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Zhao RL, Ma PH, Liu BY, Yu CH, Zhang HR, Lv Q, Yang DW, Yang YP, Liu HY, Wang FY, Yin CS, Su SG, Wang HC, Wang XY, Yan SY. Short-term and long-term effectiveness of acupuncture and Tuina on knee osteoarthritis: study protocol for a randomized controlled trial. Front Neurol 2023; 14:1301217. [PMID: 38152644 PMCID: PMC10751577 DOI: 10.3389/fneur.2023.1301217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/03/2023] [Indexed: 12/29/2023] Open
Abstract
Background The effectiveness of acupuncture and tuina in treating knee osteoarthritis (KOA) is still controversial, which limits their clinical application in practice. This study aims to evaluate the short-term and long-term effectiveness of acupuncture and tuina on KOA. Methods/design This parallel-group, multicenter randomized clinical trial (RCT) will be conducted at the outpatient clinic of five traditional Chinese medicine hospitals in China. Three hundred and thirty participants with KOA will be randomly assigned to acupuncture, tuina, or home-based exercise group with a ratio of 1:1:1. The primary outcome is the proportion of participants achieving a minimal clinically important improvement defined as a ≥ 12% reduction on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain dimension on short term (week 8) and long term (week 26) compared with baseline. Secondary outcomes are knee joint conditions (pain, function, and stiffness), self-efficacy of arthritis, quality of life, and psychological conditions, which will be evaluated by the WOMAC score and the Patient Global Assessment (PGA), and in addition, the respondents index of OMERACT-OARSI, Short Form 12 Health Survey (SF-12), arthritis self-efficacy scale, and European five-dimensional health scale (EQ-5D). Adverse events will be collected by self-reported questionnaires predefined. Clinical trial registration https://www.chictr.org.cn.
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Affiliation(s)
- Rui-li Zhao
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
| | - Pei-hong Ma
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
| | - Bao-yan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Chang-he Yu
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hao-ran Zhang
- College of Preschool Education, Beijing Youth Politics College, Beijing, China
| | - Qian Lv
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
| | - Da-wei Yang
- Guang'anmen Hospital (Southern District), China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu-ping Yang
- Weifang Hospital of Traditional Chinese Medicine, Weifang, China
| | - Hong-yan Liu
- Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital, Beijing, China
| | - Fu-yu Wang
- Guang'anmen Hospital (Southern District), China Academy of Chinese Medical Sciences, Beijing, China
| | - Chun-sheng Yin
- Weifang Hospital of Traditional Chinese Medicine, Weifang, China
| | - Shao-guang Su
- Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital, Beijing, China
| | - Hong-chi Wang
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
| | - Xi-you Wang
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shi-yan Yan
- Acupuncture and Moxibustion Department, Beijing University of Chinese Medicine, Beijing, China
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Tao QF, Wang XY, Feng SJ, Xiao XY, Shi YZ, Xie CR, Zheng H. Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis. J Neurol 2023; 270:3402-3412. [PMID: 37017736 DOI: 10.1007/s00415-023-11695-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Acupuncture has been shown to reduce tension-type headache (TTH) frequency in previous studies. Nevertheless, repeated significance testing might inflate type I error. We aimed to verify the effectiveness and safety of acupuncture in reducing TTH frequency by meta-analysis and trial sequential analysis (TSA). METHODS Ovid Medline, Embase, and Cochrane Library were searched until September 29, 2022. Randomized controlled trials comparing acupuncture with sham acupuncture, no acupuncture, or other active therapies in adults with TTH were included. The primary outcome was TTH frequency. The secondary outcomes were responder rate and adverse event. RESULTS Fourteen studies involving 2795 participants were included. Acupuncture had more reduction than sham acupuncture in TTH frequency, both after treatment (standardized mean difference [SMD] - 0.80, 95% CI - 1.36 to - 0.24, P = 0.005) and at the follow-up period (SMD - 1.33, 95% CI - 2.18 to - 0.49, P = 0.002), while TSA showed the included sample size did not exceed required information size (RIS). Acupuncture was superior over no acupuncture after treatment (SMD - 0.52, 95% CI - 0.63 to - 0.41, P < 0.001), and cumulative sample size reached RIS. In terms of responder rate, acupuncture had a higher responder rate compared with sham acupuncture both after treatment (relative ratio [RR] 1.28, 95% CI 1.12 to 1.46, P = 0.0003) and the follow-up period (RR 1.37, 95% CI 1.19 to 1.58, P < 0.0001), but the sample size is inadequate. CONCLUSION Acupuncture is an efficacious and safe treatment for TTH prevention, but this conclusion might be limited by the generally very low to low quality evidence. TSA suggested that high-quality trials are needed to verify the efficacy and safety of acupuncture compared to sham acupuncture.
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Affiliation(s)
- Qing-Feng Tao
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Xiao-Ying Wang
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Si-Jia Feng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Xin-Yu Xiao
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Yun-Zhou Shi
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Chao-Rong Xie
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China
| | - Hui Zheng
- The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China.
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Kwak SG, Kwon JB, Seo YW, Choi WK. The effectiveness of acupuncture as an adjunctive therapy to oral pharmacological medication in patient with knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33262. [PMID: 36930121 PMCID: PMC10019238 DOI: 10.1097/md.0000000000033262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/14/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND We aimed to find out whether the combined treatment of acupuncture and oral medication is more effective than sole oral medication in reducing pain and improving knee function at the end of treatment and after short-term period (4-6 weeks after treatment). Second, if it is effective, we investigated whether the effect surpasses the minimal clinically important difference. METHODS Articles published between January 1, 1992, and August 31, 2022, were searched in PubMed, Cochrane, and Embase. The PICO (population, intervention, comparison, and outcome) of this study are as follows: Population: knee osteoarthritis patients; Intervention: acupuncture (non-sham acupuncture) + oral medication (analgesic or non-steroidal anti-inflammatory drugs); Comparison: oral medication (analgesic or non-steroidal anti-inflammatory drugs); Outcome: visual analog scale (VAS) or Western Ontario and McMaster University (WOMAC) osteoarthritis index. RESULTS The combined treatment of oral medication and adjuvant acupuncture showed statistically significant improvement in VAS and WOMAC scores at the end of acupuncture treatment and short-term follow-up time (between 4 and 6 weeks after acupuncture). In addition, the degree of improvement of VAS and WOMAC index showed effects beyond minimal clinically important differences compared to pretreatment at both the end of acupuncture treatment and the short-term follow-up of acupuncture treatment. CONCLUSION The existing evidence suggests that adjuvant acupuncture may play a role in the treatment of knee osteoarthritis. However, physicians should be aware of adverse effects such as hematoma in adjuvant acupuncture treatment.
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Affiliation(s)
- Sang Gyu Kwak
- Department of Medical Statistics, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Jae Bum Kwon
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Young Woo Seo
- Department of Emergency medicine, College of Medicine, Daegu Catholic University, Daegu, Korea
| | - Won-Kee Choi
- Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea
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Tang CT, Sookochoff M, Rhea L, Carrier J, Prather H, Guan L. An audit of structure-based medical acupuncture by a single provider in patients with musculoskeletal pain using PROMIS scores as the outcome. Acupunct Med 2023; 41:48-54. [PMID: 36112861 DOI: 10.1177/09645284221118589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To assess whether structure-based medical acupuncture (SMA) can improve Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients presenting with musculoskeletal pain. METHODS An audit was conducted of all patients presenting with musculoskeletal pain treated by a single provider with SMA in 2017. Inclusion criteria included a pre-treatment and at least one post-treatment PROMIS score. Patient demographics and previous treatments tried were recorded. Documented events other than acupuncture that were thought to interfere with PROMIS scores were recorded, and no further scores were used after these events. A maximum of nine visits after the initial visit were used. The PROMIS domains assessed included anxiety, depression, pain interference and physical function. RESULTS Seventy-two patients who had been treated with SMA met the inclusion criteria. Sixty-five of the patients (90%) had chronic pain. For their presenting complaint, 59 (82%) had previously sought treatment from another non-operative provider, 60 (83%) had tried physical therapy, and 20 (28%) had even had surgery. Despite this, SMA appeared to be able to significantly improve PROMIS anxiety at visits 1-3 and PROMIS depression at visit 3. After just one treatment, minimal clinically important differences (MCID) were reached in 32%-44% of patients for PROMIS anxiety, 17%-36% for PROMIS depression, 28%-29% for PROMIS physical function, and 21%-36% for PROMIS pain interference, based on low and high cut-offs of a range of quoted MCID values. CONCLUSION In a difficult patient population with musculoskeletal pain, SMA is a technique that can likely be used to improve PROMIS anxiety and depression, although no firm conclusions can be drawn from this uncontrolled clinical audit. Of note, MCIDs were sometimes obtained even after just one treatment.
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Affiliation(s)
- Chi-Tsai Tang
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Michael Sookochoff
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Lee Rhea
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | | | - Ling Guan
- Chinese PLA General Hospital, Beijing, Beijing, China
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Teets R, Nielsen A, Moonaz S, Anderson BJ, Mah DM, Walter E, Milanes M, Jyung H, Soto Cossio LE, Meissner P, McKee MD, Kligler B. Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231202515. [PMID: 37779670 PMCID: PMC10540610 DOI: 10.1177/27536130231202515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
Background Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care. Objective To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings. Methods This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10 weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up. Results 93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic. Conclusions Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.
