Treatment of the adverse effects from acupuncture and their economic impact: a prospective study in 73,406 patients with low back or neck pain

The Immediate Effects of Muscle Energy Technique in Chronic Low Back Pain Patients with Functional Leg Length Discrepancy: A Randomized and Placebo-Controlled Trial

This study was conducted to determine the effect of muscle energy technique (MET) on pelvic alignment, leg length, pain, and fatigue in chronic low back pain (CLBP) patients with leg length discrepancy (LLD). Forty-two CLBP patients with LLD volunteered to participate and were randomly assigned to the MET group (n = 21) and placebo group (n = 21). The intervention group performed three METs with 5 s of isometric contraction and 30 s of rest once, and the placebo group performed three times the placebo-MET, maintaining the same posture as the MET group without muscle isometric contraction. X-ray equipment, tape measure, and visual analog scale were used to evaluate pelvic alignment, leg length, pain, and fatigue before and after each intervention. In comparison pre- and postintervention, only the MET group showed significant changes in pelvic alignment, leg length, pain, and fatigue (p < 0.05). In comparison between groups, there were significant differences in all variables (pelvic alignment, leg length, pain, fatigue) (p < 0.05). The results of this study confirmed the therapeutic effect of MET for improving pelvic alignment, functional LLD, pain, and fatigue in CLBP patients with functional LLD. Future research is needed to evaluate the long-term effect on more chronic low back pain patients.

Effectiveness of acupuncture as adjunctive therapy in type 2 diabetic: Study protocol for a randomized controlled trial

INTRODUCTION

The incidence of type 2 diabetes mellitus is increasing worldwide. The literature suggests that acupuncture is a possible complementary therapy for type 2 diabetes mellitus. This study aims to determine the effectiveness of acupuncture as an adjunctive therapy on homeostasis model assessment-insulin resistance (HOMA-IR), and health-related quality of life (HRQoL) in patients with type 2 diabetes mellitus.

MATERIALS AND METHODS

This randomized, double-blind, placebo controlled, and parallel design trial will be carried out in a public university teaching hospitals in Malaysia. Eligible type 2 diabetes mellitus subjects will be randomly assigned to receive either acupuncture (n = 30) or a placebo (n = 30). The intervention is carried out using press needle or press placebo on abdomen area (10 sessions of treatment). Both groups will continue with their routine diabetes care. Primary outcome of HOMA-IR will be measured at the time of recruitment (-week 0), and after completion of 10 sessions (week 7) of the treatment. Additionally, secondary outcome of HRQoL will be measured at the time of recruitment (-week 0), after completion of 5 sessions (week 3/4), and 10 sessions (week 7) of the treatment. Any adverse event will be recorded at every visit.

DISCUSSION

The findings of this study will provide important clinical evidence for the effect of acupuncture as adjunctive therapy on HOMA-IR, adiposity and HRQoL of type 2 diabetes mellitus.

TRIAL REGISTRATION NUMBER

NCT04829045.

Is acupuncture safe in the ICU? A systematic review and meta-analysis

Background and purpose

The safety of interventions for critically ill patients is a crucial issue. In recent years, several studies have treated critically ill patients with acupuncture. However, the safety of acupuncture in this setting remains to be systematically measured.

Methods

In May 2022, the electronic databases of PubMed and the Cochrane Library were searched for studies comparing acupuncture interventions to control interventions in critically ill patients. Study outcomes examined the incidence of severe adverse events (AEs), minor AEs, adverse reactions, ICU stays, and 28-day mortality.

Results

A total of 31 articles were analyzed, and no serious AEs related to acupuncture treatment were identified. No significant differences were found between the groups in the meta-analysis of minor AEs (risk ratio [RR] 5.69 [0.34, 96.60], P = 0.23, I2 = 76%). A reduced risk in the incidence of adverse reactions following acupuncture intervention was evidenced (RR 0.33 [0.22, 0.50], P = 0.00001, I2 = 44%). The patients in the acupuncture arm spent significantly less time in the intensive care unit (ICU) (Mean difference -1.45 [-11.94, -10.97], P = 0.00001, I2 = 56%) and also exhibited lower 28-day mortality rates (odds ratio 0.61 [0.48, 0.78], P = 0.0001, I2 = 0%).

