NEWS SCIENTIFICHE 2007

Abbiamo scelto per voi gli abstracts di alcune pubblicazioni scientifiche recensite nell’anno 2007 da Medline, la più importante base di dati della letteratura biomedica mondiale.

Come si può vedere, la ricerca nel campo dell'agopuntura è molto attiva ed è orientata nei settori più disparati della scienza biomedica. Chi fosse interessato a reperire tutti i lavori scientifici pubblicati in letteratura recensita dal 1966 ad oggi, può connettersi all'indirizzo Web:

http://www.ncbi.nlm.nih.gov/Pubmed

da cui avrà accesso diretto e gratuito alla consultazione di Medline.

La parola chiave (keyword) da utilizzare nelle ricerche è:

Acupuncture

ABSTRACTS 2007

J Clin Oncol. 2007 Dec 10;25(35):5584-90.

Randomized, controlled trial of acupuncture for the treatment of hot flashes in breast cancer patients.

Deng G, Vickers A, Yeung S, Cassileth B.

Memorial Sloan-Kettering Cancer Center, 1429 First Ave, New York, NY 10021, USA.

dengg@mskcc.org

PURPOSE: To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer.PATIENTS AND METHODS: Seventy-two women with breast cancer experiencing three or more hot flashes per day were randomly assigned to receive either true or sham acupuncture. Interventions were given twice weekly for 4 consecutive weeks. Hot flash frequency was evaluated at baseline, at 6 weeks, and at 6 months after initiation of treatment. Patients initially randomly assigned to the sham group were crossed over to true acupuncture starting at week 7. RESULTS: The mean number of hot flashes per day was reduced from 8.7 (standard deviation [SD], 3.9) to 6.2 (SD, 4.2) in the true acupuncture group and from 10.0 (SD, 6.1) to 7.6 (SD, 5.7) in the sham group. True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks, but the difference did not reach statistical significance (95% CI, -0.7 to 2.4; P = .3). When participants in the sham acupuncture group were crossed over to true acupuncture, a further reduction in the frequency of hot flashes was seen. This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment. CONCLUSION: Hot flash frequency in breast cancer patients was reduced following acupuncture. However, when compared with sham acupuncture, the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance. We cannot exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms.

Publication Types: Randomized Controlled Trial, Research Support, N.I.H., Extramural

PMID: 18065731

J Vet Med Sci. 2007 Nov;69(11):1163-5.

Effects of electroacupuncture on intraocular pressure and hemodynamic parameters in isoflurane anesthetized dogs.

Kim MS, Yoo JH, Seo KM, Jeong SM.

Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Florida 32610-0105, USA.

The effects of electroacupuncture (EA) on intraocular pressure (IOP) and hemodynamic parameters were evaluated in isoflurane anesthetized 10 (5 males,

5 females) normal mongrel dogs (8.1-9.8 kg, 6-8 years old). After determination of baseline IOP and hemodynamic parameters (cardiac index, systolic arterial pressure, diastolic arterial pressure, heart rate and systemic vascular resistance index), EA was applied at 3 acupoints (LI-4, LIV-3 and GB-37) for 20 min. After the EA treatment, IOP was significantly decreased in the both eyes (p<0.05). However, there were not significant differences in hemodynamic parameters between those of before and after EA treatment. From these results, the EA treatment at LI-4, LIV-3 and GB-37 would be considered one of the valuable methods for the IOP treatment in dogs.

Publication Types: Clinical Trial

PMID: 18057831

Anesthesiology. 2007 Dec;107(6):903-8.

Monitoring of neuromuscular blockade at the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting.

Arnberger M, Stadelmann K, Alischer P, Ponert R, Melber A, Greif R.

Department of Anesthesiology, Inselspital, University Hospital Bern, Switzerland.

BACKGROUND: Electrical stimulation of the P6 acupuncture point reduces the incidence of postoperative nausea and vomiting (PONV). Neuromuscular blockade during general anesthesia can be monitored with electrical peripheral nerve stimulation at the wrist. The authors tested the effect of neuromuscular monitoring over the P6 acupuncture point on the reduction of PONV. METHODS: In this prospective, double-blinded, randomized control trial, the authors investigated, with institutional review board approval and informed consent, 220 women undergoing elective laparoscopic surgery anesthetized with fentanyl, sevoflurane, and rocuronium. During anesthesia, neuromuscular blockade was monitored by a conventional nerve stimulator at a frequency of 1 Hz over the ulnar nerve (n = 110, control group) or over the median nerve (n = 110, P6 group) stimulating at the P6 acupuncture point at the same time. The authors evaluated the incidence of nausea and vomiting during the first 24 h. RESULTS: No differences in demographic and morphometric data were found between both groups. The 24-h incidence of PONV was 45% in the P6 acupuncture group versus 61% in the control group (P = 0.022). Nausea decreased from 56% in the control group to 40% in the P6 group (P = 0.022), but emesis decreased only from 28% to 23% (P = 0.439). Nausea decreased substantially during the first 6 h of the observation period (P = 0.009). Fewer subjects in the acupuncture group required ondansetron as rescue therapy (27% vs. 39%; P = 0.086). CONCLUSION: Intraoperative P6 acupuncture point stimulation with a conventional nerve stimulator during surgery significantly reduced the incidence of PONV over 24 h. The efficacy of P6 stimulation is similar to that of commonly used antiemetic drugs in the prevention of PONV.

Publication Types: Comparative Study, Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 18043058

BMC Complement Altern Med. 2007 Nov 3;7:35.

Acupuncture in the treatment of rheumatoid arthritis: a double-blind controlled pilot study.

Tam LS, Leung PC, Li TK, Zhang L, Li EK.

The Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

tamls_813@yahoo.com

BACKGROUND: In planning a randomized controlled trial of acupuncture, we conducted a pilot study using validated outcome measures to assess the feasibility of the protocol, and to obtain preliminary data on efficacy and tolerability of 3 different forms of acupuncture treatment as an adjunct for the treatment of chronic pain in patients with Rheumatoid arthritis (RA). METHODS: The study employs a randomized, prospective, double-blind, placebo-controlled trial to evaluate the effect of electroacupuncture (EA), traditional Chinese acupuncture (TCA) and sham acupuncture (Sham) in patients with RA. All patients received 20 sessions over a period of 10 weeks. Six acupuncture points were chosen. Primary outcome is the changes in the pain score. Secondary outcomes included the changes in the ACR core disease measures, DAS 28 score and the number of patients who achieved ACR 20 at week 10. RESULTS: From 80 eligible patients, 36 patients with mean age of 58 +/- 10 years and disease duration of 9.3 +/- 6.4 years were recruited. Twelve patients were randomized to each group. Twelve, 10 and 7 patients from the EA, TCA and Sham group respectively completed the study at 20 weeks (p < 0.03); all except one of the premature dropouts were due to lack of efficacy. At week 10, the pain score remained unchanged in all 3 groups. The number of tender joints was significantly reduced for the EA and TCA groups. Physician's global score was significantly reduced for the EA group and patient's global score was significantly reduced for the TCA group. All the outcomes except patient's global score remained unchanged in the Sham group. CONCLUSION: This pilot study has allowed a number of recommendations to be made to facilitate the design of a large-scale trial, which in turn will help to clarify the existing evidence base on acupuncture for RA.

TRIAL REGISTRATION: ClinicalTrials.gov NCT00404443.

Publication Types: Controlled Clinical Trial, Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17980044

Acta Obstet Gynecol Scand. 2007;86(12):1447-52.

Does acupuncture used in nulliparous women reduce time from prelabour rupture of membranes at term to active phase of labour? A randomised controlled trial.

Selmer-Olsen T, Lydersen S, Mørkved S.

Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Norway.

tone.selmer-olsen@stolav.no

BACKGROUND: To assess if acupuncture influences the onset of labour and the need for induction after prelabour rupture of membranes (PROM) in nulliparous women. Further, to investigate a possible effect of acupuncture on the woman's wellbeing. METHODS: In a randomised controlled trial (RCT), 106 nulliparous women with PROM were allocated to an acupuncture group (AG) or a control group (CG). The outcome measures were time from PROM to onset of active phase of labour, and rate of inductions if labour was absent after 2 days. The women's self-reported wellbeing was registered on a Visual Analogue Scale (VAS). RESULTS: There was no statistically significant difference between the 2 groups regarding time from PROM to active phase (median times in AG versus CG: 15 versus 20.5 h, p=0.34). Additionally, there was no difference between the 2 groups in the need for induction. We found no significant differences in self-reported wellbeing, but the women receiving acupuncture considered their treatment to be more positive than the controls (p=0.003). No adverse effects were reported. CONCLUSIONS: Acupuncture treatment used in nulliparas after PROM showed no significant effect in reducing time to active labour or in reducing rate of inductions. There was no change in wellbeing as a result of acupuncture, but it was considered positive to receive this kind of treatment while waiting for labour to begin.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17963050

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006030.

Acupuncture for glaucoma.

Law SK, Li T.

BACKGROUND: Glaucoma is a multifactorial optic neuropathy in which there is an acquired loss of retinal ganglion cells at levels beyond normal age-related loss and corresponding atrophy of the optic nerve. Although there are many existing treatments, glaucoma is a chronic condition. Some patients may seek complementary or alternative medicine such as acupuncture to supplement their regular treatment. The underlying plausibility of acupuncture is that disorders related to the flow of Chi (the traditional Chinese concept translated as vital force or energy) can be prevented or treated by stimulating the relevant points on the body surface. OBJECTIVES: The objective of this review was to assess the effectiveness and safety of acupuncture in people with glaucoma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, ZETOC, CINAHL, AMED (Allied and Complementary Medicine Database), TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System), CBM (Chinese Biological Database), the Chinese Acupuncture Trials Register and the National Center for Complementary and Alternative Medicine web site (http://nccam.nih.gov/) in February 2006. We ran update searches of CENTRAL, MEDLINE, EMBASE, LILACS and ZETOC in July 2007. We also handsearched Chinese medical journals at Peking Union Medical College Library in April 2007. SELECTION CRITERIA: We planned to include randomized and quasi-randomized clinical trials in which one arm of the study involved acupuncture treatment. DATA COLLECTION AND ANALYSIS: Two authors independently evaluated the search results against the inclusion and exclusion criteria. Discrepancies were resolved by discussion. MAIN RESULTS: We found no randomized clinical trials and subsequently no meta-analysis was conducted. Evidence was limited to a few case series of small sample size. AUTHORS' CONCLUSIONS: At this time, it is impossible to draw reliable conclusions from the available data to support the use of acupuncture for the treatment of glaucoma. Since most glaucoma patients currently cared for by ophthalmologists do not use non-traditional therapy, the clinical practice decisions will have to be based on physician judgement and patients' value given this lack of data in the literature.

Publication Types: Review

PMID: 17943876

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD002914.

Acupuncture for Bell's palsy.

He L, Zhou MK, Zhou D, Wu B, Li N, Kong SY, Zhang DP, Li QF, Yang J, Zhang X.

West China Hospital, Sichuan University, Department of Neurology, Wai Nan Guo Xue Xiang #37, Chengdu, Sichuan, China, 610041.

hlwsy@hotmail.com

BACKGROUND: Bell's palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. OBJECTIVES: The objective of this review was to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group Trials Register, MEDLINE (January 1966 to April 2006), EMBASE (January 1980 to April 2006), LILACS (from January 1982 to April 2006) and the Chinese Biomedical Retrieval System (January 1978 to April 2006) for randomised controlled trials using 'Bell's palsy' and its synonyms, 'idiopathic facial paralysis' or 'facial palsy' as well as search terms including 'acupuncture'. Chinese journals in which we thought we might find randomised controlled trials or controlled clinical trials relevant to our study were handsearched. We reviewed the bibliographies of the randomised trials and contacted the authors and known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA: We included all randomised or quasi-randomised controlled trials involving acupuncture in the treatment of Bell's palsy irrespective of any language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors identified potential articles from the literature search and extracted data independently using a data extraction form. The assessment of methodological quality included allocation concealment, patient blinding, differences at baseline of the experimental groups and completeness of follow-up. Two review authors assessed quality independently. All disagreements were resolved by discussion between the review authors. MAIN RESULTS: Six studies including a total of 537 participants met the inclusion criteria. Five of them used acupuncture while another one used acupuncture combined with drugs. No trials reported on the outcomes specified for this review.Harmful side effects were not reported in any of the trials. Flaws in study design or reporting (particularly uncertain allocation concealment and substantial loss to follow-up) and clinical differences between trials prevented conclusions about the efficacy of acupuncture. AUTHORS' CONCLUSIONS: The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.

Publication Types: Review

PMID: 17943775

Clin Exp Obstet Gynecol. 2007;34(3):137-8.

A matched controlled study to evaluate the efficacy of acupuncture for improving pregnancy rates following in vitro fertilization-embryo transfer.

Wang W, Check JH, Liss JR, Choe JK.

The University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital University Medical Center Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology & Infertility, Camden NJ, USA.

PURPOSE: To determine if acupuncture performed during the follicular phase and luteal phase but not on the day of embryo transfer could improve the outcome following IVF-ET compared to controls. METHODS: Acupuncture was started biweekly from day 5 of the follicular phase through the luteal phase but not on the day of the transfer. Controls were matched according to age, same number of previous failed IVF cycles and same type of embryo transfer (fresh or frozen). RESULTS: The clinical and ongoing (delivered pregnancy rates per transfer) for 32 women undergoing IVF-ET and acupuncture was 40.6% and 37.5%, respectively vs 53.1% and 43.7% for controls. The median number of previous failed IVF cycles was three. CONCLUSIONS: Acupuncture performed twice weekly during the follicular and luteal phase does not seem to improve pregnancy rates following IVF-ET.

Publication Types: Clinical Trial. Controlled Clinical Trial

PMID: 17937084

Emerg Med. 2007 Oct;25(8):887-93.

Prehospital analgesia with acupressure at the Baihui and Hegu points in patients with radial fractures: a prospective, randomized, double-blind trial.

Lang T, Hager H, Funovits V, Barker R, Steinlechner B, Hoerauf K, Kober A.

Department of Anesthesiology and General Intensive Care, Medical University of Vienna, A-1090 Vienna, Austria.

thomas.lang@meduniwien.ac.at

BACKGROUND: Pain during transportation is a common phenomenon in emergency medicine. As acupressure has been deemed effective for pain management by the National Institutes of Health, we conducted a study to evaluate its effectiveness in prehospital patients with isolated distal radial fracture. METHODS: This was a prospective, randomized, double-blind study. Thirty-two patients were enrolled. Acupressure was performed either at "true" points or at "sham" points. Vital signs and pain and anxiety scores were recorded before and after the acupressure treatment. Normally distributed values were compared using the Student t test. RESULTS: Pretreatment scores for pain and anxiety were similar in the 2 groups (47.6 +/- 8.9 vs 51.2 +/- 8.7 visual analog scale [VAS] score for pain, 52.4 +/- 6.0 vs 47.5 +/- 9.3 VAS score for anxiety). At the hospital, patients in the true-points group had significantly lower pain (36.6 +/- 11.0 vs 56.0 +/- 13.3 VAS score, P < .001) and anxiety scores (34.9 +/- 22.2 vs 53.4 +/- 19.7 VAS score, P = .022). CONCLUSION: Acupressure in the prehospital setting effectively reduces pain and anxiety in patients with distal radial trauma.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17920972

Arch Phys Med Rehabil. 2007 Oct;88(10):1276-83.

Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial.

Dyson-Hudson TA, Kadar P, LaFountaine M, Emmons R, Kirshblum SC, Tulsky D, Komaroff E.

Kessler Medical Rehabilitation Research and Education Center, West Orange, NJ 07052, USA.

tdyson-hudson@kmrrec.org

OBJECTIVE: To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury (SCI). DESIGN: Randomized, double blind (participants, evaluator), placebo (invasive sham) controlled trial. SETTING: Clinical research center. PARTICIPANTS: Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain. INTERVENTIONS: Participants were randomly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture (light needling of nonacupuncture points). MAIN OUTCOME MEASURE: Changes in shoulder pain intensity were measured using the Wheelchair User's Shoulder Pain Index. RESULTS: Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups (P=.005), with decreases of 66% and 43%, respectively. There was no significant difference between the 2 groups (P=.364). There was, however, a medium effect size associated with the acupuncture treatment. CONCLUSIONS: There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture. There was a medium treatment effect associated with the acupuncture, which suggests that it may be superior to sham acupuncture. This observation, along with the limited power, indicates that a larger, more definitive randomized controlled trial using a similar design is warranted.

Publication Types: Randomized Controlled Trial Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17908569

Acupunct Med. 2007 Sep;25(3):100-6.

Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid?

Lundeberg T, Lund I.

Rehabilitation Medicine, UniversityClinic, Danderyds Hospital, Stockholm, Sweden.

thomas.lundeberg@ds.se

In recent reviews regarding the efficacy of acupuncture in fibromyalgia syndrome (FMS) it has been concluded that acupuncture has no specific effect since the control procedure (superficial needling and/or needling away from 'specific' points) had similar effects. These conclusions may be questioned since superficial needling and/or needling away from specific trigger points is not inert. Also, manual acupuncture or mild electroacupuncture (EA) may not be sufficient to activate the endogenous pain inhibiting system. Patients with FMS suffer from allodynia, fatigue and muscle ache, which is partly explained by peripheral and central sensitisation. Sensitisation results in augmented and altered stimulus responses whereby light stimulation of the skin has as strong an effect as regular needling on the pain inhibitory system in FMS. Central sensitisation in FMS is also associated with expanded receptive fields of central neurons resulting in a larger topographic distribution of the pain. This would suggest that control procedures using needling away from the 'specific site' might have as strong an effect as needling within the most painful area. Also, repeated nociceptive input from muscles (as obtained by de qi) results in expansion of receptive fields which in turn may result in activation of descending pain inhibition outside the stimulated myotome. Sensitisation to pain, such as in FMS, may also be related to abnormalities in descending efferent pathways. As there is likely to be an imbalance between excitatory and inhibitory systems in FMS, stronger stimulation may therefore be needed to activate the descending pain inhibitory system. In studies using mild manual acupuncture or weak EA stimulation optimal pain inhibition may therefore not have been obtained. When conducting studies on acupuncture, the clinical condition or syndrome needs to be taken into account and the control procedure designed accordingly.

Publication Types: Review

PMID: 17906605

Acupunct Med. 2007 Sep;25(3):87-99.

Acupuncture--self-appraisal and the reward system.

Lundeberg T, Lund I, Näslund J.

Rehabilitation Medicine, UniversityClinic, Danderyds Hospital, Stockholm, Sweden.

thomas.lundeberg@ds.se

Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiological effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle or light tapping of the skin. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and unpleasantness. The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered secondary to its pain alleviating effects. This aspect of acupuncture treatment is likely to be related to activation of self-appraisal and the reward system. When a patient seeks a therapist there are expectations of a specific effect. These expectations are partly based on self-relevant phenomena and self-referentia introspection and constitute the preference. Also, when asked about the effect of the treatment, processes that orientate pre-attentive anticipatory or mnemonic information and processes that mediate self-reflection and recollection are integrated together with sensory detection to enable a decision about the patient's perception of the effect of acupuncture treatment. These 'self-appraisal' processes are dependent on two integrated networks: a ventral medial prefrontal cortex-paralimbic-limbic 'affective' pathway and a dorsal medial prefrontal cortex-cortical-hippocampal 'cognitive' pathway. The limbic structures are implicated in the reward system and play a key role in most diseases and illness responses including chronic pain and depression, regulating mood and neuromodulatory responses (eg sensory, autonomic, and endocrine). The pleasurable and neuromodulatory aspects of acupuncture as well as 'placebo needling' may partly be explained by the activation or deactivation of limbic structures including the hippocampus, amygdala, and their connections with the hypothalamus. In patients with patellofemoral pain, the effects of superficial and deep needling remained for six months. These long term pain-alleviating effects have been attributed to activation of pain inhibiting systems in cortical and subcortical pathways. When considering long term effects the cortical-cerebellar system needs to be taken into account. The cortical-cerebellar system is probably central to the development of neural models that learn and eventually stimulate routinely executed (eg motor skills) and long term (eg pain alleviation) cognitive processes. These higher order cognitive processes are initially mediated in prefrontal cortical loci but later shift control iteratively to internal cerebellar representations of these processes. Possibly part of the long term healing effects of acupuncture may be attributed to changes in the cerebellar system thereby sparing processing load in cortical and subcortical areas. As cortical and subcortical structures are activated and/or de-activated following stimulation of receptors in the skin, disregarding site, 'placebo or sham needling' does not exist and conclusions drawn on the basis that it is an inert control are invalid. 'Self' may be seen as a shifting illusion, ceaselessly constructed and deconstructed, and the effect of acupuncture may reflect its status (as well as that of the therapist).

Publication Types: Review

PMID: 17906602

Acupunct Med. 2007 Sep;25(3):65-71.

Acupuncture for mild to moderate emotional complaints in pregnancy--a prospective, quasi-randomised, controlled study.

Bosco Guerreiro da Silva J.