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Affiliation(s)
- Raymond Teets
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
| | - Steffany Moonaz
- Department of Clinical and Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA
| | - Belinda J Anderson
- College of Health Professions, Pace University, New York, NY, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Pacific College of Health and Science, New York, NY, USA
| | - Donna M Mah
- Pacific College of Health and Science, New York, NY, USA
| | - Eve Walter
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | | | - Hyowoun Jyung
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | | | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Family Medicine & Community Health, University of Massachusetts Medical School, North Worcester, NY, USA
| | - Benjamin Kligler
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrative Health Coordinating Center, US Veterans Health Administration, Washington, NY, USA
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Ge LP, Liu XQ, Zhang RK, Chen ZN, Cheng F. Comparison between acupotomy and corticosteroid injection for patients diagnosed with different classifications of tennis elbow: a randomized control trial. J Orthop Surg Res 2022; 17:433. [PMID: 36175902 PMCID: PMC9524077 DOI: 10.1186/s13018-022-03323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tennis elbow has long been one of the most controversial subjects in orthopaedics. Many scholars thought the use of open or arthroscopic surgery was reserved for patients with refractory symptoms. Therapy with percutaneous acupotomy performed under local anaesthesia also removes degenerated tissue, releases strain, and therefore provides an alternative treatment option to surgical excision. METHODS The aim of this single-blinded randomized control trial was to examine the long-term clinical effectiveness of a nonsurgical percutaneous release technique (acupotomy) and the current recommended treatment (steroid injection) in people diagnosed with a refractory tennis elbow. Ninety patients with refractory symptoms were included. The intervention period was 6 weeks. According to the classification, 38 patients had extra-articular tennis elbow, 36 patients had intraarticular tennis elbow, and 16 patients had mixed type tennis elbow. Forty-five patients were randomly assigned to treatment with percutaneous release by acupotomy according to their classified condition, and 45 patients were randomly assigned to treatment with steroid injection alone. The visual analogue scale (VAS), a tenderness assessment, a grip assessment, and the Nirschl staging system were used for outcome evaluation at pretreatment and the posttreatment timepoints from 12 to 48 weeks. RESULTS During the first weeks, there were no differences observed between the groups. By 6, 24 and 48 weeks, significant differences were observed between the two groups. The acupotomy group scored significantly better in visual analogue scale score (VAS) of pain, tenderness during palpation, pain-free grip strength (PFGS) and Nirschl staging than the corticosteroid group. CONCLUSIONS For patients with lateral epicondylitis, acupotomy is just as effective as corticosteroid injections in the short term (< 6 weeks). In the long term, acupotomy has greater efficacy and is associated with a lower rate of recurrence than corticosteroid injections in the management of lateral epicondylitis. TRIAL REGISTRATION The National Health Commission announced the "ethical review measures for biomedical research involving people" in 2019, which was not mandatory in previous studies.
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Affiliation(s)
- Lin-Pu Ge
- Department of Orthopedics, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, China
| | - Xiao-Qian Liu
- Department of Endocrinology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310007, China
| | - Rui-Kun Zhang
- Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Zhi-Neng Chen
- Department of Orthopedics, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, China
| | - Feng Cheng
- Department of Orthopedics, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, China.
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Jin M, Xie L, Mao N, Wei J, Chen J, Chen X, Mao H. The characteristics of registered acupuncture clinical trials enrolling cancer patients. Support Care Cancer 2022; 30:10461-10470. [PMID: 36048280 DOI: 10.1007/s00520-022-07331-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study sought to explore and summarize the global state of acupuncture clinical trials enrolling cancer patients included in international registries to date. METHODS All relevant trials evaluating acupuncture-related interventions for the treatment of cancer that were registered in 16 trial registries from January 1, 2001, through December 31, 2020, were identified. Subsequent publications related to these trials were additionally retrieved from the PubMed, Cochrane Library, Embase, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), and Wanfang databases. We compared information included in these registries regarding completed trials with any associated publications, with a focus on study design, sample size, and selective reporting, based on the registered protocol. RESULTS In total, 222 eligible trials across 19 countries were identified. These trials included 17 specific cancer types and 32 symptoms. The five most common cancer types were breast cancer, head and neck cancer, colorectal cancer, lung cancer, and gastric cancer, accounting for almost half of all registered trials (48.2%). The top five symptoms included in these trials were chemotherapy-induced peripheral neuropathy (CIPN), cancer-related pain, cancer-related fatigue, chemotherapy-induced nausea and vomiting (CINV), and gastrointestinal dysfunction. The overall rate of article publication was low, with publications being associated with just 33.3% of these registered trials. CONCLUSIONS This review is the first snapshot of the landscape of acupuncture clinical trials registered in international trial registries, providing a methodological basis for the management of common treatment- and disease-related side effects among cancer patients undergoing acupuncture and offering useful information that will guide future acupuncture-focused research.
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Affiliation(s)
- Ming Jin
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Lulu Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ni Mao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jianzi Wei
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Junchao Chen
- Institute of Disciplinary Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xuefen Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Huijuan Mao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Woo SH, Lee HJ, Park YK, Han J, Kim JS, Lee JH, Park CA, Choi SH, Lee WD, Yang CS, Kim MJ, Han CH. Efficacy and safety of thread embedding acupuncture for knee osteoarthritis: A randomized controlled pilot trial. Medicine (Baltimore) 2022; 101:e29306. [PMID: 35945733 PMCID: PMC9351930 DOI: 10.1097/md.0000000000029306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thread embedding acupuncture (TEA) is a widely used clinical procedure for the treatment of musculoskeletal pain. However, few clinical studies have been conducted on the efficacy and safety of TEA for knee osteoarthritis (KOA), and data from randomized controlled trials are lacking. This randomized controlled pilot study aimed to assess the feasibility of conducting large-scale studies on the efficacy and safety of TEA for KOA. METHODS Forty participants were included in the study and randomly divided into 2 groups (TEA and acupuncture) of 20 each. The intervention period was 6 weeks. The experimental group received TEA once a week (total of 6 sessions) on 14 defined knee areas, and the control group received acupuncture twice a week (total of 12 sessions) on 9 defined acupuncture points. The primary outcome measure was the visual analogue scale score, and the secondary outcome measures were the short-form McGill pain questionnaire, and Western Ontario and McMaster Universities Osteoarthritis Index scores. Participants were assessed prior to the intervention (baseline) and at 3, 6, and 10 weeks (4 weeks after the end of intervention). The adverse effects of TEA and acupuncture were documented. Hematological examination and biochemical tests were performed at the screening and at 6 weeks. RESULTS Of the 40 participants, 37 completed the study and 3 participants dropped out. Both the TEA and acupuncture groups showed a significant improvement in the visual analogue scale, short-form McGill Pain Questionnaire, and Western Ontario and McMaster Universities Osteoarthritis Index scores in a time-dependent manner. However, there was no significant interaction between group and time. No serious adverse events were reported in the groups, and no clinically significant changes were observed in the hematological and biochemical parameters. CONCLUSION This pilot study suggests that TEA is a safe and effective procedure for relieving pain in patients with KOA. The results of this study provide basic data and indicate the feasibility of large-scale clinical studies to evaluate the efficacy and safety of TEA for KOA.
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Affiliation(s)
- Sang Ha Woo
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Hyun-Jong Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Yu-kyeong Park
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Jihoon Han
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Jae Soo Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Jung Hee Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Chung A. Park
- Department of Diagnostics, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Seong-Hun Choi
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Woo Dong Lee
- Pre-major of Cosmetics and Pharmaceutics, College of Herbal Bio-Industry, Daegu Haany University, Daegu, Republic of Korea
| | - Chang Sop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Min Ji Kim
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- *Correspondence: Chang-Hyun Han, KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea (e-mail: )
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Liu CY, Tu JF, Lee MS, Qi LY, Yu FT, Yan SY, Li JL, Lin LL, Hao XW, Su XT, Yang JW, Wang LQ. Is acupuncture effective for knee osteoarthritis? A protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e052270. [PMID: 35017242 PMCID: PMC8753400 DOI: 10.1136/bmjopen-2021-052270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is one of the leading causes of disability. The effectiveness of acupuncture for treating KOA remains controversial. This protocol describes the method of a systematic review and meta-analysis evaluating the effectiveness and safety of acupuncture for treating KOA. METHODS AND ANALYSIS Four English databases (PubMed, Embase, Cochrane Library databases and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Wanfang) will be searched from the database inception to 1 September 2021. All randomised controlled trials related to acupuncture for KOA will be included. Extracted data will include publication details, basic information, demographic data, intervention details and patient outcomes. The primary outcome will be pain intensity. Risk of bias will be assessed using the Cochrane Collaboration's tool for assessing risk of bias. Article selection, data extraction and risk of bias assessment will be performed in duplicate by two independent reviewers. If the meta-analysis is precluded, we will conduct a descriptive synthesis using a best-evidence synthesis approach. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology. ETHICS AND DISSEMINATION Ethics approval is not required because individual patient data are not included. This protocol was registered in the international Prospective Register of Systematic Reviews on 25 February 2021. The systematic review and meta-analysis will be submitted for publication in a peer-reviewed journal. The findings will also be disseminated through conference presentations. TRIAL REGISTRATION NUMBER CRD42021232177.
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Affiliation(s)
- Chuan-Yang Liu
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Jian-Feng Tu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Myeong Soo Lee
- KM Science Research division, Korea Institute of Oriental Medicine, Daejon, South Korea
| | - Ling-Yu Qi
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Fang-Ting Yu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Yan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Ling Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lu-Lu Lin
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Wan Hao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Tong Su
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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10
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Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. J Bodyw Mov Ther 2022; 29:117-126. [DOI: 10.1016/j.jbmt.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/11/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022]
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11
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Chen J, Liu A, Zhou Q, Yu W, Guo T, Jia Y, Yang K, Niu P, Feng H. Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews. Int J Gen Med 2021; 14:8481-8494. [PMID: 34848997 PMCID: PMC8617312 DOI: 10.2147/ijgm.s342435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Acupuncture has been widely used in the clinical management of osteoarthritis of the knee (KOA). Many systematic reviews (SRs) and meta-analyses (MAs) have reported its effectiveness in relieving pain. This overview aimed to summarize SRs and MAs on the effectiveness and safety of acupuncture for KOA and evaluate their methodological and evidence quality of the included SRs and MAs. Methods We conducted a comprehensive literature search for SRs and MAs in four Chinese and four international databases from their inception until August 2021. Two researchers independently searched the reviews, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological quality of the included SRs and MAs. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of the included SRs and MAs. Results A total of 14 SRs and MAs were included. The evaluation results of the AMSTAR 2 tool showed that the methodological quality of all the 14 SRs and MAs was critically low. The principal causes are the lack of a pre-registration proposal and a list of excluded studies and justify the exclusions, the report on the sources of funding, and the reasons for the study designs for inclusion. The results of the GRADE evaluation showed 25 of 46 outcomes were very low-level evidence. Seventeen were of low level, four were of moderate level and none were of high level. Most outcomes were downgraded in quality of evidence mainly because of publication bias and imprecision. Conclusion The existing evidence suggests that acupuncture seems to be an effective and safe therapy for KOA. However, the deficiencies in the methodological quality and quality of evidence of the included SRs/MAs have limited the reliability of the conclusions. Therefore, further rigorous and comprehensive studies are warranted to verify the effectiveness and safety of acupuncture in KOA.
