1
|
Eucker SA, Glass O, Knisely MR, O'Regan A, Gordee A, Li C, Klasson CL, TumSuden O, Pauley A, Chen HJ, Tupetz A, Staton CA, Kuchibhatla M, Chow SC. An Adaptive Pragmatic Randomized Controlled Trial of Emergency Department Acupuncture for Acute Musculoskeletal Pain Management. Ann Emerg Med 2024:S0196-0644(24)00161-6. [PMID: 38795078 DOI: 10.1016/j.annemergmed.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 05/27/2024]
Abstract
STUDY OBJECTIVE Acute musculoskeletal pain in emergency department (ED) patients is frequently severe and challenging to treat with medications alone. The purpose of this study was to determine the feasibility, acceptability, and effectiveness of adding ED acupuncture to treat acute episodes of musculoskeletal pain in the neck, back, and extremities. METHODS In this pragmatic 2-stage adaptive open-label randomized clinical trial, Stage 1 identified whether auricular acupuncture (AA; based on the battlefield acupuncture protocol) or peripheral acupuncture (PA; needles in head, neck, and extremities only), when added to usual care was more feasible, acceptable, and efficacious in the ED. Stage 2 assessed effectiveness of the selected acupuncture intervention(s) on pain reduction compared to usual care only (UC). Licensed acupuncturists delivered AA and PA. They saw and evaluated but did not deliver acupuncture to the UC group as an attention control. All participants received UC from blinded ED providers. Primary outcome was 1-hour change in 11-point pain numeric rating scale. RESULTS Stage 1 interim analysis found both acupuncture styles similar, so Stage 2 continued all 3 treatment arms. Among 236 participants randomized, demographics and baseline pain were comparable across groups. When compared to UC alone, reduction in pain was 1.6 (95% confidence interval [CI]: 0.7 to 2.6) points greater for AA+UC and 1.2 (95% CI: 0.3 to 2.1) points greater for PA+UC patients. Participants in both treatment arms reported high satisfaction with acupuncture. CONCLUSION ED acupuncture is feasible and acceptable and can reduce acute musculoskeletal pain better than UC alone.
Collapse
Affiliation(s)
| | - Oliver Glass
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC
| | | | - Amy O'Regan
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; Biostatistics, Epidemiology, and Research Design Methods Core, Duke University, Durham, NC
| | - Cindy Li
- Department of Emergency Medicine, Duke University, Durham, NC
| | | | - Olivia TumSuden
- Adams School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Alena Pauley
- Department of Emergency Medicine, Duke University, Durham, NC
| | - Harrison J Chen
- Department of Emergency Medicine, Duke University, Durham, NC
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Catherine A Staton
- Department of Emergency Medicine, Duke University, Durham, NC; Duke Global Health Institute, Duke University, Durham, NC
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; Duke Aging Center, Duke University, Durham, NC
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| |
Collapse
|
2
|
Gagnon P, Dunning J, Bliton P, Charlebois C, Henry N, Gorby P, Mourad F. Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report. Clin Case Rep 2024; 12:e8858. [PMID: 38689684 PMCID: PMC11060885 DOI: 10.1002/ccr3.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
Collapse
Affiliation(s)
- Peter Gagnon
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physical Therapy of BoulderBoulderColoradoUSA
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Montgomery Osteopractic Physical Therapy & AcupunctureMontgomeryAlabamaUSA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- William S. Middleton VA HospitalMadisonWisconsinUSA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Arcadia UniversityGlensidePennsylvaniaUSA
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physio RoomColorado SpringsColoradoUSA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Gorby Osteopractic Physiotherapy, Colorado Springs, COColorado SpringsColoradoUSA
| | - Firas Mourad
- Department of PhysiotherapyLUNEX International University of Health, Exercise and SportsDifferdangeLuxembourg
- Luxembourg Health & Sport Sciences Research Institute ASBLDifferdangeLuxembourg
| |
Collapse
|
3
|
Tian J, Li X, Yin Y, Zhao N, Xiao H, Liu H. Accuracy and efficacy of ultrasound-guided puncture (vs. computed tomography-guided) in cervical medial branch blocks for cervicogenic pain: A randomized controlled study. IBRAIN 2024; 10:34-45. [PMID: 38682018 PMCID: PMC11045187 DOI: 10.1002/ibra.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/01/2024]
Abstract
Cervical medial branch block (CMBB) has been recognized as an effective treatment for cervicogenic pain. Previous studies mostly used ultrasound-guided out-of-plane puncture for CMBB, while this prospective study was designed to investigate the efficacy of ultrasound-guided in-plane puncture, specifically focusing on the new target of CMBB for cervical pain. This study includes two parts: the accuracy study (N = 15, CMBB was completed by ultrasound and confirmed by computed tomography [CT], in which a good distribution percentage of the analgesic solution was observed) and the efficacy study (N = 40, CMBB was completed by ultrasound or CT, while the proportion of pain relief (numerical rating scale) decrease by more than 50% postoperatively was analyzed). The results showed that the good distribution percentage of the analgesic solution was 97.8%. Furthermore, in the early period (30 min and 2 h postoperatively), the proportion of patients with pain relief was lower in the ultrasound group than that in the CT group, especially at 2 h postoperatively (52% vs. 94%). However, at 24 h postoperatively and later, the proportion of patients with pain relief gradually stabilized to about 60%-70%, and lasted for about 2 weeks to 1 month. Therefore, the new target for CMBB, guided by ultrasound in-plane, offers high visibility and accuracy. A single CMBB performed under ultrasound guidance resulted in pain relief comparable to that of a CT-guided procedure (1 day to 1 month postoperatively). This study indicated that CMBB guided by ultrasound in-plane could be regarded as a promising approach for treatment of cervicogenic pain.
Collapse
Affiliation(s)
- Jie Tian
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xin‐Yan Li
- Department of AnesthesiologySouthwest Medical UniversityLuzhouSichuanChina
| | - Yan Yin
- Department of Pain Management, West China HospitalSichuan UniversityChengduSichuanChina
| | - Nan Zhao
- Department of Anesthesia, Transplant and Surgical Intensive CareAzienda Ospedaliero Universitaria delle MarcheAnconaItaly
| | - Hong Xiao
- Department of Pain Management, West China HospitalSichuan UniversityChengduSichuanChina
| | - Hui Liu
- Department of Pain Management, West China HospitalSichuan UniversityChengduSichuanChina
| |
Collapse
|
4
|
Lee B, Kwon CY, Lee HW, Nielsen A, Wieland LS, Kim TH, Birch S, Alraek T, Lee MS. Different Outcomes According to Needling Point Location Used in Sham Acupuncture for Cancer-Related Pain: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2023; 15:5875. [PMID: 38136419 PMCID: PMC10741764 DOI: 10.3390/cancers15245875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Numerous acupuncture studies have been conducted on cancer-related pain; however, its efficacy compared to sham acupuncture remains controversial. We confirmed whether the outcome of acupuncture differs according to the needling points of sham acupuncture for cancer-related pain. We searched 10 databases on 23 May 2023 to screen acupuncture trials using sham acupuncture or waiting list as controls for cancer-related pain. Sham acupuncture was classified into two types, depending on whether the needling was applied at the same locations as verum acupuncture (SATV) or not (SATS). A network meta-analysis (NMA) was performed on the basis of a frequentist approach to assess pain severity. Eight studies (n = 574 participants) were included in the review, seven of which (n = 527 participants) were included in the NMA. The pain severity was not significantly different between SATV and verum acupuncture, but verum acupuncture significantly improved pain severity compared to SATS. The risk of bias affecting the comparisons between the verum and sham acupuncture was generally low. Previous acupuncture trials for cancer-related pain showed differing outcomes of sham and verum acupuncture, depending on the needling points of sham acupuncture. The application of SATV cannot be considered a true placebo, which leads to an underestimation of the efficacy of verum acupuncture.
Collapse
Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan 47227, Republic of Korea;
| | - Hye Won Lee
- KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - L. Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul 02447, Republic of Korea;
| | - Stephen Birch
- Kristiania University College, School of Health Sciences, 0317 Oslo, Norway; (S.B.); (T.A.)
| | - Terje Alraek
- Kristiania University College, School of Health Sciences, 0317 Oslo, Norway; (S.B.); (T.A.)
- Department of Community Medicine, Faculty of Health Sciences, National Research Center in Complementary and Alternative Medicine (NAFKAM), Institute of Health Sciences, 9037 Tromsø, Norway
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea;
| |
Collapse
|
5
|
Xiong ZY, Liu XY, Ma PH, Sun CY, Sun CY, Liu TL, Liu BY, Liu CZ, Yan SY. Placebo Response among Different Types of Sham Acupuncture for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin J Integr Med 2023; 29:941-950. [PMID: 37580465 DOI: 10.1007/s11655-023-3608-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Low back pain (LBP) is a prevalent and debilitating condition that poses a significant burden on healthcare systems. Acupuncture has been proposed as a promising intervention for LBP, but the evidence supporting its specific effect is insufficient, and the use of sham acupuncture as a control in clinical trials presents challenges due to variations in sham acupuncture techniques and the magnitude of the placebo effect. OBJECTIVE To investigate the magnitude of the placebo response of sham acupuncture in trials of acupuncture for nonspecific LBP, and to assess whether different types of sham acupuncture are associated with different responses. METHODS Four databases including PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched through April 15, 2023, and randomized controlled trials (RCTs) were included if they randomized patients with LBP to receive acupuncture or sham acupuncture intervention. The main outcomes included the placebo response in pain intensity, back-specific function and quality of life. Placebo response was defined as the change in these outcome measures from baseline to the end of treatment. Random-effects models were used to synthesize the results, standardized mean differences (SMDs, Hedges'g) were applied to estimate the effect size. RESULTS A total of 18 RCTs with 3,321 patients were included. Sham acupuncture showed a noteworthy pooled placebo response in pain intensity in patients with LBP [SMD -1.43, 95% confidence interval (CI) -1.95 to -0.91, I2=89%]. A significant placebo response was also shown in back-specific functional status (SMD -0.49, 95% CI -0.70 to -0.29, I2=73%), but not in quality of life (SMD 0.34, 95% CI -0.20 to 0.88, I2=84%). Trials in which the sham acupuncture penetrated the skin or performed with regular needles had a significantly higher placebo response in pain intensity reduction, but other factors such as the location of sham acupuncture did not have a significant impact on the placebo response. CONCLUSIONS Sham acupuncture is associated with a large placebo response in pain intensity among patients with LBP. Researchers should also be aware that the types of sham acupuncture applied may potentially impact the evaluation of the efficacy of acupuncture. Nonetheless, considering the nature of placebo response, the effect of other contextual factors cannot be ruled out in this study. (PROSPERO registration No. CRD42022304416).
