Blog of Shaftesbury Clinic

Nausea – Condition Resources

May 16, 2016BlogAcupuncture, condition, NauseaHelen

For Hyperemesis Gravidarum (Morning Sickness), see the relevant section of our pregnancy page: There is also an interesting video from the British Acupuncture Council with a patient regarding hyperemesis gravidarum (severe morning sickness) and her use of acupuncture, showing a treatment and discussion with her acupuncturist: you can see it here

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 Nausea, Vomiting and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “nausea” yields over 36,300 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 5,930 results; of which 39% 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.

Post Operative Nausea and Vomiting (PONV)

In the hospital setting, acupuncture reduced postoperative nausea and vomiting (PONV) in children, particularly during the first 4 hours after surgery and was most effective when performed before anaesthesia (Veiga-Gil at al, 2017, systematic review of 16 RCT’s, n=1773).

Sun et al’s (2008) systematic review of 15 RCT’s (n=1166) in the British Journal of Anaesthesia examined post-operative pain but also found lower incidence of opioid side effects including post-operative nausea and vomiting (PONV) in acupuncture groups. They stated that further large and well-designed studies are needed to further examine this area including the most effective points and timings to use.

Fu et al (2020a) looked specifically at nausea and vomiting post abdominal surgery in a systematic review (20 studies, n=2862), finding positive results for acupuncture intervention groups, nausea being easier to control than was vomiting.

A further systematic review in this area is due soon, looking at comparing non-invasive and invasive acupuncture in the prevention of postoperative nausea and vomiting (protocol: Fu et al, 2020b), it will be good to have the more resent research included in this where methodology and quality allow, given this is an area of greatly increased research since 2017.

Chemotherapy and Radiotherapy Related Nausea and Vomiting

Five forthcoming systematic reviews are currently awaited from Ma et al, (protocol: 2020); Huang et al (protocol: 2020); Shi et al (protocol: 2020); Hu et al, (protocol, 2019); and Hou et al, (protocol: 2021) regarding acupuncture in chemotherapy-induced vomiting and nausea.

It will be of interest to see what these five systematics review add to the literature and evidence, given the large increase in RCT’s in this area since 2017. (Of 1,860 RCT’s for this, 638 were published since 2017 [search term “acupuncture” + “nausea” + “chemotherapy” +”RCT” on scholarly resource].

Further, a systematic review protocol has been published to investigate acupuncture in radiotherapy-induced nausea and vomiting (protocol: Shu et al, 2019).

Electro Acupuncture

EA is a safe and effective form of therapy, which studies and systematic reviews, have shown may benefit patients for the symptoms of a wide range of conditions, in particular nausea prevention: post chemotherapy (Zhang et al, 2014); post surgery nausea (Ho et al, 1990); in hyperemesis gravidarum (severe “morning sickness” of pregnancy) (Ezzo et al, 2006);

Resources:

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

References:

Ezzo, J., Streitberger, K. and Schneider, A., 2006. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. Journal of Alternative & Complementary Medicine, 12(5), pp.489-495.

Fu, C., Wu, T., Shu, Q., Song, A. and Jiao, Y., 2020a. Acupuncture therapy on postoperative nausea and vomiting in abdominal operation: A Bayesian network meta analysis. Medicine, 99(23).

Fu, C.W., Shu, Q., Jiao, Y., Wu, T., Song, A.Q., Zhu, Q.C. and Zhang, W.P., 2020b. A comparison of noninvasive and invasive acupuncture in preventing postoperative nausea and vomiting: A protocol for systematic review and Bayesian network meta-analysis. Medicine, 99(31).

Ho, R.T., Jawan, B., Fung, S.T., Cheung, H.K. and Lee, J.H., 1990. Electro‐acupuncture and postoperative emesis. Anaesthesia, 45(4), pp.327-329.

Hou, X.B., Chen, D.D., Cheng, T.F., Wang, D., Dai, X.J., Wang, Y., Cui, B.X., Wang, Y.Y., Xu, H. and Chen, H.Z., 2021. Acupuncture treatment for nausea and vomiting after chemotherapy: A protocol for systematic review. Medicine: Case Reports and Study Protocols, 2(5), p.e0084.

