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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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Lee YC, Tu CH, Chung HY, Luo ST, Chu YT, MacDonald IJ, Kotha P, Huang CC, Lane HY, Lin JG, Chen YH. Antihistamine promotes electroacupuncture analgesia in healthy human subjects: A pilot study. J Tradit Complement Med 2022; 12:511-517. [PMID: 36081814 PMCID: PMC9446023 DOI: 10.1016/j.jtcme.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/29/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background and aim We have previously reported that histamine H1 receptor antagonists facilitate electroacupuncture (EA) analgesia in experimental animals. In this pilot study, we sought to determine whether the histamine H1 receptor antagonist dexchlorpheniramine (DCPA) facilitates EA analgesia in healthy human subjects. Experimental procedure Forty healthy subjects aged 20–30 years were randomly allocated to 1 of 4 groups: (1) sham EA at acupoints Zusanli (ST36) and Yanglingquan (GB34) (sham EA; n = 10); (2) EA at ST36 and GB34 (n = 10); (3) EA at ST36 and GB34 plus low-dose DCPA (2 mg, n = 10); (4) EA at ST36 and GB34 plus high-dose DCPA (4 mg, n = 10). Before and after acupuncture treatment, pain thresholds were determined by transcutaneous electrical stimuli on the glabrous skin of the left upper arm. Results After the acupuncture session, subjects in the EA plus high-dose DCPA group had a significantly higher pain threshold elevation compared with the other 3 study groups. The change from baseline in pain threshold in the EA plus high-dose DCPA group was significantly greater than the change in pain threshold with EA only, indicating that DCPA 4 mg facilitated EA analgesia. Conclusion The results suggest that combining H1 receptor antagonist treatment with EA appears to relieve pain to a greater extent compared with EA alone. This study is registered with ClinicalTrials.gov (https://clinicaltrials.gov/), number NCT03805035 (https://clinicaltrials.gov/ct2/show/NCT03805035). Histamine H1 receptor antagonist treatment appears to augment the pain-relieving effects of EA in healthy subjects. EA increased the pain thresholds in EA treated groups. Combination of EA and high-dose of DCPA further increased pain thresholds.
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Affiliation(s)
- Yu-Chen Lee
- School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
- Department of Acupuncture, China Medical University Hospital, No. 2, Yude Road, Taichung, 404332, Taiwan, ROC
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Hsin-Yi Chung
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Sih-Ting Luo
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Yu-Ting Chu
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Iona J. MacDonald
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Peddanna Kotha
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
| | - Chien-Chen Huang
- Department of Traditional Chinese Medicine, An Nan Hospital, China Medical University, No.66, Sec. 2, Changhe Road, Tainan, 709204, Taiwan, ROC
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
- Department of Psychiatry, China Medical University Hospital, No. 2, Yude Road, Taichung, 404332, Taiwan, ROC
| | - Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
- Correspondence author. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC.
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
- Chinese Medicine Research Center, China Medical University, No. 91, Hsueh-Shih Road, Taichung, 40402, Taiwan, ROC
- Department of Photonics and Communication Engineering, Asia University, No. 500, Lioufeng Road, Wufeng, Taichung, 41354, Taiwan, ROC
- Corresponding author. Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan, ROC.
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Trinh K, Zhou F, Belski N, Deng J, Wong CY. The Effect of Acupuncture on Hand and Wrist Pain Intensity, Functional Status, and Quality of Life in Adults: A Systematic Review. Med Acupunct 2022; 34:34-48. [PMID: 35251436 PMCID: PMC8886934 DOI: 10.1089/acu.2021.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: This systematic review examined the effects of acupuncture on hand-and-wrist pain intensity, functional status, quality of life, and incidence of adverse effects in adults. Methods: Searches of 6 databases and previous reviews for randomized controlled trials (RCTs) were performed. Each outcome was analyzed for participant conditions, interventions, controls, and follow-up times determined a priori. Active controls were excluded. Follow-up periods were based on Cochrane 5.1.0 guidelines. The results were tabulated and described narratively. Results: In the 10 included RCTs (622 participants), 6 had a low risk of bias. For cryotherapy-induced pain, 1 trial showed significant pain reduction post treatment. For rheumatoid arthritis, 1 trial shown significant pain reduction and function improvements post treatment and short-term. For carpal tunnel syndrome, 1 trial showed significant pain reduction and functional improvements intermediate-term, while 3 trials suggested no significant difference. For tenosynovitis, 1 trial showed significant pain reduction and function improvements short-term. For poststroke impairments, 1 trial showed significant function improvements post treatment and at short-term, while another trial suggested no significant difference. No significant improvements were noted for trapezio-metacarpal joint osteoarthritis. In 2 trials, adverse effects occurred in patients with carpal tunnel syndrome; yet acupuncture appeared to be relatively safe. Conclusions: Acupuncture may be effective and safe for short-term pain reduction and functional improvement in hand-and-wrist conditions. Clinicians should interpret the results with caution due to small sample sizes and clinical heterogeneity. Future research is warranted.
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Affiliation(s)
- Kien Trinh
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Ancaster Sports Medicine Centre, Ancaster, Ontario, Canada
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nikita Belski
- Faculty of Applied Health Sciences, Brock University, St. Catharine's, Ontario, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chi Yi Wong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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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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5
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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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Ruan A, Wang Q, Ma Y, Zhang D, Yang L, Wang Z, Xie Q, Yin Y. Efficacy and Mechanism of Electroacupuncture Treatment of Rabbits With Different Degrees of Knee Osteoarthritis: A Study Based on Synovial Innate Immune Response. Front Physiol 2021; 12:642178. [PMID: 34421630 PMCID: PMC8375319 DOI: 10.3389/fphys.2021.642178] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/04/2021] [Indexed: 01/15/2023] Open
Abstract
Knee osteoarthritis (KOA) is a chronic degenerative bone and joint disease, which is often clinically manifested as pain, joint swelling, and deformity. Its pathological manifestations are mainly synovial inflammation and cartilage degeneration. This study aims to investigate the efficacy of electro-acupuncture (EA) on model rabbits with varying degrees of KOA and to study the mechanism of EA on KOA based on the innate immune response. Mild and moderate rabbit KOA models were established using a modified Hluth method, and EA was given to both the mild and moderate model groups. The Lequesne-MG index was used to evaluate the behavioral changes in the rabbits before and after EA treatment. Morphological changes in the synovial membrane and cartilage of each group were observed by H&E staining. The Mankin scoring standard and the Krenn scoring standard were used to score the pathology of the cartilage tissue and synovial tissue, respectively. The inflammatory factors and metalloproteinases were detected in the serum of each group by ELISA. The protein and messenger RNA (mRNA) expressions of important elements related to Toll-like receptors (TLRs)-mediated innate immune response in the synovial tissue were detected by Western blot and quantitative PCR (qPCR). The Lequesne-MG index score of the rabbits gradually increased with the modeling prolonged but decreased significantly after EA treatment, indicating that EA has a better effect on alleviating the pain and improving the dysfunction. The morphological analysis showed that the inflammation of and the damage to the synovial membrane and the cartilage tissue gradually deteriorated with the modeling prolonged. However, the synovial membrane inflammation was significantly relieved after EA treatment, and the cartilage injury showed signs of repair. The ELISA analysis showed that, with the modeling prolonged, the serum-related inflammatory factors and mechanism of metalloproteinases gradually increased but decreased after EA treatment. The tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and matrix metalloproteinase3 (MMP3) of EA1 group were significantly lower than those of EA2 group. Both Western blot and qPCR results showed that the protein and mRNA expressions of the elements related to the innate immune response in the synovial membrane increased gradually with the modeling prolonged, but decreased significantly after EA treatment. Additionally, the expression of some components in EA1 group was significantly lower than that in EA2 group. These results confirm that synovial inflammation gradually aggravated with time from the early to mid-stage of KOA. EA alleviated the inflammation and histological changes in KOA rabbits by inhibiting the TLRs-mediated innate synovial immune response. This suggests that using EA in the early stage of KOA may achieve a desirable efficacy.
