Acupuncture and other traditional Chinese medicine therapies in the treatment of children's tic syndrome: A network meta-analysis

Efficacy and Safety of Acupuncture for Tourette Syndrome in Children: A Meta-Analysis and Systematic Review

Despite the widespread use of acupuncture, its effectiveness and safety in treating Tourette syndrome (TS) remain controversial. Our research seeks to further evaluate the safety and effectiveness of acupuncture as a replacement therapy approach for children with TS. We conducted a comprehensive search for studies published from their inception to October 2023. The statistical analysis and subgroup analysis were conducted by software. Conduct a meta-analysis on the extracted data using the appropriate effect models. The meta-analysis was conducted on 26 studies consisting 1862 pediatric patients, which were selected from 976 identified articles. Acupuncture group demonstrated a significantly lower risk with a risk ratio (RR) of 0.29 (95% confidence interval [CI] = 0.19, 0.44, P < .0001), with only 5% of participants experiencing adverse reactions. Acupuncture treatment resulted in an 18% improvement in total effectiveness rates (RR = 1.18, 95% CI = [1.12, 1.25], P < .00001). The pooled data demonstrated that acupuncture therapy had a significant advantage in reducing the total score with the weighted mean difference (WMD) -4.92 (95% CI = [-6.38, -3.45], P < .00001) of the Yale Global Tic Severity Scale (YGTSS), the motor tic scores (WMD = -2.24, 95% CI = [-3.14, -1.35], P < .00001), the vocal tic scores (WMD: -2.34, 95% CI = [-3.31, -1.37], P < .00001), and the Traditional Chinese Medicine Syndrome Scores (TCMSS) (WMD: -2.47, 95% CI = [-2.87, -2.07], P < .0001). This meta-analysis reveals that acupuncture is more effective than most existing treatments in mitigating the symptoms of motor and vocal tics in children with TS, while also reducing the incidence of adverse reactions.

Mechanistic insights and therapeutic approaches in tic disorders: The distinctive role of ethnomedicine and modern medical interventions

Tic disorders (TDs) are a class of neurodevelopmental disorders that have received considerable scientific attention. The genesis of TDs is increasingly understood as a complex interplay of neurobiological, genetic, and immunological factors. Animal model studies have elucidated the pathophysiology of TDs, paving the way for innovative therapeutic approaches. This review provides a comprehensive analysis of the etiologic basis, experimental framework, and treatment strategies for TDs, highlighting the contributions of ethnomedicine and modern medicine. Our synthesis aims to deepen the understanding of the disease and spur the development of superior treatments. In addition, we present new insights and hypotheses for the future management of TDs, emphasizing the need for continued research into their etiology and progression, as well as the pursuit of more effective therapies. We advocate personalized, holistic care strategies that focus on symptom relief and improving patients' quality of life. Overall, this review provides a critical compendium for TD researchers and practitioners to help navigate the complexities of these disorders.

The therapeutic effect of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy: a randomized controlled trial

Introduction

Effective treatments for preventing and treating chemotherapy-induced peripheral neuropathy (CIPN) are still under exploration. Acupuncture in the treatment of CIPN requires more clinical trial data. This study aimed to evaluate the therapeutic effect of acupuncture on CIPN and explore its efficacy and safety in improving peripheral neuropathy.

Methods

A randomized controlled trial was conducted from May 2021 to June 2023. Eligible patients were randomly divided into a verum acupuncture group and a sham acupuncture group at a 1:1 ratio with sealed opaque envelopes. The patients of both the two groups took oral mecobalamin tablets, 0.5 mg, three times a day for 2 weeks. Participants received acupuncture treatment three times a week for 2 weeks. The primary outcome was evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) 3.0. The secondary outcomes were assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-CIPN twenty-item subscale (QLQ-CIPN20), Numerical Rating Scale (NRS), Traditional Chinese Medicine (TCM) syndrome score, and nerve conduction study (NCS) testing. Assessments were conducted at baseline, 1 week, and 2 weeks.

Results

All 70 participants were recruited and randomized. In the end, 68 patients were included in the datasets and received verum acupuncture (n = 34) or sham acupuncture (n = 34). After 2 weeks of treatment and follow-up, a statistically significant difference was found in the NCI-CTCAE scores between the two groups (p = 0.02). Baseline-to-2-week assessment scores improved significantly in the intervention group (vs. controls) on EORTC QLQ-CIPN20 (p = 0.02), NRS scores (p = 0.03), TCM syndrome scores (p = 0.04), and sensory nerve action potential (SNAP) of median and peroneal nerves, sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of peroneal nerves (p < 0.05). No serious adverse events were reported.