Medical School of Sãao José do Rio Preto, Brazil.

jbgsilva@hotmail.com

BACKGROUND: The aim of this study was to describe the effects of acupuncture under real life conditions, in the treatment of emotional complaints during pregnancy. METHODS: A group of 51 conventionally treated pregnant women (with counselling by their physicians and nurses) was allocated by chance into two groups to be either treated or not by acupuncture. Both groups (28 in the study group and 23 in the control group) presented emotional complaints such as anxiety, depression and irritability. They reported the severity of symptoms using a Numerical Rating Scale (NRS) from 0 to 10; and they rated how much the symptoms disturbed five aspects of their lives: mood, sleep, relationships, social activities, sexual life and joy of living. Traditional acupuncture was used. In order to facilitate protocols we used pre-programmed points. Up to four points were permitted as optional points. RESULTS: Three women from the acupuncture group and four from the control group dropped out of the study. Over the study period, the NRS scores of intensity of emotional distress decreased by at least half in 15/25 (60%) of patients in the study group and in 5/19 (26%) of those in the control group (P=0.013). The impact of the distress on three out of the five aspects of life was significantly less in the acupuncture group when compared with the control group (P<0.05). CONCLUSIONS: Emotional complaints are very common in pregnancy and medication is always a risk. In this study, acupuncture seems to be an efficacious means of reducing symptoms and improving the quality of life of women with emotional complaints during pregnancy. Large randomised studies are recommended to confirm these results.

Publication Types: Clinical Trial

PMID: 17906599

Physiol Meas. 2007 Oct;28(10):N77-86. Epub 2007 Sep 18.

Microcirculatory characteristics of acupuncture points obtained by laser Doppler flowmetry.

Hsiu H, Huang SM, Chao PT, Jan MY, Hsu TL, Wang WK, Wang YY.

Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, Republic of China.

hhsiu@saturn.yzu.edu.tw

Acupuncture points (acupoints) form part of the meridian system that constitutes the most fundamental concept in oriental medicine, but their physiological basis has not been clarified. In this study we employed laser Doppler flowmetry (LDF) to extract the microcirculatory characteristics of acupoints and their surrounding tissues, and we interpreted the results from the viewpoint of microcirculatory physiology. Three groups of measurements were performed focusing on the following two important acupoints in oriental medicine in healthy volunteers (n = 13 for group A and n = 9 for groups B and C, respectively): Hoh-Ku (Li4, on the hand) and Ching-Ku (B64, on the foot). The two groups of measurements around Hoh-Ku (Groups A and B) were so designed as to examine the effect of the direction of the nonacupoint away from the acupoint, whereas comparison between the Hoh-Ku and the Ching-Ku measurements was to verify whether the phenomenon was consistent in the upper and the lower extremities. We found that the mean LDF signals were significantly larger at the acupoints than in their surrounding tissues (all p < 0.05), which indicates a larger blood supply into the microvascular beds of acupoints. The results indicate that the physical properties of the vascular structure of acupoints may affect the perfusion resistance, and thereby modulate the microcirculatory perfusion in accordance with tissue needs. This finding facilitates the localization of acupoints, helps in identifying the connection between microcirculatory physiology and responses to acupoint stimulation, and introduces an objective research method for understanding the mechanisms that underlie oriental medicine.

Publication Types: Clinical Trial. Research Support, Non-U.S. Gov't

PMID: 17906382

Chin J Integr Med. 2007 Sep;13(3):228-30.

Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine.

Zhang GJ, Shi ZY, Liu S, Gong SH, Liu JQ, Liu JS.

Department of Psychology, Hospital of Traditional Chinese Medicine of Shiyan City, Hubei, 442012, China.

OBJECTIVE: To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture (EA) in treating depression. METHODS: Forty-two patients with depression were randomly assigned to the observation group (22 patients) treated with EA combined with Paroxetine, and the control group (20 patients) treated with Paroxetine alone, and the therapeutic course for both groups was 6 weeks. The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale (HAMD) and treatment emergent symptoms scale (TESS), respectively. RESULTS: HAMD scores determined at the end of the 1st, 2nd, 4th, and 6th week of the treatment course were significantly lower in the observation group than those in the control group (P<0.05). The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group (72.7% vs 40.0%). No significant difference of TESS scores was found between the two groups. CONCLUSION: EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone, with milder adverse reaction and quicker initiation of effect.

Publication Types: Randomized Controlled Trial

PMID: 17898957

Arch Intern Med. 2007 Sep 24;167(17):1892-8.

German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.

Haake M, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A.

Orthopaedic Department, University of Regensburg, Bad Abbach, Germany.

BACKGROUND: To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain. METHODS: A patient- and observer-blinded randomized controlled trial conducted in Germany involving 340 outpatient practices, including 1162 patients aged 18 to 86 years (mean +/- SD age, 50 +/- 15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). Primary outcome was response after 6 months, defined as 33% improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement. RESULTS: At 6 months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs sham, 3.4% (95% confidence interval, -3.7% to 10.3%; P = .39); verum vs conventional therapy, 20.2% (95% confidence interval, 13.4% to 26.7%; P < .001); and sham vs conventional therapy, 16.8% (95% confidence interval, 10.1% to 23.4%; P < .001. CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17893311

Clin J Pain. 2007 Oct;23(8):714-9.

Should we recruit patients or healthy volunteers for acupuncture studies of chronic pain?

White P, Lewith G, Prescott P.

School of Health Professions and Rehabilitation Sciences, University of Southampton, Highfield, UK.

pjw1@soton.ac.uk

OBJECTIVE: The aim of this study was to compare the results of healthy volunteers with patients in chronic pain, in terms of acupuncture needle sensation. The search for a credible mechanism that underpins the effect of acupuncture in pain has recently involved the use of brain imaging techniques in an attempt to identify the neural correlates involved in pain control. Such studies have usually enrolled healthy participants rather than patients. This practice might be inappropriate as we are unsure if we can generalize from healthy volunteers to patients in chronic pain. METHOD: This paper describes a comparison of data obtained from 2 small randomized controlled studies, 1 involving patients with chronic pain and the other which recruited healthy volunteers. Both studies used real acupuncture and a nonpenetrating "placebo" needle in a crossover design. The outcome studied in this paper was a comprehensive needling sensation questionnaire. RESULTS: There was a difference in the sensations experienced by patients as compared with healthy volunteers. Patients tended to feel much stronger sensation. Neither group differed in distinguishing between real and placebo needling. However, patients were more likely to state that both needles were real, whereas healthy participants were more likely to suggest that neither were real. DISCUSSION: It is concluded that if the nature of the sensation felt is of importance, then it might be inappropriate to recruit healthy volunteers in lieu of patients and a larger study is required to clarify this.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17885351

Med J Aust. 2007 Sep 17;187(6):337-41.

Acupuncture for persistent allergic rhinitis: a randomised, sham-controlled trial.

Xue CC, An X, Cheung TP, Da Costa C, Lenon GB, Thien FC, Story DF.

Division of Chinese Medicine, School of Health Sciences, World Health Organization Collaborating Centre for Traditional Medicine, RMIT University, Melbourne, VIC, Australia.

charlie.xue@rmit.edu.au

OBJECTIVE: To investigate the effectiveness and safety of acupuncture in persistent allergic rhinitis (PAR) DESIGN: Randomised, single-blind, sham-controlled trial conducted from May 2004 to February 2005. PARTICIPANTS AND INTERVENTION: 80 patients with PAR (age, 16-70 years) were randomly assigned to receive real or sham acupuncture. After a 1-week baseline period, participants were treated twice weekly for 8 weeks and followed up for another 12 weeks. MAIN OUTCOME MEASURES: Nasal obstruction, sneezing, rhinorrhoea and nasal itch were each self-assessed daily on a 5-point scale, and scores were aggregated weekly. The sum of the symptom scores (total nasal symptom score, TNSS) was also determined. A secondary outcome was use of PAR relief medication. RESULTS: After 8 weeks' treatment, the weekly mean difference in TNSS from baseline was greater with real (-17.2; 95% CI, -24.6 to -9.8) than with sham acupuncture (-4.2; 95% CI, -11.0 to 2.7) (P = 0.01). The decrease in individual symptom score was also greater with real acupuncture for rhinorrhoea (P < 0.01) but not the other symptoms. At the end of follow-up, the greater difference in TNSS from baseline in the real acupuncture group was still apparent: real, -21.0 (95% CI, -29.1 to -12.9) versus sham, - 2.3 (95% CI, -10.2 to 5.6) (P = 0.001). Moreover, the differences from baseline in all four individual symptom scores were greater for the real than for the sham group (P < 0.05). Real and sham acupuncture were both well tolerated. CONCLUSION: Our findings suggest that acupuncture is effective in the symptomatic treatment of PAR. TRIAL REGISTRATION: Australian Government Therapeutic Goods Administration CTN 034/2004.

Publication Types: Randomized Controlled Trial.

PMID: 17874980

Expert Rev Neurother. 2007 Sep;7(9):1121-34.

Role of acupuncture in the treatment of migraine.

Endres HG, Diener HC, Molsberger A.

Ruhr University Bochum, Department of Medical Informatics, Statistics & Epidemiology, D-44801 Bochum, Germany.

heinz.endres@ruhr-uni-bochum.de

Since the last Cochrane review of acupuncture and headache in 2001, which found methodological and/or reporting shortcomings in the majority of the studies, several large, randomized trials on the effectiveness of acupuncture as a treatment for headache have been published. Following a brief overview of the pathophysiology of migraine and possible action mechanisms of acupuncture, we look at current studies on acupuncture and migraine and discuss the results. From these results and our own studies on acupuncture and migraine, we conclude that a 6-week course of acupuncture is not inferior to a 6-month prophylactic drug treatment, but that specific Chinese point selection, point stimulation and needling depth are not as important as had been thought. The review suggests that acupuncture should be integrated into existing migraine therapy protocols.

Publication Types: Meta-AnalysisReview

PMID: 17868011

Climacteric. 2007 Oct;10(5):371-80.

Acupuncture in managing menopausal symptoms: hope or mirage?

Alfhaily F, Ewies AA.

Department of Obstetrics and Gynaecology, Ipswich Hospital NHS Trust, Suffolk, UK.

There is an increased interest amongst women in seeking alternatives for hormone replacement therapy because of their fear of side-effects. It is claimed that acupuncture is effective for curing menopausal symptoms, and to be a safe treatment in the hands of well-trained and qualified practitioners. About one million acupuncture treatments are given in the National Health Service and two million privately each year in England for various indications. However, because its mechanism of action is not fully understood in physiological terms, acupuncture is considered by many clinicians to be of no value. This article reviews the currently available evidence as regards the effectiveness and safety of acupuncture in treating menopausal symptoms.

Publication Types: Review

PMID: 17852139

Clin Rehabil. 2007 Aug;21(8):719-28.

Effects of acupuncture and sham acupuncture in addition to physiotherapy in patients undergoing bilateral total knee arthroplasty--a randomized controlled trial.

Tsang RC, Tsang PL, Ko CY, Kong BC, Lee WY, Yip HT.

Physiotherapy Department, Queen Mary Hospital, Hong Kong, China.

tsangccr@ha.org.hk

OBJECTIVE: To compare the acute effects of acupuncture with sham acupuncture on knee pain, range of motion and ambulation in patients with knee osteoarthritis undergoing bilateral total knee arthroplasty, when added to a standard postoperative physiotherapy programme. DESIGN: Prospective patient- and assessor-blinded randomized controlled trial. SETTING: Acute inpatient physiotherapy department. PATIENTS: Thirty patients (24 women and 6 men) undergoing bilateral total knee arthroplasty were included for final analysis in the study. INTERVENTIONS: Both groups received a standard postoperative physiotherapy programme. Each patient was also given either 10 sessions of acupuncture or sham acupuncture within two weeks. MAIN OUTCOME MEASURES: The primary outcome measures were the levels of pain at rest and at maximum after exercise measured by the numeric pain rating scale. Other outcome measures included active and passive ranges of knee motion measured by standard goniometer, and ambulation measured by the timed up-and-go test. RESULTS: Thirty-six patients were recruited at the start of the study with 18 patients allocated to the acupuncture group and another 18 patients to the sham acupuncture group. On postoperative day 15, there were 30 patients with complete data; three patients in each group dropped out from the study. The mean differences (95% confidence interval (CI)) in overall averages of postoperative mean pain levels were 0.4 (-0.6 to 1.3) and -0.8 (-2.0 to 0.4) at rest and at maximum respectively. There were no significant differences in the active and passive ranges of knee motion and the time for the timed up-and-go test between the two groups. CONCLUSION: There is no difference between the acute effects of acupuncture and sham acupuncture in addition to standard postoperative physiotherapy programme in patients with knee osteoarthritis undergoing bilateral total knee arthroplasty.

Publication Types: Randomized Controlled Trial.

PMID: 17846072

Integr Cancer Ther. 2007 Sep;6(3):251-7.

The neuroimmune basis of anti-inflammatory acupuncture.

Kavoussi B, Ross BE.

Southern California University of Health Sciences, College of Acupuncture and Oriental Medicine, Whittier, CA, USA.

kavoussi@ucla.edu

This review article presents the evidence that the antiinflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system. Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity. There is also experimental evidence that the electrical stimulation of the vagus nerve inhibits macrophage activation and the production of TNF, IL-1beta , IL-6, IL-18, and other proinflammatory cytokines. It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of traditional and electro-acupuncture are directly or indirectly mediated by the efferent vagus nerve activation and inflammatory macrophage deactivation. In view of this common physiological mediation, assessing the clinical efficacy of a specific acupuncture regimen using conventional double-blind placebo-controlled trials inherently lacks objectivity due to (1) the uncertainty of ancient rules for needle placement, (2) the diffuse noxious inhibitory control triggered by control-needling at irrelevant points, (3) the possibility of a dose-response relationship between stimulation and effects, and (4) the possibility of inadequate blinding using an inert sham procedure. A more objective assessment of its efficacy could perhaps consist of measuring its effects on the surrogate markers of autonomic tone and inflammation. The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity.

Publication Types: Review

PMID: 17761638

Oncol Nurs Forum. 2007 Jul;34(4):813-20.

Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial.

Dibble SL, Luce J, Cooper BA, Israel J, Cohen M, Nussey B, Rugo H.

Institute for Health and Aging, School of Nursing, University of California, San Francisco, USA.

sue.dibble@gmail.com

PURPOSE/OBJECTIVES: To compare differences in the chemotherapy-induced nausea and vomiting (CINV) among three groups of women (acupressure, placebo acupressure, and usual care) undergoing chemo-therapy for breast cancer. DESIGN: A multicenter, longitudinal, randomized clinical trial throughout one cycle of chemotherapy. SETTING: Ten community clinical oncology programs associated with the M.D. Anderson Cancer Center and nine independent sites located throughout the United States. SAMPLE: 160 women who were beginning their second or third cycle of chemotherapy for breast cancer treatment and had moderate nausea intensity scores with their previous cycles. METHODS: Subjects were randomized to one of three groups: acupressure to P6 point (active), acupressure to SI3 point (placebo), or usual care only. Subjects in the acupressure group were taught to apply an acupressure wrist device by research assistants who were unaware of the active acupressure point. All subjects completed a daily log for 21 days containing measures of nausea and vomiting and recording methods (including antiemetics and acupressure) used to control these symptoms. MAIN RESEARCH VARIABLES: Acute and delayed nausea and vomiting. RESULTS: No significant differences existed in the demographic, disease, or treatment variables among the treatment groups. No significant differences were found in acute nausea or emesis by treatment group. With delayed nausea and vomiting, the acupressure group had a statistically significant reduction in the amount of vomiting and the intensity of nausea over time when compared with the placebo and usual-care groups. No significant differences were found between the placebo and usual-care groups in delayed nausea or vomiting. CONCLUSIONS: Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for women undergoing treatment for breast cancer to reduce the amount and intensity of delayed CINV. IMPLICATIONS FOR NURSING: Acupressure is a safe and effective tool for managing delayed CINV and should be offered to women undergoing chemotherapy for breast cancer.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, N.I.H., Extramural

PMID: 17723973

J Altern Complement Med. 2007 Jul-Aug;13(6):669-76.

Auricular acupuncture treatment for insomnia: a systematic review.

Chen HY, Shi Y, Ng CS, Chan SM, Yung KK, Zhang QL.

School of Chinese Medicine, Hong Kong Baptist University, Hong Kong.

hoiyong@gmail.com

OBJECTIVES: To review trials on the efficacy and safety of auricular acupuncture (AA) treatment for insomnia and to identify the most commonly used auricular acupoints for treating insomnia in the studies via a frequency analysis. DATA SOURCES: The international electronic databases searched included: (1) AMED; (2) the Cochrane library; (3) CINAHL; (4) EMBASE; and (5) MEDLINE. Chinese electronic databases searched included: (1) VIP Information; (2) CBMdisc; and (3) CNKI. STUDY SELECTION: Any randomized controlled trials using AA as an intervention without using any co-interventions for insomnia were included. Studies using AA versus no treatment, placebo, sham AA, or Western medicine were included. DATA EXTRACTION: Two (2) independent reviewers were responsible for data extraction and assessment. The efficacy of AA was estimated by the relative risk (RR) using a meta-analysis. RESULTS: Eight hundred and seventy eight (878) papers were searched. Six (6) trials (402 treated with AA among 673 participants) that met the inclusion criteria were retrieved. A meta-analysis showed that AA was chosen with a higher priority among the treatment subjects than among the controls (p < 0.05). The recovery and improvement rates produced by AA was significantly higher than those of diazepam (p < 0.05). The rate of success was higher when AA was used for enhancement of sleeping hours up to 6 hours in treatment subjects (p < 0.05). The efficacy of using Semen vaccariae ear seeds was better than that of the controls (p < 0.01); while magnetic pearls did not show statistical significance (p = 0.28). Six (6) commonly used auricular acupoints were Shenmen (100%), Heart (83.33%), Occiput (66.67%), Subcortex (50%), Brain and Kidney (each 33.33%, respectively). CONCLUSIONS: AA appears to be effective for treating insomnia. Because the trials were low quality, further clinical trials with higher design quality, longer duration of treatment, and longer follow-up should be conducted.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17718650

J Altern Complement Med. 2007 Jul-Aug;13(6):603-16.

Neuroimaging acupuncture effects in the human brain.

Dhond RP, Kettner N, Napadow V.

Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA.

polly@nmr.mgh.harvard.edu

Acupuncture is an ancient East Asian healing modality that has been in use for more than 2000 years. Unfortunately, its mechanisms of action are not well understood, and controversy regarding its clinical efficacy remains. Importantly, acupuncture needling often evokes complex somatosensory sensations and may modulate the cognitive/affective perception of pain, suggesting that many effects are supported by the brain and extending central nervous system (CNS) networks. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans and may be used to help map the neurophysiological correlates of acupuncture. In this review, we will summarize data from acupuncture neuroimaging research and discuss how these findings contribute to current hypotheses of acupuncture action.

Publication Types: Research Support, N.I.H., Extramural Review

PMID: 17718643

J Gerontol Nurs. 2007 Aug;33(8):23-8; quiz 30-1.

Auricular acupuncture for insomnia: duration and effects in Korean older adults.

Kim KB, Sok SR.

College of Nursing Science, Kyung Hee University, Seoul, Korea.

This study examined the duration and effects of auricular acupuncture on insomnia in a sample of 28 Korean older adults. The design was a group, pretest-posttest, repeated-measures study. Measures were the Sleep State Tool and the Sleep Satisfaction Tool. The effects of auricular acupuncture on insomnia among Korean older adults were significant. The duration effects of auricular acupuncture were maintained for 2 weeks. Clinicians should consider providing auricular acupuncture as an alternative method for improving quality of sleep in older adults.

Publication Types: Controlled Clinical Trial Research Support, Non-U.S. Gov't

PMID: 17718375

Pain Pract. 2007 Sep;7(3):256-64.

The short-term effects of acupuncture on myofascial pain patients after clenching.

Shen YF, Goddard G.

Center for Orofacial Pain, Dep. of Oral and Maxillofacial Surgery, University of California San Francisco, California 94143-0768, USA.

yosh9898@yahoo.com

AIM: Short-term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11-point (0 to 10) numeric rating scale, visual analog scale (VAS), and pain rating of mechanical pressure on the masseter muscle. METHODS: A single-blind, randomized, controlled, clinical trial with an independent observer was performed. Fifteen chronic myofascial pain subjects over the age of 18 were randomly assigned into groups: nine subjects received real acupuncture; six subjects received sham acupuncture. Each subject clenched his/her teeth for 2 minutes. Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint. Sham acupuncture was conducted by lightly pricking the skin with a shortened, blunted acupuncture needle through a foam pad, without penetrating the skin. The foam pad visually conceals the needle's point of the entry, so that the subject cannot discern which technique is being used. The subjects rated their general pain on a numeric rating scale. A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS. Statistical analysis was performed using the repeated measures anova, paired t-tests, and Fisher's exact test as appropriate. RESULTS: There was a statistically significant difference in pain tolerance with acupuncture (P = 0.027). There was statistically significant reduction in face pain (P = 0.003), neck pain (P = 0.011), and headache (P = 0.015) with perception of real acupuncture. CONCLUSION: Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture.

Publication Types: Comparative Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17714105

Electromyogr Clin Neurophysiol. 2007 Jul;47(4-5):243-50.

