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Fu TC, Wang GR, Li YX, Xu ZF, Wang C, Zhang RC, Ma QT, Ma YJ, Guo Y, Dai XY, Guo Y. Mobilizing endogenous neuroprotection: the mechanism of the protective effect of acupuncture on the brain after stroke. Front Neurosci 2024; 18:1181670. [PMID: 38737099 PMCID: PMC11084281 DOI: 10.3389/fnins.2024.1181670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open
Abstract
Given its high morbidity, disability, and mortality rates, ischemic stroke (IS) is a severe disease posing a substantial public health threat. Although early thrombolytic therapy is effective in IS treatment, the limited time frame for its administration presents a formidable challenge. Upon occurrence, IS triggers an ischemic cascade response, inducing the brain to generate endogenous protective mechanisms against excitotoxicity and inflammation, among other pathological processes. Stroke patients often experience limited recovery stages. As a result, activating their innate self-protective capacity [endogenous brain protection (EBP)] is essential for neurological function recovery. Acupuncture has exhibited clinical efficacy in cerebral ischemic stroke (CIS) treatment by promoting the human body's self-preservation and "Zheng Qi" (a term in traditional Chinese medicine (TCM) describing positive capabilities such as self-immunity, self-recovery, and disease prevention). According to research, acupuncture can modulate astrocyte activity, decrease oxidative stress (OS), and protect neurons by inhibiting excitotoxicity, inflammation, and apoptosis via activating endogenous protective mechanisms within the brain. Furthermore, acupuncture was found to modulate microglia transformation, thereby reducing inflammation and autoimmune responses, as well as promoting blood flow restoration by regulating the vasculature or the blood-brain barrier (BBB). However, the precise mechanism underlying these processes remains unclear. Consequently, this review aims to shed light on the potential acupuncture-induced endogenous neuroprotective mechanisms by critically examining experimental evidence on the preventive and therapeutic effects exerted by acupuncture on CIS. This review offers a theoretical foundation for acupuncture-based stroke treatment.
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Affiliation(s)
- Tian-cong Fu
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Guan-ran Wang
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yu-xuan Li
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhi-fang Xu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Can Wang
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Run-chen Zhang
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qing-tao Ma
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ya-jing Ma
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yi Guo
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-yu Dai
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yang Guo
- Tianjin Key Laboratory of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Zhou X, Ma Q, Yang J, Mohabbat AB, Croghan IT, Tan CLC, Chen J, Bauer BA. Clinical outcome measures reporting in randomized trials evaluating Tuina therapy for chronic nonspecific low back pain: A systematic review. Medicine (Baltimore) 2023; 102:e33628. [PMID: 37083789 PMCID: PMC10118339 DOI: 10.1097/md.0000000000033628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Tuina has gained widespread attention and utilization for the management of chronic nonspecific low back pain (CNLBP). However, evidence-based guidance for choosing accurate and appropriate outcome measures of Tuina is lacking. The objective of this study is to systematically synthesize the existing outcome measures reported in randomized controlled trials (RCTs) evaluating Tuina therapy in CNLBP. METHODS Electronic literature searches were conducted in multiple English and Chinese databases from their inception to May 2022. RCTs were included if they involved clinical outcome measures in Tuina treatment for patients with CNLBP. Outcome instruments for each study were extracted and analyzed. Evidence from included studies were assessed using the Cochrane risk-of-bias tool. RESULTS Of the 735 identified articles, 17 articles with 1628 participants were included. Measurement domains in these RCTs were mainly reported in terms of pain (94%) and physical activity (71%), followed by safety (41%), Chinese medicine outcome (35%), and quality of life (12%). Moreover, several limitations with existing outcomes were reported, including lack of emphasis on the evaluation of quality of life, inadequate safety monitoring, as well as insufficient and vague Chinese medicine outcome measures. All trials were deemed to be of poor methodological quality. CONCLUSION Pain and physical disability were the most frequently studied outcome domains in CNLBP treated by Tuina therapy. More rigorous and high-quality trials with appropriately selected outcome measures are needed in the future.
