Tag Archives: condition

Shaftesbury Clinic Star of Conditions

Hair Loss – 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.

References:

Helen
Posted on: May-16-2016 9:31 am
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Shaftesbury Clinic Star of Conditions

Gastrointestinal & Digestive Tract – 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: 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.

Dyspepsia

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 (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).

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.

Irritable Bowel Syndrome

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). 

Constipation

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.

Ulcerative Colitis

Moxibustion is an adjunctive acupuncture technique that involves burning herbs near the skin to stimulate acupuncture points. Wang et al, (2015) examined the effect of moxibustion on a specific pathway in 40 ulcerative colitis (UC) rats divided into 4 groups.

The TLR2/NF- κ B signalling pathway is one of the body’s ways of detecting and fighting pathogens. It helps the body make substances that cause inflammation and attract other fighters to the scene. However, sometimes this pathway can go wrong and cause too much inflammation and harm to the body. This can happen in some diseases, such as ulcerative colitis.

Moxibustion was found to reduce the expression of pro-inflammatory biomarkers (namely, TLR2, IRAK1, IKK-β and NF-κB) in the UC rate; and to increase the expression of anti-inflammatory biomarkers (specifically, IFN- β and IL-10) in the rats’ colonic mucosa.

The researchers suggest that moxibustion can modulate the local immune response in UC, protect the colonic mucosa and promote its repair in UC by inhibiting the TLR2/NF- κ B signalling pathway. The effects of moxibustion were similar to those of salicylazosulfapyridine treatment, a conventional drug for UC, and both treatments were significantly better than the untreated UC group.

Crohn’s Disease

Zhao et al’s (2015, n=92) RCT randomised patients with active Crohn’s disease into 2 groups: moxibustion and acupuncture, or sham control.  In Crohn’s there is an imbalance between TH17 cells (a type of immune cells that elicit inflammatory response); and Treg cells (which suppress inflammation and protect intestinal mucosa).  Acupuncture lowered Th17 levels, and raised Treg cells, to balance their relative levels and dampen inflammation.  Crohn’s Disease Activity Index (CDAI) improved with both acupuncture and sham points, but more so with true acupuncture.  There were also positive histopathological changes of the intestinal mucosa following acupuncture – such as intact epithelium, reorganised glands and less inflammatory cells.  The authors concluded that moxibustion and acupuncture can relieve intestinal inflammation in Crohn’s disease patients by regulating the ratio of Th17 and Treg cells in the intestinal mucosa, and making the lining more intact, the glands more organized, and the inflammatory cells less abundant.

Resources:

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

British Acupuncture Council IBS Factsheet including specific research, trials and mechanisms of action for acupuncture in this condition.

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

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

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

References:

Dyspepsia 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.

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.

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.

Irritable Bowel Syndrome 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.

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.

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.

Constipation References:

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.

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.

Ulcerative Colitis References:

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.

Crohn’s References:

Zhao, C., Bao, C., Li, J., Zhu, Y., Wang, S., Yang, L., Shi, Y., Liu, H., Dou, C., Ding, G. and Wang, X., 2015. Moxibustion and acupuncture ameliorate Crohn’s disease by regulating the balance between Th17 and Treg cells in the intestinal mucosa. Evidence-Based Complementary and Alternative Medicine, 2015.

Helen
Posted on: May-16-2016 9:26 am
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Shaftesbury Clinic Star of Conditions

Gout – 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.

Resources:

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

Helen
Posted on: May-16-2016 9:25 am
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Shaftesbury Clinic Star of Conditions

Gallstones – 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.

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:

Acupuncture use is well-documented for digestive system conditions. A large body of research supports the hypothesis that acupuncture influences digestive tract physiology in a number of ways. Significant portions of the neural pathways for these effects have been shown in animal model studies. Studies have examined acupuncture for the expulsion of gallstones (Diehl, 1999).

The WHO (1996) has said that “acupuncture shows good analgesic and antispasmodic effects on the biliary tract […] not only effective for relieving the colicky pain, but is also useful for expelling the stones”.  62-64, 138, 139

An RCT (Wu, 1987; n=365) looked at auricular (ear) points for gallstones and looked at stool samples to see whether gallstones has been excreted, finding that they were more likely to have been passed by the acupuncture patients than the controls, hinting that the acupuncture had helped the excretion process.  Checks with ultrasound confirmed this.

Song et al (2006; n=120) compared 2 groups, acupuncture versus a Chinese medicine protocol, finding positive effects for acupuncture in gallstones and improving spasm and pain.  Other similar studies looked at how acupuncture could strengthen gallbladder contraction and bile secretion to clear gallstones, finding positive trends for acupuncture in these regards (e.g. Zhao, 2017; Wang et al, 2011; Xuemei et al, 2006).

Chen et al (2019), in a review of TCM and acupuncture for gallstones, also hypothesise that as well as the regulation of gallbladder motility, acupuncture’s known anti-inflammatory effect may also be at play.