Electromyographic evaluation of the masseter and temporal muscles activity in volunteers submitted to acupuncture.

de Sousa RA, Semprini M, Vitti M, Borsatto MC, Hallak Regalo SC.

Department of Dental Materials and Prosthesis Ribeirão Preto School of Dentistry, University of São Paulo (USP), Brazil.

AIM: To assess the effect of acupuncture on the temporal and masseter muscles activity employing surface electromyography. METHODS: Thirty volunteers were evaluated according to three groups of acupuncture application: selected local points, selected points at distance and association of local and distant points. Bipolar surface electrodes were positioned bilaterally on the anterior portion of temporal muscle, as well as in the median region of masseter muscle. An electromyograph connected to a computer and a specific software registered the muscular activity before and after acupuncture, in the following experimental conditions: 1- Rest Position (RP); 2- Maximum Intercuspation Clenching (MIC); 3- Bilateral Molar Clenching with Cotton Rolls (BMCCR). The mean values obtained for the activities of the studied muscles were submitted to Analysis of Variance and Tukey complementary test. RESULTS: The electromyographic activity of the studied muscles was lower after the application of the methods of acupuncture in the Rest, and higher after the application of the acupuncture in the Maximum Intercuspation Clenching; the electromyographic activity of the temporal muscle was higher than the masseter muscle in the Rest and lower in the Bilateral molar clenching with cotton rolls; the electromyographic activity showed to be modified after the three used methods of acupuncture in the Maximum Intercuspation Clenching. In this clinical condition, the method of long-distance acupuncture was higher than the application of local needles and the associated method. CONCLUSION: Acupuncture provided alterations in the activity of the studied muscles, favoring conditions of rest and muscular tightness.

Publication Types: Randomized Controlled Trial.

PMID: 17711042

Complement Ther Med. 2007 Sep;15(3):180-9.

Physician and treatment characteristics in a randomised multicentre trial of acupuncture in patients with osteoarthritis of the knee.

Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Hummelsberger J, Irnich D, Hammes M, Pach D, Melchart D, Willich SN.

Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Humboldt University of Berlin, 10098 Berlin, Germany.

benno.brinkhaus@charite.de

OBJECTIVE: The aim of this paper is to describe the treatment and physician characteristics in a randomised trial of acupuncture for osteoarthritis of the knee. DESIGN: Three-armed, randomised, controlled multicentre trial with 1-year follow-up. SETTING: Twenty-eight outpatient centres in Germany. INTERVENTIONS: A total of 294 patients with osteoarthritis of the knee were randomised to 12 sessions of semi-standardised acupuncture (at least 6 local and 2 distant points needled per affected knee from a selection of predefined points, but individual choice of additional body or ear acupuncture points possible), 12 sessions of minimal acupuncture (superficial needling of at least 8 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list control (2 months no acupuncture). OUTCOME: Participating trial physicians and interventions. RESULTS: Forty-seven physicians specialised in acupuncture (mean age 43+/-8 years, 26 females) provided study interventions in 28 outpatient centres in Germany. The median duration of acupuncture training completed by participating physicians was 350 h (range 140-2508). The total number of needles used was 17.4+/-4.8 in the acupuncture group compared to 12.9+/-3.3 in the minimal acupuncture group. In total, 39 physicians (83%) stated that they would have treated patients in either a similar or in exactly the same way outside of the trial, whereas 7 (15%) stated that they would have treated patients differently (1 missing). CONCLUSIONS: Our documentation of the trial interventions shows that semi-standardised acupuncture strategy represents an acceptable compromise for efficacy studies. However, a substantial minority of participating trial physicians stated that they would have treated patients differently outside of the trial.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17709063

Complement Ther Med. 2007 Sep;15(3):172-9.

Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain.

Itoh K, Katsumi Y, Hirota S, Kitakoji H.

Department of Clinical Acupuncture and Moxibustion, Meiji University of Oriental Medicine, Kyoto 629-0392, Japan.

k_itoh@muom.meiji-u.ac.jp

INTRODUCTION: There is some evidence for the efficacy of acupuncture in chronic neck pain (CNP) treatment, but it remains unclear which acupuncture modes are most effective. Objective was to evaluate the effects of trigger point acupuncture on pain and quality of life (QOL) in CNP patients compared to three other acupuncture treatments (acupoints, non-trigger point and sham treatment). METHODS: Forty out-patients (29 women, 11 men; age range: 47-80 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating CNP for at least 6 months and normal neurological examination were randomised to one of four groups over 13 weeks. Each group received two phases of acupuncture treatment with an interval between them. The acupoint group (standard acupuncture; SA, n=10) received treatment at traditional acupoints for neck pain, the trigger point (TrP, n=10) and non-trigger point (non-TrP, n=10) groups received treatment at tenderness points for the same muscle, while the other acupuncture group received sham treatments on the trigger point (SH, n=10). Outcome measures were pain intensity (visual analogue scale; VAS 0-100mm) and disease specific questionnaire (neck disability index; NDI, 60-point scale). RESULTS: After treatment, the TrP group reported less pain intensity and improved QOL compared to the SA or non-TrP group. There was significant reduction in pain intensity between the treatment and the interval for the TrP group (p<0.01, Dunnett's multiple test), but not for the SA or non-TrP group. CONCLUSION: These results suggest that trigger point acupuncture therapy may be more effective on chronic neck pain in aged patients than the standard acupuncture therapy.

Publication Types: Comparative Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17709062

BMJ. 2007 Sep 1;335(7617):436.

Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial.

Foster NE, Thomas E, Barlas P, Hill JC, Young J, Mason E, Hay EM.

Primary Care Musculoskeletal Research Centre, Keele University, Stafford ST5 5BG.

n.foster@keele.ac.uk

OBJECTIVE: To investigate the benefit of adding acupuncture to a course of advice and exercise delivered by physiotherapists for pain reduction in patients with osteoarthritis of the knee. DESIGN: Multicentre, randomised controlled trial. SETTING: 37 physiotherapy centres accepting primary care patients referred from general practitioners in the Midlands, United Kingdom. PARTICIPANTS: 352 adults aged 50 or more with a clinical diagnosis of knee osteoarthritis. INTERVENTIONS: Advice and exercise (n=116), advice and exercise plus true acupuncture (n=117), and advice and exercise plus non-penetrating acupuncture (n=119). MAIN OUTCOME MEASURES: The primary outcome was change in scores on the Western Ontario and McMaster Universities osteoarthritis index pain subscale at six months. Secondary outcomes included function, pain intensity, and unpleasantness of pain at two weeks, six weeks, six months, and 12 months. RESULTS: Follow-up rate at six months was 94%. The mean (SD) baseline pain score was 9.2 (3.8). At six months mean reductions in pain were 2.28 (3.8) for advice and exercise, 2.32 (3.6) for advice and exercise plus true acupuncture, and 2.53 (4.2) for advice and exercise plus non-penetrating acupuncture. Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval -1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (-0.8 to 1.3) for advice and exercise plus non-penetrating acupuncture. Similar non-significant differences were seen at other follow-up points. Compared with advice and exercise alone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for non-penetrating acupuncture. CONCLUSION: The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores. Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects. TRIAL REGISTRATION: Current Controlled Trials ISRCTN88597683 [controlled-trials.com] .

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17699546

Top Stroke Rehabil. 2007 Jul-Aug;14(4):40-58.

Does acupuncture work for stroke rehabilitation: what do recent clinical trials really show?

Shiflett SC.

Department of Psychology, University of Arizona, Tucson, AZ, USA.

A number of randomized controlled trials of acupuncture for stroke recovery were critically reviewed, beginning with an existing systematic review and meta-analysis. A number of these clinical studies suffered from methodological flaws that tended to obscure and reduce the reported effect size. These flaws included inadequate statistical analysis, failure to adequately account for differences in baseline stroke severity, and the use of an inadequate posttreatment assessment period. These three flaws, taken individually or in combination, resulted in the underreporting of acupuncture effects in 5 of the randomized controlled trials reviewed. By informally adjusting study results for these limitations, it was possible to demonstrate that acupuncture is probably much more effective in assisting stroke recovery than has generally been reported, especially when the stroke is in the moderately severe range. The negative impact of well-intended but inappropriate exclusion criteria in the meta-analysis was also illustrated. The importance of giving more attention to ancillary results, such as walking speed and mortality, was illustrated as a way to gain a deeper understanding of the true impact of a still poorly understood therapy such as acupuncture. The general conclusion of the reanalysis presented here is that there is in fact substantial evidence that acupuncture is effective as an adjunctive treatment for facilitating stroke recovery.

Publication Types: Research Support, U.S. Gov't, Non-P.H.S. Review

PMID: 17698457

J Chin Med Assoc. 2007 Aug;70(8):331-8.

A randomized controlled clinical trial of auricular acupuncture in smoking cessation.

Wu TP, Chen FP, Liu JY, Lin MH, Hwang SJ.

Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

BACKGROUND: Tobacco smoking is responsible for human diseases of the lung, heart, circulatory system and various kinds of cancers, and is a serious public health problem worldwide. Acupuncture has been promoted as a treatment modality for smoking cessation. However, its efficacy still remains controversial. METHODS: We conducted a prospective, randomized, controlled trial using auricular acupuncture for smoking cessation in 131 adults who wanted to stop smoking. Thirteen subjects withdrew from the study and 118 subjects were included in the final analyses (mean age, 53.7 +/- 16.8 years; 100 males, 18 females). The treatment group (n = 59) received auricular acupuncture in Shen Men, Sympathetic, Mouth and Lung points for 8 weeks. The control group (n = 59) received sham acupuncture in non-smoking-cessation-related auricular acupoints (Knee, Elbow, Shoulder and Eye points). The enrolled subjects were then followed monthly for 6 months after stopping the acupuncture treatment. RESULTS: Between both groups before acupuncture treatment, there was no significant difference with regard to gender, mean age, education level, and mean values for the age at which smoking started, smoking duration, daily number of cigarettes smoked and nicotine dependent score. At the end of treatment, cigarette consumption had significantly decreased in both groups, but only the treatment group showed a significant decrease in the nicotine withdrawal symptom score. Smoking cessation rate showed no significant difference between the treatment group (27.1%) and the control group (20.3%) at the end of treatment. There was also no significant difference in the smoking cessation rate between the treatment group (16.6%) and the control group (12.1%) at the end of follow-up. There were no major side effects of auricular acupuncture in both groups. CONCLUSION: Our results showed that auricular acupuncture did not have a better efficacy in smoking cessation compared to sham acupuncture. Combined acupuncture with behavior counseling or with nicotine replacement therapy should be used in further smoking cessation trials to enhance the success rate of smoking cessation.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17698433

Adv Ther. 2007 May-Jun;24(3):598-602.

Dorsal root ganglion: the target of acupuncture in the treatment of asthma.

Feng JT, Hu CP, Li XZ.

Department of Respiratory Medicine, Xiangya Hospital of Central South University, Hunan, China.

Recently, high levels of neurotrophic factors have been found in bronchial asthma; these factors include nerve growth factor, brain-derived neurotrophic factor, and leukemia inhibitory factor, among others. Neurotrophic factors are first synthesized in bronchial epithelial cells, immune cells, and other cells in the airway; they are then taken up by the synapse and are finally transported to dorsal root ganglia (C7-T5). Increased neurotrophic factors in dorsal root ganglia promote the synthesis and release of substance P. As a result, substance P causes a series of reactions such as contraction of airway smooth muscles, secretion of mucous fluids, seepage of capillary vessels, release of mediators of inflammation, and aggravation of airway hyperreactivity. It is interesting to note that the anatomic locations of dorsal root ganglia (C7-T5) are similar to a series of acupuncture points in traditional Chinese medicine. These points are all situated on 2 sides of the midspinal line, and most of them belong to Back-shu acupuncture points. In traditional Chinese medicine, Back-shu points can be used to treat patients with bronchial asthma through acupuncture and moxibustion. Is it a coincidence, or is there a real connection? These points possess similar neurotonia, physical function, and therapeutic effects; the functional area of Back-shu is composed of these points. When these points are pricked with a needle along the lower border of the spinous process, dorsal root ganglia and spinal nerves are stimulated; this can help to regulate the synthesis and release of neurotransmitters. It is hypothesized that dorsal root ganglia may be the targets of acupuncture in the treatment of asthma; in this process, acupuncture has an inhibitory effect on the uptake of neurotrophic factors, or it inhibits the synthesis and release of substance P in dorsal root ganglia. As a result, airway neurogenic inflammation in asthma is relieved.

Publication Types: Review

PMID: 17660170

World J Gastroenterol. 2007 Jul 7;13(25):3417-24.

Acupuncture treatment in gastrointestinal diseases: a systematic review.

Schneider A, Streitberger K, Joos S.

Department of General Practice and Health Services Research, University Medical Hospital Heidelberg, Vossstrasse 2, Heidelberg 69120, Germany.

antonius.schneider@med.uni-heidelberg.de

The purpose of this work was to assess the evidence for effectiveness of acupuncture (AC) treatment in gastrointestinal diseases. A systematic review of the Medline-cited literature for clinical trials was performed up to May 2006. Controlled trials assessing acupuncture point stimulation for patients with gastrointestinal diseases were considered for inclusion. The search identified 18 relevant trials meeting the inclusion criteria. Two irritable bowel syndrome (IBS) trials, 1 Crohn's disease and 1 colitis ulcerosa trial had a robust random controlled trial (RCT) design. In regard to other gastrointestinal disorders, study quality was poor. In all trials, quality of life (QoL) improved significantly independently from the kind of acupuncture, real or sham. Real AC was significantly superior to sham acupuncture with regard to disease activity scores in the Crohn and Colitis trials. Efficacy of acupuncture related to QoL in IBS may be explained by unspecific effects. This is the same for QoL in inflammatory bowel diseases (IBD), whereas specific acupuncture effects may be found in clinical scores. Further trials for IBDs and in particular for all other gastrointestinal disorders would be necessary to evaluate the efficacy of acupuncture treatment. However, it must be discussed on what terms patients benefit when this harmless and obviously powerful therapy with regard to QoL is demystified by further placebo controlled trials.

Publication Types: Review

PMID: 17659687

J Adv Nurs. 2007 Sep;59(5):510-9.

Effect of Nei-Guan point (P6) acupressure on ketonuria levels, nausea and vomiting in women with hyperemesis gravidarum.

Shin HS, Song YA, Seo S.

College of Nursing Science, Kyung Hee University, Seoul, South Korea.

suksh@khu.ac.kr

AIM: This paper is a report of a study to examine the effect of Nei-Guan point acupressure on nausea, vomiting and ketonuria levels in women diagnosed with hyperemesis gravidarum. BACKGROUND: Previous studies have shown that acupressure application on the Nei-Guan point is effective in relieving nausea and vomiting associated with pregnancy and surgery. However, no findings have been supported by physiological data. METHOD: A randomized control group pretest-post-test design was implemented from 1 April 2003 to 30 April 2004 using three groups: a Nei-Guan point acupressure group, a placebo group and a control group which received only conventional intravenous treatment. The participants were 66 women admitted to two general hospitals in Korea with hyperemesis gravidarum. RESULTS: The degree of nausea and vomiting was statistically significantly lower in the Nei-Guan point acupressure group in comparison with the placebo and control groups. Ketonuria levels were reduced over time and, on days three and four of hospitalization, levels in the treatment group were statistically significantly lower than in the placebo or control groups (P < 0.05). CONCLUSION: Nei-Guan point acupressure is a useful treatment for relieving symptoms experienced by women with hyperemesis gravidarum.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17645494

Acupunct Med. 2007 Jun;25(1-2):36-40.

Sham acupuncture devices--practical advice for researchers.

McManus CA, Schnyer RN, Kong J, Nguyen LT, Hyun Nam B, Goldman R, Stason WB, Kaptchuk TJ.

Harvard Medical School, Boston, MA, USA.

mcmanusacupuncture@mac.com

Several validated sham acupuncture devices have recently become available. While some debate exists on whether such needles are the best placebo control for an RCT of acupuncture, practical advice based on research experience is missing from the literature. This paper shares our concrete experience using the most commonly used such sham needle (the 'Streitberger needle' and its paired verum needle) in a large RCT (n=135) which included a two-week run-in period. The placebo run-in gave us an opportunity to use the sham device on all participants, who were then re-randomised to receive genuine acupuncture or to continue treatment with the device. The blinding was successful both at the end of the run-in and at the conclusion of the trial despite the re-randomisation. We also report our experience with the sham needle in neuroimaging experiments where the magnetic machinery poses considerable challenges for acupuncture research.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial. Research Support, N.I.H., Extramural

PMID: 17641566

Acupunct Med. 2007 Jun;25(1-2):29-35.

Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis--an exploratory review.

Vas J, White A.

Pain Treatment Unit, Dos Hermanas, Sevilla, Spain.

There are many differing opinions on what constitutes an optimal acupuncture dose for treating any particular patient with any particular condition, and only direct comparisons of different methods in a clinical trial will provide information on which reliable decisions can be made. This article reviews the recent research into acupuncture treatment for osteoarthritis of the knee, to explore whether any aspects of treatment seem more likely to be associated with good outcome of treatment. Among four recent, high quality RCTs, one showed a much greater treatment response than the other three, and the possible factors are discussed. A recent systematic review included 13 RCTs, and this article discusses the possible explanations for differences in their outcomes. It is speculated that optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments. These factors offer some support to criteria for adequate acupuncture used in the recent review. In addition, ethnic and cultural factors may influence patients' reporting of their symptoms, and different versions of an outcome measure are likely to differ in their sensitivity - both factors which may lead to apparent rather than real differences between studies. The many variables in a study are likely to be more tightly controlled in a single centre study than in multicentre studies.

Publication Types: Review

PMID: 17641565

Acupunct Med. 2007 Jun;25(1-2):1-10.

Acupuncture for anxiety and anxiety disorders--a systematic literature review.

Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J.

School of Integrated Health, University of Westminster, London, UK.

K.Pilkington@westminster.ac.uk

INTRODUCTION: The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research. METHODS: Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes. RESULTS: Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed. CONCLUSIONS: Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17641561

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005472.

Acupuncture for insomnia.

Cheuk DK, Yeung WF, Chung KF, Wong V.

University of Hong Kong, Department of Pediatrics and Adolescent Medicine, Pokfulam Road, Hong Kong, China.

cheukkld@hkucc.hku.hk

BACKGROUND: Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are still widely practiced. However, it remains unclear whether the existing evidence is rigorous enough to support its use. OBJECTIVES: To determine the efficacy and safety of acupuncture in people with insomnia. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED (the Allied and Complementary Medicine Database), TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System), National Center for Complementary and Alternative Medicine, the National Institute of Health Clinical Trials Database, the Chinese Acupuncture Trials Register, the Trials Register of the Cochrane Complementary Medicine Field, from inception to 2006, and the sleep bibliography, which is available at www.websciences.org/bibliosleep. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials. SELECTION CRITERIA: Randomised controlled trials evaluating any form of acupuncture involving participants of any age with any type of insomnia were included. Included trials compared acupuncture with placebo or sham or no treatment, or acupuncture plus other treatments compared with the same other treatments. Trials that compared only acupuncture methods or compared acupuncture alone against other treatments alone were excluded, since they did not yield the net effect of acupuncture. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed quality according to a set of criteria for risk of selection bias, performance bias, attrition bias and detection bias. Relative risk (RR) and standardised mean difference (SMD) with 95% confidence intervals were used for binary and continuous outcomes respectively. Data were combined in meta-analyses (on an intention-to-treat basis), where more than one trial without significant clinical heterogeneity presented the same outcome. MAIN RESULTS: Seven trials met the inclusion criteria. The studies included 590 participants with insomnia, of whom 56 dropped out. Participant age ranged from 15 to 98 years, and the duration of insomnia varied from 6 months to 19 years. Co-existing medical conditions contributing to insomnia included stroke, end-stage renal disease and pregnancy. Apart from conventional needle acupuncture, different variants of acupuncture such as acupressure, auricular magnetic and seed therapy, and transcutaneous electrical acupoint stimulation (TEAS) were evaluated. Meta-analysis was limited because of considerable heterogeneity between comparison groups and between outcome measures.Based on the findings from individual trials, the review suggested that acupuncture and acupressure may help to improve sleep quality scores when compared to placebo (SMD = -1.08, 95% CI = -1.86 to -0.31, p=0.006) or no treatment (SMD -0.55, 95% CI = -0.89 to -0.21, p=0.002). TEAS also resulted in better sleep quality score in one trial (SMD = -0.74, 95% CI = -1.22 to -0.26, p=0.003). However, the efficacy of acupuncture or its variants was inconsistent between studies for many sleep parameters, such as sleep onset latency, total sleep duration and wake after sleep onset. The combined result from three studies reporting subjective insomnia improvement showed that acupuncture or its variants was not more significantly effective than control (RR = 1.66, 95% CI = 0.68 to -4.03) and significant statistical heterogeneity was observed. Only one study reported an adverse event, with one out of 16 patients (6.3%) withdrawing from acupuncture because of pain. AUTHORS' CONCLUSIONS: The small number of randomised controlled trials, together with the poor methodological quality and significant clinical heterogeneity, means that the current evidence is not sufficiently extensive or rigorous to support the use of any form of acupuncture for the treatment of insomnia. Larger high quality clinical trials employing appropriate randomisation concealment and blinding with longer follow-up are needed to further investigate the efficacy and safety of acupuncture for the treatment of insomnia.

