Shaftesbury Clinic Star of Conditions

Irritable Bowel Syndrome (IBS) – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Research and Resources on Irritable Bowel Syndrome and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “IBS” yields over 6640 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 900 results; of which 40% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

For constipation, see also our dedicated page here

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

The British Acupuncture Council has a Research digest where they examined some recent studies on IBS, such as MacPherson et al (2017; n=116) in a follow up two years after their RCT acupuncture for IBS, finding a favourable result 24 months on.  Another RCT for diarrhoea type IBS (Zheng et al, 2016; n=448) found the acupuncture group found a level of improvement in line with that of the group assigned pharmacological (Loperamide) intervention in terms of reducing stool frequency.

Zhu et al (2018a) conducted a network meta-analysis of diarrhoea type IBS, with 29 studies (n=9369) entailed in it, finding that acupuncture may improve symptoms, but that further high quality research was needed to corroborate the overall results.  A meta analysis of diarrhoea predominant IBS (Deng et al, 2017) looked at 17 trials (n=1333), finding improvement in clinical symptoms in the acupuncture groups. Similar trends have been seen in the trials for acupuncture in constipation predominant IBS, in a network meta-analysis, in which the quality of the trials was predominantly of high quality (40 trials n=11032; Zhu et al, 2018b). 

Qi et al (2022; n=90; pilot, multicentre RCT) examined a potential biological mechanism of action on IBS by reducing “visceral hypersensitivity” and modulating the gut-brain axis. They compared 3 groups: Specific acupuncture (real points); non-specific points; and sham acupuncture, and compared measurements of abdominal pain scores and types of stool. Both the specific and non-specific groups showed meaningful improvement in the IBS-D symptoms from baseline. It’s of note that non-specific real points do nonetheless have an impact, although the verum acupuncture effect is longer lived.

Research is ongoing, and recently, a protocol for a systematic review for anxiety and depression in IBS is awaited with interest (Li et al, 2021a), as is a systematic review of a comparison of acupuncture and pinaverium bromide in IBS (Li et al, 2021b), and a systematic review of acupuncture for adults with IBS-D (Guo et al, 2020). Search terms “acupuncture” + “IBS” + “RCT” + “protocol” since 2021 yield over 80 results, showing there is more to come in this area of growing interest in the very near future.

Mechanisms of Action

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Moxibustion (an adjunctive acupuncture technique that involves burning herbs near the skin to stimulate acupuncture points) was found to reduce the expression of pro-inflammatory biomarkers (namely, TLR2, IRAK1, IKK-β and NF-κB) in an ulcerative colitis rat model; and to increase the expression of anti-inflammatory biomarkers (specifically, IFN- β and IL-10) in the rats’ colonic mucosa (Wang et al, 2015). Therefore it may have a protective and anti-inflammatory effect on the gut tissue.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about IBS including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research Digest – Irritable Bowel Syndrome (IBS) (approx halfway down the document)

References:

Deng, D., Guo, K., Tan, J., Huang, G., Li, S., Jiang, Q., Xie, J., Xie, H., Zhang, Z., Chen, Y. and Peng, L., 2017. Acupuncture for diarrhea-predominant irritable bowel syndrome: a meta-analysis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 37(8), pp.907-912.

Guo, J., Xing, X., Wu, J., Zhang, H., Yun, Y., Qin, Z. and He, Q., 2020. Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis. Neural plasticity, 2020.

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021a. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021b. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

MacPherson, H., Tilbrook, H., Agbedjro, D., Buckley, H., Hewitt, C. and Frost, C., 2017. Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. Acupuncture in Medicine, 35(1), pp.17-23.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Wang, X., Liu, Y., Dong, H., Wu, L., Feng, X., Zhou, Z., Zhao, C., Liu, H. and Wu, H., 2015. Herb-partitioned moxibustion regulates the TLR2/NF-κB signaling pathway in a rat model of ulcerative colitis. Evidence-Based Complementary and Alternative Medicine, 2015.

Zheng, H., Li, Y., Zhang, W., Zeng, F., Zhou, S.Y., Zheng, H.B., Zhu, W.Z., Jing, X.H., Rong, P.J., Tang, C.Z. and Wang, F.C., 2016. Electroacupuncture for patients with diarrhea-predominant irritable bowel syndrome or functional diarrhea: a randomized controlled trial. Medicine, 95(24).

Zhu, L., Ma, Y., Ye, S. and Shu, Z., 2018a. Acupuncture for diarrhoea-predominant irritable bowel syndrome: a network meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.

Zhu, L., Ma, Y. and Deng, X., 2018b. Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis. PloS one, 13(4), p.e0196128.

Helen
Posted on: May-16-2021 13:13 pm
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Shaftesbury Clinic Star of Conditions

Heartburn, Indigestion Condition Resources

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Also known by its medical name of Dyspepsia, or commonly as indigestion or heartburn.

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Research and Resources on Dyspepsia and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “dyspepsia” yields over 8,600 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 970 results; of which 42% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

The British Acupuncture Council has a Research digest where they have looked at some more recent studies including on Dyspepsia, including a 2-arm trial where the refractory functional dyspepsia patients were seen to experience improvement in symptoms for up to two months, with no adverse side effects (RCT; n=200) (Zheng et al, 2018).   An RCT in Korea (n=76) looked at functional dyspepsia as well as other quality of life related measures, finding a significant improvement in FD symptoms for up to 8 weeks in the acupuncture group (Ko et al, 2016).  

A meta-analysis of 16 RCTs (n=1436 total) found positive results both for symptoms and quality of life, albeit that the quality of the research was low in many cases in the trails they examined, but further high quality RCT studies are needed to corroborate the trends (Pang et al, 2016). Recently, Zhang at al, (2020) reached a similar conclusion on examining 35 studies (n=3301), specifically recommending multi-centre trials and high quality RCT’s to supplement the current research body.

Mao et al’s meta-analysis (2020; n=853 over 7 RCTs) found Electroacupuncture (EA) to have greater efficacy in alleviating Functional Dyspepsia (FD) symptoms versus placebo (sham-EA). However, with the limitation of small sample size and some low quality, the findings are were cautiously interpreted, calling for further quality, large, multi-centre RCTs to supplement the evidence.

Currently, we await with interest the results of Kwon et al’s (2021) paper after “acupuncture as add-on treatment for functional dyspepsia protocol for systematic review”.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about Gastrointestinal Issues including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research Digest – Dyspepsia (just over halfway down the document)

References:

Ko, S.J., Kuo, B., Kim, S.K., Lee, H., Kim, J., Han, G., Kim, J., Kim, S.Y., Jang, S., Son, J. and Kim, M., 2016. Individualized acupuncture for symptom relief in functional dyspepsia: a randomized controlled trial. The Journal of Alternative and Complementary Medicine, 22(12), pp.997-1006.

Kwon, C.Y., Ko, S.J., Lee, B., Cha, J.M. and Park, J.W., 2021. Acupuncture as add-on treatment for functional dyspepsia: A protocol for systematic review. Medicine, 100(7).

Mao, X., Guo, S., Ni, W., Zhang, T., Liu, Q., Du, S., Luo, M., Pan, Y., Wu, B., Su, X. and Yang, Y., 2020. Electroacupuncture for the treatment of functional dyspepsia: a systematic review and meta-analysis. Medicine, 99(45).

Pang, B., Jiang, T., Du, Y.H., Li, J., Li, B., Hu, Y.C. and Cai, Q.H., 2016. Acupuncture for functional dyspepsia: what strength does it have? A systematic review and meta-analysis of randomized controlled trials. Evidence-based Complementary and Alternative Medicine, 2016.

Zhang, J., Liu, Y., Huang, X., Chen, Y., Hu, L., Lan, K. and Yu, H., 2020. Efficacy Comparison of Different Acupuncture Treatments for Functional Dyspepsia: A Systematic Review with Network Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2020.

Zheng, H., Xu, J., Sun, X., Zeng, F., Li, Y., Wu, X., Li, J., Zhao, L., Chang, X.R., Liu, M. and Gong, B., 2018. Electroacupuncture for patients with refractory functional dyspepsia: a randomized controlled trial. Neurogastroenterology & Motility, 30(7), p.e13316.