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Affiliation(s)
- Xuan Zhou
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qingyu Ma
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ivana T. Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Jiaxu Chen
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Yang J, Zhou X, Ma Q, Woods JT, Mohabbat AB, Do A, Brault JS, Jensen MA, Shin KM, Shen L, Zhao C, Cheong KCP, He K, Guo Y, Chen Z, Tang S, Tang Y, Tan CIC, Chen J, Bauer BA. Efficacy and safety of Tuina for chronic nonspecific low back pain: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33018. [PMID: 36862888 PMCID: PMC9981398 DOI: 10.1097/md.0000000000033018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Chronic nonspecific low back pain (CNLBP) is a serious medical and social problem resulting in functional decline and decreased work ability. Tuina, a form of manual therapy, has been sparsely used to treat patients with CNLBP. To systematically assess the efficacy and safety of Tuina for patients with CNLBP. METHODS Multiple English and Chinese literature databases were searched until September 2022 for randomized controlled trials (RCTs) of Tuina in the treatment of CNLBP. The methodological quality was assessed using the Cochrane Collaboration's tool, and certainty of the evidence was determined with the online Grading of Recommendations, Assessment, Development and Evaluation tool. RESULTS Fifteen RCTs with 1390 patients were included. Tuina demonstrated a significant effect on pain (SMD: -0.82; 95% CI -1.12 to -0.53; P < .001; I2 = 81%) and physical function (SMD: -0.91; 95% CI -1.55 to -0.27; P = .005; I2 = 90%) when compared to control. However, Tuina resulted in no significant improvement for quality of life (QoL) (SMD: 0.58; 95% CI -0.04 to 1.21; P = .07; I2 = 73%;) compared to control. The Grading of Recommendations, Assessment, Development and Evaluation evidence quality was determined to be low level for pain relief, physical function, and QoL measurements. Only six studies reported adverse events; none were serious. CONCLUSION Tuina might be an effective and safe strategy for treating CNLBP in terms of pain and physical function, but not for QoL. The study results should be interpreted with caution for their low-level evidence. More multicenter, large-scale RCTs with a rigorous design are required to further confirm our findings.
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Affiliation(s)
- Juan Yang
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Xuan Zhou
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qingyu Ma
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | | | - Arya B. Mohabbat
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Alexander Do
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey S. Brault
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Mark A. Jensen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Kyung-Min Shin
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Longbin Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Canghuan Zhao
- Department of Acupuncture, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Kejie He
- Department of Acupuncture, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu Guo
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Zhuoming Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shujie Tang
- Department of Orthopedics, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yong Tang
- Department of Orthopedics, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | | | - Jiaxu Chen
- Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- *Correspondence: Brent A. Bauer, Division of General Internal Medicine, Mayo Clinic, 200 1st St SW Rochester, MN 55905 (e-mail: )
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Zhang YQ, Lu L, Xu N, Tang X, Shi X, Carrasco-Labra A, Schünemann H, Chen Y, Xia J, Chen G, Liu J, Liu B, Wang J, Qaseem A, Jing X, Guyatt G, Zhao H. Increasing the usefulness of acupuncture guideline recommendations. BMJ 2022; 376:e070533. [PMID: 35217506 PMCID: PMC8868046 DOI: 10.1136/bmj-2022-070533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Yu-Qing Zhang and colleagues examine the progress and pitfalls in guideline recommendations for acupuncture and provide suggestions for improvement
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Affiliation(s)
- Yu-Qing Zhang
- CEBIM (Center for Evidence Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaorong Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoshuang Shi
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Alonso Carrasco-Labra
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yaolong Chen
- Institute of Health Data Science, Lanzhou University, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China]
| | - Jun Xia
- Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
| | - Guang Chen
- Harvard Medical School, Harvard University, Boston, USA
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiyao Wang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Amir Qaseem
- American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Xianghong Jing
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hong Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
- Shenzhen Luohu District Hospital of TCM, Shenzhen, China
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Yang M, Li SQ, Smith CM, Zhang YL, Bao T, Mao JJ. Tibetan herbal pain-relieving plaster for low back pain: A systematic review and meta-analysis. Biomed Pharmacother 2021; 140:111727. [PMID: 34015584 PMCID: PMC9254726 DOI: 10.1016/j.biopha.2021.111727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 12/18/2022] Open