Publication Types: Meta-Analysis Review

PMID: 17636800

Cochrane Database Syst Rev. 2007 Jul 18;(2):CD000961.

WITHDRAWN: Physical medicine modalities for mechanical neck disorders.

Gross AR, Aker PD, Goldsmith CH, Peloso P.

McMaster University, School of Rehabilitation Science, IAHS, Room 440, 1400 Main Street West, 4th Fl, Hamilton, Ontario, Canada, L8S 1C7.

grossa@mcmaster.ca

BACKGROUND: Twenty-six to 71 percent of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. The treatments that patients receive for neck pain are varied, as are the perceptions of the benefits of these treatments. In this age of increasing accountability, governmental agencies, third party payers and patients are demanding evidence-based practice performance. To track down the best estimate of efficacy of the various conservative management strategies for mechanical neck disorders, a four-part systematic review was prepared. Part two investigates and reports on the efficacy of physical medicine modalities. OBJECTIVES: Multiple physical medicine modalities are commonly included as part of therapeutic interventions for mechanical neck disorders (neck pain). The objective of this review was to assess the effects of physical medicine modalities for pain in adults with mechanical neck disorders. SEARCH STRATEGY: We searched Medline, Embase, Chirolars, Index to Chiropractic Literature, Cinahl, Science Citation Index, Conference Proceedings Index, National Technical Information Services and reference lists of the retrieved articles from 1985 to December 1993 and we contacted content experts. SELECTION CRITERIA: Randomised trials and controlled trials of physical medicine modalities in adults with mechanical neck disorder. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed trial quality and two reviewers independently extracted data. Investigators were contacted to obtain information or data that could not be found in the published reports. MAIN RESULTS: Thirteen trials were included. The overall quality of the included trials was generally good. Two trials using electromagnetic therapy produced a significant reduction in pain (p <0.01) with three to four weeks of daily (eight hours per day) therapy sessions; and three using laser therapy did not differ significantly from a placebo (p=0.20) for six to 10 sessions of treatment. Not enough scientific testing exists to clearly determine the effectiveness of other therapies. This includes treatments such as exercise, traction, acupuncture, heat / cold applications, electrotherapies, cervical orthoses and chronic pain / cognitive behavioural rehabilitation strategies. AUTHORS' CONCLUSIONS: There is little information available from trials to support the use of physical medicine modalities for mechanical neck pain. There is some support for the use of electromagnetic therapy and against the use of laser therapy with respect to pain reduction.

Publication Types: Review

PMID: 17636644

Cochrane Database Syst Rev. 2007 Jul 18;(1):CD000210.

WITHDRAWN: Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain.

Gadsby JG, Flowerdew MW.

De Montfort University, 47 Milton Crescent, Leicester, Leicestershire, UK, LE4 OPA.

joseph.gadsby@virgin.net

BACKGROUND: In view of the claims and counter-claims of the effectiveness of transcutaneous electrical nerve stimulation, it would seem appropriate to systematically review the literature. OBJECTIVES: To determine the effectiveness of transcutaneous electrical nerve stimulation in reducing pain and improving range of movement in patients with chronic low back pain. SEARCH STRATEGY: Electronic searches of EMBASE, MEDLINE, CISCOM, AMED for all studies of TENS in the English language, identifying those treating chronic low back pain and hand searching their references. SELECTION CRITERIA: The inclusion criterion for studies included in this review, 6 of 68 identified, was comparisons of TENS/ALTENS versus placebo in patients with chronic low back pain. DATA COLLECTION AND ANALYSIS: Outcome data on pain reduction, range of movement, functional status and work was extracted by two independent reviewers together with trial design qualities to construct a Quality Index. MAIN RESULTS: The ratio of odds of improvement in pain for each comparison was calculated: TENS vs. placebo at 1.62 (95% CI 0.90, 2.68); ALTENS vs. placebo at 7.22 (95% CI 2.60, 20.01) and TENS/ALTENS vs. placebo at 2.11 (95% CI 1.32, 3.38) times that of placebo. An improvement in pain reduction was seen in 45.80% (CI 37.00%, 55.00%) of TENS; 86.70% (CI 80.00%, 93.00%) of ALTENS; 54.00% (CI 46.20%, 61.80%) of TENS/ ALTENS and 36.40% (95%CI 28.40%, 44.40%) of placebo subjects. The odds of improvement in range of movement on ALTENS vs. placebo was 6.61 times (95% CI 2.36, 18.55) that of placebo. AUTHORS' CONCLUSIONS: Transcutaneous electrical nerve stimulation appears to reduce pain and improve the range of movement in chronic low back pain subjects. A definitive randomised controlled study of ALTENS, TENS, placebo/no treatment controls, of sufficient power, is needed to confirm these findings.

Publication Types: Review

PMID: 17636620

J Chin Med Assoc. 2007 Jul;70(7):265-8.

Acupuncture therapy results in immediate bronchodilating effect in asthma patients.

Chu KA, Wu YC, Ting YM, Wang HC, Lu JY.

Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.

kachu@vghks.gov.tw

BACKGROUND: According to previous data on asthma in the English literature, there are some results that show encouraging effects of acupuncture improving pulmonary function in asthma patients. We designed a prospective randomized crossover controlled study to determine the efficacy of acupuncture in asthma patients. METHODS: Eighteen asthma patients with bronchodilator response >20% improvement of forced expiratory volume in 1 second (FEV1) were initially randomly assigned to receive 1 performance of real acupuncture (RA) or sham acupuncture (SA) in a blinded manner. After a washout period, the patients were crossed over. Spirometry was done and recorded before and after acupuncture. RESULTS: Sixteen of 18 patients completed the study. The mean (+/-SD) FEV1 values before and after RA were 1.52 +/- 0.45L and 1.67 +/- 0.40L, respectively (p < 0.001). The mean (+/-SD) FEV1 values before and after SA were 1.49 +/- 0.40L and 1.49 +/- 0.41L, respectively (p = 0.838, not significant). The percentage change in FEV1 values after RA was better than after SA (RA, 11.57 +/- 8.11%; SA, 0.32 +/- 7.76%; p = 0.003), while the bronchodilator response of FEV1 from simple inhalation bronchodilator was better than that for RA (p < 0.001). CONCLUSION: In asthma patients, acupuncture treatment may result in immediate improvement of FEV1, but the degree of improvement is less than that from inhalation bronchodilator.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17631461

Nitric Oxide. 2007 Sep;17(2):60-8.

Evidence of enhanced non-enzymatic generation of nitric oxide on the skin surface of acupuncture points: An innovative approach in humans.

Ma SX, Li XY, Sakurai T, Pandjaitan M.

Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California at Los Angeles, Harbor-UCLA Medical Center, 1124 W. Carson Street, RB-1, Torrance, CA 90502, USA.

ma@humc.edu

The present study quantified total nitrate and nitrite (NOx-) collected from the skin surface along acupuncture points (acupoints) and determined whether non-enzymatic reduction of nitrate by bacteria is involved in chemical generation of nitric oxide (NO) on acupoints. A small plastic tube (0.5 x 7 cm) cut in half lengthwise was taped to the forearm or leg in 50 healthy volunteers. NO-collecting solutions with NO-scavenging compounds, hemoglobin or 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide, was placed inside the tubing attached to the skin surface for 20 min. The concentrations of NOx- in the collected samples were quantified by using chemiluminescence. NOx- concentration was significantly enhanced in four acupoints on the pericardium meridian and in two acupoints on the bladder meridian compared with those collected on non-meridian control areas. The time intervals of NOx- levels were significantly higher at the first 20 min of acupoint collection, but the concentrations were similar among the study groups collected at 20-40, 40-60, and 60-80 min. NOx- concentrations and numbers of bacteria colonies detected on the skin surface were markedly reduced by pretreatment of skin with sodium hypochlorite compared to water treatment. This is the first evidence showing that NO has been successfully quantified on skin acupoints by a non-invasive device in humans. We conclude that NO is physiologically released from the skin surface with a higher level at acupoints, and that the non-enzymatic reduction of nitrate by bacteria is involved in chemical generation of NO on skin acupoints in addition to l-arginine-derived NO synthesis.

Publication Types: Randomized Controlled Trial. Research Support, N.I.H., Extramural

PMID: 17613264

Int J Neurosci. 2007 Jul;117(7):1029-37.

Acupuncture increases cerebral glucose metabolism in human vascular dementia.

Huang Y, Chen J, Htut WM, Lai X, Wik G.

Department of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.

nanfanglihuang@163.com

Recent studies indicate beneficial effects of acupuncture in the rehabilitation of vascular dementia (VaD). This study used 18-flourodeoxyglucose PET measures to compare cerebral effects of conventional acupuncture for hemiplegia with that of additional VaD-specific needling. As compared to baseline, conventional acupuncture increased glucose metabolism in the temporal lobe of unaffected and in the lentiform nucleus of the affected hemisphere. Additional needling in VaD-specific points rendered higher metabolism bilaterally in the frontal lobes and the thalamus, and in the temporal lobe and the lentiform nucleus of the unaffected hemisphere. The findings further underpin acupuncture's role in stroke and VaD rehabilitation.

Publication Types: Comparative Study Randomized Controlled Trial.

PMID: 17613112

Chin J Integr Med. 2007 Jun;13(2):103-8.

Comparative study of the specificities of needling acupoints DU20, DU26 and HT7 in intervening vascular dementia in different areas in the brain on the basis of scale assessment and cerebral functional imaging.

Huang Y, Lai XS, Tang AW.

TCM College of Nanfang Medical University, Guangzhou, 510515, China.

OBJECTIVE: Using methods of clinical scale assessment and cerebral functional imaging to compare the relative specificity of needling acupoints Baihui (DU20), Shuigou (DU26) and Shenmen (HT7) in intervening vascular dementia (VD) in different areas in the brain. METHODS: Fifty patients with VD were randomized into 5 groups. Needling on conventionally used acupoints of hand and foot three Yang-meridians aiming at hemiplegia was applied to the patients in Group A, and needling on DU20 to Group B, on DU26 to Group C, on HT7 to Group D and on all the three to Group E was applied additionally. Assessments of Mini Mental State Examination (MMSE), Activities of Daily Living (ADL) and Family Attitude Questionnaire (FAQ) were made. And the positron emission computerized tomography (PET) and single photon emission computerized tomography (SPECT) examinations were conducted in 5 selected patients from each group before and after treatment. RESULTS: Needling on conventional acupoints plus DU20 could effect the inner temporal system, thalamencephalon system and prefrontal cortical system to improve memory and executive capacity of VD patients; conventional acupoints plus DU26 could effect more to the prefrontal cortical system to obviously elevate the executive capacity; that plus HT7 would reveal an effect similar to but rather weaker than plus DU20, and effect more to memory; and that plus all the three simultaneously could effect rather roundly multiple aspects of the nervous system related to intellectual activities, to elevate the recognition and enhance the executive capacity. CONCLUSION: Needling on various acupoints like DU20, DU26 and HT7 have effects on different brain areas.

Publication Types: Comparative Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17609907

J Altern Complement Med. 2007 Jun;13(5):539-46.

Bilateral effect of unilateral electroacupuncture on muscle strength.

Huang LP, Zhou S, Lu Z, Tian Q, Li X, Cao LJ, Yu JH, Wang H.

Department of Health and Exercise Science, Tianjin University of Sport, Tianjin, China.

OBJECTIVES: This study aimed to examine the bilateral effect of 4 weeks of unilateral electroacupuncture on leg muscle strength. DESIGN: The effect of unilateral electroacupuncture at two selected acupoints, Zusanli (ST-36) and Xiajuxu (ST-39), which are located on the anterior tibialis muscle, on dorsiflexion strength was evaluated by statistical analyses of the interactions between the muscle strength pre and post 4 weeks of intervention, between the two legs, and between an experimental and a control group. SETTINGS/LOCATION: The trial was carried out in the exercise rehabilitation laboratory at Tianjin University of Sport. SUBJECTS: Thirty (30) healthy men with an average age of 20.9 +/- 2.98 (SD) years were randomly allocated into an electroacupuncture group (EG) and a control group (CG). They were physically active, but without specific strength training or previous experience of acupuncture. INTERVENTIONS: Participants in the EG were given 3 sessions of electroacupuncture per week. In each session, the electroacupuncture was applied to the right leg at the acupoints with 8 duty cycles of 1 minute on and 1 minute off, pulse width of 1 millisecond, frequency of 40 Hz, and intensity of 30-40 V. Participants in the CG group kept their normal daily activities without additional intervention. OUTCOME MEASURES: The maximum strength in dorsiflexion of each leg was examined by having participants lift weights in the range of motion of approximately 20 degrees at the ankle joint. RESULTS: Repeated-measures analysis of variance with Bonferroni adjustment detected significant increase in strength of both legs (right 21.3%, left 15.2%) in the EG (p<0.05) and the increase was significantly higher than that of the CG (p<0.05). The CG showed no significant change (right 3.0%, left 4.8%), post-treatment. CONCLUSIONS: Unilateral electroacupuncture at the selected acupoints improved muscle strength of both limbs. These findings may have implications in physical therapy and rehabilitation settings.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17604558

J Altern Complement Med. 2007 Jun;13(5):533-8.

Experiences of acupuncturists in a placebo-controlled, randomized clinical trial.

McManus CA, Kaptchuk TJ, Schnyer RN, Goldman R, Kerr CE, Nguyen LT, Stason WB.

Osher Institute, Harvard Medical School, Boston, MA 02115, USA.

mcmanusacupuncture@mac.com

BACKGROUND: This paper describes the experiences of 8 licensed acupuncturists in a placebo-controlled randomized clinical trial (RCT). This information is important to the design and conduct of high-quality trials. METHODS: We conducted a RCT (N=135) with a 2-week placebo run-in followed by 4 weeks of twice-weekly treatments comparing genuine to sham acupuncture (using the Streitberger placebo needle) in the treatment of arm pain caused by repetitive use. At the end of this study, we conducted written structured interviews with 8 participating acupuncturists. The acupuncturists were not aware of the study's results at the time of these interviews. The questions focused on their experiences in the study, adherence to study protocols, their thoughts about the technical and ethical issues involved in using a sham needling device, and their expectations of trial outcomes. The questions were motivated by expressions of concerns the acupuncturists raised in feedback groups during the course of the study, and our desire to improve further trials. RESULTS: The acupuncturists differed widely in their comfort levels with the research methods used, their adherence to the study protocol, and their expectations of trial outcomes. CONCLUSIONS: We conclude that careful monitoring of acupuncturists, including observation of treatments and frequent meetings to support them throughout the trial, is necessary to maintain a high degree of quality control.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial. Research Support, N.I.H., Extramural

PMID: 17604557

J Altern Complement Med. 2007 Jun;13(5):527-32.

Correlated change in upper limb function and motor cortex activation after verum and sham acupuncture in patients with chronic stroke.

Schaechter JD, Connell BD, Stason WB, Kaptchuk TJ, Krebs DE, Macklin EA, Schnyer RN, Stein J, Scarborough DM, Parker SW, McGibbon CA, Wayne PM.

Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA.

judith@nmr.mgh.harvard.edu

BACKGROUND: Acupuncture may improve motor function in patients with chronic hemiparetic stroke, yet the neural mechanisms underlying such an effect are unknown. As part of a sham-controlled, randomized clinical trial testing the efficacy of a 10-week acupuncture protocol in patients with chronic hemiparetic stroke, we examined the relationship between changes in function of the affected upper limb and brain activation using functional magnetic resonance imaging (fMRI). METHODS: Seven (7) chronic hemiparetic stroke patients underwent fMRI and testing of function of the affected upper limb (spasticity and range-of-motion) before and after a 10-week period of verum (N=4) or sham (N=3) acupuncture. The correlation between changes in function of the affected upper limb and brain activation after treatment was tested across patients. RESULTS: We found a significant positive correlation between changes in function of the affected upper limb (spasticity and range of motion) and activation in a region of the ipsilesional motor cortex. Patients treated with verum acupuncture showed a trend toward a greater maximum activation change in this motor cortical area as compared to those treated with sham acupuncture. CONCLUSIONS: Acupuncture may improve function of the affected upper limb in chronic hemiparetic stroke patients by increasing activity in the ipsilesional motor cortex.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial.

PMID: 17604556

Rheumatology (Oxford). 2007 Sep;46(9):1445-9.

Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement.

Williamson L, Wyatt MR, Yein K, Melton JT.

The Great Western Hospital, Swindon, Wiltshire, UK. lyn.williamson@smnhst.swest.nhs.uk

OBJECTIVE: To evaluate the effects of standardized western acupuncture and physiotherapy on pain and functional ability in patients with severe osteoarthritic knee pain awaiting knee arthroplasty. METHODS: Three-arm, assessor-blind, randomized controlled trial. Participants: 181 patients awaiting knee arthroplasty. Interventions: acupuncture for 6 weeks; physiotherapy for 6 weeks; standardized advice. Main outcome measures: Oxford Knee Score questionnaire (OKS) (primary); 50 m timed walk, and duration of hospital stay following knee arthroplasty. RESULTS: There was no baseline difference between groups. At 7 weeks, there was a 10% reduction in OKS in the acupuncture group which was a significant difference between the acupuncture and the control group: Mean (s.d.) acupuncture 36.8 (7.20); physiotherapy 39.2 (8.22); control 40.3 (8.48) (P = 0.0497). These effects were no longer present at 12 weeks. There was a trend (P = 0.0984) towards a shorter in-patient stay of 1 day for the physiotherapy group [mean 6.50 days (s.d. 2.0)] compared with the acupuncture group [mean 7.77 days (s.d. 3.96)]. CONCLUSIONS: We have demonstrated that patients with severe knee osteoarthritis can achieve a short-term reduction in OKS when treated with acupuncture. However, we failed to demonstrate any other clinically or statically significant effects between the groups. Both interventions can be delivered effectively in an out-patient group setting at a district general hospital. Further study is needed to evaluate the combined effects of these treatments.

Publication Types: Comparative Study Randomized Controlled Trial.

PMID: 17604311

Chin J Integr Med. 2007 Mar;13(1):10-6.

Study on the regulatory effect of electro-acupuncture on hegu point (LI4) in cerebral response with functional magnetic resonance imaging.

Wang W, Liu L, Zhi X, Huang JB, Liu DX, Wang H, Kong XQ, Xu HB.

Radiology Department, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

OBJECTIVE: To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (L14) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating L14, for exploring the mechanism of its effect in potential clinical application. METHODS: EA was applied at volunteers' right L14 (of 9 subjects in the L14 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 x 1 x 1 mm(3) used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging. RESULTS: Data from 3 testees of the 9 subjects in the L14 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients' location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of L14 group and 5 subjects of the control group (P<0.01). In the L14 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/ audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil's island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe. CONCLUSION: The effects of EA L14 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA L14 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect's cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA L14 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17578311

Ann Intern Med. 2007 Jun 19;146(12):868-77.

Meta-analysis: acupuncture for osteoarthritis of the knee.

Manheimer E, Linde K, Lao L, Bouter LM, Berman BM.

Center for Integrative Medicine, University of Maryland School of Medicine, Kernan Hospital Mansion, Baltimore, Maryland 21207, USA.

BACKGROUND: Knee osteoarthritis is a major cause of pain and functional limitation. PURPOSE: To evaluate the effects of acupuncture for treating knee osteoarthritis. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases to January 2007. No language restrictions were applied. STUDY SELECTION: Randomized trials longer than 6 weeks in duration that compared needle acupuncture with a sham, usual care, or waiting list control group for patients with knee osteoarthritis. DATA EXTRACTION: Two authors independently agreed on eligibility, assessed methodological quality and acupuncture adequacy, and extracted outcome data on pain and function measures. DATA SYNTHESIS: Eleven trials met the selection criteria, and 9 reported sufficient data for pooling. Standardized mean differences were calculated by using differences in improvements from baseline between patients assigned to acupuncture and those assigned to control groups. Compared with patients in waiting list control groups, patients who received acupuncture reported clinically relevant short-term improvements in pain (standardized mean difference, -0.96 [95% CI, -1.21 to -0.70]) and function (standardized mean difference, -0.93 [CI, -1.16 to -0.69]). Patients who received acupuncture also reported clinically relevant short- and long-term improvements in pain and function compared with patients in usual care control groups. Compared with a sham control, acupuncture provided clinically irrelevant short-term improvements in pain (standardized mean difference, -0.35 [CI, -0.55 to -0.15]) and function (standardized mean difference, -0.35 [CI, -0.56 to -0.14]) and clinically irrelevant long-term improvements in pain (standardized mean difference, -0.13 [CI, -0.24 to -0.01]) and function (standardized mean difference, -0.14 [CI, -0.26 to -0.03]). LIMITATION: Sham-controlled trials had heterogeneous results that were probably due to the variability of acupuncture and sham protocols, patient samples, and settings. CONCLUSIONS: Sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects.

Publication Types: Meta-Analysis Research Support, N.I.H., Extramural

PMID: 17577006

Neurosci Lett. 2007 Jun 29;421(3):203-8.

Activation of the hypothalamus characterizes the response to acupuncture stimulation in heroin addicts.

Liu S, Zhou W, Ruan X, Li R, Lee T, Weng X, Hu J, Yang G.