Helen
Posted on: May-16-2021 12:58 pm
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Shaftesbury Clinic Star of Conditions

Headaches – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Over 80 NHS publications since 2005 have recommended acupuncture both for tension headaches and migraine (and many more worldwide (Birch et al, 2018)

The British Acupuncture Council (BAcC) reviewed the evidence for acupuncture in migraine and tension headaches, where a large number of trials have been carried out, considerably more effective than placebo (Tavola et al, 1992.) The BAcC concluded there was some evidence that acupuncture has a significant therapeutic effect on symptoms such as pain and frequency in migraine attacks. It was also noted in a crossover research trial that in addition to demonstrating a significant effect in reduction of frequency of attacks and their duration, that acupuncture has a very low side effect profile (Hesse et al, 1994; Loh et al, 1984).

The British Acupuncture Council has a Research digest where they examined some recent studies on headache and migraine, as well as an evidence based factsheet (links are below).

Acupuncture has had a good profile for both migraine and tension headaches since the Cochrane review of 2009, which was updated in 2016 (Linde et al), including 22 trials (n=4985), finding evidence to suggest that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches.  The researchers expressed the need for further long term trials in this area.

The current NICE headache guidelines (2012; 1.3.9) state the following: “Prophylactic treatment: Consider a course of up to 10 sessions of acupuncture over 5 to 8 weeks for the prophylactic treatment of chronic tension‑type headache.”

A systematic review on migraine without aura (Xu et al, 2018) examined 14 RCTs (n=1155), drawing the conclusion that acupuncture is safe, more beneficial that sham control in addressing symptoms, although they were reserved in the strength of this finding by the quality of some of the evidence available, meaning further studies were warranted.

A recent Randomised Controlled Trial (RCT) for acupuncture for Chronic Tension-Type Headache (N=218) used sham vs true acupuncture providing an 8 week treatment course; this study showed long-term effective prophylaxis (prevention of headaches) as the outcome, and used a 32 week follow up (Zheng at al (2022).

Tao et al (2023)’s a systematic review and meta-analysis looking at prevention of tension-type headaches (TTH) using a large sample size (n=2795; 14 RCT studies) published in the Journal of Neurology showed the efficacy of acupuncture for tension-type headache prophylaxis, whereby the acupuncture groups had more reduction than sham acupuncture in TTH frequency, both after treatment and at follow-up. The researchers concluded acupuncture to be effective and safe for TTH prevention, but noted some limitations in evidence quality, and suggested further high-quality trials to supplement the current evidence.

Ambrosie et el, (2012) looked at cost effectiveness of acupuncture use in this field, using the NHS measure of cost per quality adjusted life year (QALY) gain from treatment usage, finding  acupuncture to be cost effective by this measure.

Mechanisms of action:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:

  • Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
  • Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
  • Acupuncture may contribute to analgesia by stimulating the release of β-endorphin, which binds to opioid receptors and inhibits pain signals.
  • Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010; Park, 2009).

Resources:

British Acupuncture Council evidence based factsheet about Headaches including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council evidence based factsheet about Migraines including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research Digest – Headache and Migraine (approx halfway down the document)

BAcC Stress Factsheet

References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

Hesse J, Movelvang B, Simonsen H. (1994) Acupuncture versus metroplol in migraine prohylaxis: a randomised trial of trigger point activation. J Intern Med 235: 451-6

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.

Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

Loh L, Nathan PW, Schott GD, Zilkha KJ. (1984) Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry 47: 333-7

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Vertosick, E.A., Vickers, A. and White, A.R., 2016. Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews, (6).

National Institute for Clinical Excellence (2021) Headaches in over 12s: diagnosis and management Clinical guideline [CG150]Published: 19 September 2012 Last updated: 12 May 2021

Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.

Tao, Q.F., Wang, X.Y., Feng, S.J., Xiao, X.Y., Shi, Y.Z., Xie, C.R. and Zheng, H., 2023. Efficacy of acupuncture for tension-type headache prophylaxis: systematic review and meta-analysis with trial sequential analysis. Journal of Neurology, pp.1-11.

Tavola T, Gala C, Conte G, Inverizzi G. (1992) Traditional Chinese acupuncture in tension- type headache: a controlled study. Pain 48: 325-9

Xu, J., Zhang, F.Q., Pei, J. and Ji, J., 2018. Acupuncture for migraine without aura: a systematic review and meta-analysis. Journal of integrative medicine, 16(5), pp.312-321.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

Zheng, H., Gao, T., Zheng, Q.H., Lu, L.Y., Hou, T.H., Zhang, S.S., Zhou, S.Y., Hao, X.Y., Wang, L., Zhao, L. and Liang, F.R., 2022. Acupuncture for Patients With Chronic Tension-Type Headache: A Randomized Controlled Trial. Neurology.

Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)

Helen
Posted on: May-16-2021 12:57 pm
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Shaftesbury Clinic Star of Conditions

Constipation – Condition Resources

Blog, ,

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

A scholarly search of the available research papers on the terms “acupuncture” + “constipation” yields over 27,500 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 2,900 results; of which 43% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, much research has been carried out, and that the pace of research here has increased in recent years, meaning the research community recognise its potential role is worthy of appraisal in a scientific manner.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

The British Acupuncture Council has a Research digest where they examined some recent studies on constipation including an RCT taken in 15 hospitals in China (n=1075) where the acupuncture group was seen to increase the number of weekly spontaneous bowel movements, with the researchers recommending that further studies are needed to see the longer term outcomes (Liu et al, 2016). 

Another RCT (Zheng et al, 2018; n=684) similarly showed promise in this area, but was limited somewhat by its design in not having a sham acupuncture control (they only had three different types of verum acupuncture compared with pharmacological intervention), meaning it was difficult to know the magnitude of the effect.

A systematic review and meta-analysis of 33 trials (n=4324 total; Zheng et al, 2019) compared eight different non-drug treatments, finding acupuncture and TENS were the most effective in addressing chronic functional constipation symptoms, but interpreting the results with caution due to small study effects. A later systematic review, (Wang et al, 2020) drew similar conclusions, noting increased quality of life in acupuncture groups as well as trends towards symptomatic relief, but noting evidence quality was low, warranting further studies (28 RCT’s; n=3525). A smaller systematic review of electro-acupuncture in this field drew similar conclusions to the above in terms of positive yet tentative trends (Zhang et al, 2020; 6 studies, n=1457).

Research continues, and a number of protocols for systematic reviews in this area have been published recently, the results of which are awaited with interest: e.g. Zhu et al, 2021; Yang et al, 2020; and Chen et al, 2020.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about Gastrointestinal tract issues including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Research Digest – Constipation (approx halfway down the document)

References:

Chen, C., Liu, B., He, L., Lv, X., Guo, S. and Ai, Y., 2020. Efficacy of Acupuncture in Subpopulations with Constipation: A protocol for a Systematic Review and Individual Patient data Meta-analysis.

Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, G., Fang, J., Fu, W., Fu, L., Sun, J. and Wang, L., 2016. Acupuncture for chronic severe functional constipation: a randomized trial. Annals of internal medicine, 165(11), pp.761-769.

Wang, L., Xu, M., Zheng, Q., Zhang, W. and Li, Y., 2020. The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2020.

Yang, P., Wang, Y., Xiao, Y., Ma, Q., Ma, R., Mi, J. and Hui, J., 2020. Acupuncture for opioid-induced constipation: Protocol for a systematic review and meta-analysis. Medicine, 99(49).

Zhang, N., Hou, L., Yan, P., Li, X., Wang, Y., Niu, J., Feng, L., Li, J., Yang, K. and Liu, X., 2020. Electro-acupuncture vs. sham electro-acupuncture for chronic severe functional constipation: a systematic review and meta-analysis. Complementary Therapies in Medicine, p.102521.

Zheng, H., Liu, Z.S., Zhang, W., Chen, M., Zhong, F., Jing, X.H., Rong, P.J., Zhu, W.Z., Wang, F.C., Liu, Z.B. and Tang, C.Z., 2018. Acupuncture for patients with chronic functional constipation: a randomized controlled trial. Neurogastroenterology & Motility, 30(7), p.e13307.

Zheng, H., Chen, Q., Chen, M., Wu, X., She, T.W., Li, J., Huang, D.Q., Yue, L. and Fang, J.Q., 2019. Nonpharmacological conservative treatments for chronic functional constipation: A systematic review and network meta‐analysis. Neurogastroenterology & Motility, 31(1), p.e13441.

Zhu, D., Hu, J., Chi, Z., Ouyang, X., Xu, W., Luo, Z., Cheng, C., Wu, J., Chen, R. and Jiao, L., 2021. Effectiveness and safety of acupuncture in the treatment of chronic severe functional constipation: A protocol for systematic review and meta-analysis. Medicine, 100(7).