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Affiliation(s)
- Anmin Ruan
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Qingfu Wang
- Department of Tendon and Injury, The Third Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Yufeng Ma
- Department of Tendon and Injury, The Third Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Dong Zhang
- Department of General Surgery, The Second Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Lili Yang
- Department of Orthopedics, Beijing Longfu Hospital, Beijing, China
| | - Zhongpeng Wang
- Acupuncture and Moxibustion Department, The Third Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Qi Xie
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yueshan Yin
- Acupuncture and Moxibustion Department, The Third Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
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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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Hamasaki T, Laprise S, Harris PG, Bureau NJ, Gaudreault N, Ziegler D, Choinière M. Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2020; 72:1719-1735. [DOI: 10.1002/acr.24084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Tokiko Hamasaki
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | | | - Patrick G. Harris
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | - Nathalie J. Bureau
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
| | - Nathaly Gaudreault
- Université de Sherbrooke and Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec Canada
| | - Daniela Ziegler
- Centre Hospitalier de l’Université de Montréal Montreal Quebec Canada
| | - Manon Choinière
- Centre Hospitalier de l’Université de Montréal and Université de Montréal Montreal Quebec Canada
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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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10
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Wu N, Huang J, Yang X, Guo J, Liu F, Gu Y, Liu Y, Zhang Z, Yin S, Feng X. The long-term effect of acupuncture for patients with knee osteoarthritis: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e22599. [PMID: 33080693 PMCID: PMC7572014 DOI: 10.1097/md.0000000000022599] [Citation(s) in RCA: 2] [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] [Received: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Whether there is the long-term effect of acupuncture on patients with knee osteoarthritis (KOA) or not is controversial. According to the basic theory of traditional acupuncture, deqi is the key to the efficacy of acupuncture. This randomized controlled trial aims to evaluate the existence of long-term effects caused by deqi in patients with KOA. METHODS AND ANALYSIS A three-armed, parallel-design, randomized controlled trial is underway in China.108 KOA patients recruited by the rehabilitation center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine will be randomly assigned to the acupuncture with deqi group (A group), the acupuncture without deqi group (B group) and the waiting-list group (C group). Each patient will receive 5 30-minute sessions per week for 4 consecutive weeks and rest for 2 days between treatments, and undergo a 20-week follow-up. The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC score). The secondary outcomes include Western Ontario and McMaster Universities Osteoarthritis index (WOMAC score), Knee Injury and Osteoarthritis Outcome Score (KOOS), arthritis quality of life measurement scale simplified scale (AIMS2-SF), emotional monitoring and expectation scale. The pain visual analogue scale (VAS) and the Chinese version of modified Massachusetts General Hospital Acupuncture Sensation Scale (C-MMASS) will be used to evaluate the deqi sensation after each acupuncture treatment. At the same time, adverse events (AEs) occurred in the whole process will be recorded and analyzed. We will perform an intention-to-treat analysis and protocol (PP) analysis to statistically analyze the results of the trial. DISCUSSION This trial will be useful to study the long-term effect of acupuncture and the influence of the deqi sensation on the long-term in the treatment of KOA, and to provide a clinical basis for treatment of patients with mild to moderate knee osteoarthritis in clinic. TRIAL REGISTRATION Chinese Clinical Trial Registry, IDF: ChiCTR2000029291. Registered on January 21, 2020.
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Affiliation(s)
- Nan Wu
- School of Rehabilitation Medicine, Henan University of Chinese Medicine
| | - Jin Huang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine
| | - Xuguang Yang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine
| | - Jian Guo
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Feilai Liu
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Yujing Gu
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Yongtao Liu
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Zhenhua Zhang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine
| | - Shuai Yin
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Xiaodong Feng
- The Rehabilitation Center, First Affiliated Hospital of Henan University of Chinese Medicine
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11
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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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12
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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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13
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Ghelman R, Akiyama IY, de Souza VT, Falcão J, Orgolini V, Hosomi JK, Quadros AAJ, Oliveira ASB. A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial to evaluate the efficacy and safety of an anthroposophic multimodal treatment on chronic pain in outpatients with postpolio syndrome. Brain Behav 2020; 10:e01590. [PMID: 32162497 PMCID: PMC7177555 DOI: 10.1002/brb3.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chronic pain and fatigue are the main symptoms of postpoliomyelitis syndrome (PPS). This study aimed to evaluate the efficacy and safety of an anthroposophic multimodal treatment for chronic pain in PPS outpatients. METHODS A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial was designed to compare four groups (n = 48): groups A and B received daily active experimental transdermal gel (ETG) or placebo gel (PTG), respectively; groups C and D received weekly external therapies, art therapies, and neurofunctional reorganization, plus either daily ETG or PTG, respectively. The pain symptoms were evaluated through a visual analogue scale (VAS), the McGill questionnaire, and thermography. Quality of life and resilience were evaluated by the WHOQOL-BREF and Antonovsky sense of coherence questionnaires applied at baseline and after the interventions. RESULTS No related adverse events occurred, and 10% of the patients reports dysphagia improvement. In the groups C and D, pain reduction was statistically significant in both the placebo group (p = .02, d = 1.315) and in the ETG (p = .005, d = 2.035). However, following the week-to-week evolution of pain with the concomitant use of the ETG, this significant pain reduction occurred earlier from the 4th week and continued to decrease (p = .016, d = 1.369). In the group that received the complete multimodal treatment, the greatest significant benefit in increasing quality of life occurred in the physical domain and elevation in resilience with an emphasis on meaning and comprehension domains. CONCLUSIONS The anthroposophic multimodal treatment group presented both safety and efficacy as an analgesic in the groups that received the nonpharmacological therapies, much earlier when associated with the ETG. The multimodal approach corresponded to the pattern of better efficacy for both pain reduction and improvement in quality of life and resilience.
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Affiliation(s)
- Ricardo Ghelman
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil.,Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Ivete Y Akiyama
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Valeria T de Souza
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jussara Falcão
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Vera Orgolini
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jorge K Hosomi
- Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Abrahão A J Quadros
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
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14
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Abstract
Osteoarthritis (OA) is a worldwide endemic and debilitating disease. Previously thought to simply be damaged from "wear and tear," OA is now understood to be a complex interaction of local and systemic factors. This article reviews the pathology, symptoms, diagnosis, and various conservative, surgical, and novel treatments of OA.
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Affiliation(s)
- Benjamin Abramoff
- Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA
| | - Franklin E Caldera
- Department of PM&R, University of Pennsylvania, Penn Medicine Rittenhouse, 1800 Lombard Street, Philadelphia, PA 19146, USA.
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15
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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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16
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Li J, Li YX, Luo LJ, Ye J, Zhong DL, Xiao QW, Zheng H, Geng CM, Jin RJ, Liang FR. The effectiveness and safety of acupuncture for knee osteoarthritis: An overview of systematic reviews. Medicine (Baltimore) 2019; 98:e16301. [PMID: 31305415 PMCID: PMC6641846 DOI: 10.1097/md.0000000000016301] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA), known as severe degenerative arthritis, commonly occurs in middle-aged and elderly people all over the world. Acupuncture as traditional oriental intervention is getting widely used and several systematic reviews (SRs) have reported the effectiveness of acupuncture on pain relief and functional recovery in patients with KOA. OBJECTIVE Conducting an overview of SRs to provide more reliable evidence-based medical references for clinical practitioners and researchers of the effectiveness and safety of acupuncture for KOA. DATA SOURCES EMBASE, Medline, Web of science, the Cochrane library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, China Biology Medicine, Wan Fang Digital Journals, and PROSPERO databases from inception to December 2018, magazines, websites, and unpublished sources. SELECTION CRITERIA Potential SRs were independently selected by 2 reviewers following a predetermined protocol. DATA EXTRACTION Data information of included SRs were independently extracted by 2 reviewers following a predetermined standardized data extraction form. REVIEW APPRAISAL The risk of bias and reporting quality of included SRs were evaluated by the Risk of Bias in Systematic reviews (ROBIS) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The quality of evidence of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 12 SRs were included. All the SRs were published in recent 12 years, ranging from 2006 to 2017. According to ROBIS, 4 SRs were in low risk in domain 1 and 7 in domain 3 of phase 2, and 2 SRs were low risk in phase 3. Among 27 items of PRISMA, 19 items were reported over 70% of compliance. Using GRADE assessment, of 34 outcomes, high quality of evidence was found in 5 outcomes, 17 outcomes were rated moderate quality, and 11 outcomes were low quality. According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating KOA. In terms of Lequesne index and Lysholm knee score scale score, the effectiveness of electroacupuncture was better than that of western medicine. LIMITATIONS There might be missing information. There may be duplicated clinical trials included by each SR that might have impact on the synthetic findings. CONCLUSIONS According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating KOA. However, there are some risk of bias and reporting deficiencies still needed to be improved.