Ningbo Addiction Research and Treatment Center, Ningbo 315010, China.

lskingcn@yahoo.com.cn

Acupuncture stimulation elicited a composite of sensations termed deqi that is related to clinical efficacy. Neurobiological studies have identified the hypothalamus as an important component in mediating the deqi. Functional changes in hypothalamus persist after abstinence in addicts. We investigated the activation in the hypothalamus associated with acupuncture stimulation in healthy volunteers and heroin addicts by fMRI. Cortisol level and psychophysical responses, including the deqi sensation (an acupuncture effect of needle-manipulation), anxiety, and sharp pain, were also assessed. The activation of the hypothalamus was more robust in the addicts than that in the healthy subjects during acupuncture stimulation. The deqi scores of the heroin addicts were significantly higher than those of the healthy subjects during acupuncture treatment. An acupuncture sensation scale predicted the activation of the hypothalamus associated with the deqi sensation.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 17574746

J Nerv Ment Dis. 2007 Jun;195(6):504-13.

Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial.

Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R.

Department of Psychiatry and Behavioral Sciences and Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA.

The purpose of the study was to evaluate the potential efficacy and acceptability of accupuncture for posttraumatic stress disorder (PTSD). People diagnosed with PTSD were randomized to either an empirically developed accupuncture treatment (ACU), a group cognitive-behavioral therapy (CBT), or a wait-list control (WLC). The primary outcome measure was self-reported PTSD symptoms at baseline, end treatment, and 3-month follow-up. Repeated measures MANOVA was used to detect predicted Group X Time effects in both intent-to-treat (ITT) and treatment completion models. Compared with the WLC condition in the ITT model, accupuncture provided large treatment effects for PTSD (F [1, 46] = 12.60; p < 0.01; Cohen's d = 1.29), similar in magnitude to group CBT (F [1, 47] = 12.45; p < 0.01; d = 1.42) (ACU vs. CBT, d = 0.29). Symptom reductions at end treatment were maintained at 3-month follow-up for both interventions. Accupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD. Larger trials with additional controls and methods are warranted to replicate and extend these findings.

Publication Types: Comparative Study Randomized Controlled Trial. Research Support, N.I.H., Extramural

PMID: 17568299

Aust Fam Physician. 2007 Jun;36(6):447-8.

Acupuncture in musculoskeletal disorders - is there a point?

Pirotta M.

Department of General Practice, University of Melbourne, Victoria, Australia.

m.pirotta@unimelb.edu.au

Several surveys have identified that Australian general practitioners have largely accepted acupuncture as part of their armamentarium. About a quarter of GPs have been trained in acupuncture and the majority of those surveyed agreed that acupuncture was effective and that they had referred patients for the therapy. Acupuncture is an integral part of traditional Chinese medicine and has thousands of years of history of use. While acupuncture presents some challenges to test in randomised controlled trials, such as inadequate placebos and difficulty achieving blinding of both researchers and participants, many trials of increasingly high standard have been published; for example, the Cochrane Collaboration has over 120 reviews and protocols relating to acupuncture. This article presents some recent evidence about the use of acupuncture to treat musculoskeletal conditions.

Publication Types: Review

PMID: 17565404

Circulation. 2007 Jun 19;115(24):3121-9.

Randomized trial of acupuncture to lower blood pressure.

Flachskampf FA, Gallasch J, Gefeller O, Gan J, Mao J, Pfahlberg AB, Wortmann A, Klinghammer L, Pflederer W, Daniel WG.

Med Klinik 2, Universitätsklinikum Erlangen, Ulmenweg 18, 91054 Erlangen, Germany.

frank.flachskampf@rzmail.uni-erlangen.de

BACKGROUND: Arterial hypertension is a prime cause of morbidity and mortality in the general population. Pharmacological treatment has limitations resulting from drug side effects, costs, and patient compliance. Thus, we investigated whether traditional Chinese medicine acupuncture is able to lower blood pressure. METHODS AND RESULTS: We randomized 160 outpatients (age, 58+/-8 years; 78 men) with uncomplicated arterial hypertension in a single-blind fashion to a 6-week course of active acupuncture or sham acupuncture (22 sessions of 30 minutes' duration). Seventy-eight percent were receiving antihypertensive medication, which remained unchanged. Primary outcome parameters were mean 24-hour ambulatory blood pressure levels after the treatment course and 3 and 6 months later. One hundred forty patients finished the treatment course (72 with active treatment, 68 with sham treatment). There was a significant (P<0.001) difference in posttreatment blood pressures adjusted for baseline values between the active and sham acupuncture groups at the end of treatment. For the primary outcome, the difference between treatment groups amounted to 6.4 mm Hg (95% CI, 3.5 to 9.2) and 3.7 mm Hg (95% CI, 1.6 to 5.8) for 24-hour systolic and diastolic blood pressures, respectively. In the active acupuncture group, mean 24-hour ambulatory systolic and diastolic blood pressures decreased significantly after treatment by 5.4 mm Hg (95% CI, 3.2 to 7.6) and 3.0 mm Hg (95% CI, 1.5 to 4.6), respectively. At 3 and 6 months, mean systolic and diastolic blood pressures returned to pretreatment levels in the active treatment group. CONCLUSIONS: Acupuncture according to traditional Chinese medicine, but not sham acupuncture, after 6 weeks of treatment significantly lowered mean 24-hour ambulatory blood pressures; the effect disappeared after cessation of acupuncture treatment.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17548730

J Altern Complement Med. 2007 May;13(4):409-18.

Electrical skin impedance at acupuncture points.

Pearson S, Colbert AP, McNames J, Baumgartner M, Hammerschlag R.

Biomedical Signal Processing Laboratory, Portland State University, Portland, Oregon, USA.

OBJECTIVES: To test whether electrical skin impedance at each of three acupuncture points (APs) is significantly lower than at nearby sites on the meridian (MP) and off the meridian (NP). DESIGN: Two instruments - Prognos (MedPrevent GmbH, Waldershof, Germany), a constant-current (DC) device, and PT Probe (designed for this study), a 100-Hz sinusoidal-current (AC) device-were used to record electrical impedance at three APs (right Gallbladder 14, right Pericardium 8, and left Triple Energizer 1), and two control sites for each AP. Each AP, MP, and NP was measured four times in random order with each device. SETTING: The study was conducted over a period of 4 days at the Oregon College of Oriental Medicine (OCOM). Subjects: Twenty (20) healthy adults (14 women and 6 men), all recruited from the OCOM student body and faculty, participated in the study. RESULTS: The Prognos measurements had an intraclass correlation (ICC) = 0.84 and coefficient of variation (CV) = 0.43. The PT Probe had ICC = 0.81 and CV = 0.31. Impedance values at APs were not significantly less than at MPs or NPs. Impedance values at MPs were also not significantly less than NPs, although their individual p values were <0.05 in 4 of 6 cases. There was a significant trend of increasing impedance with repeated measurements with both the Prognos (p =0.003) and the PT Probe (p= 0.003). CONCLUSIONS: Within the reliability limits of our study methods, none of the three APs tested has lower skin impedance than at either of the nearby control points. These results are not consistent with previous studies that detected lower skin impedance at APs than nearby sites. Further study is necessary to determine whether MPs have lower skin impedance than nearby NPs. Our study suggests caution is warranted when developing, using, and interpreting results from electrodermal screening devices. Further studies are needed to clarify the clinically important and controversial hypothesis that APs are sites of lower impedance.

Publication Types: Clinical Trial

PMID: 17532733

Altern Ther Health Med. 2007 May-Jun;13(3):38-48.

In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis.

Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM.

Pacific College of Oriental Medicine, New York, USA.

OBJECTIVE: To provide an overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF), including an evidence-based evaluation of its efficacy and safety and an examination of possible mechanisms of action. DESIGN: Literature review using PubMed, the Science Citation Index, The Cochrane Library (Database of Systematic Reviews and Central Register of Controlled Trials), the New England School of Acupuncture library databases, and a cross-referencing of published data, personal libraries, and Chinese medicine textbooks. RESULTS: Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. However, this conclusion should be interpreted with caution because most studies reviewed had design limitations, and the acupuncture interventions employed often were not consistent with traditional Chinese medical principles. The reviewed literature suggests 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression. CONCLUSIONS: More high-quality randomized, controlled trials incorporating placebo acupuncture controls, authentic acupuncture interventions, and a range of outcome measures representative of both clinical outcomes and putative mechanistic processes are required to better assess the efficacy of acupuncture as an adjunct for IVF.

Publication Types: Research Support, N.I.H., Extramural Review

PMID: 17515023

J Urol. 2007 Jul;178(1):160-4; discussion 164.

Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly.

Mora B, Iannuzzi M, Lang T, Steinlechner B, Barker R, Dobrovits M, Wimmer C, Kober A.

Department of Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria.

PURPOSE: Auricular acupuncture at the relaxation point has been shown to be effective treatment for anxiety. We hypothesized that auricular acupressure may decrease anxiety in elderly individuals who are transported by ambulance before receiving ESWL. MATERIALS AND METHODS: We enrolled 100 patients with renal calculi who were transported to the local hospital by special ambulance, accompanied by 2 paramedics. Paramedic 1 performed data collection, while paramedic 2 performed auricular acupressure in patients randomly assigned to a relaxation group and a sham treated group. Anxiety was measured using a visual analog scale score on a scale of 0 to 100 mm. RESULTS: Each group consisted of 50 patients with similar demographic characteristics. The relaxation group had significantly decreased anxiety scores upon arrival at the hospital and lower anticipation of pain scores (mean+/-SD 57.6+/-21.8 to 15.4+/-9.8 and 35.7+/-29.7 to 9.5+/-4.1 mm VAS) than the sham treated group (55.5+/-25.9 to 49.8+/-28.9 and 37.7+/-24.1 to 33.8+/-25.2 mm VAS, respectively, 2-way repeated measure ANOVA each p=0.001). Estimated waiting times for treatment did not differ significantly between the 2 groups (5.0+/-2.5 and 5.5+/-2.95, respectively, repeated measures ANOVA p=0.83). The Post-Intervention Anxiety visual analog scale demonstrated the significant superiority of the true treatment group (19.5+/-5.9 and 66.8+/-27.9 mm VAS, respectively, p=0.001). CONCLUSIONS: Elderly patients who received auricular acupressure at specific relaxation points while being transported to the hospital were less anxious, anticipated less pain and were more optimistic about the outcome of treatment that they will receive than the sham treated group. These data prove that this is an effective treatment for anxiety that improves the patient overall perception of ESWL.

Publication Types: Randomized Controlled Trial.

PMID: 17499304

J Rehabil Med. 2007 Apr;39(3):205-11.

Additional therapeutic effects of electroacupuncture in conjunction with conventional rehabilitation for patients with first-ever ischaemic stroke.

Hsieh RL, Wang LY, Lee WC.

Department of Physical Medicine and Rehabilitation, Shin Kong Wo Ho-Su Memorial Hospital, Taiwan, Republic of China.

OBJECTIVE: This study examined the additional therapeutic effects of electroacupuncture for patients with first-ever ischaemic stroke. DESIGN: Randomized controlled study. SUBJECTS: A total of 63 patients with first-ever ischaemic stroke. METHODS: The study and control groups underwent a conventional rehabilitation program, with the former receiving an additional 8 courses of electroacupuncture over a period of one month. Therapeutic effects were assessed by the Fugl-Meyer Assessment for motor performance and the Functional Independence Measure (FIM) for the independence of functional performance at 2 and 4 weeks after treatment, and 3 months and 6 months after stroke. RESULTS: For total Fugl-Meyer Assessment score, improvement was more significant for the study group relative to the control group at 2 weeks (16.2 vs 10.6; p = 0.047) and 4 weeks after treatment (27.4 vs 17.1; p = 0.005), and at 3 months after the stroke (34.7 vs 21.8; p = 0.009). The Fugl-Meyer Assessment scores improved significantly, especially in upper-limb motor function for the study group. There was no statistically significant between-group difference in total FIM score improvement. CONCLUSION: Electroacupuncture can improve motor function, especially in upper-limb motor function, for patients with first-ever ischaemic stroke.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17468788

Int J Neurosci. 2007 May;117(5):591-5.

Increased temperature at acupuncture points induced by weight reduction in obese patients: a preliminary study.

Kwon YD, Lee JH, Lee MS.

Department of Oriental Rehabilitation Medicine, Wonkwang University Hospital, Gwangju, Republic of Korea.

This study investigated the temperature changes at acupuncture points resulting from a weight reduction program. A standard method using a digital infrared thermographic imaging device was employed to monitor the temperature at 20 acupuncture points in 32 participants treated for obesity at an Oriental obesity clinic. There were significant temperature increases at all of the acupuncture points except for LI4 (Hegu) and TE5 (Waiguan). The mean total temperature change at the acupuncture points was significantly correlated with the BMI change (r = .588, p < .001). The weight-reduction-induced increase in temperature at acupuncture points may reflect improvements in the circulation of energy flows. However, further study is necessary to understand fully the relationship between the temperature at acupuncture points and weight reduction, including the use of appropriate controls.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 17464777

Int J Neurosci. 2007 May;117(5):579-90.

Electroacupuncture treatment of obesity with psychological symptoms.

Cabioglu MT, Ergene N, Tan U.

Department of Physiology, Selçuk University, Meram Medical School, Konya, Turkey.

tugcab@yahoo.com

The aim was to study the effect of placebo EA, electroacupuncture (EA), and diet on obesity and accompanying psychological symptoms. One hundred and sixty-five volunteer women participated in the study. There were three groups: (i) Placebo EA, (ii) EA, and (iii) diet restriction group. EA was performed by using three ear and six body points. There was a 4.8% reduction in weight of patients with EA application, whereas patients with a diet restriction and placebo EA had a 2.5% and 2.7% weight reduction, respectively. There were significant decreases in phobia, anger, anxiety, obsession, paranoid symptoms, and depression in the EA groups compared to those of the placebo EA and diet groups. It was suggested that electroacupuncture may be an effective therapy for obesity including the psychological signs and symptoms in women.

Publication Types: Clinical Trial

PMID: 17464776

Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004987.

Acupuncture for vascular dementia.

Peng WN, Zhao H, Liu ZS, Wang S.

Guang'anmen Hospital, Acupuncture, No.5 Bei Xian Ge Street, Beijing, Xuanwu District, China, 100053.

weina_peng@sohu.com

BACKGROUND: Dementia is a widespread condition characterized by acquired global impairment of intellect, memory and personality, but with no impairment of consciousness. There is no definitive medical or surgical treatment for vascular dementia. Acupuncture is an ancient Chinese method which has been used for both the prevention and treatment of diseases for over three thousand years. Preliminary searches revealed more than 105 studies of acupuncture for treating vascular dementia. Benefit was reported in up to 70-91% of the treatment group. Body acupuncture and electroacupuncture were the most commonly used techniques. A comparison of electroacupuncture and acupuncture therapy alone suggested that the former was more effective in promoting the recovery of cognitive function. OBJECTIVES: The objective is to assess the efficacy and possible adverse effects of acupuncture therapy for treating vascular dementia. SEARCH STRATEGY: The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement group's Specialized Register on 2 February 2007 which contains records from all major health care databases and many ongoing trials databases. In addition the Allied and Complementary Medicine Database was searched and the web was searched using the search engine Copernic. SELECTION CRITERIA: Randomized Controlled Trials testing acupuncture therapy in the treatment of vascular dementia were included regardless of language and publication types.The intervention and control group had to receive identical treatment apart from the acupuncture intervention. In view of possible confounding, studies in which acupuncture was combined with other treatments were subjected to subgroup analyses. DATA COLLECTION AND ANALYSIS: Titles and abstracts identified from the searches were checked by two reviewers. If it was clear that the study did not refer to a randomized controlled trial in vascular dementia, it was excluded. If it was not clear from the abstract and title, then the full text of study was obtained for an independent assessment by two reviewers.The outcomes measured in clinical trials of dementia and cognitive impairment often arise from ordinal rating scales. Summary statistics were required for each rating scale at each assessment time for each treatment group in each trial for change from baseline. MAIN RESULTS: In the absence of any suitable randomised placebo-controlled trials in this area, we were unable to perform a meta-analysis. AUTHORS' CONCLUSIONS: The effectiveness of acupuncture for vascular dementia is uncertain. More evidence is required to show that vascular dementia can be treated effectively by acupuncture. There are no RCTs and high quality trials are few. Randomised double-blind placebo controlled trials are urgently needed.

Publication Types: Review

PMID: 17443563

JAMA. 2007 Apr 18;297(15):1697-707.

A 60-year-old woman considering acupuncture for knee pain.

Berman B.

Center for Integrative Medicine, University of Maryland School of Medicine, Kernan Hospital Mansion, Baltimore 21207, USA.

bberman@compmed.umm.edu

Mrs A, an active 60-year-old woman, has a history of degenerative osteoarthritis of her knee with pain that has progressed over the past 8 years. She has undergone arthroscopic surgery for a meniscal tear and has taken nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine, and chondroitin sulfate occasionally, but generally does not like taking medications. She is open to other therapeutic approaches and wants to know if acupuncture can help the pain, improve function, and stop her condition from progressing. The evidence for the effectiveness of acupuncture for knee pain and other common treatments, including exercise, NSAIDs, glucosamine and chondroitin, and intra-articular knee injections are compared, and costs and methods of acupuncture and selecting an acupuncturist are discussed.

Publication Types: Case Reports Clinical Conference Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Review

PMID: 17440146

Am J Chin Med. 2007;35(2):209-18.

Crossover clinical trial to determine the effect of manual acupuncture at Siguan points (bilateral LI4 and LR3) on intestinal motility in healthy subjects.

Yim YK, Kang WC, Cho JH, Shin JW, Lee NH, Choi SM, Koo ST, Park KS, Son CG.

Department of Meridian and Acupoint, College of Oriental Medicine, Daejeon University, Daejeon 300-716, South Korea.

This study examined whether manual acupuncture at the Siguan points (bilateral points LI4 and LR3) affects intestinal motility in healthy human subjects. Twenty healthy male subjects were randomly assigned either to real acupuncture (RA) at Siguan points or sham acupuncture (SA) groups in a crossover manner. All subjects underwent two experimental sessions; the RA group in the first session was treated with SA in the second session after a 2-week washout period, and vice versa. Each subject took 20 radio-markers and was treated with acupuncture 0, 12, 24, and 36 hours after radio-marker intake. Radiographs were taken at 6, 12.5, 24.5, and 48 hours, and the effect of acupuncture on intestinal motility was evaluated based on the distribution of the radio-markers in the ileum, ascending colon, transverse colon, descending colon, sigmoid/ rectum, and outside the body. Defecating habit was monitored during the trial, and complete blood counts were checked before and after the two acupuncture sessions. The RA and SA results showed extremely similar

distributions of the radio-markers in these five regions of the alimentary canal and outside the body in radiographs taken at four different times, verifying that there was no effect of manual acupuncture at the Siguan points on intestinal motility, at least in healthy human subjects.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17436362

J Clin Nurs. 2007 Apr;16(4):794-804.

Self-administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings.

Maa SH, Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH.

School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.

shmaa@mail.cgu.edu.tw

AIMS AND OBJECTIVES: To examine and compare the effects of acupressure on the perceived health-related quality of life of the participants with bronchiectasis. BACKGROUND: In an attempt to offer comfort, pain control and symptom management, nursing is becoming increasingly involved in offering complementary-alternative medicine as part of its caring-healing focus in comprehensive patient care. Acupressure is one such modality that is being increasingly used by both medical and nursing professionals. While acupressure has been reported to have beneficial effects in patients with respiratory disease, the benefits to bronchiectasis patients have remained uncertain. DESIGN: A randomized, partially blinded study consisting of three groups. METHODS: Thirty-five out-patients of both genders, aged 59.46 SD 11.52 years, who were suffering from bronchiectasis, were randomly split into one of three groups: standard care with supplemental acupressure for eight weeks (11 participants); standard care with supplemental sham acupressure for eight weeks (11 participants); and standard care alone (13 participants). Outcomes were determined by changes in daily sputum amounts, sputum self-assessment, six-minute walking distance, breathing difficulty (measured on the dyspnea visual analogue scale) and health-related quality of life (measured by the Saint George Respiratory Questionnaire). RESULTS: The sputum self-assessment score improved over time for the sham acupressure participants (P = 0.03), when compared with the controls. For acupressure participants, the Saint George respiratory questionnaire activity component scores also improved over time, compared with controls (P = 0.01) after adjustment for covariates (treatment, time, age, sex and baseline values). Other variables did not differ between the standard care alone group and the other two groups. CONCLUSIONS: Eight weeks of self-administered acupressure could be useful in reducing the effects of bronchiectasis on a patient's daily activities. RELEVANCE TO CLINICAL PRACTICE: Acupressure may be regarded as a viable nursing intervention.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17402962

J Altern Complement Med. 2007 Mar;13(2):253-61.

The psychologic consequences of chronic dyspnea in chronic pulmonary obstruction disease: the effects of acupressure on depression.

Wu HS, Lin LC, Wu SC, Lin JG.

School of Nursing, National Yang-Ming University, Taipei, Taiwan.