Collapse
Affiliation(s)
- Zhi-Yi Xiong
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xiao-Yu Liu
- School of Acupuncture-Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Pei-Hong Ma
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Chong-Yang Sun
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Cheng-Yi Sun
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Ting-Lan Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Bao-Yan Liu
- China Academy of Chinese Medical Sciences, Beijing, 100007, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
| |
Collapse
|
6
|
Lee B, Kim TH, Birch S, Alraek T, Lee HW, Nielsen A, Wieland LS, Lee MS. Comparative effectiveness of acupuncture in sham-controlled trials for knee osteoarthritis: A systematic review and network meta-analysis. Front Med (Lausanne) 2023; 9:1061878. [PMID: 36698820 PMCID: PMC9868382 DOI: 10.3389/fmed.2022.1061878] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives Although many trials have assessed the effect of acupuncture on knee osteoarthritis (KOA), its efficacy remains controversial. Sham acupuncture techniques are regarded as representative control interventions in acupuncture trials and sometimes incorporate the use of sham devices (base units) to support a non-penetrating needle. To achieve successful blinding, these trials also use acupuncture base units in the verum acupuncture group. Base units are not used in real-world clinical settings. We aimed to assess the effect sizes of verum and sham acupuncture for KOA in sham-controlled trials with or without base units. Methods A total of 10 electronic databases for randomized controlled trials (RCTs) comparing the efficacy of verum manual acupuncture and sham acupuncture for the treatment of KOA were searched for articles published before April 12, 2022. The primary outcome was pain intensity, and the secondary outcomes included physical function. The first assessment after the end of treatment was chosen for analysis. Effect sizes are reported as standardized mean differences (SMDs) with 95% confidence intervals (95% CIs). The risk of bias was assessed using the Cochrane risk of bias tool, and publication bias was evaluated using a funnel plot and Egger's test. The quality of evidence for estimates was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results Fifteen RCTs were included. There was generally a low risk of bias except for the difficulty in blinding acupuncture therapists (performance bias). Compared to verum acupuncture in sham-controlled trials using base units, verum acupuncture in sham-controlled trials without base units was more effective for improving pain (SMD -0.56, 95% CI -1.09 to -0.03) and function (SMD -0.73, 95% CI -1.36 to -0.10) in KOA. The quality of evidence for network estimates was moderate to low due to the risk of bias and imprecision. Conclusion These findings suggest that verum acupuncture in different types of sham-controlled trials has different effect sizes for KOA. Because base units are not used in clinical settings, the results of verum acupuncture in sham-controlled trials with base units need to be interpreted carefully. Systematic review registration https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/6269f962606c5e001fd8790c/, identifier reviewregistry1351.
Collapse
Affiliation(s)
- Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Terje Alraek
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, National Research Center in Complementary and Alternative Medicine, Tromsø, Norway
| | - Hye Won Lee
- KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - L. Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| |
Collapse
|
7
|
Karpatkin H, Siminovich-Blok B, Rachwani J, Langer Z, Winsor S. Effect of Acupuncture on Sensorimotor Function and Mobility in Patients with Multiple Sclerosis: A Pilot Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:42-49. [PMID: 36367978 DOI: 10.1089/jicm.2022.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: Multiple sclerosis (MS) is a progressive disease of the central nervous system that can result in highly variable effects on mobility and sensorimotor function. Persons with MS (pwMS) often use complementary and alternative approaches, such as acupuncture, to address these symptoms. However, studies of acupuncture on these symptoms have been hindered by methodologic flaws, which have limited the ability to draw conclusions about its efficacy. The purpose of this study was to examine the feasibility of an acupuncture intervention on a wide range of sensorimotor and mobility measurements in pwMS. Methods: Using a randomized crossover design, subjects experienced acupuncture or a no treatment control condition twice weekly for 4 weeks, followed by a 4-week washout period, and then crossed over to the other condition for 4 weeks. Strength, sensation, spasticity, gait, and balance were measured for all subjects, both before and after each condition. Results: Seven of the 12 subjects who started the program completed all phases. No subjects experienced adverse effects. No statistically significant changes were observed in the gait or balance measures. Small statistically significant changes were observed in upper extremity strength. Sensation and spasticity were unaffected. Discussion: The variability of MS suggests that a wide array of testing procedures be utilized, however, this may have led to difficulty with completing all phases of the study. Acupuncture did not result in changes in mobility in pwMS. Some improvements in upper extremity strength were observed. It is unclear whether these changes represent the effect of acupuncture or the inherent variability of MS.
Collapse
Affiliation(s)
- Herbert Karpatkin
- Physical Therapy Department, Hunter College, City University of New York, New York, NY, USA
| | | | - Jaya Rachwani
- Physical Therapy Department, Hunter College, City University of New York, New York, NY, USA
| | - Zabrina Langer
- Rusk Rehabilitation Department, New York University Langone Health, New York, NY, USA
| | - Stephanie Winsor
- Rusk Rehabilitation Department, New York University Langone Health, New York, NY, USA
| |
Collapse
|
8
|
Song X, Wang J, Bai L, Zou W. Bibliometric Analysis of 100 Most Highly Cited Publications on Acupuncture for Migraine. J Pain Res 2023; 16:725-747. [PMID: 36923648 PMCID: PMC10010187 DOI: 10.2147/jpr.s396909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background Migraine is a serious global health concern that imposed a huge economic burden on social health care. Over the past few decades, the analgesic effects of acupuncture have been widely recognized, and there is a growing body of research on acupuncture for migraine. Citation analysis is a branch of bibliometrics that helps researchers analyze and identify historical or landmark studies within the scientific literature. Currently, there is no analysis of the 100 most highly cited publications on acupuncture for migraine. Methods The 100 most highly cited publications on acupuncture for migraine were screened using the Science Citation Index Expanded of the Web of Science Core Collection database. CiteSpace and VOSviewer programs were used for bibliometric analysis. Results A total of 493 publications on acupuncture for migraine were identified. 100 of the most highly cited publications on acupuncture for migraine were published from 1984-2020. These publications were cited 6142 times with an h-index of 44 and 84% were original articles. The highest frequency of citations was 416. A total of 335 authors were involved in the study with 37 lead authors. 212 institutions from 20 countries contributed to the 100 most highly cited publications. The most published studies came from the United States (n=36), followed by China (n=27) and Germany (n=26). The Technical University of Munich published the largest number of papers (n = 15). Top-cited publications mainly came from the Headache (n=13, citations=582). Neuroimaging is gradually emerging as a hot topic of research. Conclusion This is the first bibliometric analysis to offer a thorough list of the 100 most highly cited papers on acupuncture for migraine, demonstrating significant progress and emerging trends in this field to assist researchers in determining the direction for further research.
Collapse
Affiliation(s)
- Xue Song
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Jiaqi Wang
- The Second Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Lu Bai
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Wei Zou
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People's Republic of China
| |
Collapse
|
9
|
Zhang S, Wang Y, Zhou M, Jia S, Liu Y, Zhang X, Tai X. A bibliometric analysis of traditional Chinese non-pharmacological therapies in the treatment of knee osteoarthritis from 2012 to 2022. Front Neurosci 2023; 17:1097130. [PMID: 36937664 PMCID: PMC10014606 DOI: 10.3389/fnins.2023.1097130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Objective The benefits of traditional Chinese non-pharmacological therapies in the treatment of Knee osteoarthritis (KOA) are receiving increasing attention. Therefore, this study aims to systematically analyze the global research on the treatment of KOA by Chinese traditional non-pharmacological therapies using bibliometric analysis and present the results with a knowledge map form. Methods Literature related to traditional Chinese non-pharmacological therapies used in the treatment of KOA from 2012 to 2022 was searched from the Web of Science core database and PubMed database. CiteSpace, SCImago Graphica and VOSviewer were used to extract nations, institutions, journals, authors, references, keywords, as well as the most widely used acupoints, therapies and evaluation indexes. Results A total of 375 literature have been included. 32 countries around the world have participated in the research. China, the United States, and Europe were at the center of the global cooperation network. The most prolific institutions and authors were from China represented by Cun-zhi Liu and Jian-feng Tu of Beijing University of Chinese Medicine, the institution with the highest cited frequency was University of York, and "Osteoarthritis Cartilage" was the most frequently cited journal. The most frequently cited literature was "OARSI guidelines for the non-surgical management of knee, hip, and poly articular osteoarthritis." 22 kinds of Chinese non-pharmacological therapies were used to treat KOA, among which acupuncture was the most commonly used one, and ST36 (Zusanli) and WOMAC were the most commonly selected acupoint and evaluation index. Conclusion In the past decade, the value of Chinese non-pharmacological therapies in the treatment of KOA has received widespread attention. It was a common concern of global researchers to relieve the pain of KOA patients and restore the quality of life. Under the background that acupuncture accounts for a relatively high proportion, the next step may consider how to make the balanced development of a variety of Chinese non-pharmacological therapies. In addition, the problem of how to eliminate the placebo effect maybe the direction of future research.
Collapse
|
10
|
Matsuura Y, Hongo S, Taniguchi H, Yasuno F, Sakai T. Effect of Acupuncture on Physical Symptoms and Quality of Life in Treatment-Resistant Major Depressive Disorder and Bipolar Disorder: a Single-Arm Longitudinal Study. J Acupunct Meridian Stud 2022; 15:336-346. [DOI: 10.51507/j.jams.2022.15.6.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/22/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yuto Matsuura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Seiji Hongo
- Himorogi Psychiatric Institute, Tokyo, Japan
| | - Hiroshi Taniguchi
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Fumiko Yasuno
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Tomomi Sakai
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| |
Collapse
|
11
|
Fleckenstein J. Kommentar zu: "Akupunktur bei chronischem unspezifischen Lenden-Becken-Hüftschmerz: eine Bayes-Netzwerk-Analyse". DEUTSCHE ZEITSCHRIFT FÜR AKUPUNKTUR 2022. [DOI: 10.1007/s42212-022-00518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Birch S, Robinson N. Acupuncture as a post-stroke treatment option: A narrative review of clinical guideline recommendations. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154297. [PMID: 35816994 DOI: 10.1016/j.phymed.2022.154297] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/05/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acupuncture may be useful to treat the various clusters of symptoms occurring after a stroke. The use of evidence to underpin clinical practice and treatment guidelines (CPGs and TGs respectively) varies from country to country and may affect what recommendations are made by guideline developers. PURPOSE To examine the extent to which international clinical and treatment guidelines on post-stroke treatment mention the role of acupuncture and to identify what symptoms they recommend for its use. METHOD Scoping of national and international websites of CPGs and TGs r on the after care and rehabilitation of stroke patients provided by professional and government organisations was conducted. The presence/absence of recommendations and the underpinning evidence was appraised for the use of acupuncture for symptoms following stroke. RESULTS Of 84 CPGs and TGs on post stroke after-care identified from 27 countries between 2001 and 2021, 49 made statements about acupuncture. Positive recommendations on the use of acupuncture were identified for 15 symptom areas from 11 countries for: stroke rehabilitation, dysphagia, shoulder pain, motor recovery, walking, balance, spasticity, upper limb extremity impairment, post-stroke pain, central post stroke pain, cognitive disorder, depression, and sleep problems. Thirty-five CPGs (2001-2018) from 18 countries published over the same period were identified that made no mention of acupuncture and therefore no recommendations were made on its use. CONCLUSIONS Currently, evidence used by international guideline developers varies and this influences whether a positive or negative recommendation is made. Recommendations to use acupuncture should be based on the best available evidence which has been quality appraised.
Collapse
Affiliation(s)
- Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Nicola Robinson
- Institute of Health and Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK; Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China.
| |
Collapse
|
13
|
Liu L, Zhang CS, Liu HL, He F, Lyu TL, Zeng L, Zhao LP, Wang MN, Qu ZY, Nie LM, Guo J, Zhang XZ, Lu YH, Wang KL, Li B, Jing XH, Wang LP. Acupuncture for menstruation-related migraine prophylaxis: A multicenter randomized controlled trial. Front Neurosci 2022; 16:992577. [PMID: 36090267 PMCID: PMC9459087 DOI: 10.3389/fnins.2022.992577] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to evaluate the efficacy of acupuncture, an alternative medicine therapy, as a preventive treatment for menstruation-related migraine (MRM). Patients and methods This was a prospective, multicenter, double-dummy, participant-blinded, randomized controlled clinical trial conducted in China between 1 April 2013, and 30 April 2014. The participants were enrolled from four study centers and randomized to into either the acupuncture group, which received 24 sessions of acupuncture at traditional acupoints plus placebo, or the medication group, which received sham acupuncture plus naproxen. The primary endpoint was change from the baseline average number of migraine days per perimenstrual period over cycles 1−3. The secondary endpoints included changes from the baseline average number of migraine days outside the perimenstrual period, mean number of migraine hours during and outside the perimenstrual period, mean visual analog scale score during and outside the perimenstrual period, ≥50% migraine responder rate, and the proportion of participants who used acute pain medication over cycles 1−3 and 4−6. Results A total of 172 women with MRM were enrolled; 170 in the intention-to-treat analyses. Our primary outcome reported a significant between-group difference that favored the acupuncture group (95% CI, 0.17–0.50; P < 0.001), with the average reduction of migraine days per perimenstrual period from the baseline was 0.94 (95% CI, 0.82–1.07) in the acupuncture group and 0.61 (95% CI, 0.50–0.71) in the medication group over cycles 1−3. Conclusion This study showed that compared to medication, acupuncture reduces the number of migraine days experienced by patients with MRM. For patients who received the acupuncture treatment over three cycles, the preventive effect of the therapy was sustained for six cycles. Clinical trial registration [https://www.isrctn.com/ISRCTN57133712], identifier [ISRCTN15663606].