Conclusion

There is no evidence to indicate a higher risk of severe or minor AEs in patients who receive acupuncture. Acupuncture demonstrated favorable results in both ICU stay and 28-day mortality measurements, in addition to presenting with fewer adverse reactions compared to routine ICU care. However, the low certainty of the evidence resulting from a high risk of bias in the included studies merits substantial consideration, and further research is still warranted.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142131, identifier: CRD42020142131.

TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface

The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

Acupuncture treatment vs. cognitive rehabilitation for post-stroke cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

Background

Cognitive impairment is one of the common sequelae after stroke, which not only hinders the recovery of patients but also increases the financial burden on families. In the absence of effective therapeutic measures, acupuncture treatment has been widely used in China to treat post-stroke cognitive impairment (PSCI), but the specific efficacy is unclear. Therefore, this review aimed to evaluate the true efficacy of acupuncture treatment in patients with PSCI.

Methods

We searched eight databases [PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China Biomedical Literature Database (CBM), China Science and Technology Journal (VIP) database, the China National Knowledge Infrastructure (CNKI) database, and Wan fang database] from the inception to May 2022 for randomized controlled trials (RCTs) related to acupuncture treatment combined with cognitive rehabilitation (CR) for PSCI. Two investigators independently used a pre-designed form to extract valid data from eligible RCTs. The risk of bias was assessed through tools provided by the Cochrane Collaboration. The meta-analysis was implemented through Rev Man software (version 5.4). The strength of the evidence obtained was evaluated using GRADE profiler software. Adverse events (AEs) were collected by reading the full text and used to evaluate the safety of acupuncture treatment.

Results

Thirty-eight studies involving a total of 2,971 participants were included in this meta-analysis. Overall, the RCTs included in this meta-analysis were poor in methodological quality. The combined results showed that acupuncture treatment combined with CR showed significant superiority compared to CR alone in terms of improving cognitive function [Mean Difference (MD) = 3.94, 95% confidence intervals (CI): 3.16-4.72, P < 0.00001 (MMSE); MD = 3.30, 95%CI: 2.53-4.07, P < 0.00001 (MoCA); MD = 9.53, 95%CI: 5.61-13.45, P < 0.00001 (LOTCA)]. Furthermore, the combination of acupuncture treatment and CR significantly improved patients' self-care ability compared to CR alone [MD = 8.66, 95%CI: 5.85-11.47, P < 0.00001 (MBI); MD = 5.24, 95%CI: 3.90-6.57, P < 0.00001 (FIM)]. Meanwhile, subgroup analysis showed that MMSE scores were not sufficiently improved in the comparison of electro-acupuncture combined with CR versus CR alone (MD = 4.07, 95%CI: -0.45-8.60, P = 0.08). However, we also observed that electro-acupuncture combined with CR was superior to the use of CR alone in improving MoCA and MBI scores in patients with PSCI [MD = 2.17, 95%CI: 0.65-3.70, P = 0.005 (MoCA); MD = 1.74, 95%CI: 0.13-3.35, P = 0.03 (MBI)]. There was no significant difference in the occurrence of adverse events (AE) between acupuncture treatment combined with CR and CR alone (P > 0.05). The certainty of the evidence was rated low level because of flaws in the study design and considerable heterogeneity among the included studies.

Conclusion

This review found that acupuncture treatment combined with CR may have a positive effect on improving cognitive function and self-care ability in PSCI patients. However, our findings should be treated with caution owing to the existence of methodological quality issues. High-quality studies are urgently required to validate our results in the future.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338905, identifier: CRD42022338905.

Low-Dose NSAIDs Efficacy in Orthopedic Applications

Non-steroidal anti-inflammatory drugs (NSAIDs) [cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) inhibitors] and COXIBs (the COX-2 selective inhibitors) may induce several potentially severe and life-threatening issues especially in elderly patients. The use of low-dose NSAIDs is associated with lower risk of side effects compared to the standard dosage. Low-dose NSAIDs could minimize the side effects of these drugs while maintaining their clinical efficacy and effectiveness. The present study evaluates the effectiveness and safety of low-dose NSAIDs in musculoskeletal applications.