OBJECTIVES: The onset of depression is often triggered by breathlessness in persons with chronic obstructive pulmonary disease (COPD). It is hypothesized that these are the psychologic consequences of chronic dyspnea. Lessening dyspnea might alleviate depressive symptoms. Acupressure has been shown in other studies to produce relaxation. The aim of this study was to determine if it would lessen dyspnea and reduce depression in patients with COPD. SUBJECTS AND DESIGN: Subjects diagnosed with COPD were chosen from one medical center and three regional hospitals in Taipei, Taiwan. A randomized, block experimental design was used, with subjects and the data collector blinded. Using age, gender, pulmonary function, smoking, and steroid use as matching factors, 44 subjects were randomly assigned to either the true acupressure or the sham acupressure groups. The true acupressure group received a program of acupressure using appropriate acupoints that promote relaxation and relieve dyspnea. The sham acupressure group received acupressure using sham acupoints different from the meridians and ganglionic sections of the true acupressure group. Both acupressure programs lasted 4 weeks, with five sessions per week that lasted 16 minutes per session. OUTCOME MEASURES: The Geriatric Depression Scale (GDS) and Dyspnea Visual Analogue Scale (DVAS) were administered prior to the program as a baseline, and again following the completion of the 4-week program. Oxygen saturation and other physiological indicators were measured before and after each session. RESULTS: The results of this study showed that the GDS scores, DVAS scores, oxygen saturation, and physiological indicators of the true acupressure group were significantly improved, compared to those of the sham acupressure group. CONCLUSIONS: These findings provide health professionals with an evidence-based intervention to use with persons with COPD. Applying this acupressure program in clinical practice, communities, and long-term care units may lessen chronic dyspnea and depression in persons with COPD.

Publication Types: Clinical Trial Randomized Controlled Trial.

PMID: 17388769

J Altern Complement Med. 2007 Mar;13(2):241-6.

Acupuncture as an adjunct for sedation during lithotripsy.

Wang SM, Punjala M, Weiss D, Anderson K, Kain ZN.

Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8041, USA.

shu-ming.wang@yale.edu

OBJECTIVE: To determine whether a combination of auricular and body acupuncture is effective as an adjunct for the preprocedural anxiety and pain management in patients undergoing lithotripsy procedures. DESIGN: Randomized controlled study. SETTING AND LOCATION: Lithotripsy suite located at the Yale New Haven Hospital, New Haven CT. SUBJECTS: Adult patients who were scheduled to receive elective lithotripsy procedures. INTERVENTIONS: Acupuncture group: Preprocedural auricular acupuncture intervention combined with intraprocedural electroacupuncture stimulation (n = 29); Sham control group: Preprocedural sham auricular acupuncture intervention combined with intraprocedural sham electroacupuncture stimulation (n = 27). OUTCOMES MEASUREMENT: Preprocedural anxiety, intraprocedural alfentanil consumption, visual analogue scale for pain. RESULTS: Patients in the acupuncture group were less anxious preprocedure than those in the Sham Control Group 32 (29-34) versus 40 (35-45) (p = 0.029). Similarly, patients in the Acupuncture Group used a lesser amount of alfentanil than those in the sham control group (p = 0.040). The adjustable alfentanil consumption as expressed by median rate of alfentanil consumption of 1 (0.6-1.6) microg kg(-1) minute(-1) in the acupuncture group was lower than that of 1.5 (0.9-2.3) microg kg(-1) minute(-1) in the sham control group. Patients in the Acupuncture group also reported lower pain scores on admission to the recovery room (p = 0.014). CONCLUSIONS: A combination of auricular and body acupuncture can be used as an adjunct treatment to decrease preprocedural anxiety and intraprocedural analgesia in patients undergoing lithotripsy.

Publication Types: Randomized Controlled Trial.

PMID: 17388767

Int J Neurosci. 2007 Apr;117(4):519-23.

Effectiveness of combined acupuncture therapy and conventional treatment on shoulder range of motion and motor power in stroke patients with hemiplegic shoulder subluxation: a pilot study.

Shin BC, Lim HJ, Lee MS.

Department of Oriental Rehabilitation Medicine, College of Oriental Medicine, Wonkwang University, Iksan, South Korea. shinbc@hanmail.net

The aim of this study was to elucidate the effects of combined conventional rehabilitation therapy and acupuncture on the active shoulder range of motion (ROM) and motor power in stroke patients with hemiplegic shoulder subluxation. Twenty-one patients received a combination of acupuncture and rehabilitation treatment at a hospital, and their active shoulder ROM and motor power were assessed at admission and discharge. The therapy produced significant improvements in joint mobility, such as in flexion, extension, internal rotation, external rotation, abduction, and adduction (p < .001), and in motor power (p < .05) in stroke patients with hemiplegic shoulder subluxation.

Publication Types: Clinical Trial Comparative Study

PMID: 17365132

Climacteric. 2007 Feb;10(1):38-45.

Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies.

Zaborowska E, Brynhildsen J, Damberg S, Fredriksson M, Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M.

Division of Obstetrics and Gynecology, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, University Hospital, Linköping, Sweden.

OBJECTIVE: To assess if transdermal or oral estrogens, acupuncture and applied relaxation decrease the number of menopausal hot flushes/24 h and improve climacteric symptoms, as assessed by the Kupperman index, more than transdermal placebo treatment. SETTING: An outpatient clinic at a Swedish university hospital. METHODS: A total of 102 postmenopausal women were recruited to two studies performed in parallel. In Study I, the women were randomized between transdermal placebo or estrogen treatment and, in Study II, between oral estrogens, acupuncture or applied relaxation for 12 weeks. Climacteric symptoms were measured with daily logbooks on hot flushes. Women completed the assessment questionnaire for the Kupperman index at baseline and after 12 weeks. RESULTS: The number of flushes/24 h decreased significantly after 4 and 12 weeks in all groups except the placebo group. Both at 4 and 12 weeks, acupuncture decreased the number of flushes more (p<0.05; p<0.01, respectively) than placebo. At 12 weeks, applied relaxation decreased the number of flushes more (p<0.05) than placebo. The Kupperman index score decreased in all groups except the placebo group. The decrease in score was significantly greater in all treatment groups than in the placebo group (p<0.01). CONCLUSION: Acupuncture and applied relaxation both reduced the number of hot flushes significantly better than placebo and should be further evaluated as alternatives to hormone therapy in women with menopausal vasomotor complaints.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17364603

Neurol Res. 2007;29 Suppl 1:S98-103.

Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial.

Yin C, Seo B, Park HJ, Cho M, Jung W, Choue R, Kim C, Park HK, Lee H, Koh H.

Department of Acupuncture, CHA Biomedical Center, College of Medicine, Pochon CHA University, Seoul 135-081, Korea.

BACKGROUND: This study assessed effects of acupuncture as an add-on to conventional antihypertensive managements such as medication or lifestyle modification for hypertensive or pre-hypertensive subjects. METHODS: A randomized, double-blind, placebo-controlled trial was conducted at Kyung Hee University Hospital. Forty-one hypertensive or pre-hypertensive (systolic BP> or =120 mmHg or diastolic BP> or =80 mmHg) volunteers were recruited and randomly assigned into real or sham acupuncture groups. The hypertensive subjects on antihypertensive medication continued their medication. Acupuncture point prescriptions were partially individualized, based on the Saam acupuncture theory. Park's sham needle method was adopted for the sham procedure. Measurements were performed at baseline, weeks 4 and 8. BP, scales of overall health and pain, and anticipation or satisfaction for the treatments, were recorded. RESULTS: Thirty subjects completed the intervention, all of whom were on antihypertensive medication. The sham acupuncture group showed no significant change in mean BP, while the real acupuncture group showed a significant (p<0.01) decrease in mean BP after 8 weeks of intervention from 136.8/83.7 to 122.1/76.8 mmHg. Other factors showed no difference between the groups throughout the study. CONCLUSION: Acupuncture seems to offer an additional benefit to the treatment of hypertensive patients.

Publication Types: Clinical Trial Comparative Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17359649

Neurol Res. 2007;29 Suppl 1:S49-54.

Acupuncture application for neurological disorders.

Lee H, Park HJ, Park J, Kim MJ, Hong M, Yang J, Choi S, Lee H.

Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul 130-701, Korea.

BACKGROUND: Acupuncture has been widely used for a range of neurological disorders. Despite its popularity, the evidence to support the use of acupuncture is contradictory. METHODS: This review was designed to summarize and to evaluate the available evidence of acupuncture for neurological disorders. RESULTS: Most of the reviewed studies suffer from lack of methodological rigor. Owing to paucity and poor quality of the primary studies, no firm conclusion could be drawn on the use of acupuncture for epilepsy, Alzheimer's disease, Parkinson's disease, ataxic disorders, multiple sclerosis, amyotrophic lateral sclerosis and spinal cord injury. For stroke rehabilitation, the evidence from recent high-quality trials and previous systematic reviews is not convincing. CONCLUSION: More rigorous trials are warranted to establish acupuncture's role in neurological disorders.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17359641

BMC Complement Altern Med. 2007 Mar 14;7:8.

Acupressure for smoking cessation--a pilot study.

White AR, Moody RC, Campbell JL.

Primary Care Research Group, Peninsula Medical School, Universities of Exeter and Plymouth, UK.

adrian.white@pms.ac.uk

BACKGROUND: Tobacco smoking is a serious risk to health: several therapies are available to assist those who wish to stop. Smokers who approach publicly funded stop-smoking clinics in the UK are currently offered nicotine replacement therapy (NRT) or bupropion, and group behaviour therapy, for which there is evidence of effectiveness. Acupuncture and acupressure are also used to help smokers, though a systematic review of the evidence of their effectiveness was inconclusive. The aim of this pilot project was to determine the feasibility of a study to test acupressure as an adjunct to one anti-smoking treatment currently offered, and to inform the design of the study. METHODS: An open randomised controlled pilot study was conducted within the six week group programme offered by the Smoking Advice Service in Plymouth, UK. All participants received the usual treatment with NRT and group behavioural therapy, and were randomised into three groups: group A with two auricular acupressure beads, group B with one bead, and group C with no additional therapy. Participants were taught to press the beads when they experienced cravings. Beads were worn in one ear for four weeks, being replaced as necessary. The main outcome measures assessed in the pilot were success at quitting (expired CO < or = 9 ppm), the dose of NRT used, and the rating of withdrawal symptoms using the Mood and Symptoms Scale. RESULTS: From 49 smokers attending four clinics, 24 volunteered to participate, 19 attended at least once after quitting, and seven remained to the final week. Participants who dropped out reported significantly fewer previous quit attempts, but no other significant differences. Participants reported stimulating the beads as expected during the initial days after quitting, but most soon reduced the frequency of stimulation. The discomfort caused by the beads was minor, and there were no significant side effects. There were technical problems with adhesiveness of the dressing. Reporting of NRT consumption was poor, with much missing data, but reporting of ratings of withdrawal symptom scores was nearly complete. However, these showed no significant changes or differences between groups for any week. CONCLUSION: Any effects of acupressure on smoking withdrawal, as an adjunct to the use of NRT and behavioural intervention, are unlikely to be detectable by the methods used here and further preliminary studies are required before the hypothesis can be tested.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17359519

Eur J Neurol. 2007 Mar;14(3):276-81.

Acupuncture treatment improves nerve conduction in peripheral neuropathy.

Schröder S, Liepert J, Remppis A, Greten JH.

Heidelberg School of Chinese Medicine, Heidelberg, Germany.

dr.schroeder@praxis-jarrestadt.de

The etiology of peripheral neuropathy (PN) often remains elusive resulting in a lack of objective therapeutic strategies. We conducted a pilot study to evaluate the therapeutic effect of acupuncture on PN as measured by changes in nerve conduction and assessment of subjective symptoms. One hundred and ninety-two consecutive patients with PN as diagnosed by nerve conduction studies (NCS) were evaluated over a period of 1 year. Of 47 patients who met the criteria for PN of undefined etiology, 21 patients received acupuncture therapy according to classical Chinese Medicine as defined by the Heidelberg Model, while 26 patients received the best medical care but no specific treatment for PN. Sixteen patients (76%) in the acupuncture group improved symptomatically and objectively as measured by NCS, while only four patients in the control group (15%) did so. Three patients in the acupuncture group (14%) showed no change and two patients an aggravation (10%), whereas in the control group seven showed no change (27%) and 15 an aggravation (58%). Importantly, subjective improvement was fully correlated with improvement in NCS in both groups. The data suggest that there is a positive effect of acupuncture on PN of undefined etiology as measured by objective parameters.

Publication Types: Controlled Clinical Trial

PMID: 17355547

Complement Ther Med. 2007 Mar;15(1):3-12.

The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients.

Molassiotis A, Helin AM, Dabbour R, Hummerston S.

School of Nursing, Midwifery & Social Work, University of Manchester, Coupland III, Coupland Street, Manchester M13 9PL, UK.

alex.molassiotis@manchester.ac.uk

BACKGROUND: Nausea, and to a lesser extend vomiting, remain significant clinical problems after the administration of chemotherapy, with up to 60% of patients reporting nausea despite use of antiemetics. Combining antiemetics with other non-pharmacological treatments may prove more effective in decreasing nausea than antiemetics alone. Hence, the aim of the current study was to evaluate the effectiveness of using acupressure in Pericardium 6 (Neiguan) acu-point in managing chemotherapy-induced nausea and vomiting. METHODS: This was a randomised controlled trial. Acupressure was applied using wristbands (Sea-Band) which patients in the experimental group had to wear for the 5 days following the chemotherapy administration. Assessments of nausea, retching and vomiting were obtained from all patients daily for 5 days. Thirty-six patients completed the study from two centres in the UK, with 19 patients allocated to the control arm and 17 to the experimental arm. RESULTS: It was found that nausea and retching experience, and nausea, vomiting and retching occurrence and distress were all significantly lower in the experimental group compared to the control group (P<0.05). The only exception was with the vomiting experience, which was close to significance (P=0.06). DISCUSSION: Results highlight the important role of safe and convenient non-pharmacological complementary therapies, such as acupressure, in the management of the complex symptoms of chemotherapy-related nausea and vomiting.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17352966

Photomed Laser Surg. 2007 Feb;25(1):21-5.

Laser needle acupuncture at Neiguan (PC6) does not mediate heart rate variability in young, healthy men.

Hübscher M, Vogt L, Banzer W.

Department of Sports Medicine, Johann Wolfgang Goethe-University Frankfurt am Main, Frankfurt/Main, Germany.

m.huebscher@sport.uni-frankfurt.de

OBJECTIVE: The aim of this randomized, double-blinded, placebo-controlled trial was to evaluate specific effects of laser needle acupuncture at the Neiguan point (PC6) on sympathetic and parasympathetic nerve activity in healthy subjects using heart rate variability (HRV) analysis. BACKGROUND DATA: Acupuncture at the Neiguan point (PC6) has been shown to modulate the autonomic nervous system. METHODS: Forty-five healthy non-smoking males were randomly divided into a placebo group (n = 20) with no laser irradiation and into an intervention group (n = 25) for which laser needle irradiation (36.8 kJ/cm(2)) was performed on the right forearm. Monitoring of HRV was performed before, during, and after intervention. RESULTS: Repeated-measures MANOVA did not show statistically significant main effects of time (F = 1.29, p = 0.27) or of group (F = 1.67, p = 0.16). The time by group interaction was also not statistically significant (F = 0.95, p = 0.54). CONCLUSION: Our results suggest that heart rate variability was not influenced by laser needle acupuncture at the Neiguan point (PC6).

Publication Types: Randomized Controlled Trial.

PMID: 17352633

Photomed Laser Surg. 2007 Feb;25(1):14-20.

Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study.

Yurtkuran M, Alp A, Konur S, Ozçakir S, Bingol U.

Division of Rheumatology, Uludag University Atatürk Rehabilitation Center, Bursa, Turkey.

merihcan@hotmail.com

OBJECTIVE: The purpose of this study was to investigate the effects and minimum effective dose of laser acupuncture in knee osteoarthritis (KOA), and to determine if it is superior to placebo treatment (sham) in the evaluation of clinical-functional outcome and quality of life. METHODS: In this randomized, placebo-controlled study, patients with grade 2 and 3 primary KOA were selected. Group I (n = 27) received 904-nm low-level laser irradiation with 10 mW/cm(2) power density, 4 mW output power, 0.4 cm(2) spot size, 0.48 J dose per session, and 120-sec treatment time on the medial side of the knee to the acupuncture point Sp9. Group II (n = 25) received placebo-laser therapy at the same place on the same point. Patients in both of the groups had treatment 5 days per week (total duration of therapy was 10 days) and 20 min per day. The study was comprised of a 2-week (10-session) intervention. Participants were evaluated before treatment (baseline), after treatment (2nd week), and at the 12th week. In this double-blind study, a blind examiner carried out all outcome assessments. The main outcome measures were as follows: pain on movement (pVAS), 50-foot walking time (50 foot w), knee circumference (KC), medial tenderness score (MTS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Nottingham Health Profile (NHP). RESULTS: Statistically significant improvement was observed in PVAS, 50 foot w, and KC in group 1. In Group II, statistically significant improvement was observed in PVAS, 50 foot w, and WOMAC. When groups were compared with each other, the improvement observed in KC was superior in Group I at the 2(nd) week (p = 0.005). CONCLUSION: Laser acupuncture was found to be effective only in reducing periarticular swelling when compared with placebo laser.

Publication Types: Randomized Controlled Trial.

PMID: 17352632

Integr Cancer Ther. 2007 Mar;6(1):36-41.

Acupuncture for chemotherapy-associated cognitive dysfunction: a hypothesis-generating literature review to inform clinical advice.

Johnston MF, Yang C, Hui KK, Xiao B, Li XS, Rusiewicz A.

Center for East-West Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.

johnston@ucla.edu

There is an emerging consensus that between one fifth and one half of breast cancer patients experience chemotherapy-associated cognitive dysfunction. Research shows that patients with cancer are often interested in acupuncture for symptom relief. A clinical question thus arises: What should physicians advise their patients regarding the use of acupuncture to alleviate or ameliorate chemotherapy-associated cognitive dysfunction? The authors review and synthesize 2 bodies of relevant research literature: (1) the developing literature on the etiology and nature of chemotherapy-associated cognitive dysfunction and (2) the literature concerning acupuncture for neurological diseases and psychological issues. There is evidence that acupuncture may be effectively used to manage a range of psychoneurological issues, some of which are similar to those experienced by patients with chemotherapy-associated cognitive dysfunction. The evidence of efficacy is more promising for psychological than neurological conditions. Given evidence of possible efficacy combined with evidence of demonstrated safety, we suggest that physicians should support patient decisions to use acupuncture services for chemotherapy-associated cognitive dysfunction, especially given the lack of proven alternatives.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17351025

BMC Complement Altern Med. 2007 Feb 26;7:6.

The effect of TCM acupuncture on hot flushes among menopausal women (ACUFLASH) study: a study protocol of an ongoing multi-centre randomised controlled clinical trial.

Borud EK, Alraek T, White A, Fonnebo V, Grimsgaard S.

National Research Center in Complementary and Alternative Medicine, University of Tromsoe, N-9037 Tromsoe, Norway.

einar.borud@fagmed.uit.no

BACKGROUND: After menopause, 10-20% of all women have nearly intolerable hot flushes. Long term use of hormone replacement therapy involves a health risk, and many women seek alternative strategies to relieve climacteric complaints. Acupuncture is one of the most frequently used complementary therapies in Norway. We designed a study to evaluate whether Traditional Chinese Medicine acupuncture-care together with self-care is more effective than self-care alone to relieve climacteric complaints. METHODS/DESIGN: The study is a multi-centre pragmatic randomised controlled trial with two parallel arms. Participants are postmenopausal women who document > or =7 flushes/24 hours and who are not using hormone replacement therapy or other medication that may influence flushes. According to power calculations 200 women are needed to detect a 50% reduction in flushes, and altogether 286 women will be recruited to allow for a 30% dropout rate.The treatment group receives 10 sessions of Traditional Chinese Medicine acupuncture-care and self-care; the control group will engage in self-care only. A team of experienced Traditional Chinese Medicine acupuncturists give acupuncture treatments. DISCUSSION: The study tests acupuncture as a complete treatment package including the therapeutic relationship and expectation. The intervention period lasts for 12 weeks, with follow up at 6 and 12 months. Primary endpoint is change in daily hot flush frequency in the two groups from baseline to 12 weeks; secondary endpoint is health related quality of life, assessed by the Women's Health Questionnaire. We also collect data on Traditional Chinese Medicine diagnoses, and we examine treatment experiences using a qualitative approach. Finally we measure biological variables, to examine potential mechanisms for the effect of acupuncture. The study is funded by The Research Council of Norway.

Publication Types: Controlled Clinical Trial Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17324253

J Soc Integr Oncol. 2007 Winter;5(1):1-10.

Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials.

Lu W, Hu D, Dean-Clower E, Doherty-Gilman A, Legedza AT, Lee H, Matulonis U, Rosenthal DS.

Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA 02115, USA.

weidong_lu@dfci.harvard.edu

Chemotherapy-induced leukopenia and neutropenia are common side effects during cancer treatment. Acupuncture has been reported as an adjunct therapy for this complication. The current study reviewed published randomized controlled trials of acupuncture's effect and explored the acupuncture parameters used in these trials. We searched biomedical databases in English and Chinese from 1979 to 2004. The study populations were cancer patients who were undergoing or had just completed chemotherapy or chemoradiotherapy, randomized to either acupuncture therapy or usual care. The methodologic quality of trials was assessed. From 33 reviewed articles, 682 patients from 11 eligible trials were included in analyses. All trials were published in non-PubMed journals from China. The methodologic quality of these trials was considerably poor. The median sample size of each comparison group was 45, and the median trial duration was 21 days. The frequency of acupuncture treatment was once a day, with a median of 16 sessions in each trial. In the seven trials in which white blood cell (WBC) counts were available, acupuncture use was associated with an increase in leukocytes in patients during chemotherapy or chemoradiotherapy, with a weighted mean difference of 1,221 WBC/muL on average (95% confidence interval 636-1,807; p < .0001). Acupuncture for chemotherapy-induced leukopenia is an intriguing clinical question. However, the inferior quality and publication bias present in these studies may lead to a false-positive estimation. Meta-analysis based on these published trials should be treated in an exploratory nature only.

Publication Types: Meta-Analysis Research Support, N.I.H., Extramural

PMID: 17309808

J Altern Complement Med. 2007 Jan-Feb;13(1):47-51.

Fu's subcutaneous needling: possible clinical evidence of the subcutaneous connective tissue in acupuncture.

Fu ZH, Wang JH, Sun JH, Chen XY, Xu JG.

Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China.

OBJECTIVES: Recently it was reported that the loose connective tissue in the subcutaneous layer rapidly responded to mechanical forces evoked by acupuncture, massage, and normal physical movements. However, there were no clinical studies to substantiate these findings so far. Fu's Subcutaneous Needling (FSN) is the innovative needling strategy acting specifically in the subcutaneous layer. A single-blinded and randomized trial was designed to compare the immediate effects of FSN with different needling directions on myofascial trigger points (MTrP) in the neck. DESIGN: For simplicity, we chose two mutually perpendicular needle directions in this study. In one group, the needle was along the local muscle fibers and pointed to the MTrP (Along Group). In the other group, the needle was across the local muscle fibers and also pointed to the MTrP (Across Group). SUBJECTS: Forty-seven (47) patients were randomly divided into two groups: the Along Group (n = 22) and the Across Group (n = 25). There were no significant differences with respect to age, duration of pain, and gender between the two groups. INTERVENTIONS: FSN needles were inserted and swayed in the subcutaneous layer 200 times in 2 minutes. RESULTS: Before and after FSN treatment, patients were subjected to the assessment of the following three parameters: motion-related pain, pain under pressure, and the range of cervical movement. Three parameters were all reduced after the FSN intervention. There were no significant differences in variation of the three parameters between the two groups. CONCLUSION: Immediate effects of FSN on alleviating MTrP in the neck were not relevant to the needling directions.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial.

PMID: 17309377

Alcohol Clin Exp Res. 2007 Mar;31(3):436-42.

Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: a randomized-controlled trial.

Kunz S, Schulz M, Lewitzky M, Driessen M, Rau H.

Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Bielefeld, Germany.

BACKGROUND: There is increasing clinical acceptance of acupuncture as a treatment of substance-related disorders. Little is known about acupuncture as a treatment for the withdrawal syndrome in inpatient settings. We compared auricular needle acupuncture with aromatherapy in reducing the duration and severity of symptoms of alcohol withdrawal. METHODS: Inpatients undergoing alcohol withdrawal were randomly allocated to needle acupuncture (n=55) and aromatherapy (n=54). Both therapies were applied daily during the first 5 consecutive treatment days. The rating scale for the assessment of the alcohol-withdrawal syndrome (AWS scale) served as the main dependent variable and was applied daily during the first 5 days of the withdrawal. Further measures included a subjective visual analog scale of craving and the Self Assessment Manikin (SAM). RESULTS: Thirty-six of the 55 patients who received acupuncture, and 38 of the 54 patients who received aromatherapy, finished the study regularly. The groups differed in their initial self-reported arousal, which then served as a covariate in the further analyses. Neither the extent of craving nor of withdrawal symptoms differed between groups over the observation period. Self-rated arousal decreased in response to both treatments from days 1 to 2 (p<0.001) and within single days (p<0.001), and we found a significant interaction between pretreatment versus posttreatment and days (p<0.001). Interactions including between-subjects effects and intervention did not achieve the significance level. CONCLUSION: The results do not support the assumption of a superiority of acupuncture over the control therapy in its specific effects on alcohol withdrawal symptoms.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17295728

J Clin Epidemiol. 2007 Mar;60(3):280-7.

Randomized trial vs. observational study of acupuncture for migraine found that patient characteristics differed but outcomes were similar.

Linde K, Streng A, Hoppe A, Weidenhammer W, Wagenpfeil S, Melchart D.

Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Munich, Germany.

Klaus.Linde@lrz.tum.de

OBJECTIVE: To compare patient characteristics and outcomes between a randomized controlled trial (RCT) and an observational study (OS) of acupuncture treatment in patients with migraine. STUDY DESIGN AND SETTING: Within the framework of a research program for acupuncture for chronic pain, both an RCT and an OS of routine care were performed in patients with migraine. One hundred forty-five patients received acupuncture in the RCT and 732 in the OS. All patients completed a pain questionnaire, including instruments evaluating disability, quality of life, and depression, at baseline and at 6-month follow-up. RESULTS: At baseline, patients participating in the RCT had a significantly longer history of complaints and more headache days but better quality of life and fewer depressive symptoms than patients participating in the OS. In unadjusted analyses, improvements after 6 months were more pronounced in the OS than in the RCT. After adjustment for potential confounders, the differences decreased but were still significant for several outcomes. CONCLUSION: Participants of the RCT were probably not representative of migraine patients undergoing acupuncture treatment in routine care under current regulations in Germany. However, changes after treatment were similar in the RCT and the OS of routine care.

Publication Types: Comparative Study Multicenter Study Randomized Controlled Trial.Research Support, Non-U.S. Gov't

PMID: 17292022

Arch Phys Med Rehabil. 2007 Feb;88(2):159-66.

The effect of electro-acupuncture on spasticity of the wrist joint in chronic stroke survivors.

Mukherjee M, McPeak LK, Redford JB, Sun C, Liu W.

Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS 66160-7601, USA.

OBJECTIVE: To quantitatively assess the change in spasticity of the impaired wrist joint in chronic stroke patients after electro-acupuncture treatment. DESIGN: Crossover design. SETTING: University medical center research laboratory. PARTICIPANTS: Seven chronic stroke subjects (age, 63.14+/-7.01y). INTERVENTION: Participants received two 6-week treatment regimens: combined electro-acupuncture and strengthening twice a week, and strengthening twice a week only. Muscle strength and spasticity of the wrist joint were quantified by using the Biodex multijoint System 3 Pro. Electro-acupuncture was given through a commercial electro-acupuncture device. MAIN OUTCOME MEASURES: Velocity sensitivity of averaged speed-dependent reflex torque (VASRT); segmented averaged speed-dependent reflex torque (SASRT); Modified Ashworth Scale (MAS) scores; and integrated electromyographic activity of the affected wrist flexors during passive stretch of the affected wrist joint. RESULTS: VASRT was reduced significantly in the combined treatment group (P=.02) after the 6-week period, but not in the strengthening-only group (P=.23); however, no significant immediate effect of electro-acupuncture was observed (P>.05). MAS scores also showed a significant reduction (P<.01). SASRT did not differ significantly across different positions of the joint or across velocity; however, significant differences were present between the 2 treatment groups (P<.05) for each position and at all the velocities except at 20 degrees /s. Integrated electromyographic activity showed a trend for reduction after the combined treatment. CONCLUSIONS: A combination of electro-acupuncture and muscle strengthening exercise for 6 weeks significantly reduced spasticity. The effect of spasticity reduction was consistent across different joint positions and different velocities of passive stretch.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 17270512

Am J Chin Med. 2007;35(1):35-51.

Effect of acupuncture treatment on the immune function impairment found in anxious women.

Arranz L, Guayerbas N, Siboni L, De la Fuente M.

Department of Physiology (Animal Physiology II), Faculty of Biological Science, Complutense University of Madrid, Spain.

It is presently accepted that emotional disturbances lead to immune system impairment, and that therefore their treatment could restore the immune response. Thus, the aim of the present work was to study the effect of an acupuncture treatment, designed specifically to relieve the emotional symptoms stemming from anxiety, on several functions (adherence, chemotaxis, phagocytosis, basal and stimulated superoxide anion levels, lymphocyte proliferation in response to phytohemagglutinin A (PHA) and natural killer (NK) activity) of leukocytes (neutrophils and lymphocytes) from anxious women. The acupuncture protocol consisted of manual needle stimulation of 19 acupoints, with each session lasting 30 min. It was performed on 34 female 30-60 year old patients, suffering from anxiety, as determined by the Beck Anxiety Inventory (BAI). Before and 72 hours after receiving the first acupuncture session, peripheral blood samples were drawn. In 12 patients, samples were also collected immediately after the first single acupuncture session and one month after the end of the whole acupuncture treatment, which consisted of 10 sessions during a year, until the complete remission of anxiety. Twenty healthy non-anxious women in the same age range were used as controls. The results showed that the most favorable effects of acupuncture on the immune functions appear 72 hours after the single session and persist one month after the end of the complete treatment. Impaired immune functions in anxious women (chemotaxis, phagocytosis, lymphoproliferation and NK activity) were significantly improved by acupuncture, and augmented immune parameters (superoxide anion levels and lymphoproliferation of the patient subgroup whose values had been too high) were significantly diminished. Acupuncture brought the above mentioned parameters to values closer to those of healthy controls, exerting a modulatory effect on the immune system.

Publication Types: Controlled Clinical Trial

PMID: 17265549

Am J Chin Med. 2007;35(1):27-33.

Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation.

Neri I, De Pace V, Venturini P, Facchinetti F.

Mother-Infant Department, University of Modena e Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy.

neri.isabella@unimo.it

The aim of the study was to evaluate cardiovascular effects and fetal behavior during moxibustion, acupuncture or acupuncture plus moxibustion applied on the BL.67 acupoint of women (beside the outer corner of the 5th toenail) in fetal breech presentation. During the acupoint stimulation (20 min, two times a week), the women were submitted to computerized non-stress test. Fourteen cases were treated by both acupuncture and moxibustion, 15 cases by moxibustion and 10 cases by acupuncture. In 56% of cases, fetal position was converted from breech position to cephalic one; the success share was 80% for moxibustion, 28% for acupuncture, 57% for acupuncture plus moxibustion; the conversion, on average, was achieved after 3 sessions. Statistical analysis indicated that acupuncture plus moxibustion was able to reduce fetal heart rate during the application of stimuli while acupuncture and moxibustion separately did not affect such parameter. Moreover, moxibustion and acupuncture with moxibustion reduced fetal movements while acupuncture only appears ineffective. The present study suggests that fetal movements were reduced by both acupuncture plus moxibustion and moxibustion and that fetal heart rate was reduced just by acupuncture plus moxibustion. The mechanisms leading the effect on fetal heart rate and fetal movements remain to be clarified. Even though further studies are needed, such preliminar report mainly investigated the impact of different stimula on the BL.67 acupoint. Unfortunately these small series of data do not allow us to draw any conclusion about the effectiveness of the different treatments.

Publication Types: Comparative Study Randomized Controlled Trial.

PMID: 17265548

Aust N Z J Obstet Gynaecol. 2007 Feb;47(1):26-30.

The effects of acupuncture during labour on nulliparous women: a randomised controlled trial.

Hantoushzadeh S, Alhusseini N, Lebaschi AH.

Department of Obstetrics and Gynecology, Vali Asr Research Centre for Reproductive Health, Imam Medical Complex, Tehran, Iran.

hantoushzadeh@sina.tums.ac.ir

BACKGROUND: Acupuncture is as an ancient system of diagnosis and treatment. It is regarded as a complementary tool for pain management. AIMS: To assess the effects of acupuncture on nulliparous women during labour with respect to pain, labour duration and maternal acceptability. METHODS: One hundred and forty-four healthy nulliparous women in active phase were randomised into the study and control group, receiving real and minimal acupuncture, respectively. Visual analogue scale was used to assess pain. Objectives were to evaluate acupuncture effect on pain and labour duration and patients' willingness to receive acupuncture for subsequent pregnancies. RESULTS: Visual analogue scale pain score in the study group was lower after two hours. Active phase duration and the oxytocin units administered were lower in the study group. Study group patients had greater willingness to receive acupuncture again. No adverse effects were detected. CONCLUSIONS: Acupuncture could reduce pain experience, active phase duration and oxytocin units. Patients were satisfied and no adverse effects were noted.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17261096

Pain. 2007 Apr;128(3):264-71.

The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain.

Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich SN, Melchart D.

Centre for Complementary Medicine Research, Dep. of Internal Medicine II, Technische Universität München, Kaiserstr. 9, 80801 Munich, Germany.

Klaus.Linde@lrz.tum.de

In a pooled analysis of four randomized controlled trials of acupuncture in patients with migraine, tension-type headache, chronic low back pain, and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome. The 864 patients included in the analysis received either 12 sessions of acupuncture or minimal (i.e. sham) acupuncture (superficial needling of non-acupuncture points) over an 8 week period. Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment. After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving. Patients were classified as responders if the respective main outcome measure improved by at least fifty percent. Both univariate and multivariate analyses adjusted for potential confounders (such as condition, intervention group, age, sex, duration of complaints, etc.) consistently showed a significant influence of attitudes and expectations on outcome. After completion of treatment, the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 (95% confidence interval 1.20-2.32). For personal expectations and confidence after the third session, odds ratios were 2.03 (1.26-3.26) and 2.35 (1.68-3.30), respectively. Results from the 6-month follow-up were similar. In conclusion, in our trials a significant association was shown between better improvement and higher outcome expectations.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17257756

Anesth Analg. 2007 Feb;104(2):301-7.

Acupuncture enhances generation of nitric oxide and increases local circulation.

Tsuchiya M, Sato EF, Inoue M, Asada A.

Departments of Biochemistry, Osaka City University Medical School, Abeno-Ku, Japan.

Although it is widely used, the mechanisms and effects of acupuncture on pain are not completely understood. Recently, increased nitric oxide (NO) synthase activity has been found in meridians and acupoints. Because NO is a key regulator of local circulation, and because change in circulation can affect the development and persistence of pain, we propose that acupuncture might regulate NO levels. We studied the effects of acupuncture on local NO levels and circulation in a randomized, double-blind, crossover study with 20 volunteers, each of whom underwent one session each of real and noninvasive sham acupuncture in a single hand and forearm with a 1-wk interval between treatments. NO concentration in the plasma from the acupunctured arm was significantly increased by 2.8 +/- 1.5 micromol/L at 5 min and 2.5 +/- 1.4 micromol/L at 60 min after acupuncture. Blood flow in palmar subcutaneous tissue of the acupunctured arm also increased, and this correlated with the NO increase. These changes were not observed in noninvasive sham-acupunctured hands and forearms. In conclusion, acupuncture increases the NO level in treated regions and thereby increases local circulation. These regulatory effects might contribute to pain relief provided by acupuncture.

Publication Types: Comparative Study Randomized Controlled Trial

PMID: 17242084

Anesth Analg. 2007 Feb;104(2):295-300.

Auricular acupuncture for dental anxiety: a randomized controlled trial.

Karst M, Winterhalter M, Münte S, Francki B, Hondronikos A, Eckardt A, Hoy L, Buhck H, Bernateck M, Fink M.

Department of Anesthesiology, Pain Clinic, Hannover Medical School, Hannover, Germany.

karst.matthias@mh-hannover.de

Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.

Publication Types: Comparative Study Randomized Controlled Trial.

PMID: 17242083

Pain. 2007 Aug;130(3):254-66.

Hypothalamus and amygdala response to acupuncture stimuli in Carpal Tunnel Syndrome.

Napadow V, Kettner N, Liu J, Li M, Kwong KK, Vangel M, Makris N, Audette J, Hui KK.

Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States.

vitaly@nmr.mgh.harvard.edu

Brain processing of acupuncture stimuli in chronic neuropathic pain patients may underlie its beneficial effects. We used fMRI to evaluate verum and sham acupuncture stimulation at acupoint LI-4 in Carpal Tunnel Syndrome (CTS) patients and healthy controls (HC). CTS patients were retested after 5 weeks of acupuncture therapy. Thus, we investigated both the short-term brain response to acupuncture stimulation, as well as the influence of longer-term acupuncture therapy effects on this short-term response. CTS patients responded to verum acupuncture with greater activation in the hypothalamus and deactivation in the amygdala as compared to HC, controlling for the non-specific effects of sham acupuncture. A similar difference was found between CTS patients at baseline and after acupuncture therapy. For baseline CTS patients responding to verum acupuncture, functional connectivity was found between the hypothalamus and amygdala--the less deactivation in the amygdala, the greater the activation in the hypothalamus, and vice versa. Furthermore, hypothalamic response correlated positively with the degree of maladaptive cortical plasticity in CTS patients (inter-digit separation distance). This is the first evidence suggesting that chronic pain patients respond to acupuncture differently than HC, through a coordinated limbic network including the hypothalamus and amygdala.

Publication Types: Controlled Clinical Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 17240066

Clin J Pain. 2007 Feb;23(2):128-35.

Acupuncture for chronic low back pain in routine care: a multicenter observational study.

Weidenhammer W, Linde K, Streng A, Hoppe A, Melchart D.

Department of Internal Medicine II, Center for Complementary Medicine Research, Technische Universität München, Germany.

Wolfgang.Weidenhammer@lrz.tu-muenchen.de

OBJECTIVE: To investigate patient characteristics and outcomes after undergoing acupuncture treatment for chronic low back pain (cLBP) in Germany and to analyze chronification, pain grading, and depression as predictors for treatment outcomes. PATIENTS AND METHODS: Patients with cLBP (ICD-10 diagnoses M54.4 or M54.5) who underwent acupuncture therapy (mean number of sessions 8.7+/-2.9) within the framework of a reimbursement and research program sponsored by German statutory sickness funds were included in an observational study. Patients were asked to complete detailed questionnaires that included questions on intensity and frequency of pain and instruments measuring functional ability, depression, and quality of life (SF-36) before and after treatment and 6 months after beginning acupuncture. Participating physicians assessed pain chronification in patients. RESULTS: A total of 2564 patients (mean age 57.7+/-14.0 y, 78.7% female), who were treated by 1607 physicians, were included in the main analysis. After 6 months (6-mo follow-up), 45.5% of patients demonstrated clinically significant improvements in their functional ability scores. The mean number of days with pain was decreased by half (from 21 to 10 d/mo). Employed patients (employed patient subgroup analysis) reported a 30% decrease from baseline in days of work lost. In all, 8.1% of patients reported adverse events, the majority of which were minor. Subgroup analyses focusing on pain severity, stage of chronification, and depression revealed statistically significant relationships both to baseline measures and to reduction of pain after acupuncture. CONCLUSIONS: Acupuncture treatment is associated with clinically relevant improvements in patients suffering from cLBP of varying degrees of chronification and/or severity.

Publication Types: Multicenter Study Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17237661

Spine. 2007 Jan 15;32(2):236-43.

Acupuncture for neck disorders.

Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T.

DeGroote School of Medicine, Office of MD Admissions, McMaster University, Hamilton, Ontario, Canada.

trinhk@mcmaster.ca

STUDY DESIGN: Systematic review. OBJECTIVE: To determine the effects of acupuncture for individuals with neck pain. SUMMARY OF BACKGROUND DATA: Neck pain is one of the 3 most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. METHODS.: We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, Cumulative Index to Nursing and Allied Health Literature from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China. Any published trials using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included. RESULTS: We found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodologic quality had a mean of 2.3 of 5 on the Jadad scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately posttreatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately posttreatment, and at short-term follow-up (pooled standardized mean difference, -0.37; 95% confidence interval, -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up. CONCLUSIONS: There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short-term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain posttreatment, and this is maintained at short-term follow-up.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17224820

CMAJ. 2007 Jan 16;176(2):179-83.

Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial.

Usichenko TI, Kuchling S, Witstruck T, Pavlovic D, Zach M, Hofer A, Merk H, Lehmann C, Wendt M.

Department of Anesthesiology and Intensive Care Medicine, Ernst Moritz Arndt University, Greifswald, Germany.

taras@uni-greifswald.de

BACKGROUND: Auricular acupuncture is a promising method for postoperative pain relief. However, there is no evidence for its use after ambulatory surgery. Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery. METHODS: One hundred and twenty patients undergoing ambulatory arthroscopic knee surgery under standardized general anesthesia were randomly assigned to receive auricular acupuncture or a control procedure. Fixed indwelling acupuncture needles were inserted before surgery and retained in situ until the following morning. Postoperative rescue analgesia was directed to achieve pain intensity less than 40 mm on a 100-mm visual analogue scale. The primary outcome measure was the postoperative requirement for ibuprofen between surgery and examination the following morning. RESULTS: Intention-to-treat analysis showed that patients from the control group (n = 59) required more ibuprofen than patients from the auricular acupuncture group (n = 61): median (interquartile range) 600 (200-800) v. 200 (0-600) mg (p = 0.012). Pain intensity on a visual analogue scale was similar in both groups at all time points registered. The majority of patients in both groups believed that they had received true acupuncture and wanted to repeat it in future. INTERPRETATION: Auricular acupuncture reduced the requirement for ibuprofen after ambulatory knee surgery relative to an invasive needle control procedure.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17224599

Rheumatology (Oxford). 2007 Mar;46(3):384-90.