Collapse
Affiliation(s)
- Lu Liu
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Claire-Shuiqing Zhang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Hui-Lin Liu
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Fan He
- School of Information Management, Wuhan University, Wuhan, China
| | - Tian-Li Lyu
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Luo-Peng Zhao
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Hospital of Traditional Chinese Medicine, Beijing Institute of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Mi-Na Wang
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zheng-Yang Qu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li-Min Nie
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jia Guo
- Traditional Chinese Medicine Department, Peking University Third Hospital, Beijing, China
| | - Xiao-Zhe Zhang
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Hui Lu
- Department of Acupuncture and Moxibustion, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ke-Lun Wang
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Bin Li
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- *Correspondence: Bin Li,
| | - Xiang-Hong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Xiang-Hong Jing,
| | - Lin-Peng Wang
- Department of Acupuncture and Moxibustion, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Lin-Peng Wang,
| |
Collapse
|
14
|
Jo HR, Noh EJ, Oh SH, Choi SK, Sung WS, Choi SJ, Kim DI, Hong SU, Kim EJ. Comparative effectiveness of different acupuncture therapies for neck pain. Medicine (Baltimore) 2022; 101:e29656. [PMID: 35984173 PMCID: PMC9387950 DOI: 10.1097/md.0000000000029656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Neck pain is a common musculoskeletal symptom that has negative effects on quality of life and work productivity. Acupuncture has been widely used for neck pain, and a number of randomized controlled trials (RCTs) and systematic reviews (SRs) have evaluated its effectiveness. However, previous studies have obtained inconsistent results regarding the effects of acupuncture for neck pain, and there is no SR for the comparative efficacy and safety of various types of acupuncture. Therefore, we herein conducted a SR and network meta-analysis to compare and rank different types of acupuncture with respect to their effectiveness in treating neck pain. METHODS We searched 9 electronic databases for relevant RCTs published from their inception to July 1, 2021. Pairwise meta-analyses and network meta-analysis were performed with R software using the frequentist framework. Change of pain intensity was assessed as the primary outcome, and change of pain-related disability and efficacy rate were assessed as secondary outcomes. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument were used to evaluate the quality of the included RCTs and the certainty of the evidence. RESULTS A total of 65 RCTs involving 5266 participants and 9 interventions were included. Three network meta-analyses were constructed for the following: pain intensity (42 RCTs, 3158 participants), pain-related disability (21 RCTs, 1581 participants), and efficacy rate (40 RCTs, 3512 participants). The results indicated that fire acupuncture, electroacupuncture, and warm acupuncture were more effective than manual acupuncture in terms of pain intensity reduction and efficacy rate, and that electroacupuncture decreased pain-related disability more effectively than manual acupuncture. Fire acupuncture ranked first among the 9 interventions. The overall q of evidence was very low according to the GRADE assessment. The reported adverse events were not serious. CONCLUSION Fire acupuncture, warm acupuncture, acupoint catgut embedding, and electroacupuncture ranked higher than other interventions (usual care, sham acupuncture, no treatment) in reducing the pain and disability index scores and the efficacy rate. However, the included trials were evaluated as being of low quality; thus, we recommend additional well-designed RCTs with larger sample sizes to confirm these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021235274.
Collapse
Affiliation(s)
- Hyo-Rim Jo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University Graduate School, Seoul, Republic of Korea
| | - Eun-Ji Noh
- Department of Obstetrics & Gynecology, College of Korean Medicine, Dongguk University Graduate School, Seoul, Republic of Korea
| | - Se-Hee Oh
- Department of Ophthalmology, Otolaryngology and Dermatology, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, Republic of Korea
| | - Seong-Kyeong Choi
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Su-Ji Choi
- Department of Obstetrics & Gynecology, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, Republic of Korea
| | - Dong-Il Kim
- Department of Obstetrics & Gynecology, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, Republic of Korea
| | - Seung-Ug Hong
- Department of Ophthalmology, Otolaryngology and Dermatology, Dongguk University Ilsan Oriental Hospital, Gyeonggi-do, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University, Seoul, Republic of Korea
- *Correspondence: Eun-Jung Kim, KMD, PhD, Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, 268, Buljeong-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea (e-mail: )
| |
Collapse
|
15
|
Manual acupuncture as prophylaxis for migraine without aura: study protocol for a multi-center, randomized, single-blinded trial. Trials 2022; 23:574. [PMID: 35854329 PMCID: PMC9295267 DOI: 10.1186/s13063-022-06510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Migraine is a highly prevalent neurological disorder. It is the third most prevalent disorder and the seventh highest cause of disability worldwide. Acupuncture may be a viable prophylactic treatment option for frequent or uncontrolled migraine. Clinical studies comparing acupuncture and placebo acupuncture have not reached a consistent conclusion in confirming whether acupuncture is effective in migraine prophylaxis. The effect of acupuncture mainly depends on acupoints and needles operation. We found that the design of the placebo acupuncture in previous studies included shallow needling at sham acupoints, non-penetrating needling at sham acupoints, and needling at inactive acupuncture points to achieve the inert effect of control group, but the non-penetrating needling at true acupoints was ignored. This randomized controlled trial aims to use true acupoints for non-penetrating acupuncture as control to evaluate the efficacy of manual acupuncture for the prophylaxis of migraine without aura (MWoA). Methods/design This is a single-blinded, randomized, controlled, prospective, multi-center trial with two parallel treatment groups. A total of 198 eligible patients with MWoA will be randomly divided into two groups (1:1 allocation ratio). The intervention group will receive manual acupuncture and the control group will receive placebo acupuncture (non-penetrating). Patients will receive three acupuncture treatment sessions per week for 4 consecutive weeks. All patients will then receive a 12-week follow-up. Discussion In this study, we are evaluating the efficacy and safety of manual acupuncture in the prophylaxis of MWoA. The placebo control is using non-penetrating needling verum acupoints. It is essential to determine an appropriate control method to ensure the methodological quality of a randomized controlled trial. Trial registration The trial has been registered in the Chinese Clinical Trial Registry (approval no. ChiCTR2000032308) in April 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06510-7.
Collapse
|
16
|
Wang CC, Lo J, Saunders R, Adama E, Bulsara C, Etherton-Beer C, Yang AWH. Light acupuncture and five-element music therapy for nurses' mental health and well-being during and post-COVID-19: protocol for a randomised cross-over feasibility study. BMJ Open 2022; 12:e057106. [PMID: 35487736 PMCID: PMC9058290 DOI: 10.1136/bmjopen-2021-057106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Australian nurses have experienced higher levels of anxiety during the COVID-19 pandemic compared with the prepandemic. This may have affected their long-term mental health and intention to stay in the profession resulting in a workforce shortage, which further impacts the health of the public. Management is urgently required to improve nurses' well-being. However, there is limited evidence available. The proposed clinical trial aims to evaluate the feasibility and therapeutic effects of using a combination of light acupuncture and five-element music therapy to improve nurses' mental health and well-being during and post-COVID-19. METHODS AND ANALYSIS This randomised, single blinding, two-arm cross-over feasibility study involves a 1-week run-in period, 2-week intervention and 1-week run-in period in between interventions. Thirty-six eligible nurses will be recruited from the community and randomised into either a combination of light acupuncture treatment and five-element music therapy group or no treatment group for 2 weeks. After a 1-week run in period, they will be swapped to the different group. The primary outcome of this study is to evaluate the feasibility of a combination of light acupuncture treatment and five-element music therapy to improve nurses' mental health and well-being. The secondary outcomes will include anxiety and depression, work productivity and activity, and quality of life assessments. Participants will be asked to complete a set of online questionnaires throughout the trial period. All analyses will be performed in R Studio V.1.1.463. ETHICS AND DISSEMINATION Ethical approval was attained from Edith Cowan University's Human Research Ethics Committee (No. 2021-02728-WANG). Research findings will be shared with hospitals and in various forms to engage broader audiences, including national and international conferences, presentations, open-access peer-reviewed journal publications, and local community workshop dissemination with healthcare professionals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12621000957897p https://www.anzctr.org.au/ACTRN12621000957897p.aspx.
Collapse
Affiliation(s)
- Carol Chunfeng Wang
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosemary Saunders
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Western Australia, Australia
| | | | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Jiao R, Zhai X, Zhang X, Xiong Z, Liu Z. Efficacy of acupuncture in improving symptoms and quality of life of patients with acne vulgaris: a randomized sham acupuncture-controlled trial. Acupunct Med 2022; 40:453-462. [PMID: 35437030 DOI: 10.1177/09645284221076506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of acupuncture in treating the symptoms and quality of life (QoL) of patients with moderate or severe acne vulgaris (AV). METHODS Participants were randomly assigned (1:1) to receive 12 treatment sessions of acupuncture or sham acupuncture over 4 weeks with 24 weeks of follow-up. The primary outcome was the change from baseline in the Skindex-16 scale total score at treatment completion. Secondary outcomes included Skindex-16 subscale score, Dermatology Life Quality Index scale total score, total lesion count and inflammatory lesion count, and visual analogue scale scores for itch and pain evaluation. RESULTS There was no statistically significant between-group difference for the primary outcome or any secondary outcomes after 4 weeks of treatment and at 16 and 28 weeks of follow-up, except for the Skindex-16 emotions subscale at week 4 (p = 0.026). No serious adverse events occurred in either group. CONCLUSION Acupuncture may not effectively relieve the symptoms of patients with moderate or severe AV, or improve QoL. Given the limitations of a relatively short treatment course compared to other studies and the likelihood that sham acupuncture is not inert, further studies with treatment durations of 12 weeks or longer and a waitlist (no treatment) control or Western medicine-treated control group should be considered to evaluate the effects of acupuncture on AV. TRIAL REGISTRATION NUMBER ChiCTR-1900023649 (Chinese Clinical Trial Registry).
Collapse
Affiliation(s)
- Ruimin Jiao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, China Academy of Chinese Medical Sciences, Beijing, China.,Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu Zhai
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuecheng Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
18
|
Dunning J, Butts R, Bliton P, Vathrakokoilis K, Smith G, Lineberger C, Eshleman N, Fernández-de-Las-Peñas C, Young IA. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: A multi-center randomized clinical trial. Cranio 2022:1-14. [PMID: 35412448 DOI: 10.1080/08869634.2022.2062137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD). METHODS One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58). RESULTS Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up. CONCLUSION Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.