Helen
Posted on: May-16-2021 8:44 am
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Shaftesbury Clinic Star of Conditions

Blood Pressure – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Useful pages: Stroke ; Angina, Arrhythmias, Coronary Heart Disease, and Heart Failure

Research and Resources on Blood Pressure, Hypertension and Acupuncture:

A scholarly search of the available research studies on “acupuncture” + “blood pressure” reveals over 43,400 papers from journals, and narrowing this to “RCT” leads to over 4,500 hits, of which 37% have been carried out since 2017.  A scholarly search of the available research studies on “acupuncture and hypertension” reveals over 44,500 papers from journals, and narrowing this to “RCT” leads to over 4,500 hits, of which 40% have been carried out since 2017.  This indicates the extent to which acupuncture is used traditionally and currently in this area; with scientific research increasing in pace and demonstrating an area worthy of scientific appraisal and consideration.  

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Hypertension is a common cardiovascular disease that affects about one billion people worldwide. 

A meta-analysis of studies compared approaches to treating essential hypertension (31 trials; n=2649; Tan et al, 2019), concluded that acupuncture may be useful in addressing hypertension, albeit that quality of the studies was limited and further research was warranted.  Another analysis of 10 trials in BP amongst stroke patients  (Hong et al, 2020; n=847) concluded that acupuncture may be a suitable treatment option for regulating BP after stroke but also noted the low-quality in the data and as need for further well-designed trials.

Niu et al, (2019) examined 13 systematic reviews of 14 non-drug therapies (including acupuncture) in addressing high blood pressure.  They concluded that massage and acupuncture plus an antihypertensive drug may benefit people who wanted to lower their blood pressure; once again methodological issues around available research limited the strength of the recommendations.

Li et al, 2014 carried out a systematic review and meta-analysis of 4 RCTs (n=386) that compared acupuncture with sham acupuncture for treating essential hypertension, in order to assess the effectiveness and safely of acupuncture as an adjunctive approach for the condition, using statistical methods to pool the results and compare the average blood pressure changes between the groups.  Acupuncture was found to significantly lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients taking antihypertensive medications, but not in patients who were not taking medications.  Acupuncture was generally safe and well-tolerated, with only minor adverse events reported.  The authors concluded that acupuncture could be a promising adjunctive therapy for hypertension, but more large-scale and long-term trials are needed to confirm its efficacy and safety.

Acupuncture was found to be a promising adjunctive therapy for essential hypertension in Yin et al’s (2007) a double-blind, randomized, controlled trial, where acupuncture was assessed for its benefits as an add-on to conventional antihypertensive managements such as medication or lifestyle modification on patients with high blood pressure.  In the small (n=30) study, the real acupuncture group showed a significant decrease in mean BP after 8 weeks.  Auricular (ear) acupuncture has also been shown to reduce preoperative blood pressure (BP) elevation in different age groups in a prospective RCT (Ma et al, 2023; n=120).

Mechanism of action:

Animal model studies have shown physiological effects from auricular (ear) acupuncture on the Heart point, whereby using this point regulates cardiovascular function (heart rate, blood pressure). Cardiac related nerve cells were shown to be regulated by the use of Heart (auricular point), lowering blood pressure in the arteries, by means of activating a certain type of nerve cell receptor (baroreceptor sensitive neurons) in part of the brainstem (nucleus tractus solitarius) (Gao et al, 2011).

Acupuncture has been shown in many mechanism-of-action trials to be sympathoinhibitory (able to downregulate the sympathetic nervous system) and lower the stress response in brain and nervous system (Middlekauff et al, 2002).

Li et al (2014) proposed a possible mechanism of action for the lowering of blood pressure, in that acupuncture could regulate the renin-angiotensin-aldosterone system (RAAS), which is involved in blood pressure regulation, by stimulating specific acupoints that correspond to the kidney and liver meridians. The other mechanism is based on the Western medicine theory of modulating the autonomic nervous system (ANS), which controls the heart rate and vascular tone. They further hypothesized that acupuncture might activate the parasympathetic branch of the ANS, thus lowering the sympathetic activity and reducing the release of stress hormones that constrict the blood vessels.

See also angina, arrythmia and heart disease and heart failure, and stress pages

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council (BAcC) Hypertension factsheet on the research into acupuncture in this condition

BAcC Stroke Factsheet

BAcC Stress Factsheet

BAcC Angina, Coronary Heart Disease, Atrial Fibrillation and Heart Failure Factsheet

BAcC Anxiety Factsheet

References:

Gao XY et al. Acupuncture-like stimulation at auricular point Heart evokes cardiovascular inhibition via activating the cardiac-related neurons in the nucleus tractus solitarius. Brain Res. 2011;1397:19-27.

Li, D.Z., Zhou, Y., Yang, Y.N., Ma, Y.T., Li, X.M., Yu, J., Zhao, Y., Zhai, H. and Lao, L., 2014. Acupuncture for essential hypertension: a meta-analysis of randomized sham-controlled clinical trials. Evidence-Based Complementary and Alternative Medicine, 2014.

Ma, J., Zhang, Y., Ge, Q. and Wu, K., 2023. The effect of auricular acupuncture on preoperative blood pressure across age groups: a prospective randomized controlled trial. Clinical and Experimental Hypertension, 45(1), p.2169452.

Middlekauff, H.R., Hui, K., Yu, J.L., Hamilton, M.A., Fonarow, G.C., Moriguchi, J., MacLellan, W.R. and Hage, A., 2002. Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. Journal of cardiac failure, 8(6), pp.399-406.

Tan, X., Pan, Y., Su, W., Gong, S., Zhu, H., Chen, H. and Lu, S., 2019. Acupuncture therapy for essential hypertension: a network meta-analysis. Annals of translational medicine, 7(12).

Hong, S., Ahn, L., Kwon, J. and Choi, D.J., 2020. Acupuncture for Regulating Blood Pressure of Stroke Patients: A Systematic Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine, 26(12), pp.1105-1116.

Niu, J.F., Zhao, X.F., Hu, H.T., Wang, J.J., Liu, Y.L. and Lu, D.H., 2019. Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: recommendations based on high-quality systematic reviews. Complementary therapies in medicine, 42, pp.322-331.

Yin, C., Seo, B., Park, H.J., Cho, M., Jung, W., Choue, R., Kim, C., Park, H.K., Lee, H. and Koh, H., 2007. Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial. Neurological research, 29(sup1), pp.98-103.

Helen
Posted on: May-16-2021 8:13 am
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Shaftesbury Clinic Star of Conditions

Bladder Issues – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Incontinence and bladder issues may be caused by structural issues, pregnancy and post-partum, overactive bladder in women, and in men there may be issues caused by prostatitis or oncology treatment following prostate cancer impacting upon the bladder function.  Bladder function can also be affected after someone has had a stroke, or related to chronic health conditions.

Research and Resources on Bladder (Urinary System) Issues and Acupuncture:

A scholarly search of the available research studies on “acupuncture” + “urinary”* reveals over 32,000 papers from journals, and narrowing this to “RCT” leads to over 3,400 hits, of which 39% have been carried out since 2017.  From this we can deduce that acupuncture is being used, traditionally and currently in this area; scientific research is being conducted in this area at an increasing pace -indicating an area worthy of scientific appraisal and consideration.  (*We did not use the search term “bladder” as this is an acupuncture meridian and point location name and would otherwise bring up articles that mention these acupoints, as well as those to do with bladder conditions).

Up to 6% of adult women experience up to 3 episodes of acute lower urinary tract infections (UTIs) annually (Alreak & al, 2002). A common issue, millions of women in the receive antibiotic treatment every year, and with raising concerns of antibiotic resistance in pathogens, alternate ways to look at this issue are warranted

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Stress Incontinence and overactive bladder:

A large, multicentre RCT (China: 12 hospitals; n=504) for women with stress incontinence showed that the electroacupuncture group experienced less urine leakage after 6 weeks of treatment, than did the sham electroacupuncture control group (Liu et al, 2017).  A further systematic review (Zhao 2018; 10 trials; n=794), showed acupuncture (in particular electroacupuncture) as more effective than sham in decreasing nocturia (night-time incontinence), relieving voiding symptoms, decreasing micturition and incontinence frequency, and enhancing quality of life

A small Chinese (n-71) randomised controlled trial for female stress urinary incontinence compared acupuncture plus pelvic floor muscle exercises with the exercises alone.  All outcomes improved significantly in both groups, with the total effective rate being higher in the acupuncture group than in the control group, along with improves quality of life scores.  A systematic review of treatment of overactive bladder, urge urinary incontinence, and related symptoms (Hartmann et al, 2009; 232 studies) acupuncture was the sole complementary treatment that showed early evidence of benefit.