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Affiliation(s)
- Jixin Chen
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Aifeng Liu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Qinxin Zhou
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Weijie Yu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Tianci Guo
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Yizhen Jia
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Kun Yang
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Puyu Niu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
| | - Huichuan Feng
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People's Republic of China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People's Republic of China
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12
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Wu J, Qian Y, Chen C, Feng F, Pan L, Yang L, Wang C. Hesperetin Exhibits Anti-Inflammatory Effects on Chondrocytes via the AMPK Pathway to Attenuate Anterior Cruciate Ligament Transection-Induced Osteoarthritis. Front Pharmacol 2021; 12:735087. [PMID: 34603050 PMCID: PMC8481891 DOI: 10.3389/fphar.2021.735087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/20/2021] [Indexed: 02/03/2023] Open
Abstract
This study aimed to determine whether hesperetin (HPT) has chondroprotective effects against the TNF-α-induced inflammatory response of chondrocytes and related mechanisms and clarify the impact of HPT on osteoarthritis (OA) induced by anterior cruciate ligament transection (ACLT). Under tumor necrosis factor-α (TNF-α) stimulation, rat chondrocytes were treated with or without HPT. The CCK-8 assay was used to detect viability and cytotoxicity. RT-qPCR and Western blot were used to examine the expression of aggrecan, collagen type II, and inflammatory and proliferative genes/proteins in chondrocytes. Flow cytometry was used to check the cell cycle to determine whether HPT protects chondrocytes against the inhibitory effect of TNF-α on chondrocyte proliferation. In addition, RNA sequencing was used to discover possible molecular targets and pathways and then validate these pathways with specific protein phosphorylation levels. Finally, immunofluorescence staining was used to examine the phosphorylation of the AMP-activated protein kinase (AMPK) pathway. The results showed that HPT restored the upregulation of interleukin 1β (IL-1β), PTGS2, and MMP-13 induced by TNF-α. In addition, HPT reversed the degradation of the extracellular matrix of chondrocytes induced by TNF-α. HPT also reversed the inhibitory effect of TNF-α on chondrocyte proliferation. RNA sequencing revealed 549 differentially expressed genes (DEGs), of which 105 were upregulated and 444 were downregulated, suggesting the potential importance of the AMPK pathway. Progressive analysis showed that HPT mediated the repair of TNF-α-induced chondrocyte damage through the AMPK signaling pathway. Thus, local treatment of HPT can improve OA induced by ACLT. These findings indicated that HPT has significant protective and anti-inflammatory effects on chondrocytes through the AMPK signaling pathway, effectively preventing cartilage degradation. Given the various beneficial effects of HPT, it can be used as a potential natural drug to treat OA.
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Affiliation(s)
- Jiaqin Wu
- National Innovation and Attracting Talents "111" Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Yuna Qian
- Engineering Research Center of Clinical Functional Materials and Diagnosis and Treatment Devices of Zhejiang Province, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
| | - Cheng Chen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fan Feng
- National Innovation and Attracting Talents "111" Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Lianhong Pan
- National Innovation and Attracting Talents "111" Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Li Yang
- National Innovation and Attracting Talents "111" Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Chunli Wang
- National Innovation and Attracting Talents "111" Base, Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
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13
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Nah S, Park SS, Choi S, Jang HD, Moon JE, Han S. Association between Chronic Knee Pain and Psychological Stress in Those over 50 Years of Age: A Nationwide Cross-Sectional Study Based on the Sixth Korea National Health and Nutrition Examination Survey (KNHANES 2013-2015). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189771. [PMID: 34574694 PMCID: PMC8467605 DOI: 10.3390/ijerph18189771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022]
Abstract
Chronic knee pain (CKP) can degrade the quality of life and cause dysfunction, resulting in the loss of independence. Psychological stress not only affects physical and mental health but is also a risk factor for CKP. In this cross-sectional study, we analyzed data from the sixth Korea National Health and Nutrition Examination Survey (2013–2015), and investigated the association between CKP and psychological stress of the Korean general population. The CKP status was determined based on survey responses of self-reported knee pain lasting for more than 30 days during the last 3 months. Psychological stress was classified as none, mild, moderate, or severe. The association between CKP and psychological stress was analyzed using multiple logistic regression analysis considering co-variables and demographic data. Logistic regression analysis adjusting for co-variables indicated that the risk of CKP increased with an increasing degree of stress, from mild (OR = 1.65, 95% CI 1.35–2.03, p < 0.001) to moderate (OR = 2.00, 95% CI 1.56–2.57, p < 0.001) and severe (OR = 3.02, 95% CI 2.08–4.37, p < 0.001). A significant association between the risk of CKP and psychological stress was identified. Therefore, when evaluating patients with CKP, it may be helpful for clinicians to check the degree of stress.
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.N.); (S.C.)
| | - Seong-San Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.-S.P.); (H.-D.J.)
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.N.); (S.C.)
| | - Hae-Dong Jang
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.-S.P.); (H.-D.J.)
| | - Ji-Eun Moon
- Clinical Trial Center, Department of Biostatistics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.N.); (S.C.)
- Correspondence: ; Tel.: +82-32-621-5116
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14
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Lindsey MH, Mortensen S, Xu H, McNichol M, Abdeen A. The Role of Acupuncture in Postoperative Pain Management of Patients Undergoing Knee Arthroplasty Surgery: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 9:01874474-202108000-00006. [PMID: 34415872 DOI: 10.2106/jbjs.rvw.20.00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Acupuncture after total knee arthroplasty (TKA) may decrease the incidence of postoperative nausea and vomiting (PONV). » Acupuncture did not decrease visual analog scale (VAS) scores in the 0 to 48-hour interval but did decrease VAS scores at >48 hours after TKA. » The heterogeneity of the studies prevented meta-analysis of opioid use with acupuncture after TKA; a systematic review demonstrated mixed results. » Additional studies are needed to investigate opioid reduction with acupuncture after TKA.
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Affiliation(s)
- Matthew H Lindsey
- Harvard Combined Orthoapedic Residency Program, Boston, Massachusetts
| | - Sharri Mortensen
- Nazarian Laboratory, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Haijun Xu
- Department of Orthopedics, Wuhan Fourth Hospital, Puai Hospital, Tonji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Megan McNichol
- Agoos Medical Library/Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Anderson BJ, Meissner P, Mah DM, Nielsen A, Moonaz S, McKee MD, Kligler B, Milanes M, Guerra H, Teets R. Barriers and Facilitators to Implementing Bundled Acupuncture and Yoga Therapy to Treat Chronic Pain in Community Healthcare Settings: A Feasibility Pilot. J Altern Complement Med 2021; 27:496-505. [PMID: 33720749 PMCID: PMC8236295 DOI: 10.1089/acm.2020.0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: To identify factors associated with implementing bundled group acupuncture and yoga therapy (YT) to treat underserved patients with chronic pain in community health center (CHC) settings. This is not an implementation science study, but rather an organized approach for identification of barriers and facilitators to implementing these therapies as a precursor to a future implementation science study. Design: This study was part of a single-arm feasibility trial, which aimed to test the feasibility of bundling GA and YT for chronic pain in CHCs. Treatment outcomes were measured before and after the 10-week intervention period. Implementation feasibility was assessed through weekly research team meetings, weekly yoga provider meetings, monthly acupuncture provider meetings, and weekly provider surveys. Settings: The study was conducted in New York City at two Montefiore Medical Group (MMG) sites in the Bronx, and one Institute for Family Health (IFH) site in Harlem. Subjects: Participants in the feasibility trial were recruited from IFH and MMG sites, and needed to have had lower back, neck, or osteoarthritis pain for >3 months. Implementation stakeholders included the research team, providers of acupuncture and YT, referring providers, and CHC staff. Results: Implementation of these therapies was assessed using the Consolidated Framework for Implementation Research. We identified issues associated with scheduling, treatment fidelity, communication, the three-way disciplinary interaction of acupuncture, yoga, and biomedicine, space adaptation, site-specific logistical and operational requirements, and patient-provider language barriers. Issues varied as to their frequency and resolution difficulty. Conclusions: This feasibility trial identified implementation issues and resolution strategies that could be further explored in future implementation studies. Clinical Trial Registration No.: NCT04296344.
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Affiliation(s)
- Belinda J Anderson
- College of Health Professions, Pace University, New York, NY, USA.,School of Nursing and Health Studies, Monmouth University, West Long Branch, NJ, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Pacific College of Health and Science, San Diego, CA, USA
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donna M Mah
- Pacific College of Health and Science, San Diego, CA, USA
| | - Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - M Diane McKee
- Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Benjamin Kligler
- Integrative Health Coordinating Center, US Veterans Health Administration, Washington, DC, USA
| | | | - Hernidia Guerra
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Yang L, Peng W. Prevalence and Factors Associated With Body Pain: Results of a Nationally Representative Survey of 9,586 Chinese Adults Aged 60 and Over. Front Public Health 2021; 9:634123. [PMID: 33763400 PMCID: PMC7982579 DOI: 10.3389/fpubh.2021.634123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Pain management has become a critical problem worldwide with the aging population. More than half of older people have experienced pain with different severity. The aim of this research is to identify the characteristics of older people with body pain and the associations between pain and characteristics of demographic, health status, and health services use amongst Chinese seniors. Methods: This cross-sectional study was based on the China Health and Retirement Longitudinal Study (CHARLS), using follow-up survey data in 2015. The national survey comprised 20,284 women and men aged 45 years or older who completed questionnaires. Data of older people who were asked whether they had troubles with body pain were extracted and analyzed. Multiple logistic regression modeling was used to determine the important indicators (demographic, health status, and health services use) amongst Chinese elderly with pain. Results: Analyses revealed that 32.5% (n = 9,586) of Chinese people aged over 60 reported having body pain. Pain is positively associated with female gender (OR = 2.08, 95% CI 1.80-2.39, p < 0.001), living in non-urban areas (OR = 1.49, 95% CI 1.25-1.77, p < 0.001), having physical disabilities (OR = 1.45, 95% CI 1.15-1.82, p = 0.002), diagnosed with stomach diseases (OR = 1.40, 95% CI 1.20-1.64, p < 0.001), diagnosed with arthritis (OR = 1.91, 95% CI 1.66-2.20, p < 0.001), self-rating with poor health status (OR = 7.03, 95% CI 5.63-8.78, p < 0.001), self-purchased over-the-counter western medications (OR = 1.50, 95% CI 1.30-1.73, p < 0.001) and self-purchased Chinese herbal medicine (OR = 1.52, 95% CI 1.24-1.85, p < 0.001). Conclusion: Body pain is common amongst the Chinese elderly. This research highlights the need for further nationwide studies exclusively focusing on people with pain including the elder population, and provides evidence-based insights for healthcare providers and policy-makers, to improve the quality of pain management. Future research should also pay attention to the importance of health literacy for health outcomes with regard to pain management.
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Affiliation(s)
- Lu Yang
- Faculty of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Wenbo Peng
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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17
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Ughreja RA, Prem V. Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis. J Bodyw Mov Ther 2021; 27:328-338. [PMID: 34391253 DOI: 10.1016/j.jbmt.2021.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/03/2021] [Accepted: 02/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis. METHODS Databases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias. RESULTS Out of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies. CONCLUSION Good quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.