Hu, J., Shen, Y., Zhang, G., He, J., Sun, M., Zhang, H., Hua, B. and Zheng, H., 2019. Effect of acupoint therapies on chemotherapy-induced nausea and vomiting: A systematic review protocol. Medicine, 98(37).

Huang, Y., Zhang, R., Yao, Q., Liu, J., OuYang, X., Hui, X., Wang, H., He, R. and Zhao, B., 2020. Acupuncture treatment for chemotherapy-induced nausea and vomiting: A protocol for systematic review and meta-analysis. Medicine, 99(21).

Ma, T.T., Zhang, T., Zhang, G.L., Dai, C.F., Zhang, B.R., Wang, X.M. and Wang, L.P., 2020. Prevention of chemotherapy-induced nausea and vomiting with acupuncture: a protocol for systematic review and meta-analysis. Medicine, 99(3).

Shi, Y., Xu, T., Chen, Q., Wu, J., Zhong, Y., Song, S., Chen, Y., Gao, W. and Zhao, L., 2019. Acupuncture for radiotherapy-induced nausea and vomiting: A systematic review protocol. Medicine, 98(24).

Shi, K., He, F., Tang, Y., Xiao, X., Zhang, J., Jin, Y., Wang, Y. and Zhang, Q., 2020. Acupuncture PC6 for postoperative nausea and vomiting at different times: A protocol for systematic review and meta analysis. Medicine, 99(22), p.e20452.

Sun, Y., Gan, T.J., Dubose, J.W. and Habib, A.S., 2008. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British journal of anaesthesia, 101(2), pp.151-160.

Veiga-Gil, L., Pueyo, J. and López-Olaondo, L., 2017. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. Revista Española de Anestesiología y Reanimación (English Edition), 64(4), pp.223-232.

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.

Helen

Posted on: May-16-2016 13:41 pm

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Tags: Acupuncture, condition, Nausea

Multiple Sclerosis – Condition Resources

May 16, 2016BlogAcupuncture, condition, MS, Multiple SclerosisHelen

Page still under construction

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.

Fatigue Study in RMMS

Khodaie et al’s RCT (2023: N=60) investigated acupuncture for fatigue in patients with relapsing-remitting MS (RRMS) in remission phase. They compared the effects of the drug amantadine alone, with amantadine with acupuncture, between two groups. Both groups took amantadine 100 mg every day and standard immune-modulating drugs. One group received acupuncture (10 sessions in 4 weeks) in addition, and the other group did not. Fatigue severity scale (FSS) was used, alongside MSQOL-54 questionnaire score (Quality of Life measure). Both groups had less fatigue, but the acupuncture group had more improvement after 4 weeks; the acupuncture group also had better quality of life, than did the control group. The results suggest that acupuncture with amantadine and standard care is better than amantadine and standard care alone for short-term relief of fatigue and quality of life in people with RRMS.

Anti-Inflammatory and Immune Effects of Acupuncture

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.

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.

References:

Khodaie, F., Naser Moghadasi, A., Kazemi, A.H. and Zhao, B., 2023. Effectiveness of acupuncture for fatigue in patients with relapsing-remitting multiple sclerosis: a randomized controlled trial. Acupuncture in Medicine, p.09645284221150824.

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.

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

Helen

Posted on: May-16-2016 13:37 pm

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Tags: Acupuncture, condition, MS, Multiple Sclerosis

Metabolic Disorders – Condition Resources

May 16, 2016BlogAcupuncture, condition, Metabolic DisordersHelen

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References:

Helen

Posted on: May-16-2016 13:31 pm

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Tags: Acupuncture, condition, Metabolic Disorders

Meningitis – Condition Resources

May 16, 2016BlogAcupuncture, condition, Meningitis, RehabilitationHelen

Page under construction

References:

Helen

Posted on: May-16-2016 13:30 pm

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Tags: Acupuncture, condition, Meningitis, Rehabilitation

Long Covid – Condition Resources

May 16, 2016BlogAcupuncture, condition, Fatigue, Long CovidHelen

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References:

Helen

Posted on: May-16-2016 13:23 pm

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Tags: Acupuncture, condition, Fatigue, Long Covid

