Evidence base

Overseas member and recovering scientist Lisa Sherman selects top abstracts of the season from the Journal of Chinese Medicine's news section to keep you up to date with the latest in acupuncture research

Lisa Sherman

Overseas Member: North Carolina

RESEARCH

Acupuncture durably improves prostate pain

Chinese clinicians report that acupuncture can durably improve symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). A total of 440 men with moderate to severe CP/ CPPS underwent 20 sessions of either verum acupuncture – at bilateral BL 33 zhong liao, BL 35 hui yang, BL 23 shen shu and SP 6 san yin jiao – or sham treatment (superficial needling at nearby non-acupoints) over eight weeks, with twenty-four weeks of follow-up. Treatment was considered effective if a reduction of at least six points from baseline was achieved on a validated prostatitis symptom index at weeks 8 and 32. At all assessment points, more men in the acupuncture group reported marked or moderate improvements in symptoms. At week 8, a treatment response was seen in 60.6 per cent of the acupuncture group, compared with 36.8 per cent of the sham group (adjusted odds ratio 2.6). At week 32, the proportions were 61.5 per cent in the acupuncture group and 38.3 per cent in the sham group (adjusted odds ratio 2.6). The authors noted that the sham treatment exceeded the threshold for minimal clinically important difference (a reduction of four points on the prostatitis symptom index), while pointing out that superficial needling at non-acupoints may have physiological effects. Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized Trial. Ann Intern Med. 2021 Oct;174(10):1357-66 〉 pubmed.ncbi.nlm.nih.gov/34399062/

Acupuncture improves low BDNF levels in cancer survivors with insomnia

Acupuncture can increase levels of brain-derived neurotrophic factor (BDNF) in cancer survivors with insomnia and low baseline BDNF, according to a team of researchers from the USA and Canada. A randomised clinical trial compared acupuncture with cognitive behavioural therapy for insomnia (CBT-I) in 160 cancer survivors, over an eightweek period. The acupuncture protocol consisted of needling at standardised acupuncture points classically used to treat insomnia – HT 7 shen men, SP 6 san yin jiao, DU 20 bai hui, DU 24 shen ting, auricular shen men and sympathetic – as well as supplementary points to treat comorbid symptoms (such as psychological distress, fatigue and pain). Needles remained in place for 30 minutes, and participants received a total of ten acupuncture treatments over eight weeks. Mean serum BDNF did not significantly increase in the acupuncture or CBT-I groups. However, when analysis was restricted to patients with low baseline BDNF, the acupuncture group demonstrated a significant (7.2 ng/mL) increase in mean serum BDNF, whereas the CBT-I group demonstrated a nonsignificant (2.9 ng/mL) increase. Although decreased BDNF has previously been associated with poor sleep, serum BDNF was not significantly correlated with sleep outcomes in this study. Effects of acupuncture versus cognitive behavioral therapy on brain-derived neurotrophic factor in cancer survivors with insomnia: an exploratory analysis, Acupunct Med. 2021 Dec;39(6):637-45 〉 pubmed.ncbi.nlm.nih.gov/33752446/

Placebo and nocebo suggestions don’t affect acupuncture effects in low back pain

Suggestions regarding either treatment benefits (placebo) or adverse side effects (nocebo) did not affect pain intensity reported after acupuncture treatment for chronic low back pain (CLBP). In a randomised trial conducted by Swiss and German researchers, 152 CLBP patients were randomised to receive either a regular expectation briefing or a high expectation briefing, and either a regular adverse side effect briefing or an intense adverse side effect briefing in a two-by-two factorial design. The intervention, consisting of briefing sessions and written materials, was standardised and delivered before the acupuncture treatment, with additional booster informative emails provided during the four-week, eight-session acupuncture course. All patients received the same standardised minimal acupuncture treatment, which had been developed in a prior CLBP trial. No difference was observed between intervention groups in terms of the effect of the briefings on patients' expectations regarding the effectiveness of the acupuncture treatment. There was also no difference in pain intensity at the end of the acupuncture treatment between the groups with different expectation briefings. The adverse side effects score in the group with the intense adverse side effect briefing was estimated to be 1.31 times higher than after a regular adverse side effect briefing, but this finding was not statistically significant. Effect of Briefing on Acupuncture Treatment Outcome Expectations, Pain, and Adverse Side Effects Among Patients With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2021 Sep 1;4(9):e2121418 〉 pubmed.ncbi.nlm.nih.gov/34505889/