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Affiliation(s)
- Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine
| | - Yu-Xi Li
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Liao-Jun Luo
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Jing Ye
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Dong-Ling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine
| | - Qi-Wei Xiao
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Hui Zheng
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
| | - Chun-Mei Geng
- Rehabilitation Department, Kunming Municipal Hospital of Traditional Chinese Medicine, Yunnan, China
| | - Rong-Jiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine
| | - Fan-Rong Liang
- School of Acupuncture-Moxibustion and Tuina, The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan
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17
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Bae SJ, Lim J, Lee S, Choi H, Jang JH, Kim YK, Oh JY, Park JH, Jung HS, Chae Y, In SI, Park HJ. Augmented Mechanical Forces of the Surface-Modified Nanoporous Acupuncture Needles Elicit Enhanced Analgesic Effects. Front Neurosci 2019; 13:652. [PMID: 31281240 PMCID: PMC6596406 DOI: 10.3389/fnins.2019.00652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/06/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past several decades, clinical studies have shown significant analgesic effects of acupuncture. The efficacy of acupuncture treatment has improved with the recent development of nanoporous needles (PN), which are produced by modifying the needle surface using nanotechnology. Herein, we showed that PN at acupoint ST36 produces prolonged analgesic effects in an inflammatory pain model; the analgesic effects of PN acupuncture were sustained over 2 h, while those using a conventional needle (CN) lasted only 30 min. In addition, the PN showed greater therapeutic effects than CN after 10 acupuncture treatments once per day for 10 days. We explored how the porous surface of the PN contributes to changes in local tissue, which may in turn result in enhanced analgesic effects. We showed that the PN has greater rotational torque and pulling force than the CN, particularly at acupoints ST36 and LI11, situated on thick muscle layers. Additionally, in ex vivo experiments, the PN showed greater winding of subcutaneous connective tissues and muscle layers. Our results suggest that local mechanical forces are augmented by the PN and its nanoporous surface, contributing to the enhanced and prolonged analgesic effects of PN acupuncture.
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Affiliation(s)
- Sun-Jeong Bae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Junsik Lim
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Semyung University, Jecheon, South Korea
| | - Sangmin Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Dongguk University, Goyang, South Korea
| | - Hansaem Choi
- Department of Energy Science and Engineering, DGIST, Daegu, South Korea
| | - Jae-Hwan Jang
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Yu-Kang Kim
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Ju-Young Oh
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jeong Hun Park
- Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyuk-Sang Jung
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Younbyung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Su-Il In
- Department of Energy Science and Engineering, DGIST, Daegu, South Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea.,College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Graduate School of Korean Medicine, Kyung Hee University, Seoul, South Korea
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18
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Lo PC, Lin FC, Tsai YC, Lin SK. Traditional Chinese medicine therapy reduces the risk of total knee replacement in patients with knee osteoarthritis. Medicine (Baltimore) 2019; 98:e15964. [PMID: 31169724 PMCID: PMC6571282 DOI: 10.1097/md.0000000000015964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Knee osteoarthritis is a degenerative disease occurring in elderly people worldwide. For severe knee osteoarthritis, total knee replacement is the final treatment option. Traditional Chinese medicine (TCM) is popular in Taiwan and has been shown to exert therapeutic effects on knee osteoarthritis. We investigated the long-term clinical effects of TCM for reducing the need for total knee replacement risk in patients with knee osteoarthritis.We used the National Health Insurance Research Database to conduct a retrospective study of patients with knee osteoarthritis between 1997 and 2003 in Taiwan. Data from the date of diagnosis of knee osteoarthritis to total knee replacement were assessed using the Cox regression proportional hazards model, and the Kaplan-Meier survival curve was used to determine the association between total knee replacement risk and TCM use.A total of 34,231 patients with knee osteoarthritis, who were diagnosed by orthopedic or rehabilitation physicians between 1997 and 2003 were included. Patients were categorized into 2 groups: 26,257 (76.7%) were TCM users and 7974 (23.3%) were TCM non-users. The mean follow-up period was 9.26 years. Multivariate regression demonstrated that using TCM may decrease the need for total knee replacement in patients with knee osteoarthritis (adjusted hazards ratio [aHR] = 0.69, 95% confidence interval [95% CI]: 0.64-0.77) compared with TCM non-users. A relationship between longer TCM use and reduced total knee replacement use was observed, especially in patients who used TCM for ≥120 days (aHR = 0.49, 95% CI: 0.42-0.56).The results of this study suggested that TCM is associated with a reduced risk of total knee replacement in patients with knee osteoarthritis, with enhanced benefits from longer durations of TCM use.
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Affiliation(s)
- Pei-Chia Lo
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University
| | | | - Yao-Chien Tsai
- Department of Chinese Medicine, Taipei City Hospital, Renai Branch
| | - Shun-Ku Lin
- Department of Chinese Medicine, Taipei City Hospital, Renai Branch
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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19
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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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20
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Jubb RW, Tukmachi ES, Jones PW, Dempsey E, Waterhouse L, Brailsford S. A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee. Acupunct Med 2018; 26:69-78. [DOI: 10.1136/aim.26.2.69] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives To compare the effect of acupuncture (manual and electroacupuncture) with that of a non-penetrating sham (‘placebo’ needle) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation. Methods Acupuncture naive patients with symptomatic and radiological evidence of osteoarthritis of the knee were randomly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘placebo’ needle system. Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome. Both manual and electrical stimulation were used. Response was assessed using the WOMAC index for osteoarthritis of the knee, self reported pain scale, the EuroQol score and plasma β-endorphin. The effectiveness of blinding was assessed. Results There were 34 patients in each group. The primary end point was the change in WOMAC pain score after the course of treatment. Comparison between the two treatment groups found a significantly greater improvement with acupuncture (mean difference 60, 95% CI 5 to 116, P=0.035) than with sham. Within the acupuncture group there was a significant improvement in pain (baseline 294, mean change 95, 95% CI 60 to 130, P<0.001) which was not seen by those who had sham acupuncture (baseline 261, mean change 35, 95% CI-10 to 80, P=0.12). Similar effects within group, but not between groups, were seen with the secondary end points of WOMAC stiffness, WOMAC function, and self reported pain. One month after treatment the between group pain difference had been lost (mean difference 46; 95% CI −9 to 100, P=0.10) although the acupuncture group was still benefiting compared to baseline (mean difference 59; 95% CI 16 to 102, P=0.009). The EuroQol score, a generic measure of health related quality of life, was not altered by the treatments. A minority of patients correctly guessed their treatment group (41% in the acupuncture group and 44% in the control group). Plasma β-endorphin levels were not affected by either treatment. Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee, and is significantly superior to non-penetrating sham acupuncture. The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture.
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Affiliation(s)
- Ronald W Jubb
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Emad S Tukmachi
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Peter W Jones
- School of Computing and Mathematics Keele University, UK
| | - Emma Dempsey
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Lynn Waterhouse
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Sue Brailsford
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
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Tegiacchi T. Interaction of energetic points, tendinomuscular meridian and 5 elements in the treatment of osteoarthritis of the knee in patients over 45 years old: a randomized controlled trial. J Acupunct Meridian Stud 2018:S2005-2901(18)30045-1. [PMID: 30343138 DOI: 10.1016/j.jams.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/04/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Acupuncture had a different approaches since its beginnings. Using traditional energetic points with an interaction of 5 elements and meridian theories with manual diagnosis of tender points has been proposed. This procedure can be an effective treatment in musculoskeletal disease but its development is short. OBJECTIVES To evaluate the efficacy of energetic points of tendinomuscular meridian in the treatment of pain, quality of life and function of the knee. DESIGN Randomized controlled trial, non standardized and double blind. Inclusions criteria were: being over 45 years, having had pain for more than 3 months, level II o greater in Kellgren-Lawrence and suffering morning stiffness. Exclusion criteria were artoplasty, corticosteroids and rehabilitation, arthropaties, autoinmune diseases and neuropathic pain. RESULTS Intervention group had significant improvement in average pain in the last 15 days at end of treatment (p<0.04) and quality of life at the end of follow-up (p<0.015). Other measurements no show significant differences between groups. CONCLUSIONS Energetic points of tendinomuscular meridian and the 5 elements related are equal or better than local acupuncture in the treatment of pain, quality of life and function in osteoarthritis of the knee. However, it is necessary to have more research with more tracing and poblation to improve the quality of the results.
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Deprescribing Benzodiazepines in Older Patients: Impact of Interventions Targeting Physicians, Pharmacists, and Patients. Drugs Aging 2018; 35:493-521. [PMID: 29705831 DOI: 10.1007/s40266-018-0544-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Benzodiazepines (BZDs; including the related Z-drugs) are frequently targets for deprescribing; long-term use in older people is harmful and often not beneficial. BZDs can result in significant harms, including falls, fractures, cognitive impairment, car crashes and a significant financial and legal burden to society. Deprescribing BZDs is problematic due to a complex interaction of drug, patient, physician and systematic barriers, including concern about a potentially distressing but rarely fatal withdrawal syndrome. Multiple studies have trialled interventions to deprescribe BZDs in older people and are discussed in this narrative review. Reported success rates of deprescribing BZD interventions range between 27 and 80%, and this variability can be attributed to heterogeneity of methodological approaches and limited generalisability to cognitively impaired patients. Interventions targeting the patient and/or carer include raising awareness (direct-to-consumer education, minimal interventions, and 'one-off' geriatrician counselling) and resourcing the patient (gradual dose reduction [GDR] with or without cognitive behavioural therapy, teaching relaxation techniques, and sleep hygiene). These are effective if the patient is motivated to cease and is not significantly cognitively impaired. Interventions targeted to physicians include prescribing interventions by audit, algorithm or medication review, and providing supervised GDR in combination with medication substitution. Pharmacists have less frequently been the targets for studies, but have key roles in several multifaceted interventions. Interventions are evaluated according to the Behaviour Change Wheel. Research supports trialling a stepwise approach in the cognitively intact older person, but having a low threshold to use less-consultative methods in patients with dementia. Several resources are available to support deprescribing of BZDs in clinical practice, including online protocols.