Liver Health – Condition Resources

May 16, 2016BlogAcupuncture, condition, LiverHelen

Page under construction

References:

Helen

Posted on: May-16-2016 13:22 pm

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Tags: Acupuncture, condition, Liver

Lupus (SLE) – Condition Resources

May 16, 2016BlogAcupuncture, Autoimmune, condition, Lupus, SLEHelen

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References:

Helen

Posted on: May-16-2016 13:21 pm

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Tags: Acupuncture, Autoimmune, condition, Lupus, SLE

Kidney – Stones (calculi); Renal Colic; CKD; Heamodialysis – Condition Resources

May 16, 2016BlogAcupuncture, condition, Kidney Stones, Renal ColicHelen

CKD

A systematic review (Melo et al, 2020) examined acupuncture’s effect in CKD over 9 RCT’s, finding positive effects on improving quality of life, fatigue, and sleep in patients with chronic kidney disease, but not on the clinical variables of the disease, such as serum creatinine and glomerular filtration rate.

According to Lui et al’s (2022) narrative overview of preclinical studies and clinical trials published in Frontiers in Nephrology, acupuncture has been shown to improve symptoms and delay the progress of chronic kidney disease (CKD). The review suggests that acupuncture may be effective in reducing albuminuria, improving glomerular filtration rate, relieving symptoms, and improving the quality of life of patients with CKD.

Specifically, in diabetic patients with CKD, a prospective RCT (Wang et al, 2014; n=59) found that auricular (ear) acupuncture may have positive effects on improving the quality of life in these patients. The auricular acupressure group had significantly higher SF-36 (Short Form-36 Health Survey) scores and lower PSQI (Pittsburgh Sleep Quality Index) scores compared to the control group, indicating improvements in quality of life and sleep quality.

A preliminary small study (Yu et al, 2017; n=53) found acupuncture at points LI4, St36, and Kid3 for 12 weeks reduced creatinine levels and increased eGFR levels in patients with CKD.

Possible mechanisms of action of acupuncture in CKD include, per Lui et al, 2022, include “oxidative stress inhibition, reducing inflammatory effects, improving haemodynamics, maintaining podocyte structure, and increasing energy metabolism” [sic], leading the researchers to conclude that acupuncture could potentially present a safe, inexpensive treatment modality toward CKD, to improve patient symptoms and slow the progress of renal dysfunction.

Fatigue in End Stage Renal Disease (ESRD)

Hadadian et al (2016) found positive effects from Transcutaneous Electrical Acupoint Stimulation (TEAS) on fatigue among ESRD patients receiving haemodialysis treatment.

Shariati et al’s RCT (2012; n=48) found acupressure beneficial for end-stage renal disease patients on haemodialysis, with Ht7, Li4 and SP6 points used, significant differences in the PSQI (Pittsburgh Sleep Quality Index) and other sleep measures of duration, and daytime function were seen between the acupressure group and the control group after intervention.

Haemodialysis side effects

An RCT (Hmwe et al. 2015; n=108), examined the effects of acupressure on depression, anxiety, and general psychological distress in patients with haemodialysis, finding it could have positive effects on improving the psychological wellbeing of patients. The acupressure group had significantly lower DASS-21 (Depression, Anxiety Stress Scales) scores and GHQ-28 (General Health Questionnaire) scores compared to the control group, indicating improvements in depression, anxiety, stress, and general psychological distress.

Studies by both Sabouhi et al (2013; n=96) and Eglence et al (2013; n=118).found acupressure to reduce fatigue in haemodialysis patients.

Renal Calculi – Kidney Stones, renal colic

Acupuncture has also been used for the management of renal colic caused by urinary calculi (kidney stones), as one of the main issues involved pain management, and the mechanisms of action of acupuncture in pain are well-understood. See our page, for example on Chronic Pain.

Acupuncture at Neiguan (PC 6) and Zusanli (ST 36) points was shown in a Chinese RCT (n=240) to have a good analgesic (painkilling) effect in renal colic pain with a low incidence of adverse reactions, this was compared to two groups who each received pharmaceutical treatments.

Wu et al (2023; n=82) also found acupuncture beneficial for acute pain in patients with urinary calculi, as did Zhang et al, 2021 (n=80), in comparison with drug treatment.