Collapse
Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Montgomery Osteopractic Physical Therapy & Acupuncture Clinic, Montgomery, AL, USA
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Research Physical Therapy Specialists, Columbia, SC, USA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Athletico Physical Therapy, Roscoe, IL, USA
| | | | - Grant Smith
- Advanced Manual Therapies, Alpharetta, GA, USA
| | | | - Noah Eshleman
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Ejercicio, Universidad Rey Juan CarlosCátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y, Alcorcón, Spain
| | - Ian A Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA
- Tybee Wellness & Osteopractic, Tybee Island, GA, USA
| |
Collapse
|
19
|
Zhou J, Jiang NN, Fang Y, Zhang XY, Cheng SR, Li XL, Hu SJ, Sun RR, Zheng HB, Huang XP, Zeng F, Liang FR, Li ZJ. Efficacy of Acupuncture Treatment of Migraine Delivered by Senior or Junior Acupuncturists: Study Protocol for a Randomized Controlled Trial. Front Neurol 2022; 12:812504. [PMID: 35197917 PMCID: PMC8858942 DOI: 10.3389/fneur.2021.812504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Acupuncture is an efficacious and safe treatment choice for migraine prevention. Results from clinical trials have shown that non-specific effects play an important role in acupuncture's efficacy. To date, however, there is no evidence available quantitatively evaluating the effect of non-specific effects, such as patients' expectations and beliefs for acupuncturists, on acupuncture efficacy, necessitating further exploration. Methods A total of 156 patients with migraine without aura (MwoA) will be randomized to either junior or senior acupuncturist group, at a ratio of 1:1. The study will last 24 weeks, for each patient, comprising baseline, treatment, and follow-up phases lasting 4, 8, and 12 weeks, respectively. All patients will undergo 12 sections of acupuncture treatment delivered by either a junior or senior acupuncturist following the same acupuncture prescription and manipulation. The primary outcomes will be changes in the number of migraine days and frequency of attacks per 4 weeks cycle, relative to the baseline. Secondary outcomes will include severity of headache pain, quality of life, anxiety/depression levels, and use of non-steroidal anti-inflammatory drugs (NSAIDs) per 4 weeks cycle, compared to the baseline, as well as adverse events and rate of positive response to treatment. Prior to randomization of patients into junior or senior acupuncturist groups, the Acupuncture Expectations Evaluation Scale (AES) will be used to evaluate their expectations and belief with regards to acupuncture efficacy delivered by senior or junior acupuncturists. Discussion Results from this clinical randomized controlled trial will help to quantitatively evaluate the extent of the effect of acupuncture treatment delivered by a senior or junior acupuncturist (high relative to low expectations) in migraine patients. Ethics and Dissemination This trial has been approved by the Institutional Review Boards and Ethics Committees of Hospital of Chengdu University of Traditional Chinese Medicine (Approval No. 2020KL-058).
Collapse
Affiliation(s)
- Jun Zhou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Nan-nan Jiang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Fang
- Neurology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-yue Zhang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shi-rui Cheng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-ling Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sheng-jie Hu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rui-rui Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua-bin Zheng
- Neurology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-peng Huang
- Neurology Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan-rong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Fan-rong Liang
| | - Zheng-jie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Zheng-jie Li
| |
Collapse
|
20
|
Kim TH, Lee MS, Birch S, Alraek T. Plausible Mechanism of Sham Acupuncture Based on Biomarkers: A Systematic Review of Randomized Controlled Trials. Front Neurosci 2022; 16:834112. [PMID: 35185461 PMCID: PMC8850388 DOI: 10.3389/fnins.2022.834112] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sham acupuncture was developed to be used as an inert control intervention in clinical trials of acupuncture. However, controversies exist regarding the validity of sham acupuncture. In this systematic review (SR) of acupuncture trials, we assessed whether serum biomarkers showed significant differences after sham and verum acupuncture treatments. Methods Any acupuncture clinical trials that evaluated serum biomarker changes between sham acupuncture and verum acupuncture were included in this review. Relevant literature was searched in the PubMed database, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL) database from inception until June 2021. The Cochrane risk of bias was assessed. Summary effect estimates for each biomarker between groups were calculated with a random effect model. Results From 51 sham acupuncture trials, we found that there were no significant differences in most of the 36 serum biomarkers after sham acupuncture and verum acupuncture needling. Only VEGF, IG-E, TNF-a, NGF, GABA, NPY, and VIP serum levels were identified as being different between the groups. The overall risk of bias of the included studies and the limited numbers of studies for meta-analysis do not strongly support the results of this SR. Conclusion Sham acupuncture techniques might have similar effects on biomarkers as the so-called “real acupuncture” techniques, which indicates that sham acupuncture, as an inert intervention similar to a placebo drug, needs to be reconsidered. Systematic Review PROSPERO Registration identifier [CRD42021260889].
Collapse
Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- *Correspondence: Myeong Soo Lee
| | - Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Terje Alraek
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| |
Collapse
|
21
|
Effect of acupuncture on in vitro fertilization-related anxiety: a systematic review and meta-analysis. Reprod Biomed Online 2022; 45:69-80. [DOI: 10.1016/j.rbmo.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/22/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022]
|
22
|
Sun N, He DM, Ye X, Bin L, Zhou Y, Deng X, Qu Y, Li Z, Cheng S, Shao S, Zhao FJ, Zhang TH, Cai J, Sun R, Liang FR. Immediate acupuncture with GB34 for biliary colic: protocol for a randomised controlled neuroimaging trial. BMJ Open 2022; 12:e050413. [PMID: 35027415 PMCID: PMC8762121 DOI: 10.1136/bmjopen-2021-050413] [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: 12/03/2022] Open
Abstract
INTRODUCTION As the main manifestation of gallstone disease, biliary colic (BC) is an episodic attack that brings patients severe pain in the right upper abdominal quadrant. Although acupuncture has been documented with significance to lead to pain relief, the immediate analgesia of acupuncture for BC still needs to be verified, and the underlying mechanism has yet to be covered. Therefore, this trial aims first to verify the immediate pain-alleviation characteristic of acupuncture for BC, then to explore its influence on the peripheral sensitised acupoint and central brain activity. METHODS AND ANALYSIS This is a randomised controlled, paralleled clinical trial, with patients and outcome assessors blinded. Seventy-two patients with gallbladder stone disease presenting with BC will be randomised into a verum acupuncture group and the sham acupuncture group. Both groups will receive one session of immediate acupuncture treatment. Improvements in patients' BC will be evaluated by the Numeric Rating Scale, and the pain threshold of acupoints will also be detected before and after treatment. During treatment, brain neural activity will be monitored with functional near-infrared spectroscopy (fNIRS), and the needle sensation will be rated. Clinical and fNIRS data will be analysed, respectively, to validate the acupuncture effect, and correlation analysis will be conducted to investigate the relationship between pain relief and peripheral-cerebral functional changes. ETHICS AND DISSEMINATION This trial has been approved by the institutional review boards and ethics committees of the First Teaching Hospital of Chengdu University of Traditional Chinese Medicine, with the ethical approval identifier 2019 KL-029, and the institutional review boards and ethics committees of the First People's Hospital of Longquanyi District, with the ethical approval identifier AF-KY-2020071. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters. TRIAL REGISTRATION NUMBER CTR2000034432.
Collapse
Affiliation(s)
- Ning Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dong-Mei He
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Xiangyin Ye
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lei Bin
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Yuanfang Zhou
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaodong Deng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuzhu Qu
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhengjie Li
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shirui Cheng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shuai Shao
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Feng-Juan Zhao
- Science and Education Department, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Tie-Huan Zhang
- Emergency Department, The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Jing Cai
- Oncology-Blood Department, The First People's Hospital of Longquanyi District, Chengdu, China
| | - Ruirui Sun
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fan-Rong Liang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| |
Collapse
|
23
|
The efficacy and safety of auriculotherapy for weight loss: A systematic review and meta-analysis. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2021.101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
24
|
On defining acupuncture and its techniques: A commentary on the problem of sham. Integr Med Res 2022; 11:100834. [PMID: 35111572 PMCID: PMC8790499 DOI: 10.1016/j.imr.2022.100834] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 12/23/2022] Open
|
25
|
Choi Y, Park IH, Kim JE, Kwon O, Kim AR, Park HJ, Lee JH, Kim JH. Acupuncture for Psychosomatic Symptoms of Hwa-byung, an Anger Syndrome: A Feasibility Randomized Controlled Trial. Front Psychol 2021; 12:651649. [PMID: 34630196 PMCID: PMC8498113 DOI: 10.3389/fpsyg.2021.651649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: Emerging studies found the potential effects of acupuncture for treating chronic pain and mental disorders, namely, depressive and anxiety disorders. Acupuncture is widely used for treating culture-related anger syndrome, Hwa-byung. This pilot trial aimed to investigate the feasibility of a clinical trial testing acupuncture for the psychosomatic symptoms of Hwa-byung. Methods: A total of 26 patients with Hwa-byung planned to be randomly assigned to the acupuncture or sham acupuncture groups. About 10 treatment sessions were applied over 4 weeks. The 100-mm visual analog scale was used to measure the six major Hwa-byung symptoms: stuffiness in the chest, heat sensations, pushing-up in the chest, feeling a mass in the throat, feelings of unfairness, and hard feelings. The criteria for assessing the success of this pilot trial were defined as improvement in three or more of the six Hwa-byung symptoms after treatment, with an effect size >0.2. Results: A total of 15 patients were finally included and randomly assigned to the acupuncture group (n = 7) or the sham acupuncture group (n = 8). After 10 treatment sessions, the Cohen's d effect sizes for acupuncture compared to sham acupuncture were >0.2 for each one of the six major Hwa-byung symptoms, which met our a priori criteria for success. Also, the effect size for the somatic symptoms of “stuffiness in the chest” was 0.81 (95% CI −0.40, 2.20), referring to a large effect size. Conclusions: Our results suggest that acupuncture treatment would be regarded as an acceptable intervention for a full-scale study of psychosomatic symptoms in patients with Hwa-byung. Trial Registration:cris.nih.go.kr, identifier: KCT0001732.
Collapse
Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - In-Hye Park
- Department of Korean Medicine, College of Korean Medicine, Sangji University, Wonju, South Korea
| | - Jung-Eun Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Ojin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ae-Ran Kim
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Hyo-Ju Park
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jun-Hwan Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju, South Korea.,Research Institute of Korean Medicine, Sangji University, Wonju, South Korea
| |
Collapse
|
26
|
Chen H, So TH, Cho WCS, Qin Z, Ma CH, Li SG, Yang Z, Jiang F, Wu J, Zhang ZJ, Kong FM, Lao L. The Adjunctive Effect of Acupuncture for Advanced Cancer Patients in a Collaborative Model of Palliative Care: Study Protocol for a 3-Arm Randomized Trial. Integr Cancer Ther 2021; 20:15347354211012749. [PMID: 33957783 PMCID: PMC8113363 DOI: 10.1177/15347354211012749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Cancer is the second leading cause of death before the age of 70. Improved cancer survival has put increasing demands on cancer care. Palliative care is the specialized multi-disciplinary care providing relief from the pain, symptoms, and stress of serious illness. The study aims to evaluate the adjunctive effect of acupuncture for advanced cancer patients in a collaborative model of palliative care. Methods/Design: This is a single-blinded, randomized, sham-controlled trial. One hundred twenty advanced cancer patients undergoing palliative care will be randomized in a ratio of 2:1:1 to manual acupuncture plus standard care group (ASC), sham acupuncture plus standard care group (SSC), and standard care group (SC). Patients in ASC and SSC will receive 9 sessions of acupuncture or sham acupuncture for 3 weeks, and will be followed up for 2 months. The primary measure is the change from baseline score of the Edmonton Symptom Assessment System at 3 weeks. The secondary measures include the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Numeric Rating Scale, and European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care. Discussion: The finding of this trial will provide high-quality evidence on the adjunctive effect of acupuncture to standard care on advanced cancer patients undergoing palliative care. Trial Registration: Clinicaltrials.gov, NCT04398875 (https://www.clinicaltrials.gov/ct2/show/NCT04398875), Registered on 21 May 2020.