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Affiliation(s)
- Reepa A Ughreja
- Department of Physiotherapy, Manipal College of Health Professions, MAHE, Bangalore, India
| | - V Prem
- Department of Physiotherapy, Manipal College of Health Professions, MAHE, Bangalore, India.
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18
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Shi X, Yu W, Wang D, Zhao Y, Deng X, Chen C, Shi S. A comparison of the effects of Chinese non-pharmaceutical therapies for pain control in knee osteoarthritis: A protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e24501. [PMID: 33663057 PMCID: PMC7909139 DOI: 10.1097/md.0000000000024501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a chronic degenerative joint disease, leading to pain and functional limitation in the elderly. The non-pharmaceutical therapy is recommended firstly by different guidelines for KOA management strategies. In China, there are various forms of non-pharmaceutical treatments for KOA, which are considered beneficial in relieving KOA pain. However, there is no consensus on which is the optimal non-pharmaceutical regimens. Thus, present network meta-analysis aims to assess the comparative efficacy of available Chinese non-pharmaceutical therapies, especially in pain management. METHODS PubMed, EMBASE, Cochrane library, Web of Science, China national knowledge infrastructure, VIP, Wan Fang will be systematically searched their inception to April 2020. Randomized controlled trials that compared the effect of non-pharmaceutical therapies on pain control in KOA will be included, including traditional acupuncture, electroacupuncture, warming needle, fired needle, acupuncture followed by moxibustion, moxibustion and massage. The primary outcome was the knee pain levels, and secondary outcome was the comprehensive indicators. Risk of bias assessment of the included studies will be performed according to the Cochrane risk of bias tool. The pairwise and network meta-analysis will be performed by STATA 14.0 and GeMTC softwares. RESULTS This study is ongoing and will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide a comprehensive evidence on the effects of Chinese non-pharmaceutical therapies for pain control in KOA. PROSPERO REGISTRATION NUMBER CRD42018106575.
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Affiliation(s)
| | - Wenjing Yu
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | | | - Ying Zhao
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
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19
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MacDonald IJ, Chen YH. The Endocannabinoid System Contributes to Electroacupuncture Analgesia. Front Neurosci 2021; 14:594219. [PMID: 33679287 PMCID: PMC7930225 DOI: 10.3389/fnins.2020.594219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
The extensive involvement of the endocannabinoid system (ECS) in vital physiological and cognitive processes of the human body has inspired many investigations into the role of the ECS and drugs, and therapies that target this system and its receptors. Activation of cannabinoid receptors 1 and 2 (CB1 and CB2) by cannabinoid treatments, including synthetic cannabinoids, alleviates behavioral responses to inflammatory and neuropathic pain. An increasing body of scientific evidence details how electroacupuncture (EA) treatments achieve effective analgesia and reduce inflammation by modulating cannabinoid signaling, without the adverse effects resulting from synthetic cannabinoid administration. CB1 receptors in the ventrolateral area of the periaqueductal gray are critically important for the mechanisms of the EA antinociceptive effect, while peripheral CB2 receptors are related to the anti-inflammatory effects of EA. This review explores the evidence detailing the endocannabinoid mechanisms involved in EA antinociception.
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Affiliation(s)
- Iona J MacDonald
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Department of Photonics and Communication Engineering, Asia University, Taichung, Taiwan
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20
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Zhou X, Xiang K, Yuan X, Wang Z, Li K. A comparison of the effects of acupoint injection combined with hyaluronic acid versus isolated hyaluronic acid for knee osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e23262. [PMID: 33217849 PMCID: PMC7676597 DOI: 10.1097/md.0000000000023262] [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: 01/15/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a kind of degenerative osteoarthropathy, which causes joint pain and limited mobility, seriously affects the quality of life of the patient. Traditional Chinese Medicine acupuncture and moxibustion has been widely used to treat KOA, and acupoint injection is 1 of the acupuncture treatment methods. The purpose of this work is to evaluate the effectiveness of Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection for KOA. METHODS We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2020. Two reviewers will independently assess the quality of the selected studies, NoteExpress and Excel software will be used to extract data, and the content will be stored in an electronic chart. Different researchers will separately screen the titles and abstracts of records acquired potential eligibility which comes from the electronic databases. Full-text screening and data extraction will be conducted afterward independently. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS This study will evaluate the efficacy and safety of Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection in the treatment of KOA, to provide high-quality, evidence-based clinical recommendations. TRIAL REGISTRATION NUMBER INPLASY2020100058 CONCLUSION:: This study will provide reliable evidence on whether Acupoint injection combined with Hyaluronic Acid injection compared with isolated Hyaluronic Acid injection is more effective in treating KOA.
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21
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Nielsen A, Teets R, Moonaz S, Anderson BJ, Walter E, Milanes M, Mah DM, Diane McKee M, Kligler B. Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot. Glob Adv Health Med 2020; 9:2164956120964716. [PMID: 33150053 PMCID: PMC7580149 DOI: 10.1177/2164956120964716] [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] [Indexed: 12/21/2022] Open
Abstract
Chronic pain is prevalent in the United States, with impact on physical and
psychological functioning as well as lost work productivity. Minority and lower
socioeconomic populations have increased prevalence of chronic pain with less
access to pain care, poorer outcomes, and higher risk of fatal opioid overdose.
Acupuncture therapy is effective in treating chronic pain conditions including
chronic low back pain, neck pain, shoulder pain, and knee pain from
osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible
and effective, and specifically so for underserved and diverse populations at
risk for health outcome disparities. Acupuncture therapy also encourages patient
engagement and activation. As chronic pain improves, there is a natural
progression to want and need to increase activity and movement recovery. Diverse
movement approaches are important for improving range of motion, maintaining
gains, strengthening, and promoting patient engagement and activation. Yoga
therapy is an active therapy with proven benefit in musculoskeletal pain
disorders and pain associated disability. The aim of this quasi-experimental
pilot feasibility trial is to test the bundling of these 2 effective care
options for chronic pain, to inform both the design for a larger randomized
pragmatic effectiveness trial as well as implementation strategies across
underserved settings.
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ray Teets
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Institute for Family Health, New York
| | - Steffany Moonaz
- Research Department, Maryland University of Integrative Medicine, Laurel, Maryland
| | - Belinda J Anderson
- College of Health Professions, Pace University, New York.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,Pacific College of Health and Science, San Diego, California and New York
| | - Eve Walter
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Institute for Family Health, New York
| | | | - Donna M Mah
- Pacific College of Health and Science, San Diego, California and New York
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Benjamin Kligler
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,US Veterans Health Administration Integrative Health Coordinating Center, Washington, DC
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22
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Gang BG, Shin JS, Lee J, Lee YJ, Cho HW, Kim MR, Kang K, Koh W, Kim EJ, Park Y, Nam D, Ha IH. Association Between Acupuncture and Knee Surgery for Osteoarthritis: A Korean, Nationwide, Matched, Retrospective Cohort Study. Front Med (Lausanne) 2020; 7:524628. [PMID: 33043034 PMCID: PMC7525124 DOI: 10.3389/fmed.2020.524628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/13/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives: The present study was undertaken to investigate the relationship between acupuncture therapy and surgery rate. Design: Matched, retrospective cohort study. Materials and Methods: From nationwide health insurance data (2002-2013 cohort data published by the National Health Insurance Service of Korea), patients with new cases of knee osteoarthritis that occurred between January 1, 2004 and December 31, 2010 were analyzed. Patients were divided into an acupuncture group (AG) and a control group (CG), based on records of acupuncture therapy. Propensity scores were calculated by using gender, age, income level, and Charlson comorbidity index (CCI), with the groups matched at a ratio of 1:3 (AG:CG). The final analysis period was 2 years after the first acupuncture therapy for AG and 2 years after initial diagnosis for CG; surgery rates were compared between the two groups. Stratified analyses were performed based on age, gender, and income level; sensitivity analyses were performed based on the frequency and duration of acupuncture therapy. Results: Propensity score-matched AG and CG included 8,605 and 25,815 subjects, respectively. Post-matching surgery rates were 0.26 and 0.93% in AG and CG, respectively. For all age groups, AG showed a lower surgery rate than CG. In the analysis based on gender, the female group showed a significantly lower hazard ratio of 0.225. In analysis based on income level, the results of the entire group were significant, with the lower income group showing the lowest hazard ratio. In sensitivity analyses, AG tended to show a lower surgery rate than CG. Conclusions: The present study demonstrated that acupuncture therapy is associated with a low rate of surgery for knee osteoarthritis. Additional studies are needed to support this conclusion.
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Affiliation(s)
| | | | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Hyun-Woo Cho
- Haeundae Jaseng Hospital of Korean Medicine, Busan, South Korea
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Kyungwon Kang
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Wonil Koh
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju, South Korea
| | - Yeoncheol Park
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
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23
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Zhang Z, Huang C, Jiang Q, Zheng Y, Liu Y, Liu S, Chen Y, Mei Y, Ding C, Chen M, Gu X, Xing D, Gao M, He L, Ye Z, Wu L, Xu J, Yang P, Zhang X, Zhang Y, Chen J, Lin J, Zhao L, Li M, Yang W, Zhou Y, Jiang Q, Chu CQ, Chen Y, Zhang W, Tsai WC, Lei G, He D, Liu W, Fang Y, Wu D, Lin J, Wei CC, Lin HY, Zeng X. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1213. [PMID: 33178745 PMCID: PMC7607097 DOI: 10.21037/atm-20-4665] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Osteoarthritis (OA) is a degenerative disease of middle-aged and elderly people, contributed a higher burden of disease in China and the world. In 2017, under the support of the Rheumatology and Immunology Expert Committee of the Cross-Strait Medical and Health Exchange Association. The objective was to develop an evidence-based diagnosis and treatment guideline for OA in China based on emerging new evidence. The guideline was registered at International Practice Guidelines Registry Platform (IPGRP-2018CN028). The grading of recommendations assessment, development and evaluation (GRADE) approach was used to rate the quality of evidence and the strength of recommendations, and the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist was followed to report the guideline. The guideline provides recommendations for the OA diagnosis, disease risks monitoring and evaluate, treatment purpose and physical, medical and surgical interventions. This guideline is intended to serve as a tool for Chinese clinicians for the best decisions-making on diagnosis and treatment of OA.