Forde et al (2016), in a literature review in the International Urogynecology Journal, stated existing studies showed promise for suggesting a role for acupuncture in addressing overactive bladder issues, however there were limitations in the research design, and further well-designed studies should follow to corroborate this.

In other studies, acupuncture treatment significantly reduced the frequency of urinary incontinence compared to a control group (Kim et al, 2008; n=52); a statistically significant difference was found in favour of acupuncture compared to “western” medicine for post-apoplectic urinary issues (Liu et al, 2008); and bladder-specific acupuncture treatments resulted in significant improvements in bladder capacity, urgency, frequency, and quality-of-life scores when compared with placebo acupuncture treatments in a randomised controlled trial (Emmons et al, 2005; n=85).

For Overactive Bladder, Aydoğmuş et al, (2014; RCT; N=82) looked at Urine Nerve Growth Factor (NGF) as a biomarker regarding acupuncture’s effect on bladder function. NGF is a chemical messenger in the body and related to the smooth muscle and urothelium (lining of the urinary tract). Comparing drug treatment solifenacin with acupuncture in two groups, they concluded that “In patients with OAB in whom anticholinergic treatment is contraindicated, acupuncture may be considered another treatment option.” NGF has been shown in a number of studies, to be mediated, normalised by acupuncture.

Acupuncture on the sacral vertebrae (spinal area at the sacrum); the area where nerves suppling the bladder emerge; has been shown to suppress bladder activity, as well as to suppress activity in the areas of the brainstem related to micturition (urination), this in turn could suppress/normalise overactivity of bladder contraction (Wang et al, 2012).

Objective (scientifically measurable) improvements from acupuncture have also been seen in urodynamic studies on females with frequency, urgency and dysuria (Chang, 1988; n=52). Urodynamic studies are medical tests measuring lower urinary tract function. Per Chang in the American Urological Association Journal of Urology : “Our studies indicated that acupuncture could be used as a simple and effective method to treat female patients with frequency, urgency and dysuria”.

More information on acupuncture and the Urinary System is available on out page here

Diabetic neurogenic bladder:

A randomised controlled trial (n=70) compared acupuncture plus the drug methycobal, with the drug alone. The acupuncture plus methycobal group saw significant improvement in the rate of urgency of urination, frequency of micturition, dribbling urination, urinary incontinence and dysuria, than did the drug alone group.  A combined approach was therefore advocated, with acupuncture improving the drug action (Tian et al, 2007)

Post-Stroke:

Acupuncture has been tentatively shown to have positive results for urinary incontinence post-stroke in a systematic review (Thomas, 2008; n=724 from 12 trials, of which 3 were acupuncture trials), although further trials for acupuncture in this field are warranted, due to the low number and quality of the research studies available at the time of the review.  A randomised controlled trial (n=58)  found the moxibustion group (an acupuncture adjunct treatment) had greater improvement in urinary symptoms than the control group (Yun et al, 2007).  In a large study in Taiwan, stroke patients in hospital who received acupuncture treatment experienced a lower incidence of urinary tract infections than did those who didn’t receive acupuncture (Yang et al, 2019)

Bed-wetting in children:

There was some evidence from a systematic review (Bower et al, 2005; 11 studies), that acupuncture could be useful for nocturnal enuresis (bed-wetting) in children when used in conjunction with other treatment, although further trials are warranted due to the low methodological quality of the research studies available at the time.

Post Hysterectomy:

A randomised controlled trial (n=110) examined electroacupuncture on recovery of urinary bladder function after radical hysterectomy.  The electroacupuncture group experienced faster improvement of recovery of bladder function, greater improvement of dynamic indexes, fewer days in hospital after surgery and a reduced likelihood of bladder infection than did the control group.

Urinary tract infection (cystitis):

A randomised controlled trial (Qin et al, 2020; n=341) found acupuncture appeared to be beneficial for treatment and prevention of recurrent UTIs, but also noted limitations in the current evidence. The researchers noted the increasing problem of antibiotic resistance, meant such research becomes increasingly important in the overall approach.

From the guidelines The Society of Obstetricians and Gynaecologists of Canada: “Acupuncture may be considered as an alternative in the prevention of recurrent urinary tract infections in women who are unresponsive to or intolerant of antibiotic prophylaxis.” (Epp and Larochelle, 2017).

Alraek et al (2002) concluded from their small RCT (n=100): “our results, as well as previous findings, indicate that acupuncture treatment may be effective in preventing recurrent lower UTIs in healthy adult women.” This echoed the small Norweigan study (N=67) which concluded that acupuncture seems a worthwhile alternative approach in the prevention of recurring lower UTI in women (Aune et al, 1998).

Prostatitis related bladder symptoms:

Pan et al (2023) in the Journal of Pain Research and Management, looked at the efficacy and safety of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), a complex male dysfunction that affects the quality of life. They compared acupuncture with western medicine and sham acupuncture in high quality randomized controlled trials (RCTs).  Outcome measures included pain score, urinary symptom score, NIH-CPSI (prostatitis symptom score), quality of life score, and efficacy rate.  Acupuncture was found superior to western medicine and sham acupuncture in improving all outcome measures.  This was a relatively small review (10 RCTs; n=798) and the team called for further future research, to supplement the evidence body.

In a review of the literature, acupuncture was found to be beneficial in reducing the symptoms of prostatitis, including urinary symptoms (Franco et al, 2019). 

Mechanisms of action of acupuncture in the urinary system:

Initial animal studies suggest a number of biochemical mechanisms of action involved the effect of acupuncture on suppressing overactive bladder (Forde et al, 2016). Physiological/animal studies have shown acupuncture to decrease the expression of a relevant biomarker (c-Fos) in the brain, along with associated reduction in stress urinary incontinence (Chung et al, 2008).

Acupuncture was also found in physiological studies to influence nitrergic neurotransmitters, which raises nitric oxide levels in bladder tissue and causes smooth muscle relaxation, leading to increased bladder capacity (Chen 2006). 

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

The British Acupuncture Council evidence based factsheet about Cystitis including specific research, trials and mechanisms of action for acupuncture in this condition.

The British Acupuncture Council evidence based factsheet about Urinary Incontinence

References:

Alraek, T., Soedal, L.I.F., Fagerheim, S.U., Digranes, A. and Baerheim, A., 2002. Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. American Journal of Public Health, 92(10), pp.1609-1611.

Aydoğmuş, Y., Sunay, M., Arslan, H., Aydın, A., Adiloğlu, A.K. and Şahin, H., 2014. Acupuncture versus solifenacin for treatment of overactive bladder and its correlation with urine nerve growth factor levels: a randomized, placebo-controlled clinical trial. Urologia Internationalis, 93(4), pp.437-443.

Aune, A., Alraek, T., Lihua, H. and Baerheim, A., 1998. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scandinavian journal of primary health care, 16(1), pp.37-39.

Bower, W.F., Diao, M., Tang, J.L. and Yeung, C.K., 2005. Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourology and Urodynamics: Official Journal of the International Continence Society, 24(3), pp.267-272.

Chang, P.L., 1988. Urodynamic studies in acupuncture for women with frequency, urgency and dysuria. The Journal of urology, 140(3), pp.563-566.

Chen, Y.L., Cen, J., Hou, W.G., Gao, Z.Q., Yu, X.M. and Ma, X.M., 2006. Effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 4(1), pp.73-75.

Chung, I.M., Kim, Y.S., Sung, Y.H., Kim, S.E., Ko, I.G., Shin, M.S., Park, H.J., Ham, D.H., Lee, H.J., Kim, K.J. and Lee, S.W., 2008. Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence. Neuroscience letters, 439(1), pp.18-23.

Emmons SL, Otto L. Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol 2005; 106: 138-43.

Epp, A. and Larochelle, A., 2017. No. 250-Recurrent urinary tract infection. Journal of Obstetrics and Gynaecology Canada, 39(10), pp.e422-e431.

Franco, J.V., Turk, T., Jung, J.H., Xiao, Y.T., Iakhno, S., Garrote, V. and Vietto, V., 2019. Non‐pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU international, 124(2), pp.197-208.

Forde, J.C., Jaffe, E., Stone, B.V., Te, A.E., Espinosa, G. and Chughtai, B., 2016. The role of acupuncture in managing overactive bladder; a review of the literature. International urogynecology journal, 27(11), pp.1645-1651.