Acupuncture in the management of trigeminal neuralgia

BACKGROUND

We aimed to assess the standing of acupuncture as a clinical tool in the management of trigeminal neuralgia against the current first-line drug treatment (carbamazepine) and the most effective surgery (microvascular decompression (MVD)).

METHODS

Data regarding efficacy, side effects and cost were compiled for each of these three modalities from the PubMed and Cochrane Library databases. Patient stress was estimated according to Holmes and Rahe's Social Readjustment Rating Scale (SRRS).

RESULTS

Acupuncture was not significantly more effective than its corresponding control (p = 0.088), but had the greatest efficacy (mean ± 95% confidence interval) of the modalities considered (86.5% ± 5.6% compared to surgery (79.3% ± 7.7%) and pharmacotherapy (71.7% ± 2.5%), respectively). Acupuncture also had fewer mean reported side effects (22.7% ± 5.9%) compared with surgery (25.3% ± 12.6%) and pharmacotherapy (88.8% ± 25.0%), and the lowest cost; after 5 years, the cost of acupuncture was estimated to be £750, compared to £1507.73 for carbamazepine and £4878.42 for MVD. Acupuncture was the least stressful according to the SRRS (53 points), whereas surgery was second most stressful (153 points) and pharmacotherapy was the most stressful intervention to patients (217 points).

CONCLUSION

Acupuncture appears more effective than pharmacotherapy or surgery. Statistical analysis of side effects was not possible due to inconsistent reporting protocols, but the data suggest that acupuncture is considerably safer than pharmacotherapy or surgery. Acupuncture also appears to be the least expensive therapeutic modality to deliver long-term (65 weeks onwards), and our analysis indicated that it was less stressful to patients than pharmacotherapy or surgery. Further study into these areas and the practicality of its availability in the UK National Health Service (NHS) and other health systems is recommended.

Effectiveness and safety of acupuncture and moxibustion for defecation dysfunction after sphincter-preserving surgery for rectal cancer: protocol for systematic review and meta-analysis

INTRODUCTION

Defecation dysfunction (DD) is one of the most common complications following sphincter-preserving surgery for rectal cancer. And there is no effective treatment of DD after sphincter-preserving surgery for rectal cancer. Although some studies suggested that acupuncture and moxibustion (AM) is effective and safe for DD after sphincter-preserving surgery for rectal cancer, lacking strong evidence, for instance, the relevant systematic review, meta-analysis and randomised controlled trial (RCT) of a large, multicentre sample, makes the effects and safety remain uncertain. The present protocol is described for a systematic review and meta-analysis to investigate the effectiveness and safety of AM for DD after sphincter-preserving surgery for rectal cancer.

METHODS AND ANALYSIS

We will search nine online databases from inception to 1 October 2019; the language of included trials will not be restricted. This study will include RCTs that performed AM as the main method of the experimental group for patients with DD after sphincter-preserving surgery for rectal cancer. Two of the researchers will independently select the studies, conduct risk of bias assessment and extract the data. We will use the fixed-effects model or random-effects model of RevMan V.5.2 software to analyse data synthesis. The risk ratios with 95% CIs and weighted mean differences or standardised mean differences with 95% CIs will be used to present the data synthesis outcome of dichotomous data respectively and the continuous data. Evidence quality of outcome will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

ETHICS AND DISSEMINATION

Ethical approval is not required in this secondary research evidence, and we will publish the results of this study in a journal or concerned conferences.

TRIAL REGISTRATION NUMBER

CRD42019140097.

Extensive pyomyositis of prevertebral muscles after acupuncture: Case report

Introduction

Severe infectious diseases that require surgery after acupuncture therapy are quite rare. There are only a few cases of pyomyositis following acupuncture reported in the literature. This paper presents a case of cervical pyomyositis developed after such treatment.