Collapse
Affiliation(s)
| | - Tsz Him So
- The University of Hong Kong, Hong Kong, China
| | | | - Zongshi Qin
- The University of Hong Kong, Hong Kong, China
| | - Chun Ho Ma
- The University of Hong Kong Clinical Centre for Teaching and Research in Chinese Medicine (Aberdeen), Hong Kong, China
| | - Shi Guang Li
- Shen Zhen Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Zhenjiang Yang
- Shen Zhen Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Fei Jiang
- University of California, San Francisco, CA, USA
| | - Junmei Wu
- The University of Hong Kong, Hong Kong, China
| | | | | | - Lixing Lao
- The University of Hong Kong, Hong Kong, China.,Virginia University of Integrative Medicine, Fairfax, VA, USA
| |
Collapse
|
27
|
Spinal Manipulation and Electrical Dry Needling in Patients With Subacromial Pain Syndrome: A Multicenter Randomized Clinical Trial. J Orthop Sports Phys Ther 2021; 51:72-81. [PMID: 32857944 DOI: 10.2519/jospt.2021.9785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare the effects of spinal thrust manipulation and electrical dry needling (TMEDN group) to those of nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current (NTMEX group) on pain and disability in patients with subacromial pain syndrome (SAPS). DESIGN Randomized, single-blinded, multicenter parallel-group trial. METHODS Patients with SAPS were randomized into the TMEDN group (n = 73) or the NTMEX group (n = 72). Primary outcomes included the Shoulder Pain and Disability Index and the numeric pain-rating scale. Secondary outcomes included the global rating of change scale (GROC) and medication intake. The treatment period was 6 weeks, with follow-ups at 2 weeks, 4 weeks, and 3 months. RESULTS At 3 months, the TMEDN group experienced greater reductions in shoulder pain and disability (P<.001) compared to the NTMEX group. Effect sizes were large in favor of the TMEDN group. At 3 months, a greater proportion of patients within the TMEDN group achieved a successful outcome (GROC score of 5 or greater) and stopped taking medication (P<.001). CONCLUSION Cervicothoracic and upper-rib thrust manipulation combined with electrical dry needling resulted in greater reductions in pain, disability, and medication intake than nonthrust peripheral joint/soft tissue mobilization, exercise, and interferential current in patients with SAPS. The effects were maintained at 3 months. J Orthop Sports Phys Ther 2021;51(2):72-81. Epub 28 Aug 2020. doi:10.2519/jospt.2021.9785.
Collapse
|
28
|
MacPherson H, Charlesworth K. The Challenges of Evaluating Specific and Nonspecific Effects in Clinical Trials of Acupuncture for Chronic Pain. Med Acupunct 2020; 32:385-387. [PMID: 33362893 DOI: 10.1089/acu.2020.1504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The Acupuncture Trialists' Collaboration has updated its individual patient data meta-analysis of acupuncture for chronic pain originally published in 2012. The updated meta-analysis, published in 2018, now includes raw trial data from 39 trials and 20,827 patients. The overall effect of acupuncture, and the effect of sham acupuncture controls, was evaluated. Results: For 4 conditions, acupuncture has statistically significantly better effects than sham acupuncture (effect sizes 0.16-0.19 [small]). When compared with usual care controls, effect sizes are larger (0.44-0.63 [moderate]). Sham acupuncture has a considerable therapeutic effect; true acupuncture compared with usual care has an effect size of around 0.5, of which 60% is ascribed to nonspecific context effects plus sham, and the remaining 40% to the specific benefit of true acupuncture. Investigators also determined no significant variation in effect related to any acupuncture characteristic; that acupuncture's effect size drops against a high-intensity control; and that only 10%-15% of acupuncture's benefit is lost at 12 months post-treatment. Conclusions: Acupuncture is more than a placebo for chronic pain, and both specific and nonspecific effects can be distinguished in a meta-analysis of appropriate size.
Collapse
Affiliation(s)
- Hugh MacPherson
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | - Karen Charlesworth
- Department of Research, Northern College of Acupuncture, York, United Kingdom
| |
Collapse
|
29
|
Acupotomy Therapy for Knee Osteoarthritis Pain: Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2168283. [PMID: 33178308 PMCID: PMC7648689 DOI: 10.1155/2020/2168283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Abstract
Methods We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm's score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate. Results We identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1–5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = −1.11; 95% confidence interval (CI), −1.51 to −0.71; p < 0.00001) and WOMAC pain score (MD = −2.32; 95% CI, −2.94 to −1.69; p < 0.00001), a higher total effectiveness rate (RR = 1.15; 95% CI, 1.09–1.21; p < 0.00001), and superior improvements in the JOA score (MD = 6.39; 95% CI, 4.11–9.76; p < 0.00001) and Lysholm's score (MD = 12.75; 95% CI, 2.61–22.89; p = 0.01) for overall pain and function. No serious adverse events were reported. Conclusion Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.
Collapse
|
30
|
Birch S, Bovey M, Alraek T, Robinson N, Kim TH, Lee MS. Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations. J Altern Complement Med 2020; 26:784-791. [PMID: 32924554 DOI: 10.1089/acm.2020.0032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms "acupuncture" + "palliative" and adding the term "safety" to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group.
Collapse
Affiliation(s)
- Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Mark Bovey
- British Acupuncture Council, Acupuncture Research Resource Center, London, United Kingdom
| | - Terje Alraek
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Nicola Robinson
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| |
Collapse
|
31
|
Ni X, Dong L, Tian T, Liu L, Li X, Li F, Zhao L. Acupuncture versus Various Control Treatments in the Treatment of Migraine: A Review of Randomized Controlled Trials from the Past 10 Years. J Pain Res 2020; 13:2033-2064. [PMID: 32884332 PMCID: PMC7434532 DOI: 10.2147/jpr.s259390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Migraine is defined as a recurrent headache of moderate to severe intensity that seriously affects the quality of life. Recent clinical trials have confirmed that acupuncture is effective in treating migraine. We aimed to review the effectiveness of acupuncture in the treatment of migraine by comparing treatment and various control groups in accordance with the newly published guidelines for systematic reviews. MATERIALS AND METHODS The following databases were searched for relevant articles published from January 1, 2010 to December 31, 2019: Embase, PubMed, Medline, Cochrane Library, and four Chinese databases. The present review included randomized controlled trials in which acupuncture was the sole treatment or an adjunctive treatment for migraine. Two researchers independently conducted the study selection, data extraction, and quality assessment processes. Disagreements between reviewers were solved by discussion and data reanalysis. The quality of each included study was evaluated using the Cochrane Collaboration risk-of-bias assessment method and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist. RESULTS Forty-nine studies were analyzed and ranked based on the latest STRICTA and Cochrane Collaboration risk-of-bias assessment standards. The analysis revealed that acupuncture reduced headache frequency compared with no treatment (mean difference [MD] = -1.80, P < 0.00001, 95% confidence interval [CI] -2.34 to -1.26) and western medicine (MD = -1.75, P = 0.003, 95% CI -2.91 to -0.58). Headache frequency did not significantly differ between patients who received real acupuncture versus those who received sham acupuncture (MD = -0.64, P = 0.24, 95% CI -1.70 to 0.42). CONCLUSION The present review evaluated the current research on the use of acupuncture for migraine, compared with various control treatments. The evidence for the effectiveness of acupuncture in controlling migraine is still limited due to the low quality of the published studies.
Collapse
Affiliation(s)
- Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| | - Linglin Dong
- Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan610075, People’s Republic of China
| | - Tian Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| | - Lu Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| | - Xiao Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| | - Fengmei Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan610075, People’s Republic of China
| |
Collapse
|
32
|
Eigenschink M, Dearing L, Dablander TE, Maier J, Sitte HH. A critical examination of the main premises of Traditional Chinese Medicine. Wien Klin Wochenschr 2020; 132:260-273. [PMID: 32198544 PMCID: PMC7253514 DOI: 10.1007/s00508-020-01625-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/26/2020] [Indexed: 12/19/2022]
Abstract
Traditional Chinese Medicine (TCM) consists of a plethora of therapeutic approaches aiming to both characterize and treat diseases. Its utilization has gained significant popularity in the western world and is even backed by the World Health Organization's decision to include TCM diagnostic patterns into the new revision of the International Classification of Diseases code, the global standard for diagnostic health information. As these developments and potentially far-reaching decisions can affect modern healthcare systems and daily clinical work as well as wildlife conservation, its underlying factual basis must be critically examined. This article therefore provides an overview of the evidence underlying the basic TCM concepts, such as Qi, meridians, acupuncture, pulse and tongue diagnostics as well as traditional herbal treatments. Moreover, it discusses whether scientific literature on TCM reflects the current standard for evidence-based research, as described in good scientific practice and good clinical practice guidelines. Importantly, misinformation regarding the therapeutic efficacy of animal-derived substances has lead and currently leads to problems with wildlife preservation and animal ethics. Nevertheless, the (re-)discovery of artemisinin more than 50 years ago introduced a novel development in TCM: the commingling of Eastern and Western medicine, the appreciation of both systems. The need for more rigorous approaches, fulfilment of and agreement to current guidelines to achieve high-quality research are of utmost relevance. Thereby, ancient knowledge of herbal species and concoctions may serve as a possible treasure box rather than Pandora's box.
Collapse
Affiliation(s)
| | - Lukas Dearing
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Tom E Dablander
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Julian Maier
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria.
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University Vienna, Waehringer Straße 13A, 1090, Vienna, Austria.
| |
Collapse
|
33
|
Ma SX. Establishing an adequate dose of acupuncture is essential for clinical trial studies. CLINICAL RESEARCH AND TRIALS 2020; 6:10.15761/crt.1000295. [PMID: 35382135 PMCID: PMC8979409 DOI: 10.15761/crt.1000295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
IMPORTANCE A number of recent clinical trials have demonstrated that acupuncture is more effective for treating chronic pain conditions compared to sham and no acupuncture, but some research questions have remained unaddressed and are standing in the way of further progress. OBSERVATIONS AND ADVANCES The effectiveness of acupuncture for pain conditions compared to usual care have been demonstrated, which has significantly enhanced the position of acupuncture in multiple pain guidelines following these studies. However, the studies also generated some conflicting results with difficulty in comparing each other. Research examining an adequate dose of acupuncture therapy with optimal intervention parameters and time table has also long been neglected and is now urgent. The dose of acupuncture depends on stimulation parameters: force/intensity and speed/frequency of manual acupuncture (MA) or electroacupuncture (EA) and time table (number of treatment sessions and duration). Various frequencies and intensities of MA and EA stimulation have been utilized in individual research. Different acupuncture treatment sessions (once, twice, three to five times per week) and periods (4, 6, 8, and 12 weeks) have been used in these clinical trials. One clinical trial using one session of needle acupuncture and laser at 12 weeks (8 to 12 treated sessions) did not improve pain in patients with chronic knee pain but similar trials of osteoarthritis knee have significant effects of pain improvement after biweekly sessions of needle acupuncture for 8 weeks of treatment. CONCLUSIONS AND RELEVANCE Determining a right treatment regimen on correct acupuncture point(s) for acupuncture is a critical first step for acupuncture clinical trials. Appropriate acupuncture parameters such as acupuncture stimulation technique, treatment sessions, and treatment duration must be considered in acupuncture clinical trials. An adequate dose of acupuncture for clinical trials should be established following dose finding workshops for acupuncture before the studies, which not only improve the therapeutic effects of the therapies but also allow the comparisons between trials and between the acupuncture community/practice and trial studies.