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Affiliation(s)
- Zhiyi Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cibo Huang
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Jiang
- Department of Rheumatism, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yi Zheng
- Department of Rheumatology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Sciences, Beijing, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Shengyun Liu
- Department of Rheumatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjuan Chen
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifang Mei
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Xin Gu
- Department of Rehabilitaion Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Dan Xing
- Department of Orthopaedics, Peking University People's Hospital, Beijing, China
| | - Min Gao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan He
- Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhizhong Ye
- Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| | - Lijun Wu
- Department of Rheumatology and Immunology, the People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jianhua Xu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pinting Yang
- Department of Rheumatic Immunology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuewu Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Yue Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jinwei Chen
- Department of Rheumatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Like Zhao
- Department of Rheumatology and Immunology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Cong-Qiu Chu
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University and VA Portland Health Care System, Portland, OR, USA
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Weiya Zhang
- Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, Nottingham, UK
| | - Wei-Chung Tsai
- Department of Internal Medicine, Kaohsiung Medical College, Kaohsiung
| | - Guanghua Lei
- Department of Orthopedic, Xiangya Hospital, Central South University, Changsha, China
| | - Dongyi He
- Department of Arthrology, Guanghua Integrative Medicine Hospital, Shanghai, China
| | - Wei Liu
- Department of Rheumatology and Immunology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongfei Fang
- Department of Rheumatology and Immunology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Darong Wu
- Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianhao Lin
- Department of Orthopedics, Peking University People's Hospital, Beijing, China
| | - Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung
| | - Hsiao-Yi Lin
- Veterans General Hospital, Taipei and National Yang-Ming Medical University, Taipei
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
PURPOSE OF REVIEW Chronic musculoskeletal pain (CMP) attributable to conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain is the most common cause of disability globally, for which no effective remedy exists. Although acupuncture is one of the most popular sensory stimulation therapies and is widely used in numerous pain conditions, its efficacy remains controversial. This review summarizes and expands upon the current research on the therapeutic properties of acupuncture for patients with CMP to better inform clinical decision-making and develop patient-focused treatments. RECENT FINDINGS We examined 16 review articles and 11 randomized controlled trials published in the last 5 years on the clinical efficacy of acupuncture in adults with CMP conditions. The available evidence suggests that acupuncture does have short-term pain relief benefits for patients with symptomatic knee osteoarthritis and chronic low back pain and is a safe and reasonable referral option. Acupuncture may also have a beneficial role for fibromyalgia. However, the available evidence does not support the use of acupuncture for treating hip osteoarthritis and rheumatoid arthritis. The majority of studies concluded the superiority of short-term analgesic effects over various controls and suggested that acupuncture may be efficacious for CMP. These reported benefits should be verified in more high-quality randomized controlled trials.
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25
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Jun P, Han CH, Yang CS, Kim MJ, Kim JS, Lee CI, Lee JH, Park CA, Lee YJ, Lee HJ. Efficacy and safety of thread embedding acupuncture on knee osteoarthritis: A randomized, controlled, pilot clinical trial. Medicine (Baltimore) 2020; 99:e21957. [PMID: 32899030 PMCID: PMC7478827 DOI: 10.1097/md.0000000000021957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although there are various therapeutic methods for the treatment of knee osteoarthritis, each has its advantages and shortcomings, and a definitive treatment method is yet to be determined. This pilot study is designed to obtain basic data for a further large-scale trial as well as provide information about the feasibility of thread embedding acupuncture (TEA) with polydioxanone thread in knee osteoarthritis patients. METHODS AND ANALYSIS This study is a clinical trial to evaluate the efficacy and safety of TEA for knee osteoarthritis. Forty participants will be recruited at the hospital and after randomization into 2 groups of 20 (experimental and control); they will be treated for 6 weeks. The experimental group will receive TEA treatment 6 times (1 time/week) in 6 weeks on 14 defined knee areas, and the control group, acupuncture treatments 12 times (2 times/week) in 6 weeks on 9 defined acupuncture points. The visual analogue scale (VAS) will be used for the primary efficacy assessment and Short-form McGill Pain Questionnaire (SF-MPQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) will be used for the secondary efficacy assessment. The follow-ups before clinical trial, 3 weeks after procedure, 6 weeks after procedure, and 4 weeks after the end of procedure will be done to compare the degree of pain with the control group, which received the acupuncture treatment. CONCLUSION The trial based on this study will provide clinical information on the efficacy and safety of TEA treatment on knee osteoarthritis. TRIAL REGISTRATION NUMBER KCT0004844.
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Affiliation(s)
- Purumea Jun
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chang-Hyun Han
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- Korean Convergence Medicine, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chang Sop Yang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Min Ji Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jae Soo Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Cho In Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Jung Hee Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Chung A. Park
- Department of Diagnostics, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Young Joon Lee
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, Gyeongsan, Republic of Korea
| | - Hyun-Jong Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
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26
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The Effect of Electroacupuncture on Dynamic Balance during Stair Climbing for Elderly Patients with Knee Osteoarthritis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3563584. [PMID: 32855648 PMCID: PMC7442999 DOI: 10.1155/2020/3563584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 12/04/2022]
Abstract
Background Poor balance is one of the risk factors for falls in patients with knee osteoarthritis (KOA), which is related to the symptoms. Electroacupuncture (EA) is one of the traditional Chinese conservative methods commonly used to improve the symptoms in patients with KOA. Objective To assess whether EA increases the dynamic balance during stair negotiation among patients with KOA. Methods A total of 40 KOA patients were assigned to two groups randomly (true electroacupuncture vs. mock electroacupuncture). Acupoints around the knee were selected in the true electroacupuncture (TEA) group with electrical stimulation (2 Hz). In the mock electroacupuncture (MEA) group, about 2 cm next to the above acupoints, the needles were inserted superficially without electrical stimulation. All the participants received 11 sessions of stimulation treatment in three weeks. The primary outcome was margin of stability (MOS). Secondary outcomes included hip kinematics and kinetics as well as pain. Results There was no significant difference between the two groups for self-reported pain (p=0.585). During ascent, there was no difference between groups in MOS value in both directions, which was the anterior-posterior (A/P) direction and medial-lateral (M/L) direction at initial contact and toe-off as well as the midstance in the gait cycle, and no difference for the hip kinematics and kinetics between the groups was detected (p > 0.05). For descent, at the toe-off event, the TEA group was more unstable as compared to the MEA group in the A/P direction (p=0.029) but not in the M/L direction, and the hip showed a larger internal rotator moment (p=0.049); at the midstance, the TEA group showed a lower abductor moment than the MEA group (p=0.003). Conclusions Based on the assessment results from the chosen patients with KOA, the TEA did not demonstrate a significant effect in improving the dynamic balance during stair negotiation in comparison with the MEA. This finding does not support EA as a conservative treatment to improve the dynamic balance in such patients.
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Electroacupuncture Prevents Osteoarthritis of High-Fat Diet-Induced Obese Rats. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9380965. [PMID: 32724821 PMCID: PMC7366230 DOI: 10.1155/2020/9380965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 01/09/2023]
Abstract
The effects of acupuncture on osteoarthritis (OA) pathogenesis have been demonstrated in vitro and in animal models. However, the potential for acupuncture to mediate protective effects on obese-induced OA has not been examined. Here, we investigated the effects of different acupuncture patterns on OA pathogenesis in high-fat diet- (HFD-) induced obese rats. After 12-week diet-induced obesity, obese rats were treated with three acupuncture protocols for 2 weeks, including ST36, GB34, and ST36+GB34. The results showed that the three acupuncture protocols both prevented obesity-induced cartilage matrix degradation and MMP expression and mitigated obesity-induced systemic and local inflammation but had different regulatory effects on lipid metabolism and gut microbiota disorder of obese-induced OA rats. Furthermore, the three acupuncture protocols increased the microbial diversity and altered the structure of community of feces in obese rats. We found that ST36 and GB34 could inhibit proinflammatory shift in the gut microbiome with an increase in the ratio of Bacteroidetes/Firmicutes and promote the recovery of relative abundance of Clostridium, Akkermansia, Butyricimonas, and Lactococcus. Although both ST36 and GB34 had an anti-inflammatory effect on serum inflammatory mediators, only the acupuncture protocol with both ST36 and GB34 could effectively inhibit LPS-mediated joint inflammation in obesity rats. Therefore, relieving obesity-related chronic inflammation, lipid metabolism disorder, and gut microbiota disorder may be an important mechanism for acupuncture with ST36 and GB34 to promote OA recovery.
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28
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Zhu J, Zheng Z, Liu Y, Lawrie S, Esser P, Izadi H, Dawes H, Xia Z, Wang C, Xiong Y, Ma X, Wade DT. The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study. Clin Rehabil 2020; 34:1497-1505. [PMID: 32602373 PMCID: PMC7649921 DOI: 10.1177/0269215520938852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. DESIGN Pilot randomised, controlled trial. SETTING Rehabilitation hospital. SUBJECTS In-patients with osteo-arthritis of the knee. INTERVENTIONS Either 1 to 3 small needle-knife treatments over seven days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation. MEASURES Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at three weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded. RESULTS 83 patients were randomized: 44 into the control group, of whom 10 were lost by three weeks and 12 at 3 months; 39 into the experimental group of whom eight were lost at three weeks and three months. The mean (SE) OKS scores at baseline were Control 35.86 (1.05), Exp 38.38 (0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0.03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (P < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months. CONCLUSIONS Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.
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Affiliation(s)
- Junchen Zhu
- The Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Zhiwen Zheng
- The Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Yaomeng Liu
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Sophie Lawrie
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Patrick Esser
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Hooshang Izadi
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Zhidao Xia
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Chao Wang
- The Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Yingzong Xiong
- The Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Xingfu Ma
- The Department of Orthopaedics, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, China
| | - Derick T Wade
- Centre for Movement and Occupational Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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29
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Wang TT, Liu Y, Ning ZY, Qi R. Efficacy and safety of acupuncture for the treatment of knee osteoarthritis: a systematic review and meta-analysis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2020. [DOI: 10.1007/s11726-020-1177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Periarticular needle-based therapies can cause periprosthetic knee infections. Arthroplast Today 2020; 6:241-245. [PMID: 32577471 PMCID: PMC7303494 DOI: 10.1016/j.artd.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/10/2020] [Accepted: 02/07/2020] [Indexed: 01/11/2023] Open
Abstract
Periarticular needle-based therapies such as dry needling, acupuncture, and genicular nerve radiofrequency ablation are becoming more popular for treatment of knee osteoarthritis. These therapies are also being used after total knee arthroplasty for persistent postoperative pain. Although limited published evidence exists for the risk of periprosthetic joint infection after these procedures, we describe one case of periprosthetic joint infection developing shortly after dry needling and another case developing shortly after genicular nerve blocks. We present details of these 2 cases along with a review of the literature regarding the use of periarticular needle-based therapies after total knee arthroplasty.