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Birch S, Lee MS, Alraek T, Kim TH. Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: A Bibliometric Analysis. J Altern Complement Med 2018; 24:752-769. [PMID: 29912569 DOI: 10.1089/acm.2018.0092] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION As positive evidence emerges for the use of an intervention to treat a health problem, the intervention gradually becomes incorporated into treatment guidelines (TGs) or clinical practice guidelines (CPGs) that are related to that health problem. To assess whether this general hypothesis can apply to acupuncture, 96 health problems were identified for which positive conclusions in systematic reviews and meta-analyses regarding the effectiveness of acupuncture have been made and then searched for TGs or CPGs that have recommended the use of acupuncture. METHODS Through August 31, 2017, searches were performed in relevant medical databases and Google using "treatment guideline," "clinical practice guideline," and the names of the 96 medical conditions as search terms. A "snow-balling" search approach was adopted. All positive recommendations were added into the registry. RESULTS A total of 1311 publications were found that recommended using acupuncture published between 1991 and 2017. The number per year reached 50 in 2005 and 100 in 2009. In addition, 2189 positive recommendations were found for the use of acupuncture. Of these, 1486 were related to 107 pain indications and 703 were related to 97 nonpain indications. These recommendations were made by a wide range of groups, such as government health institutions, national guideline, and medical specialty groups. The recommendations came from around the world but were especially abundant in North America, Europe, and Australasia. DISCUSSION AND CONCLUSION Considerably more recommendations were found for the use of acupuncture than are known within the acupuncture or medical communities. A trend by year was also found; a rise in the number of positive statements about acupuncture was typically followed by a rise in the number of recommendations of acupuncture. Thus, the recommendations followed the emergent evidence for acupuncture. Better implementation plans need to be developed for the CPG/TG recommendations about acupuncture to be more effective/efficient.
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Affiliation(s)
- Stephen Birch
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway
| | - Myeong Soo Lee
- 2 Clinical Medicine Division, Korea Institute of Oriental Medicine , Daejeon, Republic of South Korea
| | - Terje Alraek
- 1 Department of Health Sciences, Kristiania University College , Oslo, Norway .,3 Department of Community Medicine, Faculty of Medicine, National Research Centre in Complementary and Alternative Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Tae-Hun Kim
- 4 Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University , Seoul, Republic of Korea
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Abstract
BACKGROUND Hip osteoarthritis (OA) is a major cause of pain and functional limitation. Few hip OA treatments have been evaluated for safety and effectiveness. Acupuncture is a traditional Chinese medical therapy which aims to treat disease by inserting very thin needles at specific points on the body. OBJECTIVES To assess the benefits and harms of acupuncture in patients with hip OA. SEARCH METHODS We searched Cochrane CENTRAL, MEDLINE, and Embase all through March 2018. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, another active treatment, or no specific treatment; and RCTs that evaluated acupuncture as an addition to another treatment. Major outcomes were pain and function at the short term (i.e. < 3 months after randomization) and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Six RCTs with 413 participants were included. Four RCTs included only people with OA of the hip, and two included a mix of people with OA of the hip and knee. All RCTs included primarily older participants, with a mean age range from 61 to 67 years, and a mean duration of hip OA pain from two to eight years. Approximately two-thirds of participants were women. Two RCTs compared acupuncture versus sham acupuncture; the other four RCTs were not blinded. All results were evaluated at short term (i.e. four to nine weeks after randomization).In the two RCTs that compared acupuncture to sham acupuncture, the sham acupuncture control interventions were judged believable, but each sham acupuncture intervention was also judged to have a risk of weak acupuncture-specific effects, due to placement of non-penetrating needles at the correct acupuncture points in one RCT, and the use of penetrating needles not inserted at the correct points in the other RCT. For these two sham-controlled RCTs, the risk of bias was low for all outcomes.The combined analysis of two sham-controlled RCTs gave moderate quality evidence of little or no effect in reduction in pain for acupuncture relative to sham acupuncture. Due to the small sample sizes in the studies, the confidence interval includes both the possibility of moderate benefit and the possibility of no effect of acupuncture (120 participants; Standardized Mean Difference (SMD) -0.13, (95% Confidence Interval (CI) -0.49 to 0.22); 2.1 points greater improvement with acupuncture compared to sham acupuncture on 100 point scale (i.e., absolute percent change -2.1% (95% CI -7.9% to 3.6%)); relative percent change -4.1% (95% CI -15.6% to 7.0%)). Estimates of effect were similar for function (120 participants; SMD -0.15, (95% CI -0.51 to 0.21)). No pooled estimate, representative of the two sham-controlled RCTs, could be calculated or reported for the quality of life outcome.The four other RCTs were unblinded comparative effectiveness RCTs, which compared (additional) acupuncture to four different active control treatments.There was low quality evidence that addition of acupuncture to the routine primary care that RCT participants were receiving from their physicians was associated with statistically significant and clinically relevant benefits, compared to the routine primary physician care alone, in pain (1 RCT; 137 participants; mean percent difference -22.9% (95% CI -29.2% to -16.6%); relative percent difference -46.5% (95% CI -59.3% to -33.7%)) and function (mean percent difference -19.0% (95% CI -24.41 to -13.59); relative percent difference -38.6% (95% CI -49.6% to -27.6%)). There was no statistically significant difference for mental quality of life and acupuncture showed a small, significant benefit for physical quality of life.The effects of acupuncture compared with either advice plus exercise or NSAIDs are uncertain.We are also uncertain whether acupuncture plus patient education improves pain, function, and quality of life, when compared to patient education alone.In general, the overall quality of the evidence for the four comparative effectiveness RCTs was low to very low, mainly due to the potential for biased reporting of patient-assessed outcomes due to lack of blinding and sparse data.Information on safety was reported in four RCTs. Two RCTs reported minor side effects of acupuncture, which were primarily minor bruising, bleeding, or pain at needle insertion sites. Four RCTs reported on adverse events, and none reported any serious adverse events attributed to acupuncture. AUTHORS' CONCLUSIONS Acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture in people with hip osteoarthritis. Due to the small sample size in the studies, the confidence intervals include both the possibility of moderate benefits and the possibility of no effect of acupuncture. One unblinded trial found that acupuncture as an addition to routine primary physician care was associated with benefits on pain and function. However, these reported benefits are likely due at least partially to RCT participants' greater expectations of benefit from acupuncture. Possible side effects associated with acupuncture treatment were minor.
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Affiliation(s)
| | - Ke Cheng
- Shanghai University of Traditional Chinese MedicineSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - L. Susan Wieland
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard StreetBaltimoreUSA21201
| | - Xueyong Shen
- Shanghai University of Traditional Chinese Medicine, Shanghai Research Center of Acupuncture & Meridians, Shanghai Key Laboratory of acupuncture mechanism and acupoint functionSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - Lixing Lao
- The University of Hong KongSchool of Chinese Medicine10 Sassoon RoadPokfulam RdHong KongChina
| | - Menghu Guo
- Shanghai University of Traditional Chinese MedicineSchool of Acupuncture‐Moxibustion and Tuina1200, Cailun RDShanghaiChina201203
| | - Brian M Berman
- University of Maryland School of MedicineCenter for Integrative Medicine520 W. Lombard StreetBaltimoreUSA21201
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Wang K, Tang M, Ouyang L, Liu Q. Acupuncture for heart disease patients. Eur J Prev Cardiol 2018; 25:1116. [PMID: 29569491 DOI: 10.1177/2047487318767476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kai Wang
- 1 Biomedical Center, Guangdong Provincial Key Laboratory of Improved Variety Reproduction in Aquatic Economic Animals, State Key Laboratory of Biocontrol, Lab of Microbial Metabolic Engineering and Synthetic Biology, School of Life Sciences, Sun Yat-sen University, China.,2 Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Man Tang
- 1 Biomedical Center, Guangdong Provincial Key Laboratory of Improved Variety Reproduction in Aquatic Economic Animals, State Key Laboratory of Biocontrol, Lab of Microbial Metabolic Engineering and Synthetic Biology, School of Life Sciences, Sun Yat-sen University, China
| | - Lan Ouyang
- 1 Biomedical Center, Guangdong Provincial Key Laboratory of Improved Variety Reproduction in Aquatic Economic Animals, State Key Laboratory of Biocontrol, Lab of Microbial Metabolic Engineering and Synthetic Biology, School of Life Sciences, Sun Yat-sen University, China
| | - Qiuyun Liu
- 1 Biomedical Center, Guangdong Provincial Key Laboratory of Improved Variety Reproduction in Aquatic Economic Animals, State Key Laboratory of Biocontrol, Lab of Microbial Metabolic Engineering and Synthetic Biology, School of Life Sciences, Sun Yat-sen University, China
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The Immediate Analgesic Effect of Acupuncture for Pain: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:3837194. [PMID: 29234385 PMCID: PMC5676441 DOI: 10.1155/2017/3837194] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022]
Abstract
Although acupuncture is gaining popularity for the treatment of nonspecific pain, the immediate analgesic effect of acupuncture has never been reviewed. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on disease-related pain to critically evaluate the immediate effect of acupuncture for pain relief. The PubMed and Cochrane Central Register of Controlled Trials databases as well as three Chinese databases including the China National Knowledge Infrastructure (CNKI), Wanfang, and VIP platforms were searched through November 2016. The outcome was the extent of pain relief from baseline within 30 min of the first acupuncture treatment. We evaluated all RCTs comparing acupuncture with other interventions for disease-related pain. Real acupuncture showed statistically significantly greater pain relief effect compared to sham acupuncture (SMD, −0.56; 95% confidence interval [CI], −1.00 to −0.12; 9 RCTs) and analgesic injection (SMD, −1.33; 95% CI, −1.94 to −0.72; 3 RCTs). No serious adverse events were documented. Acupuncture was associated with a greater immediate pain relief effect compared to sham acupuncture and analgesic injections. Further RCTs with stricter design and methodologies are warranted to evaluate the immediate pain relief effect of acupuncture for more disease-related pain.