Collapse
Affiliation(s)
- Sheng-Xing Ma
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center and Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles and Harbor-UCLA Medical Center, Torrance, CA 90502, U.S.A
| |
Collapse
|
34
|
Xu S, Yu L, Luo X, Wang M, Chen G, Zhang Q, Liu W, Zhou Z, Song J, Jing H, Huang G, Liang F, Wang H, Wang W. Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial. BMJ 2020; 368:m697. [PMID: 32213509 PMCID: PMC7249245 DOI: 10.1136/bmj.m697] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the efficacy of manual acupuncture as prophylactic treatment for acupuncture naive patients with episodic migraine without aura. DESIGN Multicentre, randomised, controlled clinical trial with blinded participants, outcome assessment, and statistician. SETTING Seven hospitals in China, 5 June 2016 to 15 November 2018. PARTICIPANTS 150 acupuncture naive patients with episodic migraine without aura. INTERVENTIONS 20 sessions of manual acupuncture at true acupuncture points plus usual care, 20 sessions of non-penetrating sham acupuncture at heterosegmental non-acupuncture points plus usual care, or usual care alone over 8 weeks. MAIN OUTCOME MEASURES Change in migraine days and migraine attacks per four weeks during weeks 1-20 after randomisation compared with baseline (four weeks before randomisation). RESULTS Among 150 randomised patients (mean age 36.5 (SD 11.4) years; 123 (82%) women), 147 were included in the full analysis set. Compared with sham acupuncture, manual acupuncture resulted in a significantly greater reduction in migraine days at weeks 13 to 20 and a significantly greater reduction in migraine attacks at weeks 17 to 20. The reduction in mean number of migraine days was 3.5 (SD 2.5) for manual versus 2.4 (3.4) for sham (adjusted difference -1.4, 95% confidence interval -2.4 to -0.3; P=0.005) at weeks 13 to 16 and 3.9 (3.0) for manual versus 2.2 (3.2) for sham (adjusted difference -2.1, -2.9 to -1.2; P<0.001) at weeks 17 to 20. At weeks 17 to 20, the reduction in mean number of attacks was 2.3 (1.7) for manual versus 1.6 (2.5) for sham (adjusted difference -1.0, -1.5 to -0.5; P<0.001). No severe adverse events were reported. No significant difference was seen in the proportion of patients perceiving needle penetration between manual acupuncture and sham acupuncture (79% v 75%; P=0.891). CONCLUSIONS Twenty sessions of manual acupuncture was superior to sham acupuncture and usual care for the prophylaxis of episodic migraine without aura. These results support the use of manual acupuncture in patients who are reluctant to use prophylactic drugs or when prophylactic drugs are ineffective, and it should be considered in future guidelines. TRIAL REGISTRATION Clinicaltrials.gov NCT02765581.
Collapse
Affiliation(s)
- Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Lingling Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Guohua Chen
- Department of Neurology, Wuhan No.1 Hospital / Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Qing Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenhua Liu
- Department of Scientific Research Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhongyu Zhou
- Department of Acupuncture, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Jinhui Song
- Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Huitao Jing
- Department of Rehabilitation Medicine, The Second Hospital of Huangshi, Huangshi, Hubei, China
| | - Guangying Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengxia Liang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan 430065, Hubei, China
| | - Hua Wang
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine/Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Wuhan 430065, Hubei, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| |
Collapse
|
35
|
Ots T, Kandirian A, Szilagyi I, DiGiacomo SM, Sandner-Kiesling A. The selection of dermatomes for sham (placebo) acupuncture points is relevant for the outcome of acupuncture studies: a systematic review of sham (placebo)-controlled randomized acupuncture trials. Acupunct Med 2020; 38:211-226. [PMID: 32026725 DOI: 10.1177/0964528419889636] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many randomized controlled trials (RCTs) of acupuncture reveal no significant differences between acupuncture and so-called placebo acupuncture. There is a strong tendency to replace the term "placebo" by the term "sham," because any needling stimulates a certain physiological response. However, neither concept accounts for the great diversity of results in RCTs comparing verum acupuncture and sham (placebo) acupuncture. Some trials have shown little or no difference, while other studies have found statistically significant differences. OBJECTIVE Verum acupuncture and sham (placebo) acupuncture may achieve similar results to the extent that they share active constituents. We identified these common active constituents as dermatomes: the segmental structure of the human body. In our study, we tested the hypothesis that the more verum and sham (placebo) acupuncture share the same dermatomes, the closer the clinical outcomes will be, and vice versa. METHODS All major databases were searched for RCTs that tested acupuncture versus sham (placebo) acupuncture. The dermatome charts of Hansen and Schliack were used to verify verum and sham (placebo) needling locations. Reported clinical outcomes were assessed in relation to the percentage of overlap between the dermatomes stimulated by acupuncture and sham (placebo) acupuncture. RESULTS Our literature search yielded a total of 1738 references. Thirty-four studies met the inclusion criteria. The effects of sham (placebo) acupuncture varied according to the dermatomes stimulated: high overlap with those stimulated by verum acupuncture resulted in almost identical efficacy, while low overlap resulted in significant differences in efficacy. Clinical outcomes were similar when verum acupuncture and sham (placebo) acupuncture shared the same dermatomes (p < 0.01). DISCUSSION The findings of this review confirm our hypothesis. Acupuncture studies that employed verum and sham locations on overlapping dermatomes helped to create a mediocre to negative picture of acupuncture's efficacy. The segmental structure of the body with its interconnected reflex system offers an additional neurophysiological explanation for the effectiveness of acupuncture applied to structures segmentally innervated by the spinal and visceral nervous system. Further comparative acupuncture studies should be based on knowledge of segmental anatomy. In testing verum acupuncture versus sham acupuncture, the chosen sham acupuncture needling locations should be situated on non-overlapping dermatomes.
Collapse
Affiliation(s)
- Thomas Ots
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Asal Kandirian
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Istvan Szilagyi
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Susan M DiGiacomo
- Department of Anthropology, Philosophy and Social Work, Universitat Rovira i Virgili, Tarragona, Spain.,Department of Anthropology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreas Sandner-Kiesling
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
36
|
Kim TH, Lee MS, Alraek T, Birch S. Acupuncture in sham device controlled trials may not be as effective as acupuncture in the real world: a preliminary network meta-analysis of studies of acupuncture for hot flashes in menopausal women. Acupunct Med 2020; 38:37-44. [PMID: 31517500 PMCID: PMC7041625 DOI: 10.1136/acupmed-2018-011671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Randomised controlled trials of acupuncture performed using sham interventions to control for the placebo effect have mostly used two types of sham techniques: techniques with minimal insertion of acupuncture needles with no additional stimulation (shallow needling control) and techniques with sham acupuncture devices that do not penetrate the skin (sham device control). To achieve successful blinding, sham device controlled acupuncture trials also use the acupuncture base unit in the verum acupuncture group, but in the shallow needling control trials this is not necessary for the verum acupuncture treatment. OBJECTIVE In this study, we analysed the estimated comparative effectiveness of these two verum acupuncture modalities in studies of acupuncture for menopausal hot flashes that used two types of sham control treatments. METHODS We conducted a network meta-analysis that included randomised controlled trials of acupuncture for hot flashes. Electronic databases, including Medline, Embase, Cochrane Library and AMED, were searched through March 2017. Data were extracted using a predefined data extraction tool by two independent reviewers. The risk of bias was assessed using the Cochrane risk of bias tool for randomised controlled trials. A five-node network meta-analysis was conducted based on the frequentist framework. RESULTS Eight studies were included in this review. From the network meta-analysis, we found that verum acupuncture in the shallow needling controlled trials was more effective than verum acupuncture in the sham device controlled trials (SMD -7.27, 95% CI-9.11 to -5.43). Significant heterogeneity and inconsistency were not observed among the included studies or the comparisons. CONCLUSIONS From this preliminary analysis, we found that different types of verum acupuncture may have different effect sizes with respect to the severity of menopausal hot flashes.
Collapse
Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Allied Health Sciences, School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Terje Alraek
- Department of Health Sciences, Kristiania University College, Oslo, Norway
- Faculty of Medicine, Department of Community Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway, Tromso, Norway
| | - Stephen Birch
- Department of Health Sciences, Kristiania University College, Oslo, Norway
| |
Collapse
|
37
|
Citkovitz C, Betts D. Obstetrical Acupuncture: Reflections on a Much-Needed Special Issue. Med Acupunct 2019; 31:325-326. [PMID: 32952803 DOI: 10.1089/acu.2019.29132.cit] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia Citkovitz
- Department of Rehabilitation Medicine, NYU Langone Hospital, Brooklyn, NY
| | - Debra Betts
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| |
Collapse
|
38
|
Aichner S, Haile A, Hoffmann V, Olliges E, Tschöp MH, Meissner K. The Role of Tactile Stimulation for Expectation, Perceived Treatment Assignment and the Placebo Effect in an Experimental Nausea Paradigm. Front Neurosci 2019; 13:1212. [PMID: 31798402 PMCID: PMC6863803 DOI: 10.3389/fnins.2019.01212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Tactile stimulation during a placebo treatment could enhance its credibility and thereby boost positive treatment expectations and the placebo effect. This experimental study aimed to investigate the interplay between tactile stimulation, expectation, and treatment credibility for the placebo effect in nausea. Methods Ninety healthy participants were exposed to a 20-min vection stimulus on two separate days and were randomly allocated to one of three groups on the second day after the baseline period: Placebo transcutaneous electrical nerve stimulation (TENS) with tactile stimulation (n = 30), placebo TENS without tactile stimulation (n = 30), or no intervention (n = 30). Placebo TENS was performed for 20 min at a dummy acupuncture point on both forearms. Expected and perceived nausea severity and further symptoms of motion sickness were assessed at baseline and during the evaluation period. At the end of the experiment, participants in the placebo groups guessed whether they had received active or placebo treatment. Results Expected nausea decreased significantly more in the placebo groups as compared to the no treatment control group (interaction day × group, F = 6.60, p = 0.003, partial η2 = 0.20), with equal reductions in the two placebo groups (p = 1.0). Reduced expectation went along with a significant placebo effect on nausea (interaction day × group, F = 22.2, p < 0.001, partial η2 = 0.35) with no difference between the two placebo groups (p = 1.0). Twenty-three out of 29 participants in the tactile placebo group (79%) but only 14 out of 30 participants (47%) in the non-tactile placebo group believed that they had received the active intervention (p = 0.015). Bang’s blinding index (BI) indicated random guessing in the non-tactile placebo group (BI = 0; 95% CI, −0.35 to 0.35) and non-random guessing in the direction of an “opposite guess” in the tactile placebo group (BI = −0.52; 95% CI, −0.81 to −0.22). Conclusion Tactile stimulation during placebo TENS did not further enhance positive treatment expectations and the placebo effect in nausea but increased the credibility of the intervention. Further trials should investigate the interaction between perceived treatment assignment, expectation, and the placebo effect during the course of a trial.
Collapse
Affiliation(s)
- Simone Aichner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Anja Haile
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Verena Hoffmann
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Elisabeth Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Matthias H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Munich, Germany.,German Center for Diabetes Research (DZD), Munich, Germany.,Division of Metabolic Diseases, Department of Medicine, Technische Universität München, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| |
Collapse
|
39
|
Schallock H, Bartmann B, Keinki C, Huebner J. Online information on oncologists' and non-medical practitioners' websites in Germany: A critical comparison. PATIENT EDUCATION AND COUNSELING 2019; 102:2038-2048. [PMID: 31147090 DOI: 10.1016/j.pec.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To survey websites of oncologists and non-medical practitioners (NMPs) in Germany regarding range of treated symptoms, diagnostic tools and therapies offered to cancer patients as well as the quality of websites. METHODS Analysis of 98 websites of oncologists and NMPs was conducted between April and July 2018 with a standardized tool. RESULTS Range of diagnostic and therapeutic methods was high and differed between both groups. Many NMPs (65.3%) intended to support conventional therapy rather than to treat cancer. Most oncologists (85.7%) did not mention the role of complementary and alternative medicine (CAM). Texts on oncologists' websites, showed high complexity according to readability analysis using LIX score as opposed to those on NMPs websites that showed medium complexity. Only small difference of quality of websites between both groups could be detected. CONCLUSION Methods not acknowledged by evidence-based medicine as well as methods at risk for interaction with conventional cancer therapy but also treatment offers with potential benefits for cancer patients were found on NMPs websites. PRACTICE IMPLICATIONS As evidence-based CAM methods can be a useful support of cancer treatment, risk of herb drug interactions can be minimized by oncologists offering reasonable CAM.
