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

Electroacupuncture as good as drugs for chronic constipation

Electroacupuncture (EA) can be as effective as the prokinetic drug prucalopride for treating severe chronic constipation. Chinese researchers randomised 560 participants experiencing fewer than two complete spontaneous bowel movements (CBSMs) per week to either EA or prucalopride, over a 32-week period. Twenty-eight sessions of electroacupuncture were administered over the first eight weeks, followed by no-treatment over the subsequent 24 weeks. EA was found to be noninferior to prucalopride for the primary outcome measure. The proportion of participants with more than three mean weekly CSBMs was 36.2 per cent with EA versus 37.8 per cent with prucalopride. The proportion of treatment responders in weeks one to eight was also similar in the EA and prucalopride groups (24.91 per cent versus 25.54 per cent). Except during the first two weeks of treatment, no between-group differences were found in outcomes of excessive straining, stool consistency, or quality of life. Adverse events occurred in 17.69 per cent of participants in the EA group compared with 44.24 per cent in the prucalopride group. Electroacupuncture vs Prucalopride for Severe Chronic Constipation: A Multicenter, Randomized, Controlled, Noninferiority Trial. Am J Gastroenterol. 2021 May 1;116(5):1024-35 〉 https://pubmed.ncbi.nlm.nih.gov/33273258/

Electroacupuncture speeds recovery after knee replacement by improving circulation

Adding electroacupuncture (EA) treatment to conventional anaesthesia can support functional recovery after total knee arthroplasty by reducing pain and oedema and improving blood circulation. In a Chinese trial 200 patients undergoing total knee arthroplasty were randomly divided into four groups: intravenous analgesia (PCIA group), femoral nerve block analgesia (PCNA group), intravenous analgesia combined with EA treatment (PCIA + EA group) and femoral nerve block combined with EA (PCNA + EA group). Compared with the PCIA group, PCNA group, and PCIA + EA group, the PCNA + EA group showed a significantly reduced incidence of lower limb deep vein thrombosis (28 per cent, 14 per cent, 12 per cent and 4 per cent, respectively). Objective measures of blood flow were observed to be significantly better in both EA groups compared with the anaesthetic only groups on the seventh day after the operation. Both EA groups showed significantly lower coagulation markers (D-dimer index, whole blood viscosity and red blood cell aggregation) on day seven, with the PCNA + EA group additionally showing a significant reduction in platelet counts. By relieving postoperative pain and reducing the incidence of deep vein thrombosis, EA combined with femoral nerve block enabled patients to participate in joint movement and lower limb muscle strength training sooner. The Preventive Effect of Computed Tomography Image-Guided Electroacupuncture Combined with Continuous Femoral Nerve Block on Deep Vein Thrombosis After Total Knee Arthroplasty Based on an Adaptive Algorithm. World Neurosurg. 2021 May;149:362-71 〉 https://pubmed.ncbi.nlm.nih.gov/33248303/

Electrical acupoint stimulation improves cognitive state in elderly undergoing colon cancer surgery

Transcutaneous electrical acupoint stimulation (TEAS) is associated with a lower duration of postoperative cognitive decline (POCD) in elderly patients undergoing colon cancer surgery. A Chinese research team randomised 100 patients undergoing laparoscopic resection of colon cancer into TEAS and control groups. Patients in the TEAS group received percutaneous acupoint electrical stimulation at bilateral LI 4 he gu, P 6 nei guan and ST 36 zu san li points from 30 minutes before anaesthesia induction to the end of surgery. Serum inflammatory markers (IL6 and hs-CRP) were observed to be significantly lower in the TEAS group compared with controls at one hour after beginning surgery and at the end of surgery. POCD was also observed to be significantly decreased on postoperative days two and three in the TEAS group compared with the control group. The authors conclude that TEAS may reduce neuroinflammation by influencing levels of inflammatory mediators and neuropeptides involved in communication along the gut–brain axis. Effects of Transcutaneous Electrical Acupoint Stimulation on Postoperative Cognitive Decline in Elderly Patients: A Pilot Study. Clin Interv Aging. 2021 May 3;16:757-65 〉 https://pubmed.ncbi.nlm.nih.gov/33976542/

Electroacupuncture changes brain connectivity to reduce fibromyalgia pain

Electroacupuncture (EA) can reduce pain severity in fibromyalgia (FM) by changing the way the brain’s amygdala connects with its representation of the body, report American scientists. Seventy-six patients with FM were randomised to receive either electroacupuncture (EA) or mock laser acupuncture (ML), twice a week for a total of eight treatments. The EA group received low-frequency (2 Hz) EA at three pairs of acupoints: right LI 11 qu chi to LI 4 he gu, left GB 34 yang ling quan to SP 6 san yin jiao, and bilateral ST 36 zu san li. Needles were also inserted at DU 20 bai hui, right ear shen men, and left LIV 3 tai chong, but no electrical current was delivered to these sites. EA treatment was designed to generate sustained somatosensory afferent activity, while ML was designed to generate no somatosensory afference. Fibromyalgia patients who received EA experienced a greater reduction in pain severity, compared to patients who received ML (mean difference in pain index from pre- to post-treatment was -1.14 in the

EA group versus -0.46 in the ML group). Participants receiving EA treatment also exhibited resting functional connectivity between the primary somatosensory cortical representation of the leg (S1leg) and the anterior insula. Increased S1leg-anterior insula connectivity was associated with both reduced levels of pain severity and increased levels of the inhibitory neurotransmitter -aminobutyric acid (GABA) in the anterior insula following EA therapy. The authors conclude that the somatosensory component of acupuncture modulates functional connectivity and inhibitory neurochemistry in the somatosensoryinsular circuit resulting in reduced clinical pain severity in FM patients. Greater Somatosensory Afference With Acupuncture Increases Primary Somatosensory Connectivity and Alleviates Fibromyalgia Pain via Insular -Aminobutyric Acid: A Randomized Neuroimaging Trial. Arthritis Rheumatol. 2021 Jul;73(7):1318-28 〉 https://pubmed.ncbi.nlm.nih.gov/33314799/