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张 磊, 李 义, 祁 冀, 张 少, 平 瑞, 周 鑫, 喻 林, 刘 锐, 扶 世. [Effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament injury]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1171-1177. [PMID: 28951357 PMCID: PMC6765490 DOI: 10.3969/j.issn.1673-4254.2017.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament (ACL) injury. METHODS Twenty-seven cynomolgus monkeys were randomized equally into 3 groups, namely unilateral ACL injury with electroacupuncture group, unilateral ACL injury model group and blank control group. One week after modeling, the monkeys in electroacupuncture group were treated daily for 12 weeks with electroacupuncture at the acupoints Wei Yang, Yin Gu, Xi Yangguan and Qu Quan. At 4, 8, and 12 weeks during the treatment, the changes in the somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV) of the nerves of the ACL were examined with neural electrophysiological method; the changes in the morphology and the total and variable number of the proprioceptors in the ACL were observed with gold chloride staining. RESULTS; In the mokeys in the model group, the incubation period of the SEPs and MCV on the injured side of the knee were significantly extended and the amplitudes were decreased with the passage of time (P<0.05). Intervention with electroacupuncture significantly reduced the incubation period and increased the amplitudes of the SEPs and MCV (P<0.05). The total number of the proprioceptors in the ACL was significantly decreased and the variable number of the proprioceptors in ACL was increased with time in the monkeys in the model group (P<0.05); electroacupuncture intervention obviously slowed the reduction rate of total number of the proprioceptors (P<0.05) but without affecting the variable number of the proprioceptors (P>0.05). CoONCLUSION: ACL injury causes attenuation of the proprioception on the injury side, and electroacupuncture intervention can produce a positive effect on the proprioception in cynomolgus monkeys.
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Affiliation(s)
- 磊 张
- 西南医科大学附属中医医院,四川 泸州 646600Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
- 南方医科大学中医药学院,广东 广州 510515School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - 义凯 李
- 南方医科大学中医药学院,广东 广州 510515School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - 冀 祁
- 南方医科大学中医药学院,广东 广州 510515School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - 少群 张
- 南方医科大学中医药学院,广东 广州 510515School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - 瑞月 平
- 广州中医药大学,广东 广州 510403Guangzhou University of Chinese Medicine, Guangzhou 510403, China
| | - 鑫 周
- 西南医科大学附属中医医院,四川 泸州 646600Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - 林 喻
- 西南医科大学附属中医医院,四川 泸州 646600Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - 锐锋 刘
- 西南医科大学附属中医医院,四川 泸州 646600Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
| | - 世杰 扶
- 西南医科大学附属中医医院,四川 泸州 646600Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, China
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Choi TY, Lee MS, Kim JI, Zaslawski C. Moxibustion for the treatment of osteoarthritis: An updated systematic review and meta-analysis. Maturitas 2017; 100:33-48. [PMID: 28539175 DOI: 10.1016/j.maturitas.2017.03.314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/01/2017] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to update previous reviews and examine recent evidence from randomised clinical trials (RCTs) of the use of moxibustion for osteoarthritis (OA). Twelve databases were searched from inception through to September 2016 with no language limits applied. Data extraction and risk-of-bias assessments were performed by two independent reviewers. A total of 19 RCTs met all inclusion criteria and were evaluated. Three RCTs compared the effects of moxibustion with those of sham moxibustion in patients with knee OA (KOA) and found favourable effects of moxibustion on pain reduction (n=305; SMD, -0.46; 95% CI: -0.86 to -0.06, P=0.02, I2=65%), including at follow-up (n=305; SMD, -0.36; 95% CI: -0.70 to -0.01, P=0.04, I2=54%). Eleven RCTs compared the effects of moxibustion with those of conventional oral drug therapies. Eight RCTs reported a total symptom score and the meta-analysis showed superior effects of moxibustion compared with drug therapies for this measure (n=691; SMD, -0.24; 95% CI: -0.78 to 0.29; P=0.37, I2=91%) and response rate (n=758 knees; RR, 1.10; 95% CI: 1.05-1.16, P <0.0001, I2=0%). Three RCTs found superior or equivalent effects of moxibustion on symptom score compared with intra-articular injection or topical drug therapy. The existing trial evidence is sufficiently convincing to suggest that moxibustion, compared with sham moxibustion and oral drugs, is effective for pain reduction and symptom management in KOA. The level of evidence is moderate, given the high risk of bias and small sample size.
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Affiliation(s)
- Tae-Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea.
| | - Jong In Kim
- Department of Acupuncture & Moxibustion medicine, Kyung Hee Korean Medicine Hospital, Kyung Hee University, Seoul 02447, Republic of Korea
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MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Spackman E, Saramago P, Woods B, Weatherly H, Sculpher M, Manca A, Richmond S, Hopton A, Eldred J, Watt I. Acupuncture for chronic pain and depression in primary care: a programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundThere has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.AimOur aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.Methods and resultsWe synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p < 0.001) and usual care (p < 0.001) for all conditions. Using network meta-analyses, we compared acupuncture with other physical therapies for osteoarthritis of the knee. In both an analysis of all available evidence and an analysis of a subset of better-quality trials, using aggregate-level data, we found acupuncture to be one of the more effective therapies. We developed new Bayesian methods for analysing multiple individual patient-level data sets to evaluate heterogeneous continuous outcomes. An accompanying cost-effectiveness analysis found transcutaneous electrical nerve stimulation (TENS) to be cost-effective for osteoarthritis at a threshold of £20,000 per quality-adjusted life-year when all trials were synthesised. When the analysis was restricted to trials of higher quality with adequate allocation concealment, acupuncture was cost-effective. In a RCT of acupuncture or counselling compared with usual care for depression, in which half the patients were also experiencing comorbid pain, we found acupuncture and counselling to be clinically effective and acupuncture to be cost-effective. For patients in whom acupuncture is inappropriate or unavailable, counselling is cost-effective.ConclusionWe have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.Trial registrationCurrent Controlled Trials ISRCTN63787732.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Bland
- Department of Health Sciences, University of York, York, UK
| | | | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Beth Woods
- Centre for Health Economics, University of York, York, UK
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | | | - Ann Hopton
- Department of Health Sciences, University of York, York, UK
| | - Janet Eldred
- Department of Health Sciences, University of York, York, UK
| | - Ian Watt
- Department of Health Sciences/Hull York Medical School, University of York, York, UK
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Effects of Electroacupuncture for Knee Osteoarthritis: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:3485875. [PMID: 27818699 PMCID: PMC5081971 DOI: 10.1155/2016/3485875] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/01/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023]
Abstract
Purpose. This study aims to verify the effects of electroacupuncture treatment on osteoarthritis of the knee. Methods. MEDLINE/PubMed, EMBASE, CENTRAL, AMED, CNKI, and five Korean databases were searched by predefined search strategies to screen eligible randomized controlled studies meeting established criteria. Any risk of bias in the included studies was assessed with the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan version 5.3 software. Results. Thirty-one randomized controlled studies of 3,187 participants were included in this systematic review. Meta-analysis was conducted with eight studies including a total of 1,220 participants. The electroacupuncture treatment group showed more significant improvement in pain due to knee osteoarthritis than the control group (SMD −1.86, 95% CI −2.33 to −1.39, I2 75%) and in total WOMAC score than the control group (SMD −1.34, CI 95% −1.85 to −0.83, I2 73%). Compared to the control group, the electroacupuncture treatment group showed more significant improvement on the quality of life scale. Conclusion. Electroacupuncture treatment can relieve the pain of osteoarthritis of the knees and improve comprehensive aspects of knee osteoarthritis and the quality of life of patients with knee osteoarthritis.