A later RCT study (Tu et al, 2022, n=80) combined acupuncture with diclofenac drug treatment in the emergency department for patients with acute renal colic due to urolithiasis (stones); they concluded that acupuncture combined with diclofenac injection to be safe, providing fast, effective pain relief.

Qu et al (2022) conducted a systematic review and meta-analysis of acupuncture in renal colic caused by urinary calculi; over 15 studies they found acupuncture an effective and safe adjuvant therapy for kidney stone pain.

Later, Chen et al’s (2023) meta-analysis and trial sequence analysis examined 13 studies (n=1212) comparing conventional medicinal painkillers with acupuncture, finding acupuncture to be able to efficiently relieve renal colic with fewer adverse effects than those seen in pharmaceutical approaches. Both Que et al, and Chen et al (2022; 2023) noted some limitations in the number and quality of studies, warranting further future RCTs in this area.

Forthcoming is a study protocol for a randomized controlled trial published in Trials aims to evaluate the efficacy and safety of acupuncture as an adjunctive treatment to diclofenac for acute renal colic caused by urinary calculi (Cao et al, 2021).

During extracorporeal shock wave lithotripsy (ESWL) for kidney stones

Clinical studies by Tavakoli et al (2014); Rogenhofer et al (2004; n=90); Agah et al (2004; n=100) and Medina et al (2005; ) all found acupuncture effective on pain during ESWL.

A meta-analysis and systematic review of studies into acupuncture during ESWL (Chen et al, 2023b; n=1220), found acupuncture associated with higher pain relief and low side effect profile and supported the efficacy of acupuncture for pain relief during and after ESWL.

References:

Agah M, Falihi A. The efficacy of acupuncture in extracorporeal shock wave lithotripsy. Urol J. 2004 Summer;1(3):195-9.

Cao, Y., Tu, J.F., Shi, G.X., Wang, L.Q., Jia, L.C., Li, B., Liu, B.L., Yao, W.H., Pei, X.L., Qu, Z.C. and Liu, C.Z., 2021. Acupuncture as adjunctive therapy for acute renal colic caused by urinary calculi: study protocol for a randomized controlled trial. Trials, 22(1), pp.1-8.

Chen, H.T., Kuo, C.F., Hsu, C.C., Lai, L.C., Cheng, A.C., Sun, C.K. and Hung, K.C., 2023. Clinical efficacy of acupuncture for pain relief from renal colic: A meta-analysis and trial sequence analysis. Frontiers in Medicine, 9, p.1100014.

Chen, H.T., Hung, K.C., Hsu, Y.C., Kuo, J.R., Chang, Y.J., Chen, I.W. and Sun, C.K., 2023b. Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies. Frontiers in Medicine, 10, p.1114485.

Eglence, R., Karatas, N. and Tasci, S., 2013. The effect of acupressure on the level of fatigue in hemodialysis patients. Alternative Therapies in Health and Medicine, 19(6), p.23.

Hmwe, N.T.T., Subramanian, P., Tan, L.P. and Chong, W.K., 2015. The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: A randomized controlled trial. International journal of nursing studies, 52(2), pp.509-518.

Hadadian, F., Sohrabi, N., Farokhpayam, M., Farokhpayam, H., Towhidi, F., Fayazi, S., Soroush, A. and Abdi, A., 2016. The effects of transcutaneous electrical acupoint stimulation (TEAS) on fatigue in haemodialysis patients. Journal of Clinical and Diagnostic Research: JCDR, 10(9), p.YC01.

Ju, B.J. and Niu, L.L., 2012. Analysis of therapeutic effect of acupuncture at neiguan (PC 6) and zusanli (ST 36) on acute renal colic. Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion, 32(11), pp.975-978.

Liu, X., Wang, X., Ma, H. and Zhang, W., 2022. Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials. Frontiers in Nephrology, 2, p.1006506.

Melo, G.A.A., Aguiar, L.L., Silva, R.A., Pereira, F.G.F., Silva, F.L.B.D. and Caetano, J.Á., 2020. Effects of acupuncture in patients with chronic kidney disease: a systematic review. Revista Brasileira de Enfermagem, 73, p.e20180784.