Acupuncture treatment for chronic knee pain: a systematic review.

White A, Foster NE, Cummings M, Barlas P.

Peninsula Medical School, Universities of Exeter and Plymouth, Plymouth, UK.

adrian.white@pms.ac.uk

OBJECTIVES: To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain. METHODS: Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive either acupuncture treatment or a control consisting of sham (placebo) acupuncture, other sham treatments, no additional intervention (usual care), or an active intervention. The main outcome measures were short-term pain and function, and study validity was assessed using a modification of a previously published instrument. RESULTS: Thirteen RCTs were included, of which eight used adequate acupuncture and provided WOMAC outcomes, so were combined in meta-analyses. Six of these had validity scores of more than 50%. Combining five studies in 1334 patients, acupuncture was superior to sham acupuncture for both pain (weighted mean difference in WOMAC pain subscale score = 2.0, 95% CI 0.57-3.40) and for WOMAC function subscale (4.32, 0.60-8.05). The differences were still significant at long-term follow-up. Acupuncture was also significantly superior to no additional intervention. There were insufficient studies to compare acupuncture with other sham or active interventions. CONCLUSIONS:Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects.

Publication Types: Meta-Analysis Research Support, Non-U.S. Gov't Review

PMID: 17215263

Complement Ther Clin Pract. 2007 Feb;13(1):63-9.

Auriculotherapy on low back pain in the elderly.

Suen LK, Wong TK, Chung JW, Yip VY.

The Nethersole School of Nursing, Esther Lee Building, The Chinese University of Hong Kong, Shatin, Hong Kong. lornasuen@cuhk.edu.hk

The objective of the study was to examine the effectiveness of auriculotherapy using magnetic pellets for the elderly suffering from low back pain (LBP). Sixty participants who were 60-years old or above and had been suffering from LBP were recruited. Participants were randomly allocated to receive auriculotherapy on a 3-week basis using either Semen Vaccariae (control group=30) or magnetic pellets (experimental group=30). Seven auricular acupoints that are believed to have an effect on LBP were selected. Treatment effects were evaluated using the Chinese Pain Intensity Verbal Rating scale (VRS). The experimental group had indeed experienced a significant improvement in pain relief when compared with the control group; and the therapeutic effects were sustained at 2 and 4-week follow-up periods after the therapy. Findings of this study demonstrated that auriculotherapy using magnetic pellets significantly reduce the pain intensity level of the elderly suffering from non-specific LBP.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17210513

Rheumatology (Oxford). 2007 May;46(5):801-4.

Acupuncture for fibromyalgia--a systematic review of randomized clinical trials.

Mayhew E, Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK.

Edzard.Ernst@pms.ac.uk

OBJECTIVE: Acupuncture is often used and frequently advocated for the symptomatic treatment of fibromyalgia. A systematic review has previously demonstrated encouraging findings. As it is now outdated, we wanted to update it. METHODS: We searched seven electronic databases for relevant randomized clinical trials (RCTs). The data were extracted and validated independently by both authors. As no meta-analysis seemed possible, the results were evaluated in narrative form. RESULTS: Five RCTs met our inclusion criteria, all of which used acupuncture as an adjunct to conventional treatments. Their methodological quality was mixed and frequently low. Three RCTs suggested positive but mostly short-lived effects and two yielded negative results. There was no significant difference between the quality of the negative and the positive RCTs. All positive RCTs used electro-acupunture. CONCLUSION: The notion that acupuncture is an effective symptomatic treatment for fibromyaligia is not supported by the results from rigorous clinical trials. On the basis of this evidence, acupuncture cannot be recommended for fibromyalgia.

Publication Types: Review

PMID: 17189243

Maturitas. 2007 Apr 20;56(4):383-95.

Acupuncture for postmenopausal hot flashes.

Nir Y, Huang MI, Schnyer R, Chen B, Manber R.

Stanford University School of Medicine, United States. amiryael@gmail.com

OBJECTIVE: To determine whether individually tailored acupuncture is an effective treatment option for reducing postmenopausal hot flashes and improving quality of life. METHODS: In a randomized, placebo-controlled pilot study, 29 postmenopausal participants averaging at least seven moderate to severe hot flashes per 24h, with a baseline estradiol concentration of less than 50 pg/mL and a normal TSH level, were randomized to receive 7 weeks (nine treatment sessions) of either active acupuncture or placebo acupuncture (placebo needles that did not penetrate the skin at sham acupuncture points). Participants recorded hot flashes in logs that were reported daily. Global indices of the severity and frequency of hot flashes were derived from the participants' daily logs. RESULTS: Participants receiving the active treatment had a greater reduction in hot flash severity (24.5+/-30.7%) compared to those receiving placebo (4.4+/-17.1%, P=0.042). Within group repeated measures analyses of variance revealed a significant reduction in hot flash severity in the active (P=0.042), but not in the placebo treatment group (P=0.15). Although there was no significant group difference in the reduction of hot flash frequency between the active (42.4+/-32.2%) and placebo groups (32.0+/-26.5%; P>or=0.352), within group repeated measures analyses of variance revealed that the reduction was statistically significant in both groups (P<or=0.001). CONCLUSIONS: Standardized, individually tailored acupuncture treatment was associated with significantly greater decrease in the severity, but not the frequency, of hot flashes, in symptomatic postmenopausal women when compared to placebo acupuncture of equal duration. Future, larger scale, studies are needed.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17182200

Eur J Anaesthesiol. 2007 Apr;24(4):370-6.

Minimal immunoreactive plasma beta-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques.

Harbach H, Moll B, Boedeker RH, Vigelius-Rauch U, Otto H, Muehling J, Hempelmann G, Markart P.

University of Giessen, Department of Anaesthesiology, Intensive Care, Pain Therapy, Palliative Medicine, Germany.

heinz.harbach@chiru.med.uni-giessen.de

BACKGROUND AND OBJECTIVE: Acupuncture has been claimed to be associated with activation of the endogenous antinociceptive system. The analgesic effects of acupuncture have been ascribed to beta-endorphin interacting with opioid receptors. However, firstly, the release of beta-endorphin into the blood has been proven to be induced by stress, i.e. under dysphoric conditions, and, secondly, if released under stress, beta-endorphin has been shown not to be analgesic. Our aim was to test whether beta-endorphin immunoreactive material is released into the cardiovascular compartment during acupuncture comparing the most frequently used types of acupuncture with standard pain treatment under apparently low stress conditions. METHODS: This prospective study included 15 male patients suffering from chronic low back pain. beta-Endorphin immunoreactive material and cortisol were measured in the plasma of patients who underwent, in random order, therapy according to a standard pain treatment, traditional Chinese acupuncture, sham acupuncture, electro acupuncture and electro acupuncture at non-acupuncture points before, at and after the treatment. Statistical analysis was performed using two-way ANOVA with repeated measures. RESULTS: A decrease in plasma cortisol concentration measured over the five treatment protocols was highly significant (P < 0.001). The beta-endorphin immunoreactive material concentrations in plasma were minimal at all times and in all treatment conditions. The influence of treatments by various acupuncture procedures on cortisol and beta-endorphin immunoreactive material plasma concentrations over the three time points was not significantly different. CONCLUSIONS: beta-endorphin immunoreactive material in blood is not released by any type of acupuncture as tested under low stress conditions.

Publication Types: Randomized Controlled Trial.

PMID: 17156512

J Dent. 2007 Mar;35(3):259-67

The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial.

Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z.

School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester M15 6FH, United Kingdom.

OBJECTIVES: To compare the effect of real acupuncture and sham acupuncture in the treatment of temporomandibulat joint myofascial pain, in order to establish the true efficacy of acupuncture. METHODS: A double blind randomised controlled trial conducted in the TMD Clinic, at the School of Dentistry, The University of Manchester. Twenty-seven patients were assigned to one of two treatment groups. Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention. Both the assessor and the patient were blinded regarding the group allocation. Baseline assessment of the outcome variables was made prior to the first treatment session, and was repeated following the last treatment. RESULTS: The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP than those of sham acupuncture, and the majority of these reached a level of statistical significance. CONCLUSION: Acupuncture had a positive influence on the signs and symptoms of TMJ MP. In addition, this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints.

Publication Types: Comparative Study Randomized Controlled Trial.

PMID: 17095133

Midwifery. 2007 Jun;23(2):184-95.

A randomised-controlled trial in Sweden of acupuncture and care interventions for the relief of inflammatory symptoms of the breast during lactation.

Kvist LJ, Hall-Lord ML, Rydhstroem H, Larsson BW.

Department of Obstetrics and Gynaecology, Floor 2, Helsingborg Hospital, Helsingborg, SE-251 87 Sweden.

linda.kvist@helsingborgslasarett.se

OBJECTIVES: to further compare acupuncture treatment and care interventions for the relief of inflammatory symptoms of the breast during lactation and to investigate the relationship between bacteria in the breast milk and clinical signs and symptoms. DESIGN: randomised, non-blinded, controlled trial of acupuncture and care interventions. SETTING: a midwife-led breast feeding clinic in Sweden. PARTICIPANTS: 205 mothers with 210 cases of inflammatory symptoms of the breast during lactation agreed to participate. The mothers were randomly assigned to one of three treatment groups, two of which included acupuncture among the care interventions and one without acupuncture. All groups were given essential care. Protocols, which included scales for erythema, breast tension and pain, were maintained for each day of contact with the breast feeding clinic. A Severity Index (SI) for each mother and each day was created by adding together the scores on the erythema, breast tension and pain scales. The range of the SI was 0 (least severe) to 19 (most severe). FINDINGS: no significant difference was found in numbers of mothers in the treatment groups, with the lowest possible score for severity of symptoms on contact days 3, 4 or 5. No statistically significant differences were found between the treatment groups for number of contact days needed until the mother felt well enough to discontinue contact with the breast feeding clinic or for number of mothers prescribed antibiotics. Significant differences were found in the mean SI scores on contact days 3 and 4 between the non-acupuncture group and the two acupuncture groups. Mothers with less favourable outcomes (6 contact days, n=61) were, at first contact with the midwife, more often given advice on correction of the baby's attachment to the breast. An obstetrician was called to examine 20% of the mothers, and antibiotic treatment was prescribed for 15% of the study population. The presence of Group B streptococci in the breast milk was related to less favourable outcomes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: if acupuncture treatment is acceptable to the mother, this, together with care interventions such as correction of breast feeding position and babies' attachment to the breast, might be a more expedient and less invasive choice of treatment than the use of oxytocin nasal spray. Midwives, nurses or medical practitioners with specialist competence in breast feeding should be the primary care providers for mothers with inflammatory symptoms of the breast during lactation. The use of antibiotics for inflammatory symptoms of the breast should be closely monitored in order to help the global community reduce resistance development among bacterial pathogens.

Publication Types: Controlled Clinical Trial Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17052823

Pain. 2007 Feb;127(3):214-20.

Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial.

Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, Chao A, Chang CJ, Lai CH, Wong AM.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

Transcutaneous electrical nerve stimulation (TENS) is one of the non-pharmacological means of pain relief for labor and delivery. We aimed to investigate the efficacy and safety of TENS on specific acupuncture points for reducing pain in the first stage of labor. In this double-blind, placebo-controlled trial, we randomly assigned healthy full-term parturients in active phase of first-stage labor to either TENS on four acupuncture points (Hegu [Li 4] and Sanyinjiao [Sp 6]) (n=52) or the TENS placebo (n=53). Visual analogue scale (VAS) was used to assess pain before and 30 and 60 min after treatment. The primary outcome was the rate of VAS score decrease 3 in each group. A questionnaire was given at 24h post-partum to evaluate the satisfaction of pain relieving method and the willingness to have the same treatment again. Mode of delivery and neonatal effect were measured as secondary outcome. One hundred women were eligible for analysis. TENS group experienced VAS score reduction 3 significantly more common than the TENS placebo group (31/50 [62%] vs 7/50 [14%], P<0.001). Willingness of using the same analgesic method for a future childbirth was also significantly different (TENS: 48/50 [96%] vs TENS placebo: 33/50 [66%], P<0.001). Operative delivery was increased in the TENS group (12/50 [24%] vs 4/50 [8%], P=0.05), but the neonatal outcomes were not different. The application of TENS on specific acupuncture points could be a non-invasive adjunct for pain relief in the first stage of labor.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17030438

Sleep Med. 2007 Jan;8(1):43-50.

Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial.

Freire AO, Sugai GC, Chrispin FS, Togeiro SM, Yamamura Y, Mello LE, Tufik S.

Sleep Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

BACKGROUND AND PURPOSE: To investigate the efficacy of acupuncture in the treatment of moderate obstructive sleep apnea syndrome (OSAS), assessed by polysomnography (PSG) and questionnaires of functional quality of life (SF-36) and excessive daytime sleepiness (Epworth). PATIENTS AND METHODS: We performed a randomised, placebo-controlled, single-blinded study, with blinded evaluation on 36 patients presenting an apnea/hypopnea index (AHI) of 15-30/h, assessed by PSG. The study took place at the Public Hospital of the Universidade Federal de São Paulo, Brazil, in the Division of Sleep Disorders of the Department of Psychobiology, between January, 2002 and August, 2004. Patients were randomly assigned to three groups: the acupuncture group (n=12); the sham group, submitted to needle insertion in non-acupoints (n=12); and the control group, receiving no treatment (n=12). Patients received acupuncture or sham acupuncture once a week for 10 weeks. RESULTS: Twenty-six patients completed the study. The AHI (P=0.005), the apnea index (AI) (P=0.008) and the number of respiratory events (P=0.005) decreased significantly in the acupuncture group but not in the sham group. On the other hand, the control group displayed significant deterioration in some of the polysomnographic parameters, with a significant increase in the number of respiratory events (P=0.025). Acupuncture treatment significantly improved (before vs. after treatment) several dimensions of the SF-36 and Epworth questionnaires. There was no significant association between changes in the body mass index (BMI) and AHI. CONCLUSIONS: Acupuncture is more effective than sham acupuncture in ameliorating the respiratory events of patients presenting with moderate OSAS.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17023212

Menopause. 2007 Jan-Feb;14(1):45-52.

Acupuncture for hot flashes: a randomized, sham-controlled clinical study.

Vincent A, Barton DL, Mandrekar JN, Cha SS, Zais T, Wahner-Roedler DL, Keppler MA, Kreitzer MJ, Loprinzi C.

Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

OBJECTIVE: Hot flashes are a significant problem in women going through the menopausal transition that can substantially affect quality of life. The world of estrogen therapy has been thrown into turmoil with the recent results of the Women's Health Initiative trial report. Pursuant to a growing interest in the use of alternative therapies to alleviate menopausal symptoms and a few pilot trials that suggested that acupuncture could modestly alleviate hot flashes, a prospective, randomized, single-blind, sham-controlled clinical trial was conducted in women experiencing hot flashes. DESIGN: Participants, after being randomized to medical versus sham acupuncture, received biweekly treatments for 5 weeks after a baseline assessment week. They were then followed for an additional 7 weeks. Participants completed daily hot flash questionnaires, which formed the basis for analysis. RESULTS: A total of 103 participants were randomized to medical or sham acupuncture. At week 6 the percentage of residual hot flashes was 60% in the medical acupuncture group and 62% in the sham acupuncture group. At week 12, the percentage of residual hot flashes was 73% in the medical acupuncture group and 55% in the sham acupuncture group. Participants reported no adverse effects related to the treatments. CONCLUSIONS: The results of this study suggest that the used medical acupuncture was not any more effective for reducing hot flashes than was the chosen sham acupuncture.

Publication Types: Randomized Controlled Trial. Research Support, Non-U.S. Gov't

PMID: 17019380

J Affect Disord. 2007 Mar;98(3):253-7.

Effects of electroacupuncture and fluoxetine on the density of GTP-binding-proteins in platelet membrane in patients with major depressive disorder.

Song Y, Zhou D, Fan J, Luo H, Halbreich U.

Institute of Mental Health, Peking University, China.

h0594004@hkusua.hku.hk

BACKGROUND: Electroacupuncture (EA) has been used to treat Major Depressive Disorder (MDD). However, its efficacy is inconclusive and the mechanism is still unclear. Thus, the objective of this study is to investigate the therapeutic effect of EA on GTP-binding-protein (G protein) in platelet membrane using fluoxetine as a comparison. METHODS: A randomized controlled trial (RCT) was performed on 90 MDD patients, who were divided into three groups treated with fluoxetine, EA and sham EA respectively. Antibodies were utilized to quantify the levels of G protein alpha subtypes in the platelet membrane before and after 6-week anti-depressive treatment. Thirty age and sex-matched normal individuals were used as controls. RESULT: All the treatments had the same therapeutic effects in treating moderate depression. Both levels of Galphai and Galphaq in depression patients were significantly higher than those in controls and were not reduced by treatments, although the severity was considerably relieved. LIMITATIONS: The duration of treatment was limited to six weeks only. CONCLUSION: EA might be served as an alternative treatment for moderate depression and we further demonstrate that the abnormal levels of Galpha protein in platelet membrane might be a potential risk factor for MDD.

Publication Types: Randomized Controlled Trial.

PMID: 16919758

J Affect Disord. 2007 Jan;97(1-3):13-22.

A systematic review of randomized controlled trials of acupuncture in the treatment of depression.

Leo RJ, Ligot JS Jr.

Department of Psychiatry, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Erie County Medical Center, 462 Grider Street, Buffalo, NY 14215, United States.

Rleomd@aol.com

BACKGROUND: Acupuncture has become a popular complementary and alternative treatment approach. This review examined the randomized controlled trials (RCTs) examining the effects of acupuncture treatment of depression. METHODS: RCTs of the treatment of depression with acupuncture were located using MEDLINE, Allied and Complementary Medicine and the Cochrane Central Register of Controlled Trials. The methodology of RCTs was assessed using the Jadad criteria, and elements of research design, i.e., randomization, blinding, assessment of attrition rates, were quantified for systematic comparisons among studies. RESULTS: Among the 9 RCTs examined, five were deemed to be of low quality based upon Jadad criteria. The odds ratios derived from comparing acupuncture with control conditions within the RCTs suggests some evidence for the utility of acupuncture in depression. General trends suggest that acupuncture modalities were as effective as antidepressants employed for treatment of depression in the limited studies available for comparison. However, placebo acupuncture treatment was often no different from intended verum acupuncture. LIMITATIONS: The RCTs extracted were limited by small sample sizes, imprecise enrollment criteria, problems with randomization, blinding, brief duration of study and lack of longitudinal follow-up. CONCLUSIONS: Despite the findings that the odds ratios of existing literature suggest a role for acupuncture in the treatment of depression, the evidence thus far is inconclusive. However, efforts are being made to standardize complementary approaches to treat depression, and further systematized research into their use is warranted.

Publication Types: Comparative Study Review

PMID: 16899301

Int J Nurs Stud. 2007 Aug;44(6):973-81.

Effects of acupressure on dysmenorrhea and skin temperature changes in college students: a non-randomized controlled trial.

Jun EM, Chang S, Kang DH, Kim S.

Department of Nursing, College of Natural Science, Dong-eui University, Kaya-dong, Pusan, Republic of Korea.

charminggold@hanmail.net

BACKGROUND: Complementary and alternative therapies may be adopted as nursing interventions to alleviate dysmenorrhea and improve productivity, creativity, work performance, and quality of life. OBJECTIVES: This study aimed to evaluate the efficacy of San Yin Jiao (SP6) acupressure as a non-pharmacologic nursing intervention for dysmenorrhea and identify its effects on temperature changes in two related acupoints as an explanatory mechanism of chi circulation. DESIGN: A non-equivalent control group pre and post-test design was employed to verify the effects of SP6 acupressure on skin temperature and dysmenorrhea. SETTING AND PARTICIPANTS: Young college women with primary dysmenorrhea were recruited from classrooms at two universities in Korea and 58 eligible participants were allotted to either a SP6 acupressure group or placebo group that received light touch on the SP6 acupoint. METHODS: The experimental group received acupressure treatment within the first 8h of menstruation, and severity of dysmenorrhea and skin temperature changes in the Zhongwan (CV2) and Qugu (CV12) acupoints were assessed prior to and 30 min, 1, 2, and 3h following treatment. RESULTS: There was a significant difference in severity of dysmenorrhea between the two groups immediately after (F=18.50, p=0.000) and for up to 2h (F=8.04, p=0.032) post treatment. Skin temperature was significantly elevated at 30 min after acupressure at the suprapubic CV2 acupoint in the experimental group compared to the control group. Temperature elevation was also noted at the epigastric CV12 acupoint post treatment but group differences were not significant, indicating that SP6 acupressure relieves dysmenorrhea primarily by temperature elevation in the CV2 pathway. CONCLUSIONS: Acupressure to the SP6 meridian can be an effective non-invasive nursing intervention for alleviation of primary dysmenorrhea, with effects lasting 2h post treatment.

Publication Types: Comparative Study Controlled Clinical Trial Multicenter Study

PMID: 16782102