Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs

Acupuncture improves neurological function and anti-inflammatory effect in patients with acute ischemic stroke: A double-blinded randomized controlled trial

BACKGROUND AND PURPOSE

Acupuncture exerts an anti-inflammatory effect and is recommended by the World Health Organization as a complementary therapy for stroke. This study investigated the improvement in neurological function outcome in acute-stage intervention of acute ischemic stroke (AIS), and the anti-inflammatory effect of early acupuncture.

METHODS

Fifty patients with AIS were randomly assigned to either a control group (CG, 25 patients, received sham acupuncture) or treatment group (TG, 25 patients, received acupuncture treatment). Acupuncture intervention was administered twice a week for a total of 8 sessions over 4 consecutive weeks. The primary outcome was the changes in the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI) scores. The secondary outcome was the changes in serum inflammation-related biomarker levels.(ANAIS trial) RESULTS: A total of 35 patients (18 patients in the CG and 17 patients in the TG) completed the trial. The reduction in NIHSS scores was greater in the TG than in the CG between V2 (second assessment administered after acupuncture intervention) and V1 (first assessment administered before acupuncture intervention; 4.33 ± 1.91 vs. 2.68 ± 1.42, p = 0.005) and between V3 (third assessment administered 28 days after last acupuncture intervention) and V1 (6.00 ± 2.53 vs. 3.83 ± 2.31, p = 0.012). The increase in BI scores was greater in the TG than in the CG between V2 and V1 (28.89 ± 15.39 vs. 14.21 ± 19.38, p = 0.016) and between V3 and V1 (39.41 ± 20.98 vs. 25.00 ± 18.47, p = 0.038). Among participants with high inflammation, the increase in serum IL-12p70 level between V2 and V1 was greater in the TG than in the CG (0.20 ± 0.19 vs. -0.14 ± 0.30, pg/mL p = 0.006).

CONCLUSIONS

Acupuncture improved the neurological function of patients with AIS, and the relationship between acupuncture improving neurological function and anti-inflammatory effect needs further study. In addition, studies with larger sample sizes and longer follow-ups as well as multicenter clinical trials are expected in the future.

Evaluation of Newly Developed Sham Acupuncture Needle with a Special Focus on Needling Sensation: a Randomized Controlled Trial

Background

Most non-penetrating sham and placebo acupuncture needles comprise a traditional pedestal for fixing the guide tube that makes these needles difficult to operate independently. We developed a simple sham acupuncture needle to overcome this problem and focused on managing the needling sensation.

Objectives

To ascertain how differently participants feel sham and real needles and to evaluate whether sham needles are effective in clinical trials.

Methods

After enrolling 64 healthy volunteers who had experienced and were knowledgeable about acupuncture, the practitioner randomly used real and sham needles at four sites (bilateral LI4 and LI10) on the participants' forearms. A custom-made sham blunt stainless acupuncture needle (40 mm, 0.80 mm) that was inserted into a guide tube was used. Immediately after needling, the participants were questioned in regard to their identification of the needle, skin penetration sensation, and de qi.

Results

The sham needle resulted in 62.5% blinding. Inequivalent sensations were elicited by the sham needles compared to the real needles. Women reported similar needling sensations from the sham and real needles.

Conclusion

This study achieved comparatively higher sham-needle blinding and is therefore worthy of use in clinical trials. The mutual independence of the sham needle from the real needle was mediated presumably by interindividual differences among the participants and the needling sites. Sex differences in sensation were likely related to the blinding capability of the sham needle.

Contribution of Vision, Touch, and Hearing to the Use of Sham Devices in Acupuncture-Related Studies

This study investigates whether visual deprivation influences participants' accuracy in differentiating between real and sham acupuncture needles. It also evaluates the relative contributions of tactile, visual, and auditory cues that participants use in their decision-making processes. In addition, a simple sensory decision-making model for research using acupuncture sham devices as comparative controls is proposed. Forty healthy individuals underwent two conditions (blindfolded and sighted) in random sequence. Four sham and four real needles were randomly applied to the participants' lower limb acupoints (ST32 to ST39). Participants responded which needle type was applied. Participants then verbally answered a questionnaire on which sensory cues influenced their decision-making. The proportion of correct judgments, P(C), was calculated to indicate the participants' accuracy in distinguishing between the needle types. Visual deprivation did not significantly influence the participants' discrimination accuracy. Tactile cues were the dominant sensory modality used in decision-making, followed by visual and auditory cues. Sharp and blunt sensations were associated with the real and sham needles, respectively, for both conditions. This study confirmed that tactile cues were the main sensory modalities used in participant decision-making during acupuncture administration. Also, short-term blindfolding of participants during procedures will unlikely influence blinding effectiveness. CLINICAL TRIAL REGISTRATION NUMBER: Not applicable. This study does not fall under the definition of a clinical trial under the ICMJE guidelines.