Qu, Z., Wang, T., Tu, J., Yao, W., Pei, X., Jia, L., Cao, Y. and Liu, C., 2022. Efficacy and safety of acupuncture in renal colic caused by urinary calculi in adults: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2022.

Rogenhofer S, Wimmer K, Blana A, Roessler W, Wieland WF, Filbeck T. Acupuncture for pain in extracorporeal shockwave lithotripsy. J Endourol. 2004 Sep;18(7):634-7.

Sabouhi, F., Kalani, L., Valiani, M., Mortazavi, M. and Bemanian, M., 2013. Effect of acupressure on fatigue in patients on hemodialysis. Iranian journal of nursing and midwifery research, 18(6), p.429.

Shariati, A., Jahani, S., Hooshmand, M. and Khalili, N., 2012. The effect of acupressure on sleep quality in hemodialysis patients. Complementary therapies in medicine, 20(6), pp.417-423.

Tu, J.F., Cao, Y., Wang, L.Q., Shi, G.X., Jia, L.C., Liu, B.L., Yao, W.H., Pei, X.L., Cao, Y., Li, H.W. and Yan, S.Y., 2022. Effect of adjunctive acupuncture on pain relief among emergency department patients with acute renal colic due to urolithiasis: a randomized clinical trial. JAMA Network Open, 5(8), pp.e2225735-e2225735.

Tavakoli K, Taghavi R, Barakati N, Mohammadi SH. The effect of acupuncture on pain during extracorporeal shock wave lithotripsy- a clinical trial. J Shahrekord Univ Med Sci. 2014; 16(5): 84-91.

Wang, S., Chen, Z., Fu, P., Zang, L., Wang, L., Zhai, X., Gao, F., Huang, A. and Zhang, Y., 2014. Use of auricular acupressure to improve the quality of life in diabetic patients with chronic kidney diseases: a prospective randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2014.

Wu, L.M., Liu, Q., Yin, X.H., Yang, L.P., Yuan, J., Zhang, X.Q. and Wang, Y.L., 2023. Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain. World Journal of Clinical Cases, 11(18), pp.4287-4294.

Yu, J.S., Ho, C.H., Wang, H.Y., Chen, Y.H. and Hsieh, C.L., 2017. Acupuncture on renal function in patients with chronic kidney disease: a single-blinded, randomized, preliminary controlled study. The Journal of Alternative and Complementary Medicine, 23(8), pp.624-631.

Zhang, X., Liu, X., Ye, Q., Wang, X., Chen, J., Wang, Z., Zhao, P., Tao, B., Xu, G., Xu, W. and Wu, K., 2021. Acupuncture versus lornoxicam in the treatment of acute renal colic: a randomized controlled trial. Journal of Pain Research, pp.3637-3648.

Helen

Posted on: May-16-2016 13:16 pm

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Tags: Acupuncture, condition, Kidney Stones, Renal Colic

Joint Pain – Condition Resources

May 16, 2016BlogAcupuncture, condition, Joint Pain, JointsHelen

The Joints of the body are part of the MusculoSkeletal System, so you may find our page on this useful. We also have pages on Osteoarthritis, and Rheumatoid Arthritis, both of which may be causes if joint symptoms. If the cause is an injury to the joints, our Sports Injury page may be of assistance.

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).

Knee

Knee 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.

A systematic review and meta-analysis of 17 trials, showed significant benefits whereby in patients in study groups having received acupuncture, this was associated with significantly reduced chronic knee pain 12 weeks (Zhang et al, 2017). Specifically comparing treatments including acupuncture in osteoarthritic knee pain, Corbett et al’s (2013, n=9709) systematic review and network meta-analysis found that acupuncture could be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term: Acupuncture was ranked second out of 21 physical treatments in this study. The team also clarified that further research is also warranted in this area, due to the quality of the research available in some treatment areas across the studies.

Shoulder

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

Shoulder 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.

Another systematic review and meta analysis of acupuncture in shoulder pain post stroke (Lee & Lim, 2016), saw that over 12 RCTs found it more effective that rehabilitation alone finding it a useful for this, with the authors calling for further trials of high quality to corroborate this.

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 shoulder pain.