Hartmann, K.E., McPheeters, M.L., Biller, D.H., Ward, R.M., McKoy, J.N. and Jerome, R.N., 2009. Treatment of Overactive Bladder in Women. Evidence Reports/Technology Assessments No. 187.

Kim, J.H., Nam, D., Park, M.K., Lee, E.S. and Kim, S.H., 2008. Randomized control trial of hand acupuncture for female stress urinary incontinence. Acupuncture & electro-therapeutics research, 33(3-4), pp.179-192.

Liu ZS, Du Y.  [Evaluation of the curative effect of electro acupuncture on post-apoplectic urinary incontinence](in Chinese). Zhen Jiu Tui Na Yi Xue 2008; 6/2: 97-8.

Liu, Z., Liu, Y., Xu, H., He, L., Chen, Y., Fu, L., Li, N., Lu, Y., Su, T., Sun, J. and Wang, J., 2017. Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial. Jama, 317(24), pp.2493-2501.

Pan, J., Jin, S., Xie, Q., Wang, Y., Wu, Z., Sun, J., Guo, T.P. and Zhang, D., 2023. Acupuncture for Chronic Prostatitis or Chronic Pelvic Pain Syndrome: An Updated Systematic Review and Meta-Analysis. Pain Research and Management, 2023.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Qin, X., Coyle, M.E., Yang, L., Liang, J., Wang, K., Guo, X., Zhang, A.L., Mao, W., Lu, C., Xue, C.C. and Liu, X., 2020. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 127(12), pp.1459-1468.

Thomas, L.H., Cross, S., Barrett, J., French, B., Leathley, M., Sutton, C.J. and Watkins, C., 2008. Treatment of urinary incontinence after stroke in adults. Cochrane Database of Systematic Reviews, .

Tian FS et al. [Study on acupuncture treatment of diabetic neurogenic bladder]. Zhongguo Zhen Jiu. 2007 Jul;27(7):485-7

Wang, H., Tanaka, Y., Kawauchi, A., Miki, T., Kayama, Y. and Koyama, Y., 2012. Acupuncture of the sacral vertebrae suppresses bladder activity and bladder activity-related neurons in the brainstem micturition center. Neuroscience research, 72(1), pp.43-49.

Yang, J.L., Chen, T.L., Yeh, C.C., Hu, C.J., Liao, C.C., Lane, H.L. and Shih, C.C., 2019. Acupuncture treatment and the risk of urinary tract infection in stroke patients: a nationwide matched cohort study. Acupuncture in Medicine, 37(3), pp.175-183.

Yi, W.M., Li, J.J., Lu, X.M., Jin, L.L., Pan, A.Z. and Zou, Y.Q., 2008. Effects of electroacupuncture on urinary bladder function after radical hysterectomy. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 28(9), pp.653-655.

Yun, S.P., Jung, W.S., Park, S.U., Moon, S.K., Park, J.M., Ko, C.N., Cho, K.H., Kim, Y.S. and Bae, H.S., 2007. Effects of moxibustion on the recovery of post-stroke urinary symptoms. The American journal of Chinese medicine, 35(06), pp.947-954.

Zhao, Y., Zhou, J., Mo, Q., Wang, Y., Yu, J. and Liu, Z., 2018. Acupuncture for adults with overactive bladder: a systematic review and meta-analysis of randomized controlled trials. Medicine, 97(8).

Helen
Posted on: May-16-2021 8:10 am
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Shaftesbury Clinic Star of Conditions

Allergies – Condition Resources

Blog, ,

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

A scholarly search on “allergies” + “acupuncture” reveals over 3,400 papers, and narrowing to Randomised Controlled Trials (RCT’s) reveals over 369 results (Google Scholar). This shows that acupuncture is being used traditionally and currently in this area, and that it has been recognised there is a need to research it a scientific manner.

Allergic Asthma:

A large, randomised controlled research study in Germany (Brinkhaus et al 2017; n=1445) showed that up to 15 sessions of acupuncture given in addition to routine care increased both disease specific, and health related quality of life, when compared to the group who received routine care alone.

Allergic Dermatitis:

In an animal model study, acupuncture treatment was shown to inhibit swelling of the ears and ear weight in mice with oxazolone-induced skin allergic dermatitis, compared to non-acupuncture treatment (Okumura et al, 2002), and lower levels of inflammatory markers (serum and ear tissue cytokines) were also lowered in the acupuncture group.

A forthcoming systematic review protocol has been published with the aim of evaluating the efficacy and safety of acupuncture in the treatment of atopic dermatitis (protocol: Lee et al, 2019). This is another growing research area, of 451 RCT’s ever published on this, 180 have been carried out since 2017.

Chronic Pruritus:

More generally, for chronic pruritus, a condition of chronic itching that can be caused by different disease states and which adversely affects quality of life, a systematic review is awaited, the protocol having been published in the BMJ Open recently (protocol: Zhang et al, 2020).

Atopic Eczema:

A systematic review (Jiao et al, 2020) looked at 8 RCT’s (n=434), and despite some methodological limitations were able to conclude acupuncture may decrease itch sensitivity and improve the global symptoms of atopic eczema.

The results of a small (n=10), randomised controlled trial (Pfab et al, 2011), suggested acupuncture reduced itch intensity and the expression of certain immune factors (basophils) in patients with atopic eczema. The acupuncture group showed less CD63 positive basophils (allergy markers in the body) and rated mean itch intensity significantly lower than did the control group after exposure to allergens (house dust mite and timothy grass pollen).  Pfab et al 2010 (n=30) had also found that after an allergen stimulus (house mite or grass pollen skin prick), the size of the wheal and flare at the skin site were smaller in the group receiving preventative acupuncture than in the control (no acupuncture) and placebo (non-specific acupuncture points used) groups, suggesting that the actual points used are also relevant and not just the overall action of needling.  Mean itch ratings were also lower once again in the true acupuncture group.

Allergic Rhinitis (Hayfever):

The British Acupuncture Council has a Research digest where they examined some recent studies on Allergic Rhinitis, with an overall trend that acupuncture was found beneficial, comparing favourably with antihistamine use.  A review of the literature (Taw et al, 2015) found that high-quality RCTs demonstrated efficacy and effectiveness of acupuncture in this condition, and also was beneficial in terms of quality of life measures, the researchers also stated that further high quality studies are desirable in this area due to some methodological limits on study designs.  

Feng et al, (2015) carried out a systematic review and meta-analysis of acupuncture in allergic rhinitis, entailing 13 papers (N=2365 in total); the researchers stated this was a safe intervention which gave improvement in the Rhinitis Quality of Life Questionnaire (RQLQ) scores of the participants in the acupuncture groups.

Two studies have also established cost effectiveness of acupuncture in allergic rhinitis; Kim et al, (2012) carried out a systematic review of 17 RCTs using the quality-adjusted life years (QALYs) measure the NHS uses, demonstrating that as well as offering benefits, these were value for money where acupuncture was used.  Witt and Brinkhaus (2010) reached a similar conclusion but more tentatively, calling for further studies to establish this.

McDonald et al (2013) reviewed the pathophysiology of allergic rhinitis and the acupuncture research body in this area.  Acupuncture has been shown to improve clinical outcomes in patients with allergic rhinitis by modulating immune response and reducing inflammation.  Per the review of RCTs, acupuncture may down-regulate Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF) in allergic rhinitis. Acupuncture may also inhibit histamine-induced itch and TRPV1 signalling, which mediate some of the symptoms of allergic rhinitis.

According to a systematic review and meta-analysis by Yin et al (2020: 39 studies; n=4413) acupuncture can significantly improve the symptoms and quality of life of patients with allergic rhinitis. The authors searched various databases and included 30 randomized controlled trials with 4413 participants. They found that acupuncture improved the nasal symptoms and quality of life of patients with allergic rhinitis, compared to no intervention, sham acupuncture, or conventional medication. They also reported that acupuncture had a better safety profile than medication.

Possible mechanisms of action in allergy:

A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines.  The researchers concluded that “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”.  Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states. 

Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:

  • Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
  • Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
  • Acupuncture may contribute to analgesia by stimulating the release of β-endorphin, which binds to opioid receptors and inhibits pain signals.
  • Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body.  They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions.  Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone.  These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.

In an animal study, Sun et al, (2023) were able to show that electroacupuncture worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation.  The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.

Wei et al, 2015 investigated the effect of acupuncture on airway inflammation and immune responses in mice with experimental asthma. Acupuncture was effective in reducing airway hyperresponsiveness (AHR); lung inflammation; mucus secretion; and inflammatory markers including Th17 cytokines and NF-κB pathway, in the asthma model. Additionally, acupuncture increased the number and function of Treg cells – a type of white blood cell that can suppress inflammation and prevent autoimmunity.  The article suggests that acupuncture may be a useful complementary therapy for asthma patients due to anti-inflammatory and immune modulation effects.