Case presentation

A 36-year-old man presented with swelling and pain in the posterior cervical region as well as high fever and torticollis, after having received three sessions of acupuncture therapy during the preceding weeks aimed to treat his neck stiffness. Ultrasound guided fine needle aspiration (FNA) and contrast-enhanced Computed Tomography (CT) were performed, which showed a large abscess along the paraspinal muscles. The symptoms were resolved after surgical treatment and antibiotherapy.

Conclusion

Although highly infrequent, pyomyositis is a probable complication of acupuncture. In order to minimise the risk of complications, strict hygenic precautions and knowledge of the human anatomy are mandatory to decrease the rate of complications of acupuncture.

The Effectiveness of Acupuncture for Plantar Heel Pain: A Systematic Review

Introduction

Plantar heel pain (PHP) is a common complaint, yet there are no definitive guidelines for its treatment. Acupuncture is increasingly used by podiatrists, and there is a need for evidence to validate this practice. It is acknowledged that PHP and acupuncture are both complex phenomena.

Method

A systematic review (PROSPERO no. CRD42012001881) of the effectiveness of acupuncture for PHP is presented. Quality of the studies was assessed by independent assessors with reference to Quality Index (QI), ‘STandards for Reporting Interventions in Controlled Trials of Acupuncture’ (STRICTA) and ‘CONsolidated Standards Of Reporting Trials’ (CONSORT) criteria. Pooling of data, or even close comparison of studies, was not performed.

Results

Five randomised controlled trials and three non-randomised comparative studies were included. High quality studies report significant benefits. In one, acupuncture was associated with significant improvement in pain and function when combined with standard treatment (including non-steroidal anti-inflammatory drugs). In another, acupuncture point PC7 improved pain and pressure pain threshold significantly more than LI4. Other papers were of lower quality but suggest benefits from other acupuncture approaches.

Conclusions

There is evidence supporting the effectiveness of acupuncture for PHP. This is comparable to the evidence available for conventionally used interventions, such as stretching, night splints or dexamethasone. Therefore acupuncture should be considered in recommendations for the management of patients with PHP. Future research should recognise the complexity of PHP, of acupuncture and of the relationship between them, to explore the optimum use and integration of this approach. There is a need for more uniformity in carrying out and reporting such work and the use of STRICTA is recommended.

Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews

BACKGROUND AND PURPOSE

Acupuncture is widely used in the treatment of hypertension, yet its efficacy and safety for hypertension remain controversial. This overview aimed to summarize the evidence on acupuncture for hypertension.

METHODS

Eight databases were searched. The Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were performed.

RESULTS

Fifteen systematic reviews (SRs) were identified. Methodological quality and quality of evidence were unsatisfactory. Acupuncture combined with Western medicine (WM) was superior to WM in systolic blood pressure (SBP) and diastolic blood pressure (DBP), efficacy rate, and traditional Chinese medicine (TCM) syndrome. Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM. Evidence regarding the benefit of acupuncture alone for SBP and DBP, efficacy rate and TCM syndrome was inconsistent. No serious adverse effects were identified.

CONCLUSION

High-quality SRs and randomized controlled trials (RCTs) are required.

Setting a research agenda for pediatric complementary and integrative medicine: A consensus approach

BACKGROUND

Pediatric use of complementary medicine (CM) is common and offers numerous research questions about diverse therapies and conditions. Although research priorities for pediatric CM have been identified, there was a need to update in light of the rapid evolution of the field.

METHODS

Building on previous work, we conducted an international, consensus-based 4-step modified Delphi process to develop and refine a pediatric CM research agenda, including on-line questionnaires and an in-person meeting. Participants included health care professionals, researchers, and educators.

RESULTS

We received 376 responses; participants included conventional and CM providers, researchers, educators, administrators, and policy-makers from 15 countries (Australia, Bangladesh, Belgium, Canada, China, Germany, India, Israel, Italy, New Zealand, Norway, Sri Lanka, The Netherlands, United Kingdom, and United States). While it was recognized that each region must set their own priorities based on use, access, and expertise, a "minimum set" for a pediatric CM research agenda was identified. After three rounds of surveys, participants identified the highest priorities for pediatric CM research as: (i) safety of CM therapies for infants, children, and adolescents; (ii) conditions for which CM use is highly prevalent and for which conventional medicine lacks safe, cost-effective therapies; iii) therapies/therapists to be examined for quality and reproducibility of interventions, comparative and cost effectiveness, dose, etc.; and iv) identification of relevant outcomes and outcome measurement tools.