Acupuncture Treatment for Symptom Management in Atopic Dermatitis: A Study Protocol for a Randomized, Participant- and Assessor-Blind, Sham-Controlled Trial

Atopic dermatitis (AD) is a chronic inflammatory skin disease with persistent itching, which impairs quality of life (QoL). Although various conventional treatments for AD exist, patients with AD often seek complementary and alternative therapies when conventional therapy has failed to relieve their AD symptoms or has had adverse effects. Acupuncture treatment may relieve AD symptoms, but controlled trials are needed to confirm this. Following our pilot study, which found that acupuncture treatment improves AD symptoms in mild-to-moderate AD patients, we will assess the effect of acupuncture treatment for symptom relief of AD using a trial with a complemented protocol. This is a two-arm, randomized, participant- and assessor-blinded, sham-controlled trial. A total of 36 mild-to-moderate AD patients will be randomly assigned in a 1:1 ratio to receive eight sessions twice weekly of either verum acupuncture (VA) or nonpenetrating sham acupuncture (SA) over four weeks. The primary outcome measured will be the change in the total Scoring Atopic Dermatitis (SCORAD) score. Secondary outcomes will be (1) changes in AD symptoms, QoL, dyspepsia symptoms, and electroencephalography (EEG) between baseline and week 4 and (2) changes in AD symptoms and QoL at baseline and at weeks 2, 4, and 8. This study will assess acupuncture treatment for the alleviation of AD symptoms in patients with mild-to-moderate AD. This clinical trial gas been registered in Korean Clinical Trial Registry (registration number: KCT0002796; date of registration: April 13, 2018).

Discrimination accuracy between real and sham press needles in the hands

OBJECTIVES

To evaluate the blinding effectiveness of a modified blunt sham press needle on the basis of the ability of subjects to discriminate between real and sham acupuncture needles compared with their discrimination ability based on pure guessing, and to define differences between senses (touch and vision) in the rates of correctly identified needles.

METHODS

Sixty-three healthy students and staff members were recruited through convenience sampling. First, real or sham acupuncture was randomly administered to the left LI4 point while subjects could not observe the needle tip. A real or sham needle tip was then shown to the subjects. Finally, a random combination of real or sham acupuncture needles were randomly administered to the left and right LI4 points, this time with the subjects observing the procedure. In all conditions the subjects gave their judgement as Yes or No in response to questions asking them to identify the needle type. The proportion of correct judgements (P(C)) was computed for the last part of the trial in left and right LI4 points, and the rates of correctly identified needles for each trial were obtained.

RESULTS

The subjects' accuracy of discrimination between the real and sham acupuncture needles in left and right LI4 points was not significantly different from that based on pure guess (P(C)=0.50 (chance level)), which indicates complete inability to discriminate between needles. The rates of correctly identified needles using touch, vision and a combination of both senses were not significantly different (p=0.807).

CONCLUSIONS

The findings from this study show that this sham acupuncture device successfully blinded subjects to real and sham press needles, suggesting that it is effective for subject blinding in studies on acupuncture using press needles, and facilitating evaluation of the effects of acupuncture in placebo-controlled trials using a rigorous scientific research methodology.

Acupuncture and assisted reproductive technology

BACKGROUND

Acupuncture is commonly undertaken during an assisted reproductive technology (ART) cycle although its role in improving live birth and pregnancy rates is unclear.

OBJECTIVES

To determine the effectiveness and safety of acupuncture as an adjunct to ART cycles for male and female subfertility.

SEARCH METHODS

All reports which described randomised controlled trials of acupuncture in assisted conception were obtained through searches of the Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, Ovid MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing & Allied Health Literature), AMED , www.clinicaltrials.gov (all from inception to July 2013), National Research Register, and the Chinese clinical trial database (all to November 2012).

SELECTION CRITERIA

Randomised controlled trials of acupuncture for couples who were undergoing ART, comparing acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo or sham acupuncture plus ART for the treatment of primary and secondary infertility. Women with medical illness that was deemed to contraindicate ART or acupuncture were excluded.

DATA COLLECTION AND ANALYSIS

Twenty randomised controlled trials were included in the review and nine were excluded. Study selection, quality assessment and data extraction were performed independently by two review authors. Meta-analysis was performed using odds ratio (OR) and 95% confidence intervals (CI). The outcome measures were live birth rate, clinical ongoing pregnancy rate, miscarriage rate, and any reported side effects of treatment. The quality of the evidence for the primary outcome (live birth) was rated using GRADE methods.

MAIN RESULTS

This updated meta-analysis showed no evidence of overall benefit of acupuncture for improving live birth rate (LBR) regardless of whether acupuncture was performed around the time of oocyte retrieval (OR 0.87, 95% CI 0.59 to 1.29, 2 studies, n = 464, I(2) = 0%, low quality evidence) or around the day of embryo transfer (ET) (OR 1.22, 95% CI 0.87 to 1.70, 8 studies, n = 2505, I(2) = 69%, low quality evidence). There was no evidence that acupuncture had any effect on pregnancy or miscarriage rates, or had significant side effects.

AUTHORS' CONCLUSIONS

There is no evidence that acupuncture improves live birth or pregnancy rates in assisted conception.

Placebo acupuncture devices: considerations for acupuncture research

Determining an appropriate control for use in acupuncture research remains one of the largest methodological challenges acupuncture researchers face. In general, acupuncture controls fall under one of two categories: (1) sham acupuncture, in which the skin is punctured with real acupuncture needles either fully at nonacupoint locations or shallowly at acupoint locations or both and (2) placebo acupuncture, which utilizes nonpenetrating acupuncture devices. In this study, we will focus on non-penetrating placebo acupuncture devices (blunted-needle and nonneedle devices) that are currently available in acupuncture research. We will describe each device and discuss each device's validation and application in previous studies. In addition, we will outline the advantages and disadvantages of these devices and highlight how the differences among placebo devices can be used to isolate distinct components of acupuncture treatment and investigate their effects. We would like to emphasize that there is no single placebo device that can serve as the best control for all acupuncture studies; the choice of an acupuncture control should be determined by the specific aim of the study.