Elbow

The British Acupuncture Council has a Research digest where they examined some recent studies on lateral elbow pain, as well as an evidence based factsheet (tennis elbow – links are below), finding promising evidence in the field.

Gadau et al, (2014) conducted a systematic review of 19 RCTs of varying quality were examined, and overall the evidence suggested acupuncture was more effective than sham control. Tang et al (2015) looed at a smaller number of RCT and were more tentative about the outcomes due to concern over trial designs and highlighted a need for further research.

Recent small trials include one comparing acupuncture and manipulation (n=35; Hsu et al, 2016) in which both groups experienced improvement in pain and function. Another looked at ultrasound imaging of the affected tendon to evaluate acupuncture’s effect, finding reduction of tendon thickness after 10 sessions as well as improvement in pain scores (Ural et al 2017; n-41). A further trial (Wong et al, 2017; n=34) compared acupuncture and extracorporeal shockwave therapy (ESWT), finding a trend of improvement in pain scores in both groups.

Hip

There is less research in this area, although it is growing, a systematic review (Manheimer et al, 2018; n=413, for 6 trials) found Acupuncture beneficial as an add-on to usual GP care, with a small but significant benefit for physical quality of life in Osteoarthritis of the hip.

Back pain and Neck Pain

We have separate pages for these conditions for you to read more about acupuncture’s use in back pain, and in neck pain.

Resources:

Evidence Based Acupuncture Factsheet on Pain

BAcC Frozen Shoulder Factsheet

BAcC Neck Pain Factsheet

BAcC Osteoarthritis of the Knee Factsheet

References:

General Chronic 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.

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

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.

Knee

Corbett, M.S., Rice, S.J.C., Madurasinghe, V., Slack, R., Fayter, D.A., Harden, M., Sutton, A.J., Macpherson, H. and Woolacott, N.F., 2013. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and cartilage, 21(9), pp.1290-1298.

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.

Zhang, Q., Yue, J., Golianu, B., Sun, Z. and Lu, Y., 2017. Updated systematic review and meta-analysis of acupuncture for chronic knee pain. Acupuncture in Medicine, 35(6), pp.392-403.

Shoulder

Lee, S.H. and Lim, S.M., 2016. Acupuncture for poststroke shoulder pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2016.

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.

Elbow

Gadau, M., Yeung, W.F., Liu, H., Zaslawski, C., Tan, Y.S., Wang, F.C., Bangrazi, S., Chung, K.F., Bian, Z.X. and Zhang, S.P., 2014. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC Complementary and Alternative Medicine, 14(1), pp.1-19.

Tang, H., Fan, H., Chen, J., Yang, M., Yi, X., Dai, G., Chen, J., Tang, L., Rong, H., Wu, J. and Liang, F., 2015. Acupuncture for lateral epicondylitis: a systematic review. Evidence-based complementary and alternative medicine, 2015.

Hsu, C.Y., Lee, K.H., Huang, H.C., Chang, Z.Y., Chen, H.Y. and Yang, T.H., 2016. Manipulation therapy relieved pain more rapidly than acupuncture among lateral epicondylalgia (tennis elbow) patients: a randomized controlled trial with 8-week follow-up. Evidence-Based Complementary and Alternative Medicine, 2016.

Ural, F.G., Öztürk, G.T., Bölük, H. and Akkuş, S., 2017. Ultrasonographic evaluation of acupuncture effect on common extensor tendon thickness in patients with lateral epicondylitis: a randomized controlled study. The Journal of Alternative and Complementary Medicine, 23(10), pp.819-822.

Wong, C.W.Y., Ng, E.Y.L., Fung, P.W., Mok, K.M., Yung, P.S.H. and Chan, K.M., 2017. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 7, pp.21-26.

Hip

Manheimer, E., Cheng, K., Wieland, L.S., Shen, X., Lao, L., Guo, M. and Berman, B.M., 2018. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews, (5).

Helen

Posted on: May-16-2016 13:15 pm

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Tags: Acupuncture, condition, Joint Pain, Joints

Insomnia – Condition Resources

May 16, 2016BlogAcupuncture, condition, Insomnia, Sleep DisturbanceHelen

The British Acupuncture Council factsheet explores a number of research trials and concludes acupuncture could be considered as an option in this condition, in that most trials have found it to be effective (see link below).