CONCLUSIONS

The results of our study identify that "first do no harm" is the leading research priority for pediatric CM research, followed by more research on effectiveness of CM therapies for conditions not safely and effectively treated with conventional care. In order to improve pediatric health care, interdisciplinary collaborative approaches are needed between CM and conventional providers and researchers.

Health economic evidence gaps and methodological constraints in low back pain and neck pain: Results of the Research Agenda for Health Economic Evaluation (RAHEE) project

Despite the increased interest in economic evaluations, there are difficulties in applying the results of such studies in practice. Therefore, the "Research Agenda for Health Economic Evaluation" (RAHEE) project was initiated, which aimed to improve the use of health economic evidence in practice for the 10 highest burden conditions in the European Union (including low back pain [LBP] and neck pain [NP]). This was done by undertaking literature mapping and convening an Expert Panel meeting, during which the literature mapping results were discussed and evidence gaps and methodological constraints were identified. The current paper is a part of the RAHEE project and aimed to identify economic evidence gaps and methodological constraints in the LBP and NP literature, in particular. The literature mapping revealed that economic evidence was unavailable for various commonly used LBP and NP treatments (e.g., injections, traction, and discography). Even if economic evidence was available, many treatments were only evaluated in a single study or studies for the same intervention were highly heterogeneous in terms of their patient population, control condition, follow-up duration, setting, and/or economic perspective. Up until now, this has prevented economic evaluation results from being statistically pooled in the LBP and NP literature, and strong conclusions about the cost-effectiveness of LBP and NP treatments can therefore not be made. The Expert Panel identified the need for further high-quality economic evaluations, especially on surgery versus conservative care and competing treatment options for chronic LBP. Handling of uncertainty and reporting quality were considered the most important methodological challenges.

Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials

PURPOSE

Nonsteroidal anti-inflammatory drugs are a mainstay for medical treatment of chronic lower back pain (CLBP). Increased dose intervals for medication have been associated with increased patient adherence to prescriptions. The purpose of this clinical trial was to compare the efficacy and safety of a once daily dose of aceclofenac controlled release (CR) and a twice daily dose of aceclofenac for CLBP management.

MATERIALS AND METHODS

A prospective, randomized, single center, open-label clinical trial was performed to compare the efficacy and safety of aceclofenac CR (200 mg once daily) to aceclofenac dose (100 mg twice daily). Fifty patients in each group were enrolled for the study. The primary end point was Visual Analogue Scale (VAS) change at baseline to that at 2 weeks after medication and safety profiles. Also, change in quality of life measured by EuroQoL 5D (EQ-5D) and Oswestry Disability Index (ODI) functional score for the lumbar spine were also assessed.

RESULTS

Within groups at pre- and post-treatment, there were significant VAS reductions for aceclofenac CR and aceclofenac (p=0.028). EQ-5D increased significantly in both groups (p=0.037). ODI scores decreased significantly in both groups (p=0.012). However, there were no significant differences between aceclofenac CR and aceclofenac at pre- and post-treatment. Patients with aceclofenac CR showed significant increases in heartburn and indigestion and adverse gastrointestinal effects, compared to aceclofenac.

CONCLUSION

In patients with CLBP, aceclofenac CR and aceclofenac demonstrated significant symptomatic pain relief, improvement in quality of life and functional scores. Aceclofenac CR slightly increased gastrointestinal adverse effects, such as heartburn and indigestion.

Study of acupuncture for low back pain in recent 20 years: a bibliometric analysis via CiteSpace

Background

Acupuncture has been applied to relieve low back pain (LBP) in many countries. However, a bibliometric analysis of the global use of acupuncture for LBP is rare.

Objective

The aim of this study was to demonstrate the state of the art and trends concerning the global use of acupuncture for LBP in recent 20 years.