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31
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Shi X, Yu W, Zhang W, Wang T, Battulga O, Wang L, Guo C. A comparison of the effects of electroacupuncture versus transcutaneous electrical nerve stimulation for pain control in knee osteoarthritis: a Bayesian network meta-analysis of randomized controlled trials. Acupunct Med 2020; 39:163-174. [PMID: 32567333 DOI: 10.1177/0964528420921193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND To compare the effectiveness of electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) for pain control in knee osteoarthritis (KOA). METHODS Four English (MEDLINE, EMBASE, Cochrane Library and Web of Science) and three Chinese (China Science Journal Citation Report (VIP), Wanfang and China National Knowledge Infrastructure (CNKI)) language databases were searched for eligible randomized controlled trials (RCTs), comparing four approaches: EA, TENS, medication and sham/placebo controls. The primary outcome was pain intensity, measured by visual analogue scale (VAS), numeric-rating scale (NRS) or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. Classic pairwise and Bayesian network meta-analyses were conducted to integrate the treatment efficacy/effectiveness through direct and indirect evidence. RESULTS Thirteen studies were included. In the direct meta-analyses, there was no statistically significant overall effect of EA (mean difference (MD) -4.77, 95% confidence interval (CI) -12.51 to 2.96), while the overall effects of high-frequency transcutaneous electrical nerve stimulation (H-TENS) (MD -16.63, 95% CI -24.57 to -8.69) and medication (MD -7.12, 95% CI -12.07 to -2.17) were statistically significant. In the network meta-analyses, the relative effect of the EA and H-TENS groups (MD 5.07, 95% CI -11.33 to 21.93) on pain control did not differ. Meanwhile, H-TENS demonstrated the highest probability of being the first best treatment, and EA had the second highest probability. CONCLUSION The present analysis indicated that both EA and TENS exert significant pain relieving effects in KOA. Among the four treatments, H-TENS was found to be the optimal treatment choice for the management of KOA pain in the short-term, and EA the second best treatment option. Given that the application of TENS is recommended by various international guidelines for the treatment of KOA, EA may also represent a potentially effective non-pharmacologic therapy.
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Affiliation(s)
- Xiaowei Shi
- Department of Massage, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjing Yu
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Tong Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Oyunerdene Battulga
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lijuan Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Changqing Guo
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Sun N, Wang LQ, Shao JK, Zhang N, Zhou P, Fang SN, Chen W, Yang JW, Liu CZ. An expert consensus to standardize acupuncture treatment for knee osteoarthritis. Acupunct Med 2020; 38:327-334. [PMID: 32309995 DOI: 10.1177/0964528419900789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acupuncture has been advocated for as a potentially effective therapy for patients with knee osteoarthritis (KOA) in systematic reviews and guidelines. However, there is still a lack of agreement on the optimal therapeutic protocol for acupuncture. This aim of this study was to develop an expert consensus regarding the therapeutic protocol of acupuncture to guide doctors in clinical practice. METHODS An initial list of items was based on an overview of research evidence from four databases and clinical problem investigation with a multidisciplinary panel. A two-step process was used to optimize the list, including semi-structured interviews with three acupuncture clinical experts and a three-round Delphi consensus survey with the voting panel. A nine-point Likert-type scale (1 = strongly disagree, 9 = strongly agree) was used to measure agreement. RESULTS In total, 52 professionals (response rate: 52%) confirmed their participation in the voting panel. The initial list including 28 items was evaluated. Following a three-round Delphi survey, a consensus was achieved including 37 items that can be broadly categorized into six domains: (1) main treatment principles, (2) acupuncture treatment, (3) dose of acupuncture intervention, (4) primary outcomes, (5) adverse events and (6) others. CONCLUSION This expert consensus could be used to guide doctors in clinical practice and help patients with KOA gain access to appropriate and coordinated acupuncture treatment.
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Affiliation(s)
- Ning Sun
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Kai Shao
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Na Zhang
- School of Acupuncture, Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ping Zhou
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Sai-Nan Fang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Chen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- Acupuncture Research Center, School of Acupuncture, Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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McKee MD, Nielsen A, Anderson B, Chuang E, Connolly M, Gao Q, Gil EN, Lechuga C, Kim M, Naqvi H, Kligler B. Individual vs. Group Delivery of Acupuncture Therapy for Chronic Musculoskeletal Pain in Urban Primary Care-a Randomized Trial. J Gen Intern Med 2020; 35:1227-1237. [PMID: 32076985 PMCID: PMC7174252 DOI: 10.1007/s11606-019-05583-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acupuncture has been shown to be effective for the treatment of chronic musculoskeletal back, neck, and osteoarthritis pain. However, access to acupuncture treatment has been limited in medically underserved and low-income populations. OBJECTIVE Acupuncture therapy delivered in groups could reduce cost and expand access. We compared the effectiveness of group versus individual acupuncture for pain and function among ethnically diverse, low-income primary care patients with chronic musculoskeletal pain. DESIGN This was a randomized comparative effectiveness non-inferiority trial in 6 Bronx primary care community health centers. Participants with chronic (> 3 months) back, neck, or osteoarthritis pain were randomly assigned to individual or group acupuncture therapy for 12 weeks. PARTICIPANTS Seven hundred seventy-nine participants were randomized. Mean age was 54.8 years. 35.3% of participants identified as black and 56.9% identified as Latino. Seventy-six percent were Medicaid insured, 60% reported poor/fair health, and 37% were unable to work due to disability. INTERVENTIONS Participants received weekly acupuncture treatment in either group or individual setting for 12 weeks. MAIN MEASURES Primary outcome was pain interference on the Brief Pain Inventory at 12 weeks; secondary outcomes were pain severity (BPI), physical and mental well-being (PROMIS-10), and opiate use. Outcome measures were collected at baseline, 12 and 24 weeks. KEY RESULTS 37.5% of individual arm and 30.3% in group had > 30% improvement in pain interference (d = 7.2%, 95% CI - 0.6%, 15.1%). Non-inferiority of group acupuncture was not demonstrated for the primary outcome assuming a margin of 10%. In the responder analysis of physical well-being, 63.1% of individual participants and 59.5% of group had clinically important improvement at 12 weeks (d = 3.6%, 95% CI - 4.2%, 11.4%). CONCLUSIONS Both individual and group acupuncture therapy delivered in primary care settings reduced chronic pain and improved physical function at 12 weeks; non-inferiority of group was not shown. TRIAL REGISTRATION Clinicaltrials.gov # NCT02456727.
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Affiliation(s)
- M. Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, USA
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Belinda Anderson
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
- Pacific College of Oriental Medicine, Chicago, USA
| | - Elizabeth Chuang
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
| | - Mariel Connolly
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
| | - Qi Gao
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
| | - Eric N Gil
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
| | - Claudia Lechuga
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
- Institute of Clinical and Translational Research, Albert Einstein College of Medicine, New York, USA
| | - Mimi Kim
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
| | - Huma Naqvi
- Department of Rehab Medicine, Albert Einstein College of Medicine, New York, USA
| | - Benjamin Kligler
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, USA
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Integrative Health Coordinating Center , U.S. Veterans Health Administration, Washington, D.C., USA
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Paley CA, Johnson MI. Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews. MEDICINA (KAUNAS, LITHUANIA) 2019; 56:E6. [PMID: 31878346 PMCID: PMC7023333 DOI: 10.3390/medicina56010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/23/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.
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Affiliation(s)
- Carole A. Paley
- Research and Development Dept, Airedale National Health Service (NHS) Foundation Trust, Skipton Road, Steeton, Keighley BD20 6TD, UK
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, UK;
| | - Mark I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, UK;
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Chen YJ, Shimizu Bassi G, Yang YQ. Classic Chinese Acupuncture versus Different Types of Control Groups for the Treatment of Chronic Pain: Review of Randomized Controlled Trials (2000-2018). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:6283912. [PMID: 31885655 PMCID: PMC6914898 DOI: 10.1155/2019/6283912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the effectiveness of classic Chinese acupuncture in the treatment of chronic pain by comparing treatment groups with different types of control groups in accordance with the newly published guidelines for systematic reviews. METHODS We searched EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials databases from 2000 to 2018. We included randomized controlled trials that included acupuncture as the sole treatment or as an adjunctive treatment for chronic pain. The outcome was pain intensity measured by the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, 11-point numeric rating scale (NRS), and other tools. Two researchers conducted the study selection, data extraction, and quality assessment processes independently. Disagreements were solved by discussion and reanalysis of the data. The quality of all included studies was evaluated using the CBNG (the Cochrane Back and Neck Group) and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklists. RESULTS Sixty-one studies were fully analyzed and ranked based on the newest STRICTA and CBNG standards. We found good evidence that receiving acupuncture is better than not receiving treatment or being placed on a waiting list and reasonable evidence that it is better than conventional or usual care. Limited evidence was found regarding placebo treatments that involve the expectation of needling (real or fake). CONCLUSION Sham acupuncture may not be appropriate as a control intervention for assessing the effectiveness of acupuncture. Acupuncture effectiveness in controlling chronic pain is still limited due to the low quality of the studies published.
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Affiliation(s)
- Yan-Jiao Chen
- Shanghai Research Institute of Acupuncture & Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Shanghai 200030, China
| | - Gabriel Shimizu Bassi
- Shanghai Research Institute of Acupuncture & Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Shanghai 200030, China
| | - Yong-Qing Yang
- Shanghai Research Institute of Acupuncture & Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Shanghai 200030, China
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Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis: A Multicenter Randomized Clinical Trial. Clin J Pain 2019; 34:1149-1158. [PMID: 29864043 PMCID: PMC6250299 DOI: 10.1097/ajp.0000000000000634] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA). Materials and Methods: In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months. Results: Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ2=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months. Discussion: The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA. Level of Evidence: Level 1b—therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).
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Kim J, Kim SR, Lee H, Nam DH. Comparing Verum and Sham Acupuncture in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:8757685. [PMID: 31534469 PMCID: PMC6732586 DOI: 10.1155/2019/8757685] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/09/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Acupuncture is often used for relieving symptoms of fibromyalgia syndrome (FMS). Our aim is to ascertain whether verum acupuncture is more effective than sham acupuncture in FMS. METHODS We collected RCTs to investigate the effects of verum acupuncture and sham acupuncture on pain, sleep quality, fatigue, and general status in FMS patients. The databases used for data retrieval were PubMed, Central Cochrane, EMBASE, PsycINFO, CNKI, VIP, OASIS, KoreaMed, and RISS. Selection/exclusion from the retrieved records was performed according to prespecified criteria, and the final selected records were assessed according to the Cochrane risk of bias tool. The results of the included trials were synthesized on the basis of outcomes, and subgroup analysis depended on the type of add-on sham acupuncture that was performed. RESULTS Ten RCTs (690 participants) were eligible, and eight RCTs were eventually included in the meta-analysis. The synthesis showed a sizable effect of verum acupuncture compared with sham acupuncture on pain relief (standardized mean difference (SMD) -0.49, Z = 3.26, P=0.001; I 2 = 59%), improving sleep quality (SMD -0.46, Z = 3.24, P=0.001; I 2 = 0%), and reforming general status (SMD -0.69, Z = 6.27, P < 0.00001; I 2 = 4%). However, efficacy on fatigue was insignificant (SMD -0.10, Z = 0.51, P=0.61; I 2 = 46%). When compared with a combination of simulation and improper location of needling, the effect of verum acupuncture for pain relief was the most obvious. CONCLUSIONS Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and reforming general status in FMS posttreatment. However, evidence that it reduces fatigue was not found.