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Lin X, Huang K, Zhu G, Huang Z, Qin A, Fan S. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. J Bone Joint Surg Am 2016; 98:1578-85. [PMID: 27655986 DOI: 10.2106/jbjs.15.00620] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acupuncture reportedly relieves chronic knee pain and improves physical function in patients diagnosed with osteoarthritis, but the duration of these effects is controversial. The aim of this study was to evaluate the temporal effects of acupuncture on chronic knee pain due to knee osteoarthritis by means of a meta-analysis. METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published through March 2015. Ten randomized controlled trials of acupuncture compared with sham acupuncture, usual care, or no intervention for chronic knee pain in patients with clinically diagnosed or radiographically confirmed knee osteoarthritis were included. All of the studies were available in English. Weighted mean differences (WMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated. RESULTS The acupuncture groups showed superior pain improvement (p < 0.001; WMD = -1.24 [95% CI, -1.92 to -0.56]; I(2) > 50%) and physical function (p < 0.001; WMD = 4.61 [95% CI, 2.24 to 6.97]; I(2) > 50%) in the short term (up to 13 weeks). The acupuncture groups showed superior physical function (p = 0.016; WMD = 2.73 [95% CI, 0.51 to 4.94]; I(2) > 50%) but not superior pain improvement (p = 0.199; WMD = -0.55 [95% CI, -1.39 to 0.29]; I(2) > 50%) in the long term (up to 26 weeks). Subgroup analysis revealed that the acupuncture groups tended to have better outcomes compared with the controls. Significant publication bias was not detected (p > 0.05), but the heterogeneity of the studies was substantial. CONCLUSIONS This meta-analysis demonstrates that acupuncture can improve short and long-term physical function, but it appears to provide only short-term pain relief in patients with chronic knee pain due to osteoarthritis. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xianfeng Lin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, People's Republic of China
| | - Kangmao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, People's Republic of China
| | - Guiqi Zhu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Zhaobo Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, People's Republic of China
| | - An Qin
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, People's Republic of China
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Seo BK, Sung WS, Park YC, Baek YH. The electroacupuncture-induced analgesic effect mediated by 5-HT1, 5-HT3 receptor and muscarinic cholinergic receptors in rat model of collagenase-induced osteoarthritis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:212. [PMID: 27411565 PMCID: PMC4943008 DOI: 10.1186/s12906-016-1204-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Osteoarthritis (OA) is an degenerative disease characterized by chronic joint pain. Complementary and alternative treatment such as acupuncture have been utilized to alleviate pain. The objective of this study was to investigate the analgesic mechanisms of electroacupuncture (EA) in the collagenase-induced osteoarthritis (CIOA) rat model. METHODS Four weeks after inducing CIOA by injecting collagenase solution into the left knee of 5-week-old male Sprague-Dawley rats, 2 Hz and 100 Hz EA on Zusanli (ST 36) was performed. The analgesic effect of EA was evaluated by the tail flick latency (TFL) and paw pressure threshold (PPT) tests. To investigate the analgesic mechanism, serotonergic and muscarinic cholinergic receptor agonists and antagonists were injected 20 min prior to EA and the resultant changes were evaluated by the TFL and PPT tests. RESULTS EA on Zusanli (ST 36) demonstrated an analgesic effect in the CIOA rat model. The 2 Hz EA treatment showed a significantly greater analgesic effect than the 100 Hz treatment. The analgesic effect of 2 Hz EA was not strengthened by 5-HT1, 5-HT2, 5-HT3, and muscarinic cholinergic receptor agonist pretreatment, was blocked by 5-HT1, 5-HT3, and muscarinic cholinergic receptor antagonist pretreatment, but not blocked by 5-HT2 receptor antagonist pretreatment. CONCLUSIONS In the CIOA rat model, EA on Zusanli (ST 36) exhibited analgesic effects, and 2 Hz EA resulted in a significantly greater analgesic effect than 100 Hz EA. The analgesic effect of 2 Hz EA was reduced by pretreatment of 5-HT1 receptor, 5-HT3 receptor and muscarinic cholinergic receptor antagonists.
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Affiliation(s)
- Byung-Kwan Seo
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | - Won-Suk Sung
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | - Yeon-Cheol Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea
| | - Yong-Hyeon Baek
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea.
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A review of inflammatory signaling pathway regulated by acupuncture. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2016. [DOI: 10.1016/s1003-5257(17)30013-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Forty per cent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. It has been claimed that acupuncture has a role in management of cancer pain and guidelines exist for treatment of cancer pain with acupuncture. This is an updated version of a Cochrane Review published in Issue 1, 2011, on acupuncture for cancer pain in adults. OBJECTIVES To evaluate efficacy of acupuncture for relief of cancer-related pain in adults. SEARCH METHODS For this update CENTRAL, MEDLINE, EMBASE, PsycINFO, AMED, and SPORTDiscus were searched up to July 2015 including non-English language papers. SELECTION CRITERIA Randomised controlled trials (RCTs) that evaluated any type of invasive acupuncture for pain directly related to cancer in adults aged 18 years or over. DATA COLLECTION AND ANALYSIS We planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors (CP, OT) independently extracted data adding it to data extraction sheets. Data sheets were compared and discussed with a third review author (MJ) who acted as arbiter. Data analysis was conducted by CP, OT and MJ. MAIN RESULTS We included five RCTs (285 participants). Three studies were included in the original review and two more in the update. The authors of the included studies reported benefits of acupuncture in managing pancreatic cancer pain; no difference between real and sham electroacupuncture for pain associated with ovarian cancer; benefits of acupuncture over conventional medication for late stage unspecified cancer; benefits for auricular (ear) acupuncture over placebo for chronic neuropathic pain related to cancer; and no differences between conventional analgesia and acupuncture within the first 10 days of treatment for stomach carcinoma. All studies had a high risk of bias from inadequate sample size and a low risk of bias associated with random sequence generation. Only three studies had low risk of bias associated with incomplete outcome data, while two studies had low risk of bias associated with allocation concealment and one study had low risk of bias associated with inadequate blinding. The heterogeneity of methodologies, cancer populations and techniques used in the included studies precluded pooling of data and therefore meta-analysis was not carried out. A subgroup analysis on acupuncture for cancer-induced bone pain was not conducted because none of the studies made any reference to bone pain. Studies either reported that there were no adverse events as a result of treatment, or did not report adverse events at all. AUTHORS' CONCLUSIONS There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.
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Affiliation(s)
- Carole A Paley
- Research & Development Department, Airedale NHS Foundation Trust, Airedale General Hospital, Steeton, Keighley, West Yorkshire, UK, BD20 6TD
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Woodbury A, Soong SN, Fishman D, García PS. Complementary and alternative medicine therapies for the anesthesiologist and pain practitioner: a narrative review. Can J Anaesth 2015; 63:69-85. [DOI: 10.1007/s12630-015-0506-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/23/2015] [Accepted: 10/02/2015] [Indexed: 01/22/2023] Open
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Salehi A, Marzban M, Imanieh MH. The Evaluation of Curative Effect of Acupuncture. J Evid Based Complementary Altern Med 2015; 21:202-14. [DOI: 10.1177/2156587215598422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/04/2015] [Indexed: 02/05/2023] Open
Abstract
The present study attempts to critically evaluate previously published research articles on the efficiency of acupuncture in the treatment of diseases. First, 35 systematic reviews or meta-analysis were found in the Cochrane database. Second, 54 related articles were selected by searching important scientific databases. Based on the results obtained regarding the efficacy of acupuncture for the treatment of various diseases, the articles were divided into 3 groups. The first group of articles confirmed the efficacy of treatment by acupuncture. In the second group of articles, the therapeutic effect of acupuncture was shown; however, further research is required to verify the results. In the third group of articles there is no evidence regarding the therapeutic effect of acupuncture till now. There is an urgent need to design and conduct double-blinded randomized clinical trials with high-quality methodologies. This provides a more careful evaluation of acupuncture efficiency in relation to the treatment of a vast array of diseases, based on scientific evidence.