Methods

Literature relating to acupuncture for LBP from 1997 to 2016 was retrieved from Web of Science. CiteSpace was used to analyze country/institution, cited journals, authors/cited authors, cited references, and keywords. An analysis of counts and centrality was used to reveal publication outputs, countries/institutions, core journals, active authors, foundation references, hot topics, and frontiers.

Results

A total of 958 references were obtained, and the total number of publications continually increased over the investigated period. Journal articles (662) were the most frequently occurring document type. The most productive country and institution in this field was the USA (342) and Harvard University (47), respectively. The J Altern Complem Med (69) was the most productive journal, and Pain (636) was the most cocited journal, which reflected the nature of the research. The Haake’s (2007) article (cocitation counts: 130) and the Cherkin’s (2001) article (centrality: 0.59) were the most representative and symbolic references, with the highest cocitation number and centrality, respectively. Cherkin was the most influential author, with the highest number of publications of 25 and a cocitation number of 226. The four hot topics in acupuncture for LBP were research method, evaluation, economy, and comprehensive therapy. The three frontier topics were intervention, test reliability, and prevalence.

Conclusion

This study provides an insight into acupuncture for LBP and valuable information for acupuncture researchers to identify new perspectives on potential collaborators and cooperative institutions, hot topics, and research frontiers.

Acupuncture for patients with lumbar spinal stenosis: a randomised pilot trial

OBJECTIVE

To assess the safety and feasibility of acupuncture for participants with symptomatic lumbar spinal stenosis (LSS) in a pilot study.

METHODS

50 participants with a clinical and radiological diagnosis of LSS were randomised to receive acupuncture combined with usual care (acupuncture group), or usual care alone (control group). Participants in the acupuncture group were offered 12-16 sessions of manual acupuncture±electroacupuncture over 6 weeks and maintained their usual self-management. The control group was provided with physical therapy as required and maintained their usual self-management. The primary outcome was the change in back-specific functional status, as measured by the Oswestry disability index (ODI) at the 3-month follow-up. Secondary outcomes included symptoms and other relevant domains. Outcome assessors were not blinded.

RESULTS

39 participants (78%) completed the trial with 524 treatment visits. There were no significant differences between the two groups in back-specific function (ODI: mean difference -2.5, 95% CI -8.9 to 3.8). Pain in the back and/or leg showed small improvements at 3 months, while there were no significant differences in other secondary outcomes. The total number of adverse events was 61 (12% of 524 treatment visits). All but one were minor and transient. The one severe adverse event was deemed to be unrelated to acupuncture.

CONCLUSIONS

The study was feasible. Acupuncture combined with usual care did not confer significant functional improvements over usual care alone. Further randomised trials with adequate sample sizes and outcome assessor blinding are warranted to evaluate the role of acupuncture for LSS.

TRIAL REGISTRATION NUMBER

NCT01987622.

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists

OBJECTIVES

Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland.

METHODS

A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period.

RESULTS

In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to (≤) 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%.

DISCUSSION

While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment.

Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials

Background

Acupuncture and moxibustion have widely been used to treat lateral elbow pain (LEP). A comprehensive systematic review of randomized controlled trials (RCTs) including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.

Methods

Revised STRICTA (2010) criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. A total of 19 RCTs that compared acupuncture and/or moxibustion with sham acupuncture, another form of acupuncture, or conventional treatment were included.

Results

All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture. Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound. There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone.

Conclusion

Moderate quality studies suggest that acupuncture is more effective than sham acupuncture. Interpretations of findings regarding acupuncture vs. conventional treatment, and acupuncture and moxibustion combined vs. manual acupuncture alone are limited by the methodological qualities of these studies. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP.

Two sets of acupoint combination of similar functions engage shared neural representation: a functional magnetic resonance imaging study

OBJECTIVE

To investigate whether the neural representations underlying alternating two acupoint combinations (ACs) are the same or not.