Auricular acupressure can help prevent burnout in healthcare workers

Auricular acupressure can mitigate some of the negative impact of occupational stressors on frontline healthcare workers. American researchers carried out a randomised trial in 117 staff working at a paediatric trauma centre. Participants were randomised to receive auricular acupuncture, auricular acupressure, or auricular massage delivered over a period of three weeks. Acupressure treatment (using ear seeds) was associated with a significant reduction in measures of psychological burnout and secondary traumatic stress. The authors suggest that the stress reduction offered by auricular acupressure may support healthcare workers' ability to develop caring relationships with their patients. Effects of Acupuncture and Acupressure on Burnout in Health Care Workers: A Randomized Trial. J Trauma Nurs. 2021 Nov-Dec 01;28(6):350-62 〉 pubmed.ncbi.nlm.nih.gov/34766929/

Acupuncture helps pregnant women with pelvic pain stay active

Treating pelvic girdle pain (PGP) in pregnancy with either acupuncture or transcutaneous electrical nerve stimulation (TENS) may enable pregnant women to stay active, according to research carried out in Sweden. One hundred and thirteen women with PGP between weeks 1228 of pregnancy received either ten acupuncture sessions (two per week), or daily home-based TENS therapy, over a five-week period. Points chosen were based on the individual woman’s symptoms and clinical presentation from a list of points used in a previous trial of acupuncture for PGP – DU 20 bai hui, LI 4 he gu, BL 26 guan yuan shu, BL 32 ci liao, BL 33 zhong liao, BL 54 zhi bian, KID 11 heng gu, BL 60 kun lun, GB 30 huan tiao, SP 12 chong men and ST 36 zu san li. Although disability due to PGP usually tends to increase over the course of pregnancy, both study groups managed to preserve their functioning and physical activity levels at followup, with no significant differences detected between the groups. Significant within-group reductions in evening pain intensity were observed in both groups (acupuncture -0.96, TENS -1.29) and concern about pain dropped significantly in both groups (acupuncture -1.44, TENS -1.99). The acupuncture group also showed a significant improvement in PGP-related functioning at follow-up, as well as higher satisfaction with treatment. The authors suggest that either intervention could be recommended as a nonpharmacological alternative for pain relief and maintenance of physical activity in pregnant women with PGP. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial. BMJ Open. 2021 Oct 1;11(10):e046314 〉 pubmed.ncbi.nlm.nih.gov/34598980/

Acupuncture visibly improves pelvic floor structure in postpartum women

Chinese clinicians have used fourdimensional ultrasound to observe changes in postpartum pelvic floor structure after acupuncture treatment. Eighty patients diagnosed with postpartum female pelvic floor dysfunction (FPFD) were divided into a treatment group and a control group. All patients in both groups received conventional physiotherapy for four weeks, while those in the treatment group were given additional daily acupuncture treatment. Manual needling was carried out at REN 12 zhong wan, REN 4 guan yuan, REN 6 qi hai, and bilateral ST 25 tian shu and ST 36 zu san li, along with moxibustion at bilateral BL 28 pang guang shu and BL 23 shen shu, and electro-stimulation at REN 3 zhong ji and bilateral ST 28 shui dao. After treatment, patients were examined using transperineal pelvic floor ultrasound. The shape and activity of the bladder neck, cervix and anal canal, under resting, anal sphincter and Valsalva movements were recorded. After acupuncture treatment, observed changes in pelvic floor anatomy indicated an improvement in pelvic dysfunction (decrease in bladder neck descent, anal levator muscle area and muscle hole diameter), along with a reduced possibility of cystocele (bulging of the bladder into the vagina) and uterine prolapse. Evaluation of acupuncture treatments of postpartum female pelvic floor dysfunction by four-dimensional transperineal pelvic floor ultrasound. Medicine (Baltimore). 2021 Oct 22;100(42):e27236 〉 pubmed.ncbi.nlm.nih.gov/34678860/