Conclusion

This study supports the feasibility of acupuncture combined with medication as an intervention for patients with CIPN and confirms its efficacy and safety in improving peripheral neuropathy.

Clinical Trial Registration

The Chinese Clinical Trial Registry, identifier ChiCTR2100045762.

Acupuncture in Pediatrics: A Scoping Review

Background: The use of acupuncture for common pediatric conditions continues to grow in the United States. Six previous reviews have summarized the research; however, approximately 8 years have accumulated adding to this growing body of literature. Objectives: The aim of this article is to provide a scoping review of acupuncture research in pediatric conditions and a summary of the effectiveness of acupuncture in the pediatric population. Methods: A systematic search was performed to identify clinical trials and reviews published between August 2015 and October 2023. Trials and reviews were excluded if they were not: (1) acupuncture specific, (2) data limited to pediatric patients, and (3) published in English. The literature was assessed and synthesized into a scoping review and commentary. Results: Seventy-one publications were identified (42 clinical trials and 29 reviews) that represented 17 conditions and 10 countries; the top 2 were China and the United States. The top five areas of new research (based on numbers of clinical trials) are pain, cerebral palsy (CP), attention-deficit hyperactivity disorder, autism spectrum disorder, and nausea and vomiting. Conclusions: Clinical trials in pediatric acupuncture represent a small but important subset of acupuncture literature. Data are positive for postoperative nausea and vomiting and promising for CP, nocturnal enuresis, perioperative pain, procedural pain, and tic disorders. Several factors preclude additional firm conclusions from being drawn, including a limited number of trials, small sample size (n < 100) of the majority of randomized controlled trials (78.6%), and heterogeneity of treatment approaches. Continued research on the use of acupuncture for pediatric conditions is warranted, particularly in conditions demonstrating recent promising evidence.

Exploring acupuncture as a therapeutic approach for tic disorders: a review of current understanding and potential benefits

Tic disorders (TD) refer to a condition where individuals experience recurring motor movements (e.g., eye blinking) and/or vocalizations (e.g., throat clearing). These disorders vary in terms of duration, cause, and manifestation of symptoms. Tourette's syndrome (TS) involves the presence of ongoing motor and vocal tics for a minimum of 1 year, with fluctuating intensity. Persistent chronic motor or vocal tic disorder is characterized by either motor or vocal tics (not both) present for at least 1 year. Provisional TD presents with either motor or vocal tics (not both) that have been present for less than 12 months. Though medications like Aripiprazole and dopamine receptor blockers are frequently prescribed, their potential unwanted consequences increase, may result in low adherence. In an effort to improve and broaden the care available for children diagnosed with TD, alternative methods such as acupuncture are being investigated and considered. Acupuncture is a method of traditional Chinese medicine that includes the placement of thin needles into particular areas of the body in order to correct any disruptions or irregularities. Research has demonstrated that acupuncture can help regulate abnormal brain function and relieve tic symptoms in individuals with TD. Additional studies are required to fully evaluate the usefulness of complementary treatments in addressing TD in young individuals, despite its common usage. Herein, we summarized the therapeutic effects of acupuncture in the treatment of TD.

Improving hemodialysis patient depression outcomes with acupuncture: A randomized controlled trial

OBJECTIVE

To evaluate the efficacy and safety of acupuncture as a supplementary treatment for mild to moderate depression in hemodialysis patients.

METHOD

This multicenter, randomized, controlled, single-masked trial included 64 hemodialysis patients aged 18-75 divided into two groups. One group received genuine acupuncture, while the other received sham acupuncture over 12 weeks. The primary outcome measure was Hamilton Depression Scale (HAMD) scores; an inclusion criterion was HAMD scores of 10-23. Secondary outcomes included life quality improvements and changes in biochemical markers, such as serum albumin and hemoglobin levels. To assess the predictive effects of acupuncture treatment and biochemical parameters on depressive symptoms, a multivariable linear regression analysis was conducted.