Collapse
Affiliation(s)
- Henriette Schallock
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Berit Bartmann
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Christian Keinki
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Jutta Huebner
- Dept. of Hematology and Medical Oncology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| |
Collapse
|
40
|
Yang M, Sun M, Du T, Long H, Chen J, Liang F, Lao L. The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 28:1415-1425. [PMID: 31529993 DOI: 10.1177/2047487319876761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to assess the efficacy and safety of acupuncture in the treatment of patients with stable angina pectoris. Methods A literature search was performed in nine databases, including PubMed and the Cochrane Library, from their inception to 30 August 2018. Randomized controlled trials that compared acupuncture therapy with sham acupuncture or no treatment were included. Two reviewers under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines assessed the eligibility of each record and extracted essential information independently. The data were merged using a fixed-effect model. Results Pooled analysis of 17 eligible trials with 1516 participants showed that acupuncture was associated with reduced angina attack frequency (–4.91; 95% confidence interval, –6.01– –3.82; p < 0.00001) and improved depression (–1.23; 95% confidence interval, –1.47– –1.00; p < 0.00001) and anxiety level (–0.96; 95% confidence interval, –1.16– –0.75; p < 0.00001) relative to sham treatment or standard care alone. No increased risk of adverse events was observed during treatment (relative risk, 0.70; 95% confidence interval, 0.33–1.48; p = 0.35). No significant improvement was shown in nitroglycerin use or angina intensity. The included studies were associated with unclear to high risk of selection or performance bias, and the quality of evidence was low to moderate. Conclusions Acupuncture may safely and effectively improve physical restrictions, emotional distress, and attack frequency in patients with stable angina pectoris. However, angina intensity and medication use were not reduced. Studies with adequate blinding and a valid sham control group are still warranted due to the current low quality of evidence.
Collapse
Affiliation(s)
- Mingxiao Yang
- School of Chinese Medicine, University of Hong Kong, China
- Department of Chinese Medicine, University of Hong Kong-Shenzhen Hospital, China
| | - Mingsheng Sun
- School of Acupuncture, Chengdu University of TCM, China
| | - Ting Du
- Department of Rehabilitation, Xishan People's Hospital, China
| | - Hulin Long
- Department of Acupuncture, Teaching Hospital of Chengdu University of TCM, China
| | - Ji Chen
- School of Acupuncture, Chengdu University of TCM, China
| | - Fanrong Liang
- School of Acupuncture, Chengdu University of TCM, China
| | - Lixing Lao
- School of Chinese Medicine, University of Hong Kong, China
- Department of Chinese Medicine, University of Hong Kong-Shenzhen Hospital, China
| |
Collapse
|
41
|
Lown EA, Banerjee A, Vittinghoff E, Dvorak CC, Hartogensis W, Melton A, Mangurian C, Hu H, Shear D, Adcock R, Morgan M, Golden C, Hecht FM. Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial. Glob Adv Health Med 2019; 8:2164956119870444. [PMID: 31453017 PMCID: PMC6696841 DOI: 10.1177/2164956119870444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 07/02/2019] [Indexed: 01/16/2023] Open
Abstract
Background We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC). Objective To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT). Design Two-armed RCTs with enrollment of 5 to 30 study days. Setting Two pediatric teaching hospitals. Patients Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver. Intervention Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments. Main Outcome A composite nausea/vomiting measure for the child. Secondary Outcomes Child's nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect. Parent Outcomes Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age. Discussion Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.
Collapse
Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Anu Banerjee
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Wendy Hartogensis
- Osher Center for Integrative Medicine, University of California, San Francisco, California
| | - Alexis Melton
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, School of Medicine, University of California, San Francisco, California
| | - Hiroe Hu
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Deborah Shear
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Robyn Adcock
- Compass Care/Integrative Pediatric Pain and Palliative Care (IP3), UCSF Benioff Children's Hospital, San Francisco, California
| | - Michael Morgan
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Carla Golden
- Department of Pediatric Hematology-Oncology, UCSF Benioff Children's Hospital, Oakland, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, California
| |
Collapse
|
42
|
Chen H, Yang M, Ning Z, Lam WL, Zhao YK, Yeung WF, Ng BFL, Ziea ETC, Lao L. A Guideline for Randomized Controlled Trials of Acupuncture. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:1-18. [PMID: 30612455 DOI: 10.1142/s0192415x19500010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Guidelines for clinical trials of acupuncture are scarce, particularly in their guidance on choosing an adequate control in an acupuncture trial. This guideline was developed to address the research methodology for clinical research in acupuncture which contains the essential elements to be considered in the design, preparation and reporting of an acupuncture RCT. Particularly, investigators focused on the control design because of the unique feature of acupuncture. As one size does not fit all, one single design cannot answer all research questions. Therefore, we recommend that the clinical questions be answered in different stages of trials by choosing the appropriate control or comparator. This concept is adapted from classical drug trials developed by the Food and Drug Administration (FDA) of USA in which trials are staged in four phages in order to address different research questions. From the points listed above, this guideline offers the specific recommendations in an acupuncture RCT.
Collapse
Affiliation(s)
- Haiyong Chen
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mingxiao Yang
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhipeng Ning
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Lok Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Ying Ke Zhao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Eric Tat-Chi Ziea
- The Chinese Medicine Department, Hospital Authority, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
43
|
Abstract
BACKGROUND Gastroparesis, a state of delayed gastric emptying in the absence of mechanical obstruction of the stomach, has a substantial impact on people's daily function and quality of life when symptomatic. Current treatment options are based on limited evidence of benefits. Acupuncture is widely used to manage gastrointestinal disorders, although its role in people with symptomatic gastroparesis is unclear. We therefore undertook a systematic review of the evidence. OBJECTIVES To assess the benefits and harms of acupuncture, in comparison with no treatment, sham acupuncture, conventional medicine, standard care, or other non-pharmacological active interventions for symptom management in people with gastroparesis. SEARCH METHODS On 26 March 2018, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus, PsycINFO, AMED, Korean medical databases (including Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, Research Information Centre for Health Database, KoreaMed, and the National Assembly Library), and Chinese databases (including the China Academic Journal). We also searched two clinical trials registries for ongoing trials. We imposed no language limitations. SELECTION CRITERIA We selected all randomised controlled trials comparing the penetrating type of acupuncture with no treatment, sham acupuncture, conventional medicine, standard care, and other non-pharmacological active interventions for people with symptomatic gastroparesis of any aetiology (i.e. surgical, diabetic, or idiopathic). Trials reporting outcomes at least four weeks from baseline (short-term outcomes) were eligible. We defined long-term outcomes as those measured after 12 weeks from baseline. The primary outcome was improvement of gastroparesis symptoms in the short term. Secondary outcomes were: improvement of symptoms measured after three months, change in the rate of gastric emptying, quality of life, use of medication, and adverse events in the short and long term. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible trials based on predefined selection criteria. Two review authors independently extracted data and evaluated the risk of bias. The review authors contacted investigators to obtain missing information wherever possible. MAIN RESULTS We included 32 studies that involved a total of 2601 participants. Acupuncture was either manually stimulated (24 studies) or electrically stimulated (8 studies). The aetiology of gastroparesis was diabetes (31 studies) or surgery (1 study). All studies provided data on the proportion of people with symptoms 'improved', although the definition or categorisation of improvement varied among the studies. Most measured only short-term outcomes (28 studies), and only one study employed validated instruments to assess subjective changes in symptoms or reported data on quality of life or the use of medication. Reporting of harm was incomplete; minor adverse events were reported in only seven trials. Most studies had unclear risk of bias in terms of allocation concealment (29/32), outcome assessor blinding (31/32) and selective reporting (31/32), as well as high risk of bias in terms of participant/personnel blinding (31/32). Acupuncture was compared with sham acupuncture (needling on non-acupuncture points), three different types of gastrokinetic drugs (domperidone, mosapride, cisapride), and a histamine H₂ receptor antagonist (cimetidine).There was low-certainty evidence that symptom scores of participants receiving acupuncture did not differ from those of participants receiving sham acupuncture at three months when measured by a validated scale.There was very low-certainty evidence that a greater proportion of participants receiving acupuncture had 'improved' symptoms in the short term compared to participants who received gastrokinetic medication (4 to 12 weeks) (12 studies; 963 participants; risk ratio (RR) 1.25; 95% confidence interval (CI) 1.17 to 1.33, I² = 8%). Short-term improvement in overall symptom scores favouring acupuncture was also reported in five studies with considerable heterogeneity.Acupuncture in combination with other treatments, including gastrokinetics, non-gastrokinetics and routine care, was compared with the same treatment alone. There was very low-certainty evidence in favour of acupuncture for the proportion of participants with 'improved' symptoms in the short term (4 to 12 weeks) (17 studies; 1404 participants; RR 1.22; 95% CI 1.16 to 1.28; I² = 0%). Short-term improvement in overall symptom scores, favouring acupuncture, were also reported (two studies, 132 participants; MD -1.96, 95% CI -2.42 to -1.50; I² = 0%).Seven studies described adverse events, including minor bleeding and hematoma, dizziness, xerostomia, loose stool, diarrhoea, abdominal pain, skin rash and fatigue. The rest of the trials did not report whether adverse events occurred.Subgroup analyses revealed that short-term benefits in terms of the proportion of people with 'improved' symptoms did not differ according to the type of acupuncture stimulation (i.e. manual or electrical). The sensitivity analysis revealed that use of a valid method of random sequence generation, and the use of objective measurements of gastric emptying, did not alter the overall effect estimate in terms of the proportion of people with 'improved' symptoms. The asymmetric funnel plot suggests small study effects and publication bias towards positive reporting. AUTHORS' CONCLUSIONS There is very low-certainty evidence for a short-term benefit with acupuncture alone or acupuncture combined with gastrokinetic drugs compared with the drug alone, in terms of the proportion of people who experienced improvement in diabetic gastroparesis. There is evidence of publication bias and a positive bias of small study effects. The reported benefits should be interpreted with great caution because of the unclear overall risk of bias, unvalidated measurements of change in subjective symptoms, publication bias and small study reporting bias, and lack of data on long-term outcomes; the effects reported in this review may therefore differ significantly from the true effect. One sham-controlled trial provided low-certainty evidence of no difference between real and sham acupuncture in terms of short-term symptom improvement in diabetic gastroparesis, when measured by a validated scale. No studies reported changes in quality of life or the use of medication.Due to the absence of data, no conclusion can be made regarding effects of acupuncture on gastroparesis of other aetiologies. Reports of harm have remained largely incomplete, precluding assessments of the safety of acupuncture in this population. Future research should focus on reducing the sources of bias in the trial design as well as transparent reporting. Harms of interventions should be explicitly reported.
Collapse
Affiliation(s)
- Kun Hyung Kim
- Pusan National University HospitalDepartment of Korean MedicineGudeok‐Ro, Seo‐GuBusanKorea, South49241
| | - Myeong Soo Lee
- Korea Institute of Oriental MedicineClinical Medicine Division461‐24 Jeonmin‐dong, Yuseong‐guDaejeonKorea, South34054
| | - Tae‐Young Choi
- Korea Institute of Oriental MedicineMedical Research Division461‐24 Jeonmin‐dong, Yuseong‐guDaejeonKorea, South305‐811
| | - Tae‐Hun Kim
- College of Korean Medicine, Kyung Hee UniversityKorean Medicine Clinical Trial Center#23 Kyungheedae‐roDongdaemun‐guSeoulKorea, South130‐872
| | | |
Collapse
|
44
|
Zhang GS, Zhang CS, Tan HY, Wang Y, DaCosta C, Zhang AL, Xue CC, Xie YM. Systematic Review of Acupuncture Placebo Devices with a Focus on the Credibility of Blinding of Healthy Participants And/Or Acupuncturists. Acupunct Med 2018; 36:204-214. [DOI: 10.1136/acupmed-2017-011484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 11/04/2022]
Abstract
Background An ideal placebo design in clinical research should resemble the intervention under investigation to facilitate blinding, yet remain clinically inert. With regard to physical interventions such as acupuncture, a true placebo device has not been developed and validated. Since 1998, researchers have designed several placebo acupuncture devices (PADs). The three most widely used PADs are the Streitberger, the Park and the Takakura device. Aim This review focuses on evaluating studies of these devices, in the context of credibility of blinding (COB), assessment of penetrating pain or sensation, and de qi sensation. Methods Electronic database searches were conducted in four English and two Chinese databases from their inception until November 2016. All studies included in the review were conducted on healthy participants and compared verum manual acupuncture with any of the aforementioned PADs with respect to one or more of the above three outcomes related to blinding effect. Results The synthesised analyses of the 15 included studies showed that the Streitberger and Park placebo devices may not blind participants successfully when tested at a sensitive acupuncture point (LI4). In terms of penetrating sensation, there were significant differences between these two placebo devices and verum acupuncture when applied at this point. The Takakura device was the only PAD that had the potential to blind the acupuncturist. However, the blinding analyses of all outcome measures were inconsistent. Conclusion Overall, there were insufficient data to confirm the blinding effects of these skin-contact PADs as each device was associated with limitations that warrant further design improvements.