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tibetan traditional medicine CheeZheng Pain-Relieving Plaster (CZPRP) is frequently used as an over-the-counter external analgesic for musculoskeletal pain; however, its evidence for low back pain (LBP) has not been evaluated. AIM OF THE STUDY This study aims to assess the efficacy and safety of CZPRP for both acute, subacute and chronic LBP through a systematic review and meta-analysis of clinical trials. MATERIALS AND METHODS PubMed, CENTRAL, CNKI, CQVIP, and Wanfang databases were searched through April 20, 2020 for randomized controlled trials of CZPRP for LBP. Eligible comparators were placebo, active treatment, or usual care. Clinical outcomes included pain severity, lower back function score, pain-free rate, and adverse events (AEs). Qualitative evaluations were conducted using the Cochrane risk of bias assessment tools. Quantitative analyses were conducted using a random-effects model. RESULTS This study includes 1674 LBP patients from nine clinical studies. Pooled analyses among subjects with acute LBP show 1) significant pain reductions (mean difference -0.84, 95% confidence interval[CI] -1.31, -0.37) in CZPRP plus diclofenac versus diclofenac, 2) significant improvements in lower back function (standard mean difference -1.50, 95% CI -2.16, -0.85) in CZPRP versus diclofenac, and 3) a higher pain-free rate in CZPRP alone (risk ratio 1.48, 95% CI 1.16, 1.89; I2 = 61%) or CZPRP plus nonsteroidal anti-inflammatory drugs (NSAIDs) (risk ratio 1.66, 95% CI 1.14, 2.40; I2 = 0%) versus NSAIDs. However, in a heterogeneous population with mixed LBP subtypes, there was no significant difference in pain outcomes between CZPRP and diclofenac. Additionally, CZPRP use did not increase AEs compared with no CZPRP (p = 0.40). All nine studies are associated with moderate to high risk of bias. CONCLUSIONS The use of CZPRP is associated with improved acute LBP outcomes compared to diclofenac. However, due to the moderate to high risk of bias of the studies, future rigorous randomized controlled trials are needed to evaluate the effects of CZPRP for acute and chronic LBP.
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Affiliation(s)
- Mingxiao Yang
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA.
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA
| | - Colleen M Smith
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA
| | - Yi Lily Zhang
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY 10021, USA.
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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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Teut M, Ullmann A, Ortiz M, Rotter G, Binting S, Cree M, Lotz F, Roll S, Brinkhaus B. Pulsatile dry cupping in chronic low back pain - a randomized three-armed controlled clinical trial. Altern Ther Health Med 2018; 18:115. [PMID: 29609566 PMCID: PMC5879872 DOI: 10.1186/s12906-018-2187-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 01/13/2023]
Abstract
Background We aimed to investigate the effectiveness of two different forms of dry pulsatile cupping in patients with chronic low back pain (cLBP) compared to medication on demand only in a three-armed randomized trial. Methods 110 cLBP patients were randomized to regular pulsatile cupping with 8 treatments plus paracetamol on demand (n = 37), minimal cupping with 8 treatments plus paracetamol on demand (n = 36) or the control group with paracetamol on demand only (n = 37). Primary outcome was the pain intensity on a visual analogue scale (VAS, 0–100 mm) after 4 weeks, secondary outcome parameter included VAS pain intensity after 12 weeks, back function as measured with the ‘Funktionsfragebogen Hannover Rücken’ (FFbH-R) and health related quality of life questionnaire Short form 36 (SF-36) after 4 and 12 weeks. Results The mean baseline-adjusted VAS after 4 weeks was 34.9 mm (95% CI: 28.7; 41.2) for pulsatile cupping, 40.4 (34.2; 46.7) for minimal cupping and 56.1 (49.8; 62.4) for control group, resulting in statistically significant differences between pulsatile cupping vs. control (21.2 (12.2; 30.1); p < 0.001) and minimal cupping vs. control (15.7 (6.9; 24.4); p = 0.001). After 12 weeks, mean adjusted VAS difference between pulsatile cupping vs. control was 15.1 ((3.1; 27.1); p = 0.014), and between minimal cupping vs. control 11.5 ((− 0.44; 23.4); p = 0.059). Differences of VAS between pulsatile cupping and minimal cupping showed no significant differences after 4 or 12 weeks. Pulsatile cupping was also better (− 5.8 (− 11.5;-0.1); p = 0.045) compared to control for back function after 4 weeks, but not after 12 weeks (− 5.4 (− 11.7;0.8); p = 0.088), pulsatile cupping also showed better improvements on SF-36 physical component scale compared to control at 4 and 12 weeks (− 5.6 (− 9.3;-2.0); p = 0.003; − 6.1 (− 9.9;-2.4); p = 0.002). For back function and quality of life minimal cupping group was not statistically different to control after 4 and 12 weeks. Paracetamol intake did not differ between the groups (cupping vs. control (7.3 (− 0.4;15.0); p = 0.063); minimal cupping vs. control (6.3 (− 2.0;14.5); p = 0.133). Conclusions Both forms of cupping were effective in cLBP without showing significant differences in direct comparison after four weeks, only pulsatile cupping showed effects compared to control after 12 weeks. Trial registration The study was registered at ClinicalTrials.gov (identifier: NCT02090686).