RESULTS

Following acupuncture treatment, HAMD scores significantly decreased, quality of life scores improved, and biochemical indicators (serum albumin, hemoglobin, transferrin, and total protein levels) showed some improvement, indicating the effectiveness of acupuncture in alleviating depressive symptoms and enhancing overall health in hemodialysis patients. Multivariable regression analysis showed that acupuncture treatment (P = 0.004) and serum albumin levels (P = 0.03) were significant predictors of improvement in depressive symptoms, with an adjusted R2 of 0.45, indicating that the model explained 45 % of the variance in symptom improvement. Other biochemical indicators, such as hemoglobin, transferrin, and total protein, did not show significant predictive effects (P > 0.05). No serious adverse events were observed during the treatment.

CONCLUSION

Acupuncture is a safe and effective adjunct therapy for alleviating mild to moderate depression in hemodialysis patients. Acupuncture treatment and certain biochemical indicators (such as serum albumin) have significant predictive value for improving depressive symptoms.

Acupuncture in the treatment of chemotherapy-induced peripheral neuropathy: a meta-analysis and data mining

Background

The efficacy and acupoint selection of acupuncture in treating chemotherapy-induced peripheral neuropathy (CIPN) remain controversial. This study aims to explore the specific efficacy and acupoint selection of acupuncture in treating CIPN through a meta-analysis and data mining.

Methods

Searching for clinical trials on acupuncture treatment for CIPN in 8 databases, evaluating its efficacy and safety through a meta-analysis, and exploring its acupoint selection through data mining.

Results

The meta-analysis included 21 studies and 2,121 patients, showing that compared with the control group, the acupuncture group could significantly improve neuropathic pain intensity (SMD = -0.66, 95% CI [-1.07, -0.25], p = 0.002), significantly reduce the NCI-CTCAE (MD = -0.29, 95%CI [-0.50, -0.08], p < 0.01), significantly reduce the FACT-NXT score (MD = 2.09, 95% CI [0.73,3.45], p < 0.05), significantly increase the motor conduction velocities (MCV) of median nerve (MD = 2.38, 95% CI [2.10, 2.67], p < 0.001), the sensory conduction velocities (SCV) of the median nerve (MD = 0.56, 95 %CI [-1.45, 2.57], p = 0.58), the SCV of the tibial nerve (MD = 1.78, 95% CI [0.50, 3.05], p < 0.01), and the SCV of sural nerves (MD = 4.60, 95% CI [0.17, 9.02], p < 0.05), as well as improving the quality of life score (MD =7.35, 95% CI [1.53, 13.18], p = 0.01). Data mining showed that the core acupoints for acupuncture treatment of CIPN were LI4, ST36, LI11, LR3, and SP6.

Conclusion

Acupuncture can improve the neuropathic pain intensity, the intensity of the CIPN, MCV of the median nerve, SCV of the tibial nerve and peroneal nerve, quality of life, and has good safety in CIPN patients. LI4 (Hegu), ST36 (Zusanli), LI11 (Quchi), LR3 (Taichong), and SP6 (Sanyinjiao) are the core acupuncture points for treating CIPN, and this protocol has the potential to become a supplementary treatment for CIPN.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier CRD42024551137.

Efficacy and safety of herbal medicine combined with acupuncture in pediatric epilepsy treatment: A meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the efficacy and safety of herbal medicine and acupuncture combination for pediatric epilepsy treatment.

METHODS

Databases were searched from their interception until October 2023 to identify randomized controlled trials focusing on the therapeutic efficacy of herbal medicine-acupuncture combination (intervention group) for pediatric epilepsy. The primary outcome was the risk of treatment failure, whereas the secondary outcomes included the risk of post-treatment electroencephalogram (EEG) abnormalities and adverse events. Subgroup analyses were conducted based on the type of herbal compound formulas. Meta-regression analysis was conducted to examine the influence of patient demographics and clinical history on the therapeutic efficacy of herbal medicine-acupuncture combination for pediatric epilepsy. To assess the cumulative evidence, trial sequential analysis (TSA) was performed.