METHODS

In this functional magnetic resonance imaging study, two sets of analgesia ACs were utilized, including Waiguan (TE5) and Qiuxu (GB40) for Group A, and Neiguan (PC6) and Taichong (LR3) for Group B, which are the most commonly adopted in clinical treatment. Each group had 20 healthy subjects. An experimental design was proposed, which consisted of a pre-needling resting phase, a needling phase and a post-needling resting phase. This paradigm optimally mimics the clinical protocol as well as focuses on both the stimulation and the resting periods. The results were subjected to general linear model analysis, conjunction analysis and the functional connectivity analysis.

RESULTS

The rostral anterior cingulated cortex was engaged in the initiative period of the acupuncture effect in both groups, and it was chosen as the seed region for the functional connectivity analysis for the following resting period. The results showed that several shared brain regions were involved in both groups, in particular the insula, amygdala and hypothalamus. Moreover, significant differences were located at the posterior cingulated cortex as revealed by a two sample -test (P<0.05, corrected). Other regions showed no significant differences. This finding was further supported by the spatial correlation analysis that the two groups were significantly correlated (r =0.51, P<0.01).

CONCLUSION

This preliminary research helps us understand the neurophysiological mechanisms of acupuncture when following clinical guidelines on ACs, as well as provides an important opportunity to develop better treatment strategies for reducing, or even preventing pain.

Acupuncture for lumbar spinal stenosis: a systematic review and meta-analysis

OBJECTIVES

Lumbar spinal stenosis (LSS) negatively affects patients' quality of life. No systematic review evaluating the effects and safety of acupuncture for this population is available. We aimed to evaluate evidence indicating the effectiveness and safety of acupuncture for LSS.

METHODS

We searched five English-language databases (EMBASE, MEDLINE, CENTRAL, CINAHL, and AMED) and one Chinese database (CAJ) for randomised controlled trials (RCTs) and non-randomised controlled clinical trials (CCTs) of needle acupuncture for LSS. CCTs were analyzed only in terms of safety and intervention-related information.

RESULTS

Six RCTs (n=582) and six CCTs, which were all from China and reported in Chinese, were included. High or uncertain risk of bias and clinical heterogeneity due to different acupuncture techniques were observed. All RCTs compared different combinations or techniques of acupuncture. None of the included studies mentioned safety issues. Acupuncture combined with other interventions and/or with additional stimulation increased the number of improved patients compared with acupuncture alone or relatively simpler stimulation (n=582; relative risk, 1.16; 95% confidence interval 1.08-1.25). Pain intensity, overall symptoms, and functional outcomes related to LSS and quality of life showed significantly favourable improvement in the treatment group compared with the control group, which lasted for up to 6 months post-treatment.

CONCLUSIONS

We found no conclusive evidence of the effectiveness and safety of acupuncture for LSS because of high or uncertain risk of bias and the limited generalisability of the included studies. Future trials using rigorous methodology, appropriate comparisons and clinically relevant outcomes should be conducted.

Acupuncture adverse events in China: a glimpse of historical and contextual aspects

The article by He and colleagues, "Adverse Events Following Acupuncture: A Systematic Review of the Chinese Literature for the Years 1956-2010" is an important and timely contribution. In this commentary, the article is reviewed and issues are highlighted about how to interpret and contextualize the results of their study. While their review has been well performed, certain areas have been identified where the results may be inaccurate due to problems in the reporting of original incidents. For example, potential problems were found in the reporting of the minor adverse event (AE) of fainting and the more serious AEs of pneumothorax and hepatitis. The article by He and colleagues highlights the issue that almost all AEs associated with acupuncture in the modern period are due to the administration of the therapy rather than the therapy itself. Future prospective studies can address some of the shortcomings identified in this review.

A Systematic Review of Cost-Effectiveness Analyses Alongside Randomised Controlled Trials of Acupuncture

Objective

To summarise the evidence on the cost-effectiveness of acupuncture.

Methods

We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted.

Results

Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs.

Conclusions

Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.

Acupuncture for the treatment of dry eye: a multicenter randomised controlled trial with active comparison intervention (artificial teardrops)

PURPOSE

To evaluate the effects of acupuncture compared to a control group using artificial tears.

METHODS

SETTING & DESIGN

multicenter randomised controlled trial (three local research hospitals of South Korea).