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Steel A, Rapport F, Adams J. Towards an implementation science of complementary health care: Some initial considerations for guiding safe, effective clinical decision-making. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang YT, Qi Y, Tang FY, Li FM, Li QH, Xu CP, Xie GP, Sun HT. The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials. J Back Musculoskelet Rehabil 2017; 30:1187-1195. [PMID: 28946531 DOI: 10.3233/bmr-169736] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND LBP is one of the most common symptoms with high prevalence throughout the world. Conflicting conclusions exist in RCTs on cupping for LBP. OBJECTIVE To assess the effects and safety of cupping for the patients with LBP. METHODS Pubmed, Cochrane Library databases, and Embase database were electronically researched. RCTs reporting the cupping for the patients with LBP were included. The meta-analysis was conducted using Review Manager software (version 5.3, Nordic Cochrane Centre). The primary outcome was VAS scores. The secondary outcomes included ODI scores, MPPI scores and complications. RESULTS Six RCTs were included in this synthesized analysis. The results showed that cupping therapy was superior to the control management with respect to VAS scores (SMD: -0.73, [95% CI: -1.42 to -0.04]; P= 0.04), and ODI scores (SMD: -3.64, [95% CI: -5.85 to -1.42]; P= 0.001). There was no statistical significant difference as regard to MPPI scores. No serious adverse event was reported in the included studies. CONCLUSIONS Cupping therapy can significantly decrease the VAS scores and ODI scores for patients with LBP compared to the control management. High heterogeneity and risk of bias existing in studies limit the authenticity of the findings.
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Affiliation(s)
- Yun-Ting Wang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yong Qi
- Department of Orthopaedics, Guangdong No.2 Provincial People's Hospital, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fu-Yong Tang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fei-Meng Li
- Guangdong Traditional Medical and Sports Injury Rehabilitation Research Institute, Guangdong No.2 Provincial Peopie's Hospital, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Qi-Huo Li
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chang-Peng Xu
- Department of Orthopaedics, Guangdong No.2 Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Guo-Ping Xie
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hong-Tao Sun
- Department of Orthopaedics, Guangdong No.2 Provincial People's Hospital, Guangzhou, Guangdong, China
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Shi N, Zhong LL, Zhang C, Han X, Wang Y, Liu Y, Wang L, Liu M, Lu A. Developing clinical practice guidelines for the integration of Chinese medicine and biomedicine: A new process. Eur J Integr Med 2016; 8:916-920. [PMID: 32288885 PMCID: PMC7102766 DOI: 10.1016/j.eujim.2016.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Despite the integration of Chinese medicine and biomedicine which has emerged in clinical practice worldwide, a comprehensive development process for clinical practice guidelines (CPG) has up to now been missing. A valid method for the rational use of predictions for herb-drug interaction is a biggest challenge in guideline development process. METHODS This article summarises the development process by reviewing key literature from CPG developers. It focuseson key methods and challenges specific to CPGs for integration by using text mining and bioinformatics to provide a powerful adjunct to CPG development. RESULTS The guideline development process identified, together with new approaches, incorporates evidence-based methodology and provides better decisions through analysis of uncertain herb-drug interaction. CONCLUSIONS This new process used three basic phases (preparation, development, and finalization) and seven steps providing a set of methodological principles for CPG development intergrating Chinese medicine and biomedicine.
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Affiliation(s)
- Nannan Shi
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077, Hong Kong
| | - Linda L.D. Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077, Hong Kong
| | - Chi Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Xuejie Han
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Yuexi Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Yuqi Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Liying Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Mengyu Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
| | - Aiping Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Nanxiaojie, Beijing 100700, China
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Kowloon 999077, Hong Kong
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Challenges for clinical practice guidelines in traditional medicines: The example of acupuncture. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ren J, Li X, Sun J, Han M, Yang GY, Li WY, Robinson N, Lewith G, Liu JP. Is traditional Chinese medicine recommended in Western medicine clinical practice guidelines in China? A systematic analysis. BMJ Open 2015; 5:e006572. [PMID: 26041487 PMCID: PMC4458581 DOI: 10.1136/bmjopen-2014-006572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs. OBJECTIVE To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence. METHODS All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors' Association.TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations. RESULTS A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation). CONCLUSIONS Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise.