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Kligler B, Buonora M, Gabison J, Jacobs E, Karasz A, McKee MD. "I Felt Like It Was God's Hands Putting the Needles In": A Qualitative Analysis of the Experience of Acupuncture for Chronic Pain in a Low-Income, Ethnically Diverse, and Medically Underserved Patient Population. J Altern Complement Med 2015; 21:713-9. [PMID: 26247238 DOI: 10.1089/acm.2014.0376] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine the experience of patients from a low-income, ethnically diverse medically underserved population receiving acupuncture for chronic pain. DESIGN Qualitative analysis using inductive thematic analysis of interviews with participants from an acupuncture trial. SETTINGS/LOCATION Four community health centers in the Bronx, New York. PARTICIPANTS Thirty-seven adults with chronic neck or back pain or osteoarthritis who participated in a previous acupuncture trial. INTERVENTIONS Up to 14 weekly acupuncture treatments. OUTCOME MEASURES Pain and quality of life were examined in the original trial; this study examines qualitative outcomes. RESULTS The themes grouped naturally into three domains of the acupuncture experience: the decision-making process, the treatment experience, and the effect of acupuncture on health. Regarding decision-making, important factors were a willingness to try something new even if you do not necessarily "believe" in it or have specifically positive expectations; a sense that medications were not working for their pain, that they also caused significant adverse effects, and that natural strategies might be preferable; and a feeling of desperation. Cost and access were significant barriers to acupuncture treatment. Regarding the process of acupuncture, the open and personal communication with the acupuncturist was an important factor, as were the sense that the process of acupuncture related to a natural process of healing or correction within the body and that part of making acupuncture successful required being open to the power of the mind to generate a positive outcome. Regarding the effect of treatment, notable aspects were the deep sense of rest and relaxation participants reported during treatment as well as the benefit they experienced for conditions other than pain. CONCLUSIONS The themes that emerged in this ethnically diverse, low-income population were very similar to those that have emerged over the past decade of qualitative research on the acupuncture experience in other patient populations.
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Affiliation(s)
- Benjamin Kligler
- 1 Department of Integrative Medicine, Mount Sinai Beth Israel Medical Center , New York, NY
| | | | | | - Emilie Jacobs
- 3 Mount Sinai St. Luke's Roosevelt Medical Center , New York, NY
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YU HL, XU LL, MA TM. Therapeutic effect of electro-acupuncture in the treatment of Achilles tendonitis. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2015. [DOI: 10.1016/s1003-5257(15)30042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee SH, Kwon GS, Kang MS, Yoon HM, Kim CH. Comparative study on the effects of bee venom pharmacopuncture according to the treatment method for knee osteoarthritis. J Pharmacopuncture 2015; 15:7-14. [PMID: 25780649 PMCID: PMC4331948 DOI: 10.3831/kpi.2012.15.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 10/25/2012] [Indexed: 11/09/2022] Open
Abstract
Objectives: The purpose of this study is to compare the effects of bee venom pharmacopuncture (BVP) therapy according to the methods used to treat knee osteoarthritis (OA): intra-acupoint combined with intra-articular injection, intra-acupoint injection, and intra-articular injection. Methods: A total of 69 patients were recruited by the Department of Acupuncture & Moxibustion at Dong- Eui Oriental University Hospital from February 1 to July 23, 2012. The patients were assigned to 3 groups: the first group with intra-acupoint combined with intraarticular BVP Injection (the experimental group), the 2nd group with intra-acupoint BVP injection (control groupⅠ), and the 3rd group with intra-articular BVP injection (control groupⅡ). The participants were assigned in the order in which they were recruited. Treatments were done twice a week, for a total of 9 times. The effectiveness was assessed by using the visual analouge scale (VAS) and the Korea Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC). Results: All three groups exhibited significant VAS and KWOMAC effects. Moreover, the 4 week follow-up after the final treatment showed a persistence of BVP effects. However, when the groups were compared, no statistically significant differences in VAS and KWOMAC were noted, but when improvement was considered, the results showed that intra-articular injection was more effective than intra-acupoint injection. Especially, intra-acupoint combined with intra-articular injection was the most effective among the three treatments. Conclusions: Combining intra-acupoint with intraarticular injection, depending on the patient's symptoms, may produce better results when conservatively treating knee OA.
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Affiliation(s)
- Seung-Hwon Lee
- Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine, Busan, Korea
| | - Gi-Sun Kwon
- Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine, Busan, Korea
| | - Min-Soo Kang
- Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea
| | - Hyun-Min Yoon
- Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine, Busan, Korea
| | - Cheol-Hong Kim
- Department of Acupuncture & Moxibustion, Dong-Eui University College of Oriental Medicine, Busan, Korea
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Kang HJ, Yoon JW, Park JH, Cho CK, Yoo HS. Cancer pain control for advanced cancer patients by using autonomic nerve pharmacopuncture. J Pharmacopuncture 2015; 17:62-9. [PMID: 25780711 PMCID: PMC4332014 DOI: 10.3831/kpi.2014.17.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022] Open
Abstract
Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP) treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP) along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae) to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases) with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12 ─ 20 mL injection) of each patient’s dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS) for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain.
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Affiliation(s)
- Hwi-Joong Kang
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Jung-Won Yoon
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Ji-Hye Park
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Chong-Kwan Cho
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
| | - Hwa-Seung Yoo
- East-West Cancer Center, Dunsan Korean Medical Hospital of Daejeon University, Daejeon, Korea
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Goldstein JL, Cryer B. Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:31-41. [PMID: 25653559 PMCID: PMC4310346 DOI: 10.2147/dhps.s71976] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective anti-inflammatory and analgesic agents and are among the most commonly used classes of medications worldwide. However, their use has been associated with potentially serious dose-dependent gastrointestinal (GI) complications such as upper GI bleeding. GI complications resulting from NSAID use are among the most common drug side effects in the United States, due to the widespread use of NSAIDs. The risk of upper GI complications can occur even with short-term NSAID use, and the rate of events is linear over time with continued use. Although gastroprotective therapies are available, they are underused, and patient and physician awareness and recognition of some of the factors influencing the development of NSAID-related upper GI complications are limited. Herein, we present a case report of a patient experiencing a gastric ulcer following NSAID use and examine some of the risk factors and potential strategies for prevention of upper GI mucosal injuries and associated bleeding following NSAID use. These risk factors include advanced age, previous history of GI injury, and concurrent use of medications such as anticoagulants, aspirin, corticosteroids, and selective serotonin reuptake inhibitors. Strategies for prevention of GI injuries include anti-secretory agents, gastroprotective agents, alternative NSAID formulations, and nonpharmacologic therapies. Greater awareness of the risk factors and potential therapies for GI complications resulting from NSAID use could help improve outcomes for patients requiring NSAID treatment.
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Affiliation(s)
- Jay L Goldstein
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Byron Cryer
- Division of Gastroenterology, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, TX, USA
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Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. PHYSICAL THERAPY REVIEWS 2014; 19:252-265. [PMID: 25143704 PMCID: PMC4117383 DOI: 10.1179/108331913x13844245102034] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an 'intramuscular' procedure involving the isolated treatment of 'myofascial trigger points' (MTrPs). OBJECTIVES To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. MAJOR FINDINGS According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. 'sensitive loci' or 'nociceptors') when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. CONCLUSIONS Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as 'pistoning' or 'sparrow pecking'; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical 'acupuncture' literature that have used the very same 'dry needles' to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just 'TrPs'.
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Affiliation(s)
- James Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA
- American Academy of Manipulative Therapy, Montgomery, AL, USA
| | - Raymond Butts
- University of South Carolina, Columbia, SC, USA
- Palmetto Health Research Physical Therapy Specialists, Columbia, SC, USA
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Liu F, Fang J, Shao X, Liang Y, Wu Y, Jin Y. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupunct Med 2014; 32:340-5. [PMID: 24820260 DOI: 10.1136/acupmed-2013-010460] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Electroacupuncture (EA) has beneficial effects in patients with various inflammatory diseases. However, the underlying mechanism remains unclear. As the kappa B inhibitor/nuclear factor-kappa B (IκB/NF-κB) pathway exerts a pivotal role in the mammalian immune response, we examined the involvement of the IκB/NF-κB pathway in EA-induced anti-inflammation. METHODS Ninety tissue chamber implanted rats were randomly divided into control (C), model (M) and EA (E) groups. Physiological saline and human recombinant interleukin-1β (hr IL-1β) were injected into the rats in groups C and M, respectively, and EA treatment was applied to the rats in group E after IL-1β injection. Nuclear staining of p65 (a subunit of NF-κB) was quantified in the exudate cells by immunohistochemical analysis and IκBα expression in the cytoplasm was quantified by western blot analysis. RESULTS Our results showed that, compared with group C, the percentage of cells with nuclear-localised p65 was increased in group M by 71.3%, 50.7% and 33.1% at 1, 5 and 24 h time points (p<0.01), respectively. This increase was fully inhibited in group E at 5 and 24 h time points (p<0.01). The expression of IκBα was stably enhanced in group M (p<0.05) during the test period. Compared with group M, greater expression of IκBα in group E was only observed at the 1 h time point (p<0.01). CONCLUSIONS Collectively, our data suggest that EA inhibits the nuclear translocation of p65 and increases the expression of IκBα, which leads to the suppression of NF-κB activation in a rat tissue chamber model of inflammation.