Liu et al (2014) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes.  EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.

Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines.  They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis.  They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.

Per MacDonald et al (2015), acupuncture may:

  • reduce inflammation and nasal congestion by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins
  • modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation
  • influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors
  • activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine

Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function).  Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.


Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council Research Digest – Allergic Rhinitis (approx halfway down the document)

BAcC Asthma Factsheet

British Acupuncture Council (BAcC) evidence based factsheet about Allergic Rhinitis including specific research, trials and mechanisms of action for acupuncture in this condition

Our pages on Asthma, Eczema and Psoriasis and Allergic Rhinitis (Hayfever) may also be of interest.

References:

Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S.N. and Witt, C.M., 2017. Acupuncture in patients with allergic asthma: a randomized pragmatic trial. The Journal of Alternative and Complementary Medicine, 23(4), pp.268-277.

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W. and Li, H., 2015. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), pp.57-62.

Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.

Jiao, R., Yang, Z., Wang, Y., Zhou, J., Zeng, Y. and Liu, Z., 2020. The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis. Acupuncture in Medicine, 38(1), pp.3-14.

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007;  6:  251-7.

Kim, S.Y., Lee, H., Chae, Y., Park, H.J. and Lee, H., 2012. A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupuncture in Medicine, 30(4), pp.273-285.

Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

Lee, H.C. and Park, S.Y., 2019. Preliminary comparison of the efficacy and safety of needle-embedding therapy with acupuncture for atopic dermatitis patients. Evidence-Based Complementary and Alternative Medicine, 2019.

Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine, 32(4), pp.340-345.

McDonald, J.L., Cripps, A.W., Smith, P.K., Smith, C.A., Xue, C.C. and Golianu, B., 2013. The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based Complementary and Alternative Medicine, 2013.

McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.

Okumura M et al. Effects of acupuncture on an oxazolone induced skin allergic dermatitis animal model using male ICR mice. Journal of the Showa Medical Association 2002; 62: 229-36.

Pfab, F., Huss‐Marp, J., Gatti, A., Fuqin, J., Athanasiadis, G.I., Irnich, D., Raap, U., Schober, W., Behrendt, H., Ring, J. and Darsow, U., 2010. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema–a blinded, randomized, placebo‐controlled, crossover trial. Allergy, 65(7), pp.903-910.

Pfab, F., Athanasiadis, G.I., Huss-Marp, J., Fuqin, J., Heuser, B., Cifuentes, L., Brockow, K., Schober, W., Konstantinow, A., Irnich, D. and Behrendt, H., 2011. Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema: a pilot trial. The Journal of Alternative and Complementary Medicine, 17(4), pp.309-314.

Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine, 2023

Taw, M.B., Reddy, W.D., Omole, F.S. and Seidman, M.D., 2015. Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), pp.216-220.

Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.

Wei, Y., Dong, M., Zhang, H., Lv, Y., Liu, J., Wei, K., Luo, Q., Sun, J., Liu, F., Xu, F. and Dong, J., 2015. Acupuncture attenuated inflammation and inhibited Th17 and Treg activity in experimental asthma. Evidence-based complementary and alternative medicine, 2015.

Witt, C.M. and Brinkhaus, B., 2010. Efficacy, effectiveness and cost-effectiveness of acupuncture for allergic rhinitis—an overview about previous and ongoing studies. Autonomic Neuroscience, 157(1-2), pp.42-45.

Yin, Z., Geng, G., Xu, G., Zhao, L. and Liang, F., 2020. Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials. Chinese medicine, 15(1), pp.1-28.

Zhang, L., Deng, Y., Yao, J., Xiao, X., Yu, S., Shi, Y., Zheng, H., Zheng, Q., Zhou, S., Cao, W. and Liu, Y., 2020. Acupuncture for patients with chronic pruritus: protocol of a systematic review and meta-analysis. BMJ open, 10(8), p.e034784.

Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.

Helen
Posted on: May-16-2021 7:56 am
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Shaftesbury Clinic Star of Conditions

Cancer Care – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care.

Acupuncture is often used alongside the conventional medical care as an adjunct for wellbeing and symptomatic issues, where appropriate. In many settings, oncology caregivers arrange or recommend complementary approaches to support patients overall wellbeing alongside their care. The role of this, in partnership with the GP, consultant and caregivers is to complement the conventional treatments in a supportive role.

Acupuncture and complementary therapies are there to support the patient with their symptoms, whilst they go through the medical treatments under their oncology consultant. Many hospitals, cancer units and support services recognise a supportive role for integrative approaches alongside medical and surgical treatments.

Let your consultant and medical team know if you are considering acupuncture to help with side effects and symptoms, so that they can be fully involved the whole way.

Cancer Research UK has information on their own website about acupuncture and its potential use in supporting oncology patients with chemotherapy induced nausea, where they recommend using a British Acupuncture Council Member; Macmillan Cancer Support also has its own dedicated page on acupuncture (links to both are in Resources section below). Acupuncture’s role here is focussed on symptomatic issues and side effects of the conventional oncology treatment.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

As per systematic reviews of the research (Garcia et al, 2013, 41 RCT studies), acupuncture is commonly employed used in this field, aiming to support the patient alongside their conventional treatment and in line with the oncology team, and has been researched as far as symptoms such as fatigue, pain, hot flushes, emotional issues, chemotherapy induced nausea and vomiting (Zhang et al, 2014); radiation-induced xerostomia; and weakness, are concerned, these symptoms may be being caused by the disease itself, or the treatment being received. The evidence is positive for nausea prevention in acupuncture, but Garcia et al (2013) were not able to draw such compelling conclusions for the other symptoms, warranting further research.

A Systematic review and meta-analysis of randomized controlled trials (Höxtermann & al, 2022) shows that acupuncture is safe to use for oncology patients as an adjunct to routine treatment.

Per Rademacher, (2021). “Acupuncture, a form of traditional Chinese medicine, has been accepted into the arena of integrative oncology therapies used to ease symptom burden throughout oncology care. Research supports the safe use of acupuncture for disease and treatment-related symptoms including pain, fatigue, depression, chemotherapy-induced peripheral neuropathy, and nausea/vomiting. The body of knowledge in oncology acupuncture is significant; yet, additional evidence is warranted. Specific acupuncture research in hematopoietic cell transplantation recipients is necessary to address the unique experiences of this population.”

Ben-Ayre et al (2023: n=99) conducted a randomised controlled trial that examined the impact of integrative therapies on pain and anxiety among patients undergoing gynaecological oncology (cancer) surgery; addition of intraoperative acupuncture significantly reduced severe pain, compared with the control group and the group that received preoperative touch/relaxation only.  The combination of preoperative touch/relaxation and intraoperative acupuncture also improved the patients’ scores in the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire. Elsewhere, Mao et al (2023; n=298) compared massage with acupuncture for musculoskeletal pain symptoms in patients with advanced cancer, with both groups receiving the intervention for 10 weeks, with monthly boosters for up to 26 weeks. Improvements were seen in pain and insomnia symptoms in both groups, along with improved quality of life and decreased medication use. The researchers recommended these non-pharmacological therapies alongside conventional treatments.

Per Walker et al’s, (2010; n=50) RCT entailing 12 weeks of either acupuncture or venlafaxine for hot flushes symptoms following breast cancer treatment, they concluded that “[acupuncture] is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer.” Patients had less frequency of hot flushes with acupuncture treatment, up to a year after treatment. De Valois et al (2022; n=415) reported the real-world clinical outcomes of a long-term service which offered breast cancer survivors auricular (ear, NADA protocol) acupuncture for hot flush symptoms. Entailing 415 patient referrals and over 2285 treatments over 15 years, and it was found that this protocol was safe and effective for women experiencing post-cancer treatment hot flushes, who did not want to use pharmacological means to control their symptoms (de Valois et al, 2022).

Acupuncture was investigated in an RCT by Pfister et al (2010; n=58), in an RCT where the outcome measures of pain and xerostomia (dry mouth symptom) following either acupuncture or control for oncology patients with a history of neck dissection (due to surgery for cancers such as thyroid or upper aerodigestive oncological issues. Acupuncture (4x weekly Rx) was found to improve their xerostomia symptoms, as well as the post-neck dissection pain, better than usual treatment control. Participants having acupuncture also required less painkilling medication. Overall, significant improvements were seen in pain, dysfunction, and xerostomia in the acupuncture group, versus usual care this “support[s] the potential role of acupuncture in addressing post–neck dissection pain and dysfunction, as well as xerostomia” (Pfister et al, 2010).