STUDY POPULATION

150 patients with moderate to severe dry eye.

INTERVENTION

Participants were randomly allocated into four weeks of acupuncture treatment (bilateral BL2, GB14, TE 23, Ex1, ST1, GB20, LI4, LI11 and single GV23) or to the artificial tears group (sodium carboxymethylcellulose).

MAIN OUTCOME MEASURE(S)

The ocular surface disease index (OSDI), tear film break-up time (TFBUT), Schirmer Ι test, visual analogue scale (VAS) for self-assessment of ocular discomfort, general assessment (by both acupuncture practitioners and participants) and quality of life (QOL) through the Measure Yourself Medical Outcome Profile-2 (MYMOP-2).

RESULTS

There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI (MD -16.11, 95% CI [-20.91, -11.32] with acupuncture and -15.37, 95% CI [-19.57, -11.16] with artificial tears; P = 0.419), VAS (acupuncture: -23.84 [-29.59, -18.09]; artificial tears: -22.2 [-27.24, -17.16], P = 0.530) or quality of life (acupuncture: -1.32 [-1.65, -0.99]; artificial tears: -0.96 [-1.32, -0.6], P = 0.42) immediately after treatment. However, compared with artificial tears group, the OSDI (acupuncture: -16.15 [-21.38, -10.92]; artificial tears: -10.76 [-15.25, -6.27], P = 0.030) and VAS (acupuncture: -23.88 [-30.9, -16.86]; artificial tears: -14.71 [-20.86, -8.55], P = 0.018) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment. TFBUT measurements increased significantly in the acupuncture group after treatment.

CONCLUSIONS

Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01105221.

Complementary and alternative medicine for rheumatoid arthritis and osteoarthritis: an overview of systematic reviews

This review critically evaluates the literature on complementary and alternative medicine (CAM) as treatment options for rheumatoid arthritis and osteoarthritis.

DESIGN

Electronic databases were searched to identify all relevant systematic reviews of the effectiveness of CAM in rheumatoid arthritis and osteoarthritis published between January 2010 and January 2011. Reviews were defined as systematic if they included explicit and repeatable inclusion and exclusion criteria for studies. Their methodological quality was assessed using the Oxman criteria for systematic reviews.

RESULTS

Five systematic reviews met our inclusion criteria. They all arrived at cautious conclusions. Four reviews were of high quality and one was burdened with high risk of bias. The evidence to support the effectiveness of CAM as a treatment option for rheumatoid arthritis and osteoarthritis is ambiguous.

Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: an overview of systematic reviews

Older patients with sexual dysfunction (SD) and/or erectile dysfunction (ED) often use complementary and alternative medicine (CAM). The aim of this overview of systematic reviews is to critically evaluate the evidence for or against the effectiveness of CAM. Six electronic databases were searched to identify all relevant systematic reviews (SRs). Their methodological quality was assessed independently by two reviewers using the Oxman score. Four SRs met our inclusion criteria. They evaluated: acupuncture, ginseng, maca and yohimbine. The methodological quality of all of the SRs was good. However, the primary studies were often associated with considerable risk of bias. Cautiously positive conclusions were drawn for yohimbine and ginseng as treatment options for ED. For acupuncture and maca the evidence was insufficient for ED and SD respectively. It is concluded that there is some encouraging evidence but more and better studies are required to establish the value of CAM for SD and ED.

Multiple psoas abscess formation after pharmacopuncture -a case report-

Acupuncture has been widely used in alternative medicine for pain relief but may have many complications due to lack of appropriate cares. Pharmacopuncture is a sort of acupuncture that injects a herbal ingredient through a thin tube for the purpose of combining the effects of the herb and acupuncture and it has many pitfalls. The agents used in pharmacopuncture are not refined for a desired effect and not produced by sterile standard processes under strict medical surveillance. We report a case of a 44-yr-old male patient who had multiple abscesses in the psoas region with fever, right low back and hip pain that began after the pharmacopuncture treatment. This case shows that although pharmacopuncture has been practiced widely, it is important that the appropriate aseptic technique should be used to prevent severe infections and other complications.