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Affiliation(s)
- Jiwon Kim
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Su-Ryun Kim
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Hyangsook Lee
- Department of Anatomy, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dong-Hyun Nam
- Department of Biofunctional Medicine and Diagnosis, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
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Paolucci T, Bellomo RG, Centra MA, Giannandrea N, Pezzi L, Saggini R. Mesotherapy in the treatment of musculoskeletal pain in rehabilitation: the state of the art. J Pain Res 2019; 12:2391-2401. [PMID: 31440078 PMCID: PMC6679691 DOI: 10.2147/jpr.s209610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/29/2019] [Indexed: 01/15/2023] Open
Abstract
Background Mesotherapy can be included as an ancillary treatment in the management of localized pain in rehabilitation, but there are no definitive treatment protocols for this approach. Objectives The purpose of this review was to examine new indications for more standard protocols of mesotherapy in rehabilitation. Materials and methods This systematic review was performed using the following resources: PubMed, Cochrane, PEDro, Scopus, and Google Scholar. The following algorithm was developed, based on the PICO acronym, to evaluate the effects of mesotherapy, with pain as the primary outcome (MESH terms): [mesotherapy AND pain], [mesotherapy AND musculoskeletal], [mesotherapy AND musculoskeletal disorder], [intradermal therapy AND pain], and [intradermal therapy AND musculoskeletal disorder]. Results Seven articles (N=7) satisfied the inclusion criteria and were considered in the review: two of them treated osteoarthritis of the knee (3 sessions) and pes anserine (9 sessions) emphasizing a good efficacy of mesotherapy. Five studies analyzed spine diseases (specifically, two was about chronic and nonspecific neck pain, two about acute low back pain and one about chronic spinal pain): the results of mesotherapy treatment are encouraging both for the resolution of acute and chronic musculoskeletal vertebral pain from one to five sessions. Conclusion Mesotherapy showed a good effect to reduce acute and chronic musculoskeletal pain and, also, it is a well-tolerated treatment. Nonetheless future randomized controlled trials should be desirable for more uniform treatment protocols.
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Affiliation(s)
- T Paolucci
- University G.d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - R G Bellomo
- University of Study of Urbino Carlo Bo, Department of Biomolecular Sciences, Urbino, Italy
| | - M A Centra
- University G.d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - N Giannandrea
- University G.d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - L Pezzi
- University G.d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
| | - R Saggini
- University G.d'Annunzio Chieti, Department of Medical and Oral Sciences and Biotechnologies, Chieti-Pescara, Italy
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Acupuncture of different treatment frequency in knee osteoarthritis: a protocol for a pilot randomized clinical trial. Trials 2019; 20:423. [PMID: 31296249 PMCID: PMC6625113 DOI: 10.1186/s13063-019-3528-8] [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: 12/04/2018] [Accepted: 06/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to determine whether 3 sessions per week of acupuncture treatment is superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Methods/design This is a two parallel-group, assessor-blinded, randomized controlled trial. Sixty patients with knee osteoarthritis (Kellgren–Lawrence grade II or III) will be recruited and randomly allocated to receive 24 or 8 sessions (group M or group L) of acupuncture treatment in a 1:1 ratio. Patients in group M will receive 3 sessions per week of acupuncture for 8 weeks. Patients in group L will receive acupuncture once per week for 8 weeks. The primary outcome is the response rate—the percentage of patients achieving a decrease ≥ 2 points on a numerical rating pain scale and a decrease ≥ 6 points in the Western Ontario and McMaster Universities Osteoarthritis Index function score at 8 weeks compared with baseline. Secondary outcomes include pain, function, overall effect, quality of life, and treatment credibility and expectancy. Discussion Three sessions per week of acupuncture treatment may be superior to 1 session per week of acupuncture treatment for symptomatic outcomes in knee osteoarthritis. Results of the study will be of great importance for the guidelines of clinical therapy. Trial registration Clinicaltrials.gov, NCT03359603. Registered on 1 December 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3528-8) contains supplementary material, which is available to authorized users.
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40
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Sun N, Tu JF, Lin LL, Li YT, Yang JW, Shi GX, Lao LX, Liu CZ. Correlation between acupuncture dose and effectiveness in the treatment of knee osteoarthritis: a systematic review. Acupunct Med 2019; 37:261-267. [PMID: 31271300 DOI: 10.1136/acupmed-2017-011608] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acupuncture is a widely used treatment for knee osteoarthritis, but evidence of its effectiveness from randomised controlled trials (RCTs) is contradictory. OBJECTIVE To systematically review RCTs to determine whether the effect of acupuncture is dose dependent for symptom management in knee osteoarthritis. METHODS Seven English/Chinese databases were searched through January 2017. Study quality was assessed using the Cochrane Collaboration tool. Slavin's qualitative best-evidence synthesis approach was used to provide methodological rigour. Included RCTs were separated into three categories according to the dose of acupuncture treatment: high dosage (HD), medium dosage (MD) and low dosage (LD). Correlation between dose and effect of treatment was analysed. RESULTS Eight RCTs with a total of 2106 subjects met the eligibility criteria. Numbers of studies using the various doses of acupuncture were 1 for LD, 1 for MD and 6 for HD, respectively. Compared with LD and MD acupuncture treatments, strong evidence showed that there was a positive correlation between HD acupuncture treatment and positive outcomes. CONCLUSION The effect of acupuncture may be associated with dose of acupuncture, with a higher dosage related to better treatment outcomes in terms of relief of pain and dysfunction in patients with knee osteoarthritis.
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Affiliation(s)
- Ning Sun
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jian Feng Tu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lu Lu Lin
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Ting Li
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Weng Yang
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guang Xia Shi
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Li Xing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Cun Zhi Liu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Hakakzadeh A, Shariat A, Moradi V, Ingle L, Honarpishe R, Noormohammadpour P, Ansari NN. Multimodal Impact of Acupuncture, Exercise Therapy, And Concurrent Functional Electrical Stimulation On Osteoarthritis of the Knee: a Case Report. ACUPUNCTURE ELECTRO 2019. [DOI: 10.3727/036012919x15650315071942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Knee osteoarthritis (OA) causes functional limitation in weight-bearing actlVltles including walking. To investigate the multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation (FES) on knee osteoarthritis. We designed a multidisciplinary
treatment package including acupuncture; home based exercise therapy, and concurrent functional electrical stimulation during treadmill walking. Outcomes measurements included the numerical rating scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tampa Scale of
Kinesiophobia (TSK). Measurements were completed at baseline and following the treatment phase which consisted of six individual sessions. A 48-year-old male, office worker presented with a history of chronic right knee. During the previous year, he was diagnosed with knee osteoarthritis after
clinical physical examination by a sports medicine physician. Following our novel training intervention, the patient reported a reduction in pain intensity from 8 to 2 on the NRS, improved in all KOOS subscale scores, and improved in the TSK scale (reduction from 15 to 11). In addition, the
patient reported that he was able to return to work and undertake normal activities of daily living with reduced knee pain. This case report showed that our novel multimodal intervention including six sessions of acupuncture, exercise therapy, and treadmill walking with functional electrical
stimulation (FES) had a positive impact on knee pain and function in a middle-aged male with knee osteoarthritis.
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Nielsen A, Anderson B, Citkovitz C, Botet P, Correia S, Duque V, Greene S, Mah D, Moore D, Pagliarini A, McKee MD, Kligler B. Developing and employing a 'responsive manualization' in the 'Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment' comparative effectiveness study. Acupunct Med 2019; 37:184-191. [PMID: 30900480 DOI: 10.1177/0964528419834015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this article is to describe the process used to develop an acupuncture therapy manual for a large effectiveness trial comparing individual care against group care for chronic pain in an underserved population. The design needed to not only ensure research consistency and replicability but also be 'responsive' to real world heterogeneous and evolving presentations in challenging physical settings. BACKGROUND Chronic pain is prevalent in the United States. While acupuncture is effective for chronic pain, minority, ethnically diverse and lower socioeconomic populations have limited access. Group acupuncture is proposed as a lower cost option to facilitate access in safety net settings, but research on the effectiveness of group versus individual acupuncture is lacking. METHODS We engaged a modified Delphi process with expert practitioners from diverse backgrounds who were experienced in individual and group practice. All contributions were recorded and collated for second- and third-round consensus discussions that included contributions by the trial's research acupuncturists. RESULTS A 'responsive manual' flow chart was created with suggested sequencing that included interviews concurrent with palpation, Tui na, Gua sha, acupuncture needling, ear treatment, basic recommendations and options for departure with rationale. The manual was implemented by six research acupuncturists in five primary care settings in the Bronx, New York, with weekly team meetings to discuss manual use. There were no serious adverse events (AE) and few minor AE reported in this trial. CONCLUSION A 'responsive manual' can be structured and implemented that is not only consistent and replicable but also flexible to accommodate the real-world clinical needs of practitioners and patients in challenging physical settings.