Zhang et al’s (2018), systematic review (n=1327) and meta-analysis found that acupuncture “had a marked effect on fatigue in cancer patients”, improving this side effect / symptom of CRF (cancer related fatigue). Side effects were minimal, and it was suitable to use as an adjunct to the medical treatment.

Mao et al (2022) and the ASCO (American Society of Clinical Oncology) board produced the Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology–ASCO Guideline, aiming to provide evidence-based recommendations to doctors and health care providers on integrative approaches to managing pain in patients with cancer. After review of systematic reviews and meta-analyses from 1990-2021 (227 studies), they recommended acupuncture for aromatase inhibitor–related joint pain, and acupuncture, reflexology or acupressure for general cancer pain or MSK pain.

Shih et al (2023) carried out a systematic review and meta-analysis of the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression due to chemotherapy.  Looking at 25 RCT’s (n=1713), they examined outcome measures of G-CSF (a type of protein that helps the body make more blood cells, particularly white blood cells); of white and red blood cell counts, neutrophils and natural killer cells counts.  The results showed that acupuncture significantly increased the levels of G-CSF, WBC, RBC, NEU, ANC, Hb, PLT, and NK cells compared with control groups. The levels of PLT and NK cells also increased cumulatively over time.  They suggested a role alongside conventional medicine for acupuncture in this area.

Resources:

British Acupuncture Council evidence based factsheet about Cancer Care including specific research, trials and mechanisms of action for acupuncture in this condition.

Cancer Research UK (2021): Acupuncture

Macmillan Cancer Care (2021): Acupuncture

References:

Ben‐Arye, E., Segev, Y., Galil, G., Marom, I., Gressel, O., Stein, N., Hirsh, I., Samuels, N., Schmidt, M., Schiff, E. and Lurie, I., 2023. Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety. Cancer, 129(6), pp.908-919.

de Valois, B., Young, T., Thorpe, P., Degun, T. and Corbishley, K., 2022. Acupuncture in the real world: evaluating a 15-year NADA auricular acupuncture service for breast cancer survivors experiencing hot flushes and night sweats as a consequence of adjuvant hormonal therapies. Supportive Care in Cancer, 30(6), pp.5063-5074.

Garcia, M.K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., Palmer, J.L. and Cohen, L., 2013. Systematic review of acupuncture in cancer care: a synthesis of the evidence. Journal of Clinical Oncology, 31(7), p.952.

Höxtermann & al, 2022. Cancer Volume 128, Issue 11 p. 2159-2173

Mao, J.J., Liou, K., Romero, S.A., Baser, R.E., Wong, G., Xiao, H., Deng, G., Mo, Z., Walker, D., MacLeod, J.E. and Li, Q.S., 2023. Acupuncture versus massage for pain in patients living with advanced cancer: The IMPACT randomized clinical trial.

Mao, J.J., Ismaila, N., Bao, T., Barton, D., Ben-Arye, E., Garland, E.L., Greenlee, H., Leblanc, T., Lee, R.T., Lopez, A.M. and Loprinzi, C., 2022. Integrative medicine for pain management in oncology: society for integrative oncology–ASCO guideline. Journal of Clinical Oncology, 40(34), pp.3998-4024.

Pfister, D.G., Cassileth, B.R., Deng, G.E., Yeung, K.S., Lee, J.S., Garrity, D., Cronin, A., Lee, N., Kraus, D., Shaha, A.R. and Shah, J., 2010. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. Journal of Clinical Oncology, 28(15), p.2565.

Rademacher, A., 2021. Complementary Medicine: Acupuncture. In Blood and Marrow Transplant Handbook (pp. 747-757). Springer, Cham.

Shih, Y.W., Wang, M.H., Monsen, K.A., Chang, C.W., Rias, Y.A. and Tsai, H.T., 2023. Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis. Journal of Integrative and Complementary Medicine.

Walker, E.M., Rodriguez, A.I., Kohn, B., Ball, R.M., Pegg, J., Pocock, J.R., Nunez, R., Peterson, E., Jakary, S. and Levine, R.A., 2010. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol, 28(4), pp.634-640.

Zhang, X., Jin, H.F., Fan, Y.H., Lu, B., Meng, L.N. and Chen, J.D., 2014. Effects and mechanisms of transcutaneous electroacupuncture on chemotherapy-induced nausea and vomiting. Evidence-Based Complementary and Alternative Medicine, 2014.

Zhang, Y., Lin, L., Li, H., Hu, Y. and Tian, L., 2018. Effects of acupuncture on cancer-related fatigue: a meta-analysis. Supportive Care in Cancer, 26, pp.415-425.

Helen
Posted on: May-15-2021 13:49 pm
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Shaftesbury Clinic Star of Conditions

Back Pain – Condition Resources

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

1.1m people in the UK suffer with back pain every year. Evidence based research has shown that acupuncture is significantly better than no treatment, and better or equal to standard medical care for back pain (BAcC factsheet – see link below). Evidence suggests acupuncture may be a useful adjunct to your usual medical care, and it is important to let you doctor know if you choose to use it alongside the standard approach.

The British Acupuncture Council also has this interesting video from a patient perspective of a patient and acupuncturist discussing his use of acupuncture for back pain, and showing a treatment taking place: you can find it here. A further video from the British Acupuncture Council of another patient for low back pain is also available here

About the research:

Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page.  Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.

Research and Resources on Back Pain and Acupuncture:

A scholarly search of the available research studies on “acupuncture” + “back pain” reveals over 58,000 papers from journals, and narrowing this to “RCT” leads to over 7,750 hits, of which over a third have been carried out since 2017.  As regards a search on “acupuncture” + “sciatica” in scholarly research, this yields over 11,200 papers, and narrowing this to “RCT” leads to over 1,330 hits, of which just under a third have been carried out since 2017.  From this we can deduce that acupuncture is being used traditionally and currently in these area; being scientifically researched in this area, and with an increasing pace of research being carried out – indicating an area worthy of scientific appraisal and consideration.  

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

Back pain

Back pain is the single most common condition for which patients seek acupuncture, and many parts of the NHS either offer or recommend acupuncture for back pain, with over 100 clinical practice guidelines worldwide giving positive recommendations for acupuncture for back pain (Birch et al, 2018).  The Scottish Intercollegiate Guidelines Network recommends acupuncture for back pain.

Back pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827) acupuncture showed a significant clinical superiority over usual care and a smaller advantage over sham.  The researchers found that treatment effects persisted over time and couldn’t be explained solely in terms of placebo effects, meaning that acupuncture treatment was a reasonable option for some types of chronic pain, including back pain.

The American College of Physicians’ clinical practise guidelines nonpharmacologic treatment options for low back pain reviewed new evidence and found acupuncture useful for pain relief and to some extent function, although they had reservations about the strength of the evidence, meaning long term studies are needed (Chou et al, 2016, 2017).

The Clinical Practise Guidelines for managing low back pain, a systematic review on 13 sets of guidelines by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration looked at non-invasive techniques including acupuncture – acupuncture was one of the top recommended (non-invasive) interventions in the guidelines, where 10 sessions over 12 weeks was the recommended intervention for low back pain, and commented that high-quality guidelines support this whilst underlining that different techniques have different levels of effectiveness (Wong et al, 2017).

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back pain.

A US government’s National Institutes of Health: “Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).” (NCCIH, 2022).

Sciatica

Sciatica is also known by its medical name lumbar radiculopathy, and is where nerves become impinged in the lower back, causing referred pain and neurological (nerve-related) symptoms into the areas that nerve supplies, usually buttock and lower limb.

Evidence suggests acupuncture may provide pain relief in sciatica; RCTs such as Wang (2009; n=139) comparing acupuncture and TENS and finding in favour of acupuncture; another finding for acupuncture’s effectiveness along with an increase in pain threshold in the true acupuncture group (Chen et al, 2009; n=90).

Other studies have looked at how the above may come about, for example Inoue et al (2008), in a clinical trial where patients had improvement in pain and nerve symptoms from lower back impingement, and put forward the theory that as seen in animal studies the blood flow in the region of the sciatic nerve was modulated by acupuncture, as well as the well known mechanisms of action of acupuncture in pain relief and inflammation reduction.

A network meta-analysis comparing 21 different therapies for sciatica (Lewis et al, 2015), finding acupuncture the second-best therapy in terms of addressing pain intensity and in terms of overall effect and having a statistically significant effect, leading them to suggest it should be considered as a treatment option.

