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 arthritic neck pain

Four weeks of acupuncture treatment can alleviate cervical spondylosis (CS)-related neck pain and improve quality of life, with effects persisting for a minimum of three months. Eight hundred and ninety-six patients were randomised by Chinese researchers to receive optimised, shallow, or sham acupuncture. Treatment in the optimised acupuncture group consisted of traditional acupuncture (at bilateral SI 15 jian zhong shu, TH 3 zhong zhu, DU 14 da zhui and two bilateral pairs of M-BW-35 hua tuo jia ji points), followed by intradermal needle therapy (INT, at bilateral SI 15 jian zhong shu, and two bilateral pairs of M-BW-35 hua tuo jia ji points). Those in the shallow acupuncture received subcutaneous needling at the same points as in the OAG, followed by INT using the same method as in the OAG. Sham acupuncture was carried out using shallow needling at sham points. Patients received eight to ten treatment sessions, two to three times a week, for four weeks. At week 4, significant differences in favour of optimised acupuncture were observed for changes in neck pain scores between the OAG and both the shallow and sham acupuncture groups. The differences in scores between the OAG and the shallow and sham acupuncture groups were still significant at week 16. Optimized acupuncture treatment (acupuncture and intradermal needling) for cervical spondylosis-related neck pain: a multicenter randomized controlled trial Pain. 2020 Sep 14

Acupuncture better than drugs for IBS

Acupuncture may be more effective than drug treatment for irritable bowel syndrome (IBS), according to research carried out in China. Five hundred and thirty-one patients with IBS were randomised to receive acupuncture or pharmacological treatment (PEG 4000 20 g/d, for IBS-C, and pinaverium bromide 150 mg/d, for IBS-D) over a six-week period, followed by a twelveweek follow-up. Acupuncture (at DU 20 bai hui, M-HN-3 yin tang, and bilateral LIV 3 tai chong, ST 36 zu san li, SP 6 san yin jiao, ST 25 tian shu and ST 37 shang ju xu) was carried out three times a week for six weeks (18 sessions). From baseline to week 6, total IBS symptom scores decreased by 123.51 in the acupuncture group and 94.73 in the drug treatment group, and these between-group differences in symptom scores in favour of acupuncture were found to persist at week 18. These results suggest that acupuncture is more effective than drug treatment for IBS, and results in clinically meaningful benefits, with effects lasting up to 12 weeks. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc. 2020 Aug;95(8):1671-83

Acupressure helps gut recover after C-section

Postoperative acupressure can help with the recovery of the gastrointestinal system (GIS) after caesarean section, report Turkish investigators. A total of 160 primipara pregnant women delivered by caesarean section under spinal anaesthesia were randomised into four groups: group 1 received acupressure, group 2 received coffee (three times a day), group 3 chewed sugar-free gum for 15 minutes (six hours post-operation), and group 4 was a control. Participants in the acupressure group received 10 minutes of acupressure at bilateral ST 36 zu san li twice in the postoperative period (1.5 hours and 5 hours after the participant was brought to her room). The results showed that acupressure led to the occurrence of flatulation and defaecation earlier than did the interventions in the other three groups (coffee, gum-chewing and control groups), and the difference was significant. Effects of acupressure, gum chewing and coffee consumption on the gastrointestinal system after caesarean section under spinal anaesthesia. J Obstet Gynaecol. 2020 Aug 17;1-8

Acupuncture reduces plantar fasciitis pain

Manual acupuncture (MA) and electroacupuncture (EA) can decrease heel pain and improve function in patients with plantar heel pain syndrome (PHPS). Chinese researchers randomised 92 patients to receive 12 treatment sessions of EA or MA over four weeks with 24 weeks of follow-up. MA was carried out at two ah shi points, plus BL 57 cheng shan, KI 3 tai xi and BL 60 kun lun. EA was performed at the same points (2 Hz for 30 minutes). Treatment responders were defined as patients with at least a 50 per cent reduction from baseline in worst pain intensity experienced during their first steps in the morning. Both EA and MA appeared to have positive effects, resulting in decreased heel pain and improved plantar function compared with baseline. In the EA group, 54.8 per cent of patients were classified as responders, compared with 50.0 per cent of the MA group after the four-week treatment, a non-significant difference. Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial. Acupunct Med. 2020 Aug 18;964528420947739

Benefits of acupuncture in menopause are long lasting

The beneficial effect of acupuncture on menopause symptoms can last for at least 21 weeks post-treatment, according to a Danish research team. Data was analysed from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks, and randomised to an early intervention group that received treatment immediately and a late intervention group with a six-week delay. Western medical style acupuncture was administered at REN 3 zhong ji, REN 4 guan yuan and bilateral LIV 8 qu quan, SP 6 san yin jiao and SP 9 yin ling quan. A

statistically significant, sustained longterm beneficial effect of acupuncture was found for hot flushes, sweating and sleeping issues, lasting up to 21 weeks post-treatment. Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial. Acupunct Med. 2020 Jun 9;964528420920280