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Affiliation(s)
- Arya Nielsen
- 1 Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Belinda Anderson
- 2 Pacific College of Oriental Medicine, New York, NY, USA.,3 Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Claudia Citkovitz
- 4 Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Patricia Botet
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | - Susana Correia
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | | | - Selina Greene
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | - Donna Mah
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | - Dana Moore
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | - Amy Pagliarini
- 2 Pacific College of Oriental Medicine, New York, NY, USA
| | - M Diane McKee
- 3 Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin Kligler
- 1 Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,3 Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,5 Integrative Health Coordinating Center, U.S. Veterans' Health Administration, Washington, DC, USA
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Kligler B, Nielsen A, Kohrherr C, Schmid T, Waltermaurer E, Perez E, Merrell W. Acupuncture Therapy in a Group Setting for Chronic Pain. PAIN MEDICINE 2019; 19:393-403. [PMID: 28595273 DOI: 10.1093/pm/pnx134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective This project was designed to test the feasibility and effectiveness of acupuncture therapy given in a group setting for chronic pain. Design Nonrandomized, repeated measures quasi-experimental trial. Setting Care was delivered in a primary care clinic waiting area after clinic hours. Subjects Included were primary care patients (≥18 years old) with chronic pain of the neck, back, shoulder, or osteoarthritis of any site of at least three months' duration. Methods Subjects received eight weekly acupuncture therapy sessions in a group setting. Acupuncture therapy included a combination of palpation, acupuncture needling, Tui na, Gua sha, and auricular treatment. Baseline pain levels were established in a two- to four-week run-in; assessment of the intervention impact on pain intensity, mood, and functional status were made at the end of the treatment period (eight weeks) and 16 weeks after completion of intervention (24 weeks). Results Of the total 113 participants recruited for the trial, 96 completed the 24-week protocol. We found a statistically and clinically significant decrease in pain severity, pain interference, and depression in our study population. There were no serious adverse events. Conclusions Acupuncture therapy offered in the group setting was effective in reducing pain severity, pain interference, and depression in patients with chronic neck, back, or shoulder pain or osteoarthritis. Benefit persisted through the 24-week measure despite no additional treatment. This finding has potentially important implications for improving access to effective acupuncture treatment for patients with limited financial resources.
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Affiliation(s)
- Benjamin Kligler
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arya Nielsen
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Mount Sinai Beth Israel Medical Center, New York, New York
| | - Corinne Kohrherr
- Mount Sinai Beth Israel Medical Center, New York, New York.,Hunter-Bellevue School of Nursing, New York, New York, USA
| | - Tracy Schmid
- Mount Sinai Beth Israel Medical Center, New York, New York
| | - Eve Waltermaurer
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elidania Perez
- Department of Family Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Mount Sinai Beth Israel Medical Center, New York, New York
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Abstract
Osteoarthritis of the knee is a common disease that causes significant disability. Most patients can be managed conservatively in the outpatient setting. A small minority require surgery. The cornerstones of treatment are weight loss, exercise and analgesia. Walking aids, medial patellar taping, acupuncture and transcutaneous electrical nerve stimulation are useful management adjuncts. Current evidence does not support routine prescription of glucosamine and chondroitin supplements. Early consultation with an orthopaedic surgeon should be made when conservative measures fail.
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Affiliation(s)
- Yiyang Liow
- Division of Family Medicine, National University Health System, Singapore
| | - Wilson Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Victor Weng Keong Loh
- Division of Family Medicine, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lorenc A, Feder G, MacPherson H, Little P, Mercer SW, Sharp D. Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions. BMJ Open 2018; 8:e020222. [PMID: 30327397 PMCID: PMC6196876 DOI: 10.1136/bmjopen-2017-020222] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify potentially effective complementary approaches for musculoskeletal (MSK)-mental health (MH) comorbidity, by synthesising evidence on effectiveness, cost-effectiveness and safety from systematic reviews (SRs). DESIGN Scoping review of SRs. METHODS We searched literature databases, registries and reference lists, and contacted key authors and professional organisations to identify SRs of randomised controlled trials for complementary medicine for MSK or MH. Inclusion criteria were: published after 2004, studying adults, in English and scoring >50% on Assessing the Methodological Quality of Systematic Reviews (AMSTAR); quality appraisal checklist). SRs were synthesised to identify research priorities, based on moderate/good quality evidence, sample size and indication of cost-effectiveness and safety. RESULTS We included 84 MSK SRs and 27 MH SRs. Only one focused on MSK-MH comorbidity. Meditative approaches and yoga may improve MH outcomes in MSK populations. Yoga and tai chi had moderate/good evidence for MSK and MH conditions. SRs reported moderate/good quality evidence (any comparator) in a moderate/large population for: low back pain (LBP) (yoga, acupuncture, spinal manipulation/mobilisation, osteopathy), osteoarthritis (OA) (acupuncture, tai chi), neck pain (acupuncture, manipulation/manual therapy), myofascial trigger point pain (acupuncture), depression (mindfulness-based stress reduction (MBSR), meditation, tai chi, relaxation), anxiety (meditation/MBSR, moving meditation, yoga), sleep disorders (meditative/mind-body movement) and stress/distress (mindfulness). The majority of these complementary approaches had some evidence of safety-only three had evidence of harm. There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP, and manual therapy/manipulation for neck pain, but few SRs reviewed cost-effectiveness and many found no data. CONCLUSIONS Only one SR studied MSK-MH comorbidity. Research priorities for complementary medicine for both MSK and MH (LBP, OA, depression, anxiety and sleep problems) are yoga, mindfulness and tai chi. Despite the large number of SRs and the prevalence of comorbidity, more high-quality, large randomised controlled trials in comorbid populations are needed.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gene Feder
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | - Paul Little
- Primary Care and Population Science Unit, University of Southampton, Southampton, UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Deborah Sharp
- Population Health Sciences, Bristol Medical School, Bristol, UK
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Abstract
PURPOSE OF REVIEW Acupuncture is now recommended for several chronic pain conditions. Despite supportive evidence of its effectiveness, this ancient approach is often misunderstood, and may still be underused in mainstream practice. A critical review on its effectiveness and practice integration, and mechanisms of action is essential to the medical community that is continuing to seek nonopioid therapies for chronic pain. RECENT FINDINGS Mounting evidence supports the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches. Additional data are emerging that support the use of acupuncture as an adjunct or alternative to opioids, and in perioperative settings. Findings related to its mechanisms of action include transient receptor potential cation channel vanilloid 1 activation in the periphery, microglial suppression in the cerebral cortex and spinal cord, and regulation of cytokines and other key inflammatory factors in the spinal cord. Incremental integration of acupuncture into pain medicine practices and training programmes continues to grow. SUMMARY Acupuncture is effective, safe, and cost-effective for treating several chronic pain conditions when performed by well-trained healthcare professionals. Further studies on its use as an adjunct or alternative to opioids, and in perioperative settings are needed.
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Davis RT, Badger G, Valentine K, Cavert A, Coeytaux RR. Acupuncture for Chronic Pain in the Vermont Medicaid Population: A Prospective, Pragmatic Intervention Trial. Glob Adv Health Med 2018; 7:2164956118769557. [PMID: 29662722 PMCID: PMC5896847 DOI: 10.1177/2164956118769557] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction In response to the opioid crisis, the 2016 Vermont legislature commissioned a study to assess acupuncture for patients with chronic pain in the Vermont Medicaid population. Objective To assess the feasibility, acceptability, and effectiveness of acupuncture provided by licensed acupuncturists for Vermont Medicaid patients with chronic pain. Methods A total of 156 Medicaid patients with chronic pain were offered up to 12 acupuncture treatments within a 60-day period at the offices of 28 Vermont licensed acupuncturists. PROMIS® questionnaires were administered prior to and at the end of the treatment period to assess changes in pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance, and social isolation. Questionnaires also captured patients’ overall impressions of treatments as well as self-reported changes in medication use and work function. Results One hundred eleven women (71%) and 45 men (29%) with a wide range of pain complaints received a mean of 8.2 treatments during the intervention period. Measurements captured prior to and at the end of the treatment period showed significant improvements in group mean pain intensity, pain interference, physical function, fatigue, anxiety, depression, sleep disturbance, and social isolation as assessed by Patient-Reported Outcomes Measurement Information System (PROMIS) measures (paired t tests, P < .01). Fifty-seven percent of patients using analgesic (nonopioid) medication reported reductions in use. Thirty-two percent of patients using opioid medication reported reductions in use of opioid medication following the intervention. Seventy-four percent of employed patients reported improved capacity to work. Ninety-six percent of patients said that they would recommend acupuncture to others with chronic pain, and 91% reported qualitative improvements, including physical (31%), functional/behavioral (29%), and psycho-emotional (24%) improvements. Conclusions Our findings demonstrate that acupuncture treatment for chronic pain is feasible and well received by patients in the Vermont Medicaid population. Receiving care from Licensed Acupuncturists was associated with significant improvements in physical, functional, psycho-emotional, and occupational outcomes compared with before receiving acupuncture treatments.
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Affiliation(s)
| | - Gary Badger
- Acupuncture Vermont, South Burlington, Vermont
| | - Kristina Valentine
- 2Larner College of Medicine, University of Vermont, South Burlington, Vermont
| | - Alexander Cavert
- 2Larner College of Medicine, University of Vermont, South Burlington, Vermont
| | - Remy R Coeytaux
- 3Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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Schiphof D, van den Driest JJ, Runhaar J. Osteoarthritis year in review 2017: rehabilitation and outcomes. Osteoarthritis Cartilage 2018; 26:326-340. [PMID: 29330103 DOI: 10.1016/j.joca.2018.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs). DESIGN A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1st 2016 to May 15th 2017 using the terms 'osteoarthritis', 'randomized controlled trial', and 'systematic review'. Inclusion criteria were: clinically or radiologically diagnosed patients with OA, rehabilitation treatment, RCT or SRs. A selection of the included studies is discussed based on study quality and perceived importance to the field; including those that are innovative, inform the direction of the field or generate controversy. Methodological quality of the included studies was assessed using the PEDro-scale for RCTs and the Amstar guideline for SRs. RESULTS From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields. CONCLUSIONS Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.
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Affiliation(s)
- D Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - J J van den Driest
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Therapeutic Effectiveness and Safety of Mesotherapy in Patients with Osteoarthritis of the Knee. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:6513049. [PMID: 29507592 PMCID: PMC5817326 DOI: 10.1155/2018/6513049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/12/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the therapeutic effectiveness and safety of mesotherapy by comparing it with the classic systematic therapy in patients with osteoarthritis (OA). Methods Sixty patients were included and classified into two groups based on the existence of contraindications for nonsteroidal anti-inflammatory drugs (NSAIDs). These patients were treated with oral NSAIDs (Group A) or mesotherapy (Group B). After completing the treatment, the patients were followed up for 6 months. Their clinical features, laboratory results, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. Results A total of 50 patients completed treatment and follow-up. The patients in Group B had significantly fewer gastric acid-related complaints and requested less supplementary treatment for recurrent pain (p < 0.05). The patients in both groups exhibited decreased blood viscosity after treatment (p < 0.05). WOMAC scores, specifically those for pain and stiffness, were found to be significantly improved after either type of treatment (p < 0.05). Mesotherapy also ameliorated physical function (p < 0.05). Furthermore, Group B presented with better outcomes than Group A (p < 0.05 or p < 0.01). Conclusion Our results suggest that mesotherapy is an effective and safe treatment for patients with OA. Clinicians should consider mesotherapy as an alternative therapy for patients with contraindications for NSAID use.
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