Mechanisms of Action

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom”) we are not able to give a simple yes or no response.  We are able to tell you from our combined decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

You may also find this of interest; our blog on the NICE (NHS regulatory body) guidelines, where NCE recommended acupuncture use for chronic pain, in an evidence based review: Blog on acupuncture and chronic pain

British Acupuncture Council evidence based factsheet about back pain including specific research, trials and mechanisms of action for acupuncture in this condition.

Evidence Based Acupuncture Factsheet on Pain

References:

General Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Back Pain References:

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J. and Grusing, S., 2017. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine, 166(7), pp.493-505.

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J. and Grusing, S., 2016. Noninvasive treatments for low back pain.

NCCIH (2022) LINK: https://www.nccih.nih.gov/health/acupuncture-in-depth viewed GMT19:52 11/08/22

Wong, J.J., Côté, P., Sutton, D.A., Randhawa, K., Yu, H., Varatharajan, S., Goldgrub, R., Nordin, M., Gross, D.P., Shearer, H.M. and Carroll, L.J., 2017. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European journal of pain, 21(2), pp.201-216.

Lewis, R.A., Williams, N.H., Sutton, A.J., Burton, K., Din, N.U., Matar, H.E., Hendry, M., Phillips, C.J., Nafees, S., Fitzsimmons, D. and Rickard, I., 2015. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal, 15(6),

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.pp.1461-1477.

Sciatica References

Chen, M.R., Ping, W., Cheng, G., Xiang, G.U.O., Wei, G.W. and Cheng, X.H., 2009. The warming acupuncture for treatment of sciatica in 30 cases. Journal of Traditional Chinese Medicine, 29(1), pp.50-53

Inoue, M., Kitakoji, H., Yano, T., Ishizaki, N., Itoi, M. and Katsumi, Y., 2008. Acupuncture treatment for low back pain and lower limb symptoms—the relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow. Evidence-Based Complementary and Alternative Medicine, 5(2), pp.133-143

Lewis, R.A., Williams, N.H., Sutton, A.J., Burton, K., Din, N.U., Matar, H.E., Hendry, M., Phillips, C.J., Nafees, S., Fitzsimmons, D. and Rickard, I., 2015. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal, 15(6), pp.1461-1477.

Wang ZX. [Clinical observation on electroacupuncture at acupoints for treatment of senile radical sciatica]. Zhongguo Zhenjiu 2009; 29(2): 126-8.

Helen
Posted on: May-15-2021 13:42 pm
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Shaftesbury Clinic Star of Conditions

Asthma – Condition Resources

Blog, ,

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Asthma affects around 5.4 million people in the UK. The British Acupuncture Council has produced a research based fact sheet for patients, as well as a review of the evidence for effectiveness in this area (see Resources, below).

Research and Resources on Asthma and Acupuncture:

A scholarly search of the available research studies on “acupuncture and asthma” reveals over 44,000 papers from journals, and narrowing this to “systematic review” leads to over 15,000 hits, of which 38% have been carried out since 2017.  From this we can deduce that acupuncture is being used extensively, traditionally and currently in this area; widely scientifically researched in this area, and that the pace at which the research is being carried is increasing – leading us to understand this is an area worthy of scientific appraisal and consideration.  

Interpreting the Evidence:

Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page.  Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research

Asthma:

There is some evidence from trials to suggest acupuncture may be a useful adjunct to usual care, be beneficial over placebo and can improve quality of life and be cost effective in asthma (Karlson & Bennicke, 2013; Chu et al 2007; Rheinhold et al, 2014).

Some systematic reviews have been carried out into acupuncture in this area, with the most recent looking at 11 trials, found that many were only small trials and that more research would be needed (Martin et al, 2002) and a Cochrane meta-analysis a year later (McCarney et al, 2003) looked at 12 studies (n=350) drew a similar conclusion. More recently Chen et al, (2020) proposed a protocol for a new systematic review and meta analysis of the research, as they noted that an increasing amount of research trials have been done in this area in recent years, warranting a further, large and structured review.

Pang et al (2023) carried out a systematic review and meta-analysis of 16 RCTs to evaluate the effectiveness of acupuncture for treatment of asthma in adults.  Acupuncture was well-tolerated and could improve FEV1% (lung function), Cai’s AQLQ (quality of life in Asthma score)), symptom score, ACT score, and exacerbation frequency compared with sham/placebo acupuncture. However, other lung function and medication use parameters were not statistically significant.  The researchers also noted that further studies with appropriate controls, more participants, and high-quality evidence are needed.

Allergic Asthma:

Brinkahus et al, (2017) carried out a large randomised pragmatic trial in Germany (n=1445) giving acupunctrure in addition to usual care for allergic asthma, and comparing to a usual care alone group.  They found symptomatic improvement, as well as improvement in quality of life (asthma quality of life questionnaire – AQLQ) measures for the acupuncture group.

Mechanisms of action:

In the condition of allergic asthma, inflammatory considerations may play a key part in the process. Acupuncture has been shown to have anti-inflammatory effects, and a review article (Kavoussi & Ross, 2007) suggests this may be due to activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines which have been seen in studies.

Other studies (Zijlstra et al, 2003) suggest some of the anti-inflammatory effects exhibited in acupuncture may be due to stimulation of vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) within the body when acupuncture is applied, and these further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states. 

Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:

  • Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
  • Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
  • Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines.  They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis.  They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.

Per MacDonald et al (2015), acupuncture may: reduce inflammation by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.

Animal Studies in Asthma Models

Wei et al, 2015 investigated the effect of acupuncture on airway inflammation and immune responses in mice with experimental asthma. Acupuncture was effective in reducing airway hyperresponsiveness (AHR); lung inflammation; mucus secretion; and inflammatory markers including Th17 cytokines and NF-κB pathway, in the asthma model. Additionally, acupuncture increased the number and function of Treg cells – a type of white blood cell that can suppress inflammation and prevent autoimmunity.  The article suggests that acupuncture may be a useful complementary therapy for asthma patients due to anti-inflammatory and immune modulation effects.

Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function).  Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council evidence based factsheet about asthma including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Review Paper: Bronchial asthma and acupuncture: the evidence for effectiveness

References:

Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S.N. and Witt, C.M., 2017. Acupuncture in patients with allergic asthma: a randomized pragmatic trial. The Journal of Alternative and Complementary Medicine, 23(4), pp.268-277.

Chen, Y.M., Xie, X.L., Xiao, P.Y., Wang, Q.H., Wang, J.S., Yu, X.D. and Deng, S., 2020. Acupuncture on treating asthma: A protocol for systematic review and meta analysis. Medicine, 99(1).

Chu, K.A., Wu, Y.C., Ting, Y.M., Wang, H.C. and Lu, J.Y., 2007. Acupuncture therapy results in immediate bronchodilating effect in asthma patients. Journal of the Chinese Medical Association, 70(7), pp.265-268.

Karlson, G. and Bennicke, P., 2013. Acupuncture in asthmatic children: a prospective, randomized, controlled clinical trial of efficacy. Alternative therapies in health and medicine, 19(4), p.13.

Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8

Martin, J., Donaldson, A.N.A., Villarroel, R., Parmar, M.K.B., Ernst, E. and Higginson, I.J., 2002. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. European Respiratory Journal, 20(4), pp.846-852.

McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.

McCarney RW et al. Acupuncture for chronic asthma. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD000008. DOI: 10.1002/14651858.CD000008.pub2

Pang, J., Shergis, J.L., Zheng, L., Liu, S., Guo, X., Zhang, A.L., Lin, L., Xue, C.C. and Wu, L., 2023. Clinical Evidence for Acupuncture for Adult Asthma: Systematic Review and Meta-Analysis of Randomised Sham/Placebo-Controlled Trials. Complementary Therapies in Medicine, p.102956.

Reinhold, T., Brinkhaus, B., Willich, S.N. and Witt, C., 2014. Acupuncture in patients suffering from allergic asthma: is it worth additional costs?. The Journal of Alternative and Complementary Medicine, 20(3), pp.169-177.

Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.

Wei, Y., Dong, M., Zhang, H., Lv, Y., Liu, J., Wei, K., Luo, Q., Sun, J., Liu, F., Xu, F. and Dong, J., 2015. Acupuncture attenuated inflammation and inhibited Th17 and Treg activity in experimental asthma. Evidence-based complementary and alternative medicine, 2015.

Helen
Posted on: May-15-2021 13:39 pm
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