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Affiliation(s)
- Fang Liu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Provicine, China Department of acu-moxibusion, Zhejiang Hospital of Integrated Chinese & Western Medicine, Hangzhou, China
| | - Jianqiao Fang
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Provicine, China
| | - Xiaomei Shao
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Provicine, China
| | - Yi Liang
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Provicine, China
| | - Yuanyuan Wu
- Department of Neurobiology and Acupuncture Research, The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Provicine, China
| | - Yabei Jin
- Department of acu-moxibusion, Zhejiang Hospital of Integrated Chinese & Western Medicine, Hangzhou, China
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Ashraf A, Zarei F, Hadianfard MJ, Kazemi B, Mohammadi S, Naseri M, Nasseri A, Khodadadi M, Sayadi M. Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: a randomized controlled trial. Knee 2014; 21:439-44. [PMID: 24462108 DOI: 10.1016/j.knee.2013.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/29/2013] [Accepted: 12/16/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA. METHOD Patients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. ( LEVEL OF EVIDENCE 2.) RESULTS Twenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P<0.001, 95% CI: 1.62-3.25 and 1.58-3.20 respectively). Function improved in each group (paired t test, P=0.001, 95% CI of 0.94-2.38 in group one and 0.97-2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P=0.005, CI: -0.43-0.82 and P=0.037, CI: -0.44-0.80 respectively) and two (P=0.025, CI: -0.45-0.79 and P=0.035, CI: -0.29-0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures. CONCLUSION Both lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other. Iranian Registry of Clinical Trials: IRCT201201108235N1. URL: http://irct.ir/searchen.php.
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Affiliation(s)
- Alireza Ashraf
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran; Burn Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Zarei
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Hadianfard
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrooz Kazemi
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soleiman Mohammadi
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Naseri
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Nasseri
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Khodadadi
- Geriatric Research Center Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Behbahan University of Medical Sciences, Behbahan, Iran
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Taleço TM, Louzada R, Alves P, Cortez J, Duarte JS. Acupuncture for Pain Treatment in Charcot-Marie-Tooth Disease. Med Acupunct 2014. [DOI: 10.1089/acu.2013.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Tiago Marques Taleço
- Chronic Pain Clinic, Anesthesia Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Raquel Louzada
- Chronic Pain Clinic, Anesthesia Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Pedro Alves
- Radiology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Jorge Cortez
- Chronic Pain Clinic, Anesthesia Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - João Silva Duarte
- Chronic Pain Clinic, Anesthesia Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
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Khamba B, Aucoin M, Lytle M, Vermani M, Maldonado A, Iorio C, Cameron C, Tsirgielis D, D'Ambrosio C, Anand L, Katzman MA. Efficacy of acupuncture treatment of sexual dysfunction secondary to antidepressants. J Altern Complement Med 2013; 19:862-9. [PMID: 23790229 DOI: 10.1089/acm.2012.0751] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antidepressants including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are known to cause secondary sexual dysfunction with prevalence rates as high as 50%-90%. Emerging research is establishing that acupuncture may be an effective treatment modality for sexual dysfunction including impotence, loss of libido, and an inability to orgasm. OBJECTIVES The purpose of this study was to examine the potential benefits of acupuncture in the management of sexual dysfunction secondary to SSRIs and SNRIs. SUBJECTS Practitioners at the START Clinic referred participants experiencing adverse sexual events from their antidepressant medication for acupuncture treatment at the Mood and Anxiety Disorders, a tertiary care mood and anxiety disorder clinic in Toronto. DESIGN Participants received a Traditional Chinese Medicine assessment and followed an acupuncture protocol for 12 consecutive weeks. The acupuncture points used were Kidney 3, Governing Vessel 4, Urinary Bladder 23, with Heart 7 and Pericardium 6. Participants also completed a questionnaire package on a weekly basis. OUTCOMES MEASURED The questionnaire package consisted of self-report measures assessing symptoms of depression, anxiety, and various aspects of sexual function. RESULTS Significant improvement among male participants was noted in all areas of sexual functioning, as well as in both anxiety and depressive symptoms. Female participants reported a significant improvement in libido and lubrication and a nonsignificant trend toward improvement in several other areas of function. CONCLUSIONS This study suggests a potential role for acupuncture in the treatment of the sexual side-effects of SSRIs and SNRIs as well for a potential benefit of integrating medical and complementary and alternative practitioners.
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Affiliation(s)
- Baljit Khamba
- 1 START Clinic for Mood and Anxiety Disorders , Toronto, Ontario, Canada
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48
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Effect of siguan acupuncture on gastrointestinal motility: a randomized, sham-controlled, crossover trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:918392. [PMID: 23762166 PMCID: PMC3670549 DOI: 10.1155/2013/918392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/17/2013] [Accepted: 04/19/2013] [Indexed: 02/08/2023]
Abstract
Siguan acupoints have been used to treat gastrointestinal symptoms in acupuncture practices for a long time. This study aimed to investigate the effects of Siguan acupuncture on gastrointestinal motility under accelerated conditions using a randomized, sham-acupuncture-controlled, crossover study. Twenty-one healthy male subjects were hospitalized and randomized into either a real acupuncture group (at Siguan acupoints) or a sham acupuncture group. Subjects were administered with mosapride citrate (15 mg a day) for 2 days starting 24 hours before the first acupuncture treatment. Immediately after the administration of radio markers, acupuncture treatment was conducted 4 times at 12-hour intervals. Gastrointestinal motility was assessed using radiograph distribution of the radio-markers located in the small intestine, ascending colon, transverse colon, descending colon, rectum, and outside the body immediately after the first acupuncture treatment and at 6, 12, 24, and 48 hours. After a 2-week washout period, the real acupuncture group in the first session was treated with sham acupuncture in the second session, and vice versa. Gastrointestinal motility was generally reduced in the real acupuncture group compared with the sham acupuncture group throughout the 4 different time points. A significant difference was observed at 24 hours following the first acupuncture treatment (P < 0.05).
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49
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Bai L, Lao L. Neurobiological foundations of acupuncture: the relevance and future prospect based on neuroimaging evidence. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:812568. [PMID: 23737848 PMCID: PMC3666300 DOI: 10.1155/2013/812568] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/17/2013] [Indexed: 01/22/2023]
Abstract
Acupuncture is currently gaining popularity as an important modality of alternative and complementary medicine in the western world. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography open a window into the neurobiological foundations of acupuncture. In this review, we have summarized evidence derived from neuroimaging studies and tried to elucidate both neurophysiological correlates and key experimental factors involving acupuncture. Converging evidence focusing on acute effects of acupuncture has revealed significant modulatory activities at widespread cerebrocerebellar brain regions. Given the delayed effect of acupuncture, block-designed analysis may produce bias, and acupuncture shared a common feature that identified voxels that coded the temporal dimension for which multiple levels of their dynamic activities in concert cause the processing of acupuncture. Expectation in acupuncture treatment has a physiological effect on the brain network, which may be heterogeneous from acupuncture mechanism. "Deqi" response, bearing clinical relevance and association with distinct nerve fibers, has the specific neurophysiology foundation reflected by neural responses to acupuncture stimuli. The type of sham treatment chosen is dependent on the research question asked and the type of acupuncture treatment to be tested. Due to the complexities of the therapeutic mechanisms of acupuncture, using multiple controls is an optimal choice.
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Affiliation(s)
- Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China
| | - Lixing Lao
- Center for Integrative Medicine, School of Medicine, University of Maryland, 520 W. Lombard Street, Baltimore, MD 21201, USA
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50
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Qin Y, He J, Xia L, Guo H, He C. Effects of electro-acupuncture on oestrogen levels, body weight, articular cartilage histology and MMP-13 expression in ovariectomised rabbits. Acupunct Med 2013; 31:214-21. [PMID: 23519019 DOI: 10.1136/acupmed-2012-010289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Electro-acupuncture (EA) treatment has been shown to decrease pain and improve the function of ovariectomised (OVX) rats with osteoarthritis (OA); however, the underlying mechanisms remain unclear. OBJECT We used OVX rabbits to replicate natural human menopausal processes and to evaluate whether EA could be used to prevent and treat postmenopausal OA. METHODS The rabbits were randomly divided into four groups of eight: a normal control group (NC), an OVX group, an ERT group (oestrogen replacement therapy after OVX) and an EA group (EA therapy after OVX). After the interventions, all of the animals were killed. Serum oestrogen levels and body weight were measured. The transcription of matrix metalloproteinase-13 (MMP-13) mRNA was detected using reverse transcriptase-PCR. Modified Mankin scores were used for histological assessment. Expression of MMP-13 in cartilage was determined by immunohistochemistry. RESULTS Both the EA group and the ERT group had increased serum oestrogen levels (p=0.028, p=0.037 respectively), as well as decreased expression of MMP-13 (p=0.000, p=0.000, respectively), relative to the OVX group. The body weight of the EA group was lower than that of the OVX group and the NC group (p=0.007), as well as the ERT group (p=0.010). CONCLUSIONS EA could be a new method for preventing and treating postmenopausal OA by producing endogenous sex hormones that inhibit the expression of MMP-13 and cause weight loss with no side effects and a relatively low cost.
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Affiliation(s)
- Yuxi Qin
- Rehabilitation Key Laboratory of Sichuan Province, Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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