in this report. These reviews evaluated the efficacy of acupuncture for treating the side effects of breast cancer chemotherapy, menstrual disturbances, menopausal symptoms, female infertility, uterine fibroids and polycystic ovary syndrome. Acupuncture was clearly beneficial in the management of chemotherapy-induced nausea and vomiting. In addition, current evidence suggests that acupuncture administered close to embryo transfer during in vitro fertilisation treatment improves the rates of pregnancy and live birth. In conclusion, there is no convincing evidence of the efficacy of acupuncture except for specific conditions, which include acupuncture administered with embryo transfer to improve the outcome of in vitro fertilisation and acupuncture for the management of chemotherapy-induced nausea and vomiting. More well-designed trials using rigorous methodology are required to evaluate the efficacy of acupuncture in treating gynaecologic conditions.