RESULTS

The analysis included 10 trials involving a total of 882 pediatric patients. Meta-analysis revealed that the intervention group had a lower risk of treatment failure than the control group (risk ratio [RR] = 0.3, 95% confidence interval [CI]: 0.19-0.47, P<0.00001, I2 = 0%, 10 trials). Subgroup analyses showed that therapeutic efficacy was consistent among the different herbal compound formulas. Meta-regression analysis revealed that the efficacy of the treatments did not significantly vary with patient age, male sex, and duration of seizure history. TSA suggested that herbal medicine-acupuncture combination exerted a robust and conclusive effect on seizure treatment. Although the combined used of herbal medicine and acupuncture was not associated with a lower risk of post-treatment EEG abnormalities (RR = 0.82, 95%CI:0.6-1.11, P = 0.2, 3 trials), the risk of adverse events was reduced (RR = 0.27, 95%CI:0.18-0.41, P<0.00001, 4 trials).

CONCLUSION

The meta-analysis suggested that combined use of herbal medicine and acupuncture is a promising and safe clinical approach for pediatric epilepsy treatment. Further large-scale studies are necessary to conclusively determine the efficacy and safety of herbal medicine and acupuncture in pediatric epilepsy treatment.

Therapeutic efficacy of acupuncture point stimulation for stomach cancer pain: a systematic review and meta-analysis

PURPOSE

In recent years, traditional Chinese medicine has received widespread attention in the field of cancer pain treatment. This meta-analysis is the first to evaluate the effectiveness and safety of acupuncture point stimulation in the treatment of stomach cancer pain.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Embase, WANFANG, China National Knowledge Infrastructure (CNKI), and Chinese Journal of Science and Technology (VIP) databases as well as forward and backward citations to studies published between database creation to July 27, 2023. All randomized controlled trials (RCTs) on acupuncture point stimulation for the treatment of patients with stomach cancer pain were included without language restrictions. We assessed all outcome indicators of the included trials. The evidence from the randomized controlled trials was synthesized as the standardized mean difference (SMD) of symptom change. The quality of the evidence was assessed using the Cochrane Risk of Bias tool. This study is registered on PROSPERO under the number CRD42023457341.

RESULTS

Eleven RCTs were included. The study included 768 patients, split into 2 groups: acupuncture point stimulation treatment group (n = 406), medication control group (n = 372). The results showed that treatment was more effective in the acupuncture point stimulation treatment group than in the medication control group (efficacy rate, RR = 1.63, 95% CI 1.37 to 1.94, p < 0.00001), decreasing in NRS score was greater in acupuncture point stimulation treatment group than in the medication control group (SMD = -1.30, 95% CI -1.96 to -0.63, p < 0.001).

SYSTEMATIC REVIEW REGISTRATION

https://clinicaltrials.gov/, identifier CRD42023457341.

Acupuncture for insomnia symptoms in hypertensive patients: a systematic review and meta-analysis

PURPOSE

In the realm of pain management, traditional Chinese medicine, specifically acupuncture, has garnered increasing attention. This meta-analysis pioneers the evaluation of acupuncture's effectiveness in treating insomnia among hypertensive patients.

METHODS

We conducted a comprehensive search across several databases-PubMed, Web of Science, Cochrane Library, WANFANG, China National Knowledge Infrastructure (CNKI), Sinomed, and the Chinese Journal of Science and Technology (VIP). Additionally, forward and backward articles of studies published from the inception of these databases until 10 September 2023, were reviewed. This systematic review and meta-analysis included all randomized controlled trials (RCTs) focusing on acupuncture for insomnia in hypertensive patients, without imposing language or date restrictions. We rigorously assessed all outcome measures reported in these trials. The evidence was synthesized by calculating the difference between mean differences (MD) in symptom change. The quality of the evidence was determined using the Cochrane Risk of Bias tool. This study is registered with PROSPERO under number CRD42023461760.

RESULTS

Our analysis included 16 RCTs, comprising 1,309 patients. The findings revealed that acupuncture was significantly more effective than the control group in reducing insomnia symptoms, as indicated by a greater decrease in the PSQI score (MD = -3.1, 95% CI [-3.77 to -2.62], p < 0.00001). Additionally, improvements in both systolic and diastolic blood pressure were more pronounced in the acupuncture group compared to the control group (SBP: MD = -10.31, 95% CI [-16.98 to -3.64], p = 0.002; DBP: MD = -5.71, 95% CI [-8.19 to -3.23], p < 0.00001). These results suggest that acupuncture not only improves sleep quality but also lowers blood pressure in patients suffering from hypertension and insomnia. Further research is warranted to elucidate optimal acupuncture points and the duration of treatment for maximized therapeutic effect.Systematic review registration:https://www.crd.york.ac.uk/prospero, CRD42023461760.