Group acupuncture is a valuable treatment for low-income populations with diabetic neuropathy

Acupuncture is a valuable adjunctive treatment for low-income and marginalised populations with painful diabetic neuropathy (PDN). In addition to reducing pain and improving QOL, acupuncture may offer powerful benefits by increasing patient activation and hope. American researchers conducted a randomised clinical trial of a 12week group acupuncture intervention for PDN which included semistructured qualitative interviews about participants' experiences with PDN and the intervention. They recruited 40 participants from diverse racial/ethnic backgrounds from a public hospital and conducted in-depth qualitative interviews with a subset of 17 people. Participants randomised to acupuncture experienced greater decreases in pain compared with usual care as well as improved quality of life. Those who received acupuncture reported being able to decrease reliance on pain medication, improve their sleep and daily function, reduce stress, and engage more with their own self-care. They noted that the acupuncture intervention also gave them hope in the face of their chronic disease. ‘It Gave Me Hope’ Experiences of Diverse Safety Net Patients in a Group Acupuncture Intervention for Painful Diabetic Neuropathy. Health Equity. 2020 May 22;4(1):225-31

Acupuncture better than drugs or surgery for trigeminal neuralgia

Acupuncture appears more effective than pharmacotherapy or surgery for the management of trigeminal neuralgia, and is safer and cheaper to deliver than surgical or pharmacotherapeutic interventions. British authors compared acupuncture against the current first-line drug treatment (carbamazepine) and the most effective surgery (microvascular decompression – MVD), in a total of 17 studies. Acupuncture had the greatest efficacy of the modalities considered (86.5 per cent) compared to surgery (79.3 per cent) and pharmacotherapy (71.7 per cent). Acupuncture also had fewer reported side effects (22.7 per cent) compared with surgery (25.3 per cent) and pharmacotherapy (88.8 per cent). Acupuncture also had the lowest associated cost; after 5 years, the cost of acupuncture was estimated to be £750, compared to £1507.73 for carbamazepine and £4878.42 for MVD. Acupuncture was also rated as the least stressful intervention by patients. Acupuncture in the management of trigeminal neuralgia. Acupunct Med. 2020 Jun 10;964528420924042

Five weeks of acupuncture treatment needed to relieve chronic pain

Acupuncture treatment duration should not be less than five weeks in order to achieve an adequate analgesic effect in chronic pain conditions. An international author team from the UK, USA and China included data from 77 randomised clinical trials involving 8,830 patients in their systematic review. Analysis of response time suggested that a treatment duration of 5 weeks or more was needed to achieve 80 per cent of maximum analgesic effect. Higher analgesic effects for acupuncture were observed when baseline pain intensity was higher, and when pain was located in the neck, shoulder and knee area. Maximum analgesic effects of sham acupuncture and conventional therapy were 22.6 and 15.8 points on a 0-100 scale. The absolute effect of true acupuncture was 26.1 points for low back pain, and 34.9 points for other pain body locations, in patients with a baseline pain intensity of 60 points. To achieve 90 per cent of the maximum effect, the duration of acupuncture treatment should be at least 11 weeks. The response-time relationship and covariate effects of acupuncture for chronic pain: a systematic review and model-based longitudinal meta-analysis. Eur J Pain. 2020 Jun 13

Moxibustion and acupressure recommended for post-Covid care

Chinese guidelines for discharged patients with Covid-19 most frequently recommend moxibustion and acupressure as home-based nursing interventions. REN 12 zhong wan and ST 36 zu san li were the two most promoted acupuncture points for moxibustion and acupressure interventions for these patients in the five guidelines surveyed. Home-based traditional Chinese medicine nursing interventions for discharged patients with COVID-19: a rapid review of Chinese guidelines. Integr Med Res. 2020 Sep;9(3):100479

Acupuncture exerts anti-inflammatory effects by blocking NF-KB

Acupuncture may exert antiinflammatory effects by acting as an antagonist of the important gene transcription factor nuclear factor kappa B (NF-KB), suggest the authors of a review article from China. NF-KB is a protein transcription factor considered to be a regulator of innate immunity. The NF-KB signalling pathway links pathogenic signals and cellular danger signals thus organising cellular resistance to invading pathogens. NF-KB controls transcription of DNA, cytokine production and cell survival, and most of the inflammatory responses caused by infection, inflammatory cytokines, and engagement of antigen receptors are associated with the activation of NF-KB. The authors discuss studies describing acupuncture’s ability to regulate inflammatory disease pathways by inhibiting the NF-KB activation via various biochemical mechanisms including those involving microRNAs, sirtuins, and other intracellular signalling cascade components. Understanding the crosstalk between acupuncture and NFKB may help explain how acupuncture influences inflammatory conditions. Crosstalk between Acupuncture and NF- KB in Inflammatory Diseases. Evid Based Complement Alternat Med. 2020 Jun 8;2020:7924985

With thanks to the Journal of Chinese Medicine