Collapse
Affiliation(s)
- George Shengxi Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hsiewe Ying Tan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Yanyi Wang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Cliff DaCosta
- School of Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Anthony Lin Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Charlie Changli Xue
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Yi Min Xie
- Centre for Innovative Structures and Materials, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| |
Collapse
|
45
|
Fleckenstein J, Baeumler P, Gurschler C, Weissenbacher T, Annecke T, Geisenberger T, Irnich D. Acupuncture reduces the time from extubation to 'ready for discharge' from the post anaesthesia care unit: results from the randomised controlled AcuARP trial. Sci Rep 2018; 8:15734. [PMID: 30356057 PMCID: PMC6200780 DOI: 10.1038/s41598-018-33459-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022] Open
Abstract
Acupuncture may improve peri-operative care as it reduces post-operative symptoms, such as pain, nausea and vomiting, or sedation. This patient-assessor blinded, randomised trial in 75 women undergoing gynaecologic laparoscopy evaluated the effects of acupuncture combined with a standardised anaesthetic regimen (ACU) on post-anaesthetic recovery, when compared to acupressure (APU) or standard anaesthesia alone (CON). Main outcome measure was the time from extubation to ‘ready for discharge’ from recovery as assessed by validated questionnaires. The main outcome differed significantly between groups (p = 0.013). Median time to ready for discharge in the ACU group (30 (IQR: 24–41) min) was 16 minutes (35%) shorter than in the CON group (46 (36–64) min; p = 0.015) and tended to be shorter than in the APU group (43 (31–58) min; p = 0.08). Compared to CON (p = 0.029), median time to extubation was approximately 7 minutes shorter in both, the ACU and the APU group. No acupuncture or acupressure-related side-effects could be observed. A difference in time to recovery of 16 minutes compared to standard alone can be considered clinically relevant. Thus, results of this study encourage the application of acupuncture in gynaecological laparoscopy as it improves post-anaesthetic recovery.
Collapse
Affiliation(s)
- J Fleckenstein
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany. .,Department of Traditional Chinese Medicine/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Personalhaus 4, Inselspital, CH-3010, Bern, Switzerland.
| | - P Baeumler
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany
| | - C Gurschler
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany
| | - T Weissenbacher
- Department of Obstetrics and Gynaecology, Ludwig-Maximillians-University (LMU) Hospital, Maistraße 11, D-80337, Munich, Germany
| | - T Annecke
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany.,Department of Anaesthesiology and Intensive Care, University Hospital of Cologne, Uniklinik Köln, D-50924, Cologne, Germany
| | - T Geisenberger
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany.,Department of Anaesthesiology, Ospidal Engiadina Bassa, Via da l'Ospidal 280, CH-7550, Scuol, Switzerland
| | - D Irnich
- Department of Anaesthesiology, Ludwig-Maximilians University (LMU), Marchioninistraße 15, D-81377, Munich, Germany
| |
Collapse
|
46
|
Fleckenstein J, Krüger P, Ittner KP. Effects of single-point acupuncture (HT7) in the prevention of test anxiety: Results of a RCT. PLoS One 2018; 13:e0202659. [PMID: 30161153 PMCID: PMC6116988 DOI: 10.1371/journal.pone.0202659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background The number of students using neuro enhancement to improve their performance and to prevent test anxiety is increasing. The acupuncture point Heart 7 (HT7) has been described as being prominent in reducing states of anxiety. Methods We conducted a randomized placebo-controlled, two-armed pilot trial to investigate the efficacy of a single-point acupuncture treatment at bilateral HT7 compared to sham laser acupuncture on test anxiety. Test anxiety was induced applying the standardised protocol of the Trier Social Stress Test. Outcome measures included saliva samples analysed for cortisol and amylase, anxiety questionnaires and heart rate variability. Results Twenty-five male subjects (age 28 ± 5 years) were allocated to either verum acupuncture (n = 12) or sham laser acupuncture (n = 13). Cortisol peaked 20 min after the stress test (2-fold, 18.11 ± 2 nmol/l) and amylase 10 min after (2-fold, 259 ± 49 U/ml) with no difference between groups. There were no differences between groups regarding either anxiety questionnaires or physiological parameters. Compared to reference data (3-fold increase in cortisol), increase in stress hormones and heart rate seemed somewhat reduced. Conclusions Acupuncture may be a possible approach for the treatment of anxiety. Due to the lack of a no control treatment group, we cannot determine the magnitude of possible specific needle effects at HT7 to promote specific effects in the neuroendocrine system. Finally this study only examines the efficacy of a single time treatment.
Collapse
Affiliation(s)
- Johannes Fleckenstein
- Department of TCM/Acupuncture, Institute of Complementary Medicine, University of Bern, Personalhaus 4 Inselspital, Bern, Switzerland
- University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
- Department of Sports Medicine, Institute of Sports Sciences, Goethe-University Frankfurt, Frankfurt am Main, Germany
- * E-mail:
| | - Peter Krüger
- University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| | - Karl-Peter Ittner
- University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany
| |
Collapse
|
47
|
Liu L, Zhao LP, Zhang CS, Zeng L, Wang K, Zhao J, Wang L, Jing X, Li B. Acupuncture as prophylaxis for chronic migraine: a protocol for a single-blinded, double-dummy randomised controlled trial. BMJ Open 2018; 8:e020653. [PMID: 29858418 PMCID: PMC5988062 DOI: 10.1136/bmjopen-2017-020653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Approximately 1.4%-2.2% of the global population suffers from chronic migraine. Acupuncture may serve as an alternative management for chronic migraine, where pharmacological prophylaxis is not suitable. However, the effects of acupuncture as migraine prophylaxis have not been confirmed. This study is designed as a single-blinded, double-dummy randomised controlled trial to evaluate the efficacy and safety of acupuncture compared with topiramate in patients with chronic migraine. METHODS AND ANALYSIS A total of 60 participants will be randomly assigned to two different groups. Participants will receive verum acupuncture and placebo medicine in the treatment group, while participants in the control group will be treated with sham acupuncture and real medicine (topiramate). All participants will receive a 12-week treatment and then be followed up for another 12 weeks. The primary outcome is the reduction of monthly headache days, and the secondary outcomes include the reduction of the number of days with acute headache medications, and changes of Migraine Disability Assessment, Migraine-Specific Quality of Life Questionnaire, Headache Impact Test, State-Trait Anxiety Inventory-trait, and Beck Depression Inventory-II scores from baseline to endpoints. ETHICS AND DISSEMINATION Ethical approval of this study was granted by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University (2017BL-045-01). Written informed consent will be obtained from all participants. Outcomes of the trial will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN13563102; Pre-results.
Collapse
Affiliation(s)
- Lu Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luo-Peng Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing Institute of Traditional Chinese Medicine, Beijing, China
| | - Claire Shuiqing Zhang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Lin Zeng
- Peking University Third Hospital, Research Centre of Clinical Epidemiology, Beijing, China
| | - Kelun Wang
- Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Jingxia Zhao
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
- Beijing Key Laboratory of Clinic and Basic Research with Traditional Chinese Medicine on Psoriasis, Beijing Institute of Traditional Chinese Medicine, Beijing, China
| | - Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Xianghong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bin Li
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
48
|
Acupuncture: How Might the Mechanisms of Treatment Have Contributed to the Diagnosis of “Patterns” and Pattern-based Treatments – Speculations on the Evolution of Acupuncture as a Therapy. Implications for Researchers. JOURNAL OF ACUPUNCTURE RESEARCH 2018. [DOI: 10.13045/jar.2018.00101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
49
|
Au KY, Chen H, Lam WC, Chong CO, Lau A, Vardhanabhuti V, Mak KC, Jiang F, Lam WY, Wu FM, Chan HN, Ng YW, Ng BFL, Ziea ETC, Lao L. Sinew acupuncture for knee osteoarthritis: study protocol for a randomized sham-controlled trial. Altern Ther Health Med 2018; 18:133. [PMID: 29685141 PMCID: PMC5913871 DOI: 10.1186/s12906-018-2195-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 04/10/2018] [Indexed: 01/09/2023]
Abstract
Background Sinew acupuncture is a new modality of acupuncture in which needles are inserted into acupoints, ashi points or spasm points of sinew and muscles along the meridian sinew pathway. A previous observational study revealed that sinew acupuncture has immediate analgesic effects on various soft tissue injuries, including knee injuries. However, no rigorous trials have been conducted. This study aims to examine whether sinew acupuncture can safely relieve pain and symptoms of knee osteoarthritis (KOA) and improve patients’ functional movement and quality of life. Methods/design A randomized, sham-controlled, patient- and assessor-blinded trial will be conducted to compare the efficacy of sinew acupuncture and sham acupuncture. Subjects will be assessed by the physician and acupuncturists. A sample of eighty-six eligible subjects will be randomized into either the sinew acupuncture group or the sham acupuncture group. The intervention will be performed in the Hong Kong Tuberculosis Association Chinese Medicine Clinic cum Training Centre of the University of Hong Kong by acupuncturists with over 3 years of acupuncture experience. Subjects will receive 10 sessions of interventions for 4 weeks, followed by a 6-week follow-up. The visual analogue scale (VAS) score at week 4 will be the primary outcome. The Western Ontario and McMasters University Osteoarthritis Index (WOMAC), Timed Up & Go Test (TUG), 8-step Stair Climb Test (SCT) and the 36-Item Short Form Survey (SF-36) will be secondary outcomes. Discussion Sinew acupuncture is a potential alternative non-pharmacological therapy for KOA. This rigorous trial will expand our knowledge of whether sinew acupuncture reduces pain intensity and improves symptoms, functional movements, and quality of life of KOA patients. Trial registration The study was registered at ClinicalTrials.gov (Identifier: NCT03099317) in March 2017.
Collapse
|
50
|
Niemtzow R, Baxter J, Gallagher RM, Pock A, Calabria K, Drake D, Galloway K, Walter J, Petri R, Piazza T, Burns S, Hofmann L, Biery J, Buckenmaier C. Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project. Mil Med 2018; 183:e486-e493. [DOI: 10.1093/milmed/usy028] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/06/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Richard Niemtzow
- United States Air Force Acupuncture and Integrative Medical Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - John Baxter
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Rollin M Gallagher
- Penn Pain Medicine Center, University of Pennsylvania, 1840 South Street, Tuttleman Center, Philadelphia, PA
| | - Arnyce Pock
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kathryn Calabria
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - David Drake
- Hunger Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA
- Virginia Commonwealth University, 907 Floyd Avenue, Richmond, VA
| | - Kevin Galloway
- Defense and Veterans Center for Integrative Pain Management, 11300 Rockville Pike, Suite 709, Rockville, MD
| | - Joan Walter
- Samueli Institute, 1150 Kersey Road, Silver Spring, MD
| | - Richard Petri
- William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX
| | - Thomas Piazza
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Stephen Burns
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - Lew Hofmann
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, 1060W Perimeter Road, Joint Base Andrews, MD
| | - John Biery
- Naval Branch Health Clinic, 450 Turner Street, Pensacola, FL
| | - Chester Buckenmaier
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
- Defense and Veterans Center for Integrative Pain Management, 11300 Rockville Pike, Suite 709, Rockville, MD
| |
Collapse
|