Acupuncture helps with opiate withdrawal

Acupuncture therapies can be used effectively to help reduce relapse and promote recovery of opioid dependent patients who are receiving methadone maintenance treatment (MMT). A network meta-analysis carried out by Chinese authors combined data from 20 trials with a total of 1,661 participants, which compared western medicine (WM), traditional Chinese medicine (TCM), and four types of acupuncture intervention; manual acupuncture (MA), electroacupuncture (EA), auricular acupuncture (AA) and transcutaneous electrical acupoint stimulation (TEAS). Pairwise comparison showed MA was more efficacious than WM (mean difference -8.59), EA (MD -6.15) and TEAS (MD -10.44) for improving opiate withdrawal scale scores. In the network meta-analysis, MA was more effective than WM in terms of effective rate (RR: 1.40), and opiate withdrawal scale scores (MD: -5.74). The authors concluded that manual acupuncture may be the best choice for treating opioid dependence. Acupuncture for Opioid Dependence Patients Receiving Methadone Maintenance Treatment: A Network Meta-Analysis. Front Psychiatry. 2021 Dec 13;12:767613 〉 pubmed.ncbi.nlm.nih.gov/34966304/

Acupuncture compares well to drug therapy for migraine

Acupuncture can be a safe alternative to conventional drug therapy, concludes a systematic review by Chinese authors. Meta-analysis of 15 randomised controlled trials involving 2,847 participants showed a statistically significant reduction in migraine episodes at both the end of the treatment course (standardised mean difference -0.29) and at follow-up (SMD -0.29), compared with sham acupuncture. Acupuncture was found to have a similar effect to prophylactic drugs on reducing migraine frequency immediately post-treatment (SMD=−0.21), while at follow-up acupuncture significantly outperformed medication (SMD = − 0.14). The response rate to acupuncture treatment was also significantly greater than that for both sham acupuncture (relative risk 1.3) and drug treatment (RR 1.24). Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis. J Neurol. 2021 Nov;268(11):4128-37 〉 pubmed.ncbi.nlm.nih. gov/32839839/

Acupuncture effective for vertebral fractures

Acupuncture is effective for treating osteoporotic vertebral compression fracture (OVCF), according to Australian systematic review authors. Fourteen RCTs involving 1,130 patients were included in their meta-analysis. Compared with control groups, acupuncture showed a greater benefit on pain reduction caused by OVCFs at one week (mean difference = -1.26), one month (MD = -1.63) and six months (MD = -1.13) post-treatment. Acupuncture treatment was also associated with fewer adverse events, lower disability index scores, and higher bone density than controls (safety RR: 0.30, disability MD = -3.19, bone density MD = 0.15). The Efficacy and Safety of Acupuncture for Treating Osteoporotic Vertebral Compression Fracture- (OVCF-) Induced Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Evid Based Complement Alternat Med. 2021 Sep 29;2021:8574621 〉 pubmed.ncbi.nlm.nih.gov/34630619/

Acupuncture improves knee performance

Acupuncture can improve the performance of the knee joint by enhancing muscle contraction characteristics, report Chinese investigators. Twenty healthy male subjects were randomly divided into a true acupuncture (TA) and a sham acupuncture (SA) group. ST 32 fu tu, ST 34 liang qiu, ST 36 zu san li, SP 10 xue hai and BL 57 cheng shan were selected for acupuncture. SA consisted of non-penetrating stimulation using a blunt needle. The results showed that acupuncture had a significant effect on knee joint explosive force and joint stiffness. The average maximum torque, average work, average power, average peak power and total work measured in the TA group increased significantly after acupuncture, with no increase measured in any parameter after SA. Immediate Effects of Acupuncture on Explosive Force Production and Stiffness in Male Knee Joint. Int J Environ Res Public Health. 2021 Sep 9;18(18):9518 〉 pubmed.ncbi.nlm.nih.gov/34574441/

With thanks to the Journal of Chinese Medicine