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Affiliation(s)
- Jun Ren
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xun Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jin Sun
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mei Han
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Guo-Yan Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-Yuan Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nicola Robinson
- Faculty of Health and Social Care, London South Bank University, London, UK
| | - George Lewith
- Complementary and Integrated Medicine Research Unit, Primary Care and Population Sciences, Southampton University, Southampton, UK
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- NAFKAM, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Jung SY, Kim BG, Kwon D, Park JH, Youn SK, Jeon S, Um HY, Kwon KE, Kim HJ, Jung HJ, Choi E, Park BJ. An outbreak of joint and cutaneous infections caused by non-tuberculous mycobacteria after corticosteroid injection. Int J Infect Dis 2015; 36:62-9. [PMID: 26026822 DOI: 10.1016/j.ijid.2015.05.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/13/2015] [Accepted: 05/16/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES An outbreak of joint and cutaneous infections among patients who had been injected at a single clinic in South Korea was investigated. METHODS In this retrospective case-control study, 61 cases were diagnosed based on symptoms and signs of septic arthritis or cutaneous infection that developed after injections at the clinic between April and September 2012; 64 controls were investigated by administering questionnaires on risk factors and analyzing the clinic medical records. An environmental investigation was performed, and clinical specimens of the cases were analyzed by pulsed-field gel electrophoresis. RESULTS All cases were injected with triamcinolone. A greater number of triamcinolone injections (adjusted odds ratio 4.3, 95% confidence interval 1.5-12.1 for six or more visits, compared with one or two visits) was associated with the development of an infection. In the clinic, only the triamcinolone injection was prepared by mixing with lidocaine and normal saline, and an alcohol swab was prepared using boiled tap water by members of the clinic staff. Although injected medications and environmental cultures were not found to be responsible, a single strain of Mycobacterium massiliense was isolated from the affected sites of 16 cases. CONCLUSIONS Repeated injection of triamcinolone contaminated with NTM from the clinic environment may have caused this post-injection outbreak.
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Affiliation(s)
- Sun-Young Jung
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Bong Gi Kim
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Donghyok Kwon
- Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention (KCDC), Osong-eup, Cheongwon-gun, Chungcheongbuk-do, South Korea
| | - Ji-Hyuk Park
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju-si, Gyeongsangbuk-do, South Korea
| | - Seung-Ki Youn
- Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention (KCDC), Osong-eup, Cheongwon-gun, Chungcheongbuk-do, South Korea
| | - Semi Jeon
- Division of Tuberculosis and Bacterial Respiratory Infection, Center for Infectious Diseases, Korea National Institute of Health (KNIH), Osong-eup, Cheongwon-gun, Chungcheongbuk-do, South Korea
| | - Hye-Yeon Um
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Kyoung-Eun Kwon
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Hyun-Jung Kim
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Hyun-Joo Jung
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Eunmi Choi
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea
| | - Byung-Joo Park
- Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg, 136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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Hsu YC, Chao HR, Shih SI. Human exposure to airborne aldehydes in Chinese medicine clinics during moxibustion therapy and its impact on risks to health. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2015; 50:260-271. [PMID: 25594119 DOI: 10.1080/10934529.2015.981112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many air toxicants, and especially aldehydes, are generated by moxibustion, which means burning Artemisia argyi. Our goal was to investigate indoor-air aldehyde emissions in Chinese medicine clinics (CMCs) during moxibustion to further evaluate the potential health risks, including cancer risk and non-cancer risk, to the medical staff and adult patients. First, the indoor-air-quality in 60 public sites, including 15 CMCs, was investigated. Four CMCs with frequent use of moxibustion were selected from the 15 CMCs to gather the indoor airborne aldehydes in the waiting and therapy rooms. The mean values of formaldehyde and acetaldehyde in the CMCs' indoor air were 654 and 4230 μg m(-3), respectively, in the therapy rooms, and 155 and 850 μg m(-3), respectively, in the waiting rooms. The average lifetime cancer risks (Rs) and non-cancer risks (hazard quotients: HQs) of airborne formaldehyde and acetaldehyde among the CMC medical staff exceeded the acceptable criteria (R < 1.00 × 10(-3) and HQ < 1.00) for occupational workers. The patients' Rs and HQs were also slightly higher than the critical values (R = 1.00 × 10(-6) and HQ = 1.00). Our results indicate that airborne aldehydes pose a significant threat to the health of medical staff, and slightly affected the patients' health, during moxibustion in the CMCs.
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Affiliation(s)
- Yi-Chyun Hsu
- a Department of Environmental Engineering , Kun Shan University , Tainan City , Taiwan
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