Group acupuncture better than individual acupuncture for cancer pain

Group acupuncture is superior to individual acupuncture for relieving pain in cancer patients, and costs half as much to deliver, according to a trial carried out in Canada. Effectiveness and cost data from a noninferiority trial of group versus individual acupuncture for cancer-related pain were analysed. In the trial, 74 patients were randomly assigned to individual or group acupuncture treatments twice per week for six weeks. Individual acupuncture treatments were individualised and open to modification over the course of the study to accommodate the individual’s changing symptomatology, but all prescriptions included LI 4 he gu and LIV 3 tai chong. Group acupuncture was performed in a room containing up to six people per session, and needle placement and manipulation procedures identical to the individual treatments were followed. Group acupuncture participants experienced more significant reduction in paindiscomfort scores compared with individual acupuncture participants. The effect size on pain-discomfort for group acupuncture (d = 0.80) was significantly higher than that of individual acupuncture (d = 0.34). The cost of delivering acupuncture treatment for the group arm over six weeks ($201.25) was nearly half of the individual arm ($400). The authors point out that their findings have implications for the use of group acupuncture in low-resource settings and in healthcare systems where acupuncture for cancer patients is not covered by public health insurance. Cost-Utility of Group Versus Individual Acupuncture for Cancer-Related Pain Using Quality-Adjusted Life Years in a Noninferiority Trial. J Altern Complement Med. 2021 May;27(5):390-97 〉 https://pubmed.ncbi.nlm.nih.gov/33904784/

Acupressure reduces pain and speeds recovery after gallbladder removal

Acupressure can reduce pain and speed up recovery of gut motility following gall bladder removal, according to research from Turkey. Sixty-five patients undergoing laparoscopic cholecystectomy were randomly assigned to intervention and light touch placebo groups. In the intervention group, acupressure was applied for a total of twelve minutes, spending three minutes at each of: ST 25 tian shu, REN 12 zhong wan, SJ 6 zhi gou and HT 7 shen men, at zero, four and eight hours after the operation. The results showed that acupressure significantly reduced postoperative pain, increased intestinal sounds and shortened the time to defecation, compared with the placebo intervention. The effect on gastrointestinal system functions, pain and anxiety of acupressure applied following laparoscopic cholecystectomy operation: A randomised, placebo-controlled study. Complement Ther Clin Pract. 2021 May;43:101304 〉 https://pubmed.ncbi.nlm.nih.gov/33540298/

Acupuncture is one of the safest medical treatments

Acupuncture can be considered to be one of the safer treatments in medicine, conclude a team of authors from China and Germany. Their systematic review included data from 21 studies covering 12.9 million acupuncture treatments. Meta-analyses suggested that at least one adverse effect (AE) occurs in 9.31 per cent of patients undergoing a series of acupuncture treatments, and in 7.57 per cent of treatments. Serious adverse effects (SAEs) were judged to be rare, with estimates of 1.01 per 10,000 patients and 7.98 per million treatments. AEs requiring medical treatment were uncommon, occurring in 1.14 per 1,000 patients. On average, 9.4 AEs occurred per 100 treatments. The most commonly reported minor AEs were very mild. Half of the AEs reported were bleeding, pain or flare at the needle site that could be argued to represent intended acupuncture reaction. AE definitions and assessments varied largely. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021 Sep 6;11(9):e045961 〉 https://pubmed.ncbi.nlm.nih.gov/34489268/

Acupuncture is one of the top treatments for dental anxiety

Acupuncture is amongst the most successful interventions for reducing anxiety in dental patients, according to American authors. Their systematic review covered 408 articles, with a total of 50,343 patients undergoing 14 different types of non-pharmaceutical intervention to alleviate dental anxiety. Music, cognitive behavioural therapy, relaxation, massage, acupuncture/ acupressure, hypnosis, and natural sounds were the most successful interventions, reducing anxiety in over 70 per cent of experiments. Dealing with Anxious Patients: A Systematic Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures. J Altern Complement Med. 2021 Sep;27(9):717-26 〉 https://pubmed.ncbi.nlm.nih.gov/34076531/

Acupuncture for stroke – the sooner the better

Acupuncture is safe and beneficial for stroke survivors, and the sooner it is deployed, the better, according to a network meta-analysis by Chinese authors. Thirty-eight trials involving 3,836 participants were included. The results showed that acupuncture treatment (Acu) was significantly more effective than non-acupuncture treatment (Non-Acu) with good safety. Acu within 48 hours post-stroke (Acu I) was shown to be superior to acupuncture within 2-15 days post-stroke (Acu II) (standard mean difference [SMD]: 7.17, acupuncture within 16-30 days post-stroke (Acu III) (SMD: 20.73), acupuncture within 1 month to half a year post-stroke (Acu IV) (SMD: 26.95). The optimal acupuncture intervention time-point for stroke was judged to be within 48 hours post-stroke, with the significant effect period lasting until 15 days after onset. Efficacy and safety of dissimilar acupuncture intervention time-points in treating stroke: a systematic review and network meta-analysis. Ann Palliat Med. 2021 Sep 6;apm-21-1127 〉 https://pubmed.ncbi.nlm.nih.gov/34498479/

With thanks to the Journal of Chinese Medicine