A randomised controlled trial (n=224) found acupuncture intervention superior to waiting list control for insomnia, and the effect continued over 13 weeks, and the treatment was safe with a very low side effect profile (Chung et al, 2018). Another RCT (n=72) using sleep monitors as well as patient questionnaires found varying degrees of sleep improvement and a significant improvement in the Insomnia Severity Index (Yin et al, 2017).

A recent systematic review (Shergis et al, 2016), looked at 30 studies (n=2363 in total), some trials used a medicine for the control group, whereas others used a sham or placebo in comparison to acupuncture. Acupuncture was found superior in both cases, although many of the studies had some risk of bias, meaning that further better designed studies would be needed to corroborate these trends.

There is also promising research for acupuncture in insomnia where this is linked to another condition such as depression and sleep quality (Dong et al, 2017 – systematic review and meta-analysis for depression-related insomnia); or stroke (Lee et al, 2016 – systematic review and meta-analysis of 13 RCTs for insomnia after stroke).

Mechanisms of action:

Acupuncture is believed to stimulate the nervous system and has been shown to affect the levels of neurotransmitters in the body. Studies have shown effects which may be linked to a an influence on sleep, in particular acupuncture can increase the levels of a number of neurotransmitters and their modulators including a significant increase in melatonin secretion at night-time (Spence et al, 2004; n=18 with a related decrease in anxiety scores).

Acupuncture has also been shown to influence levels of serotonin, noradrenaline, dopamine, GABA and endorphins in mechanism of action studies (e.g. Samuels et al, 2008 – literature review; Zhou et al, 2008 in an animal model); and to increase nitric oxide activity in the brain in an animal model (Gao et al, 2007, n=48 mice). Acupuncture has been shown in mechanism of action studies to downregulate pain and stress reactions in the brain and nervous system and calm the sympathetic nervous system.

Resources:

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

British Acupuncture Council Research Digest – Insomnia section (near to bottom of document)

References:

Chung, K.F., Yeung, W.F., Yu, B.Y.M., Leung, F.C.Y., Zhang, S.P., Zhang, Z.J., Ng, R.M.K. and Yiu, G.C., 2018. Acupuncture with or without combined auricular acupuncture for insomnia: a randomised, waitlist-controlled trial. Acupuncture in Medicine, 36(1), pp.2-13.

Dong, B., Chen, Z., Yin, X., Li, D., Ma, J., Yin, P., Cao, Y., Lao, L. and Xu, S., 2017. The efficacy of acupuncture for treating depression-related insomnia compared with a control group: a systematic review and meta-analysis. BioMed research international, 2017.

Gao, X.Y., Ma, Q.L. and Hu, B., 2007. Effects of acupuncture at” Sishencong”(EX-HN 1) on physiological functions in the sleep disorder model mouse. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 27(9), pp.681-683.

Samuels, N., Gropp, C., Singer, S.R. and Oberbaum, M., 2008. Acupuncture for psychiatric illness: a literature review. Behavioral Medicine, 34(2), pp.55-64.

Shergis, J.L., Ni, X., Jackson, M.L., Zhang, A.L., Guo, X., Li, Y., Lu, C. and Xue, C.C., 2016. A systematic review of acupuncture for sleep quality in people with insomnia. Complementary therapies in medicine, 26, pp.11-20.

Spence, D.W., Kayumov, L., Chen, A., Lowe, A., Jain, U., Katzman, M.A., Shen, J., Perelman, B. and Shapiro, C.M., 2004. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. The Journal of neuropsychiatry and clinical neurosciences, 16(1), pp.19-28.

Yin, X., Gou, M., Xu, J., Dong, B., Yin, P., Masquelin, F., Wu, J., Lao, L. and Xu, S., 2017. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep medicine, 37, pp.193-200.

Zhou Q et al. The effect of electro-acupuncture on the imbalance between monoamine neurotransmitters and GABA in the CNS of rats with chronic emotional stress-induced anxiety. Int J Clin Acupunct 2008 ;17: 79-84

Helen

Posted on: May-16-2016 13:12 pm

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Tags: Acupuncture, condition, Insomnia, Sleep Disturbance