Mechanisms of Action:

Zhao et al, 2017  used acupoints ST25, LR14, GB34 and ear point CO11 in an animal model to investigate its effect on gallbladder pressure and Sphincter of Oddi (SO) motility.  Whilst ST25 or LR14 increased SO myoelectrical activity and decreased gallbladder pressure; points GB34 or CO11 decreased SO myoelectrical activity and increased gallbladder pressure, showing a direct physiological connection with acupoint use and physiological response in the gallbladder.

Hao at al, 2022 theorised that improving gallbladder motility is a key part of managing gallstones, and they used an animal model, looking at the mechanisms of action of this process, using RNA sequencing to see which genes in the gallbladder are influenced by electroacupuncture at  the Gallbladder 34 acupoint, and suggesting that that EA achieved the effects by modulating the metabolism. 

Earlier animal models had shown similar promise, for example Ma and Yang (1996), where electroacupuncture at GB34 and 24 increased the action and electromyogram of SO, as well as the secretions of hepatic bile, and decreased the formation of gallstones, and the cholesterol content of the bile, all helping to discharge any gallstones.

A study is awaited, the protocol for which was published in the BMJ (Sun et al, 2022); to investigate the prompt pain-relieving qualities of acupuncture for of biliary colic (BC), and its impact on peripheral acupoint sensitivity and brain activity. A RCT (n=72), will involve acu-puncture vs placebo. Brain activity will be monitored using functional near-infrared spectroscopy (fNIRS), during treatment, and pain related measures will be examined.

A further study (protocol Sun et al, 2021) is awaited where the researchers will look at brain scans (fMRI) in the use of acupoints GB34 and EX-LE6 for biliary colic, to see what is occurring in which areas of the brain upon treatment, and which point is more effective. 

References:

Chen, Q., Zhang, Y., Li, S., Chen, S., Lin, X., Li, C. and Asakawa, T., 2019. Mechanisms underlying the prevention and treatment of cholelithiasis using traditional chinese medicine. Evidence-Based Complementary and Alternative Medicine, 2019.

Diehl, D.L., 1999. Acupuncture for gastrointestinal and hepatobiliary disorders. The Journal of Alternative and Complementary Medicine, 5(1), pp.27-45.

Hao, M., Dou, Z., Xu, L., Shao, Z., Sun, H. and Li, Z., 2022. RNA Sequencing Analysis of Gene Expression by Electroacupuncture in Guinea Pig Gallstone Models. Evidence-Based Complementary and Alternative Medicine, 2022.

Ma, C. and Yang, W., 1996. The preventing and treating effects of electro-acupuncture on cholelithiasis in golden hamster. Zhen ci yan jiu= Acupuncture Research, 21(4), pp.68-72.

Song, M.P., 2006. Clinical observation on frequency-changeable electroacupuncture for treatment of cholelithiasis. Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion, 26(11), pp.772-774.

Sun, N., Zhou, Y.F., Zhou, J., Zuo, W.W., Ye, X.Y., Deng, X.D., Li, Z.J., Cheng, S.R., Qu, Y.Z., Zhou, J. and Sun, R.R., 2021. The cerebral mechanism underlying the acupoints with specific effect for gallbladder stone disease: protocol for a randomized controlled task-fMRI trial. Trials, 22(1), p.399.

Sun, N., He, D.M., Ye, X., Bin, L., Zhou, Y., Deng, X., Qu, Y., Li, Z., Cheng, S., Shao, S. and Zhao, F.J., 2022. Immediate acupuncture with GB34 for biliary colic: protocol for a randomised controlled neuroimaging trial. BMJ open, 12(1), p.e050413.

Wang, G.M., Wen, F.Y., Li, L.X., Zheng, H., Huang, Y.H. and Song, Y.Q., 2011. Observation of effect on contraction function of gallbladde by acupuncture at Jianjing (GB 21). Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 31(10), pp.910-912.

WHO (1996) Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials By World Health Organization

Wu, X., 1987. Auricular pressure in the treatment of gallstones: A randomized, clinical trial of traditional chinese medicine. Hepatology, 7(4), pp.781-784.

Xuemei, C., Jiaping, T. and Ling, W., 2006. Treatment of cholelithiasis by acupuncture and oral decoction. Journal of Traditional Chinese Medicine= Chung i tsa Chih Ying wen pan, 26(3), pp.167-169.

Zhao, J., Yu, Y., Luo, M., Li, L. and Rong, P., 2017. Bi-directional regulation of acupuncture on extrahepatic biliary system: an approach in guinea pigs. Scientific Reports, 7(1), pp.1-11.

Resources: British Acupuncture Council evidence based factsheet about Kidney Stones, which also covers Gallstones research, including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
Posted on: May-16-2016 9:24 am
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Shaftesbury Clinic Star of Conditions

Shoulder Pain and Frozen Shoulder – 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.

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).

Shoulder Pain and Frozen 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.

Clinical trials have suggested that acupuncture may benefit frozen shoulder symptoms (Cheing et al, 2008 – n=70; compared to electrotherapy), with some suggestions it may be good to use in combination with other manual therapies (Ma et al, 2006 – compared to physiotherapy, n=75), and where benefits were seen with acupuncture, but even more so in combination with acupuncture and exercise (Sun et al, 2001; n=35); however in additional high-quality and larger, long term follow-up studies need to be done in the future to confirm these findings.

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).

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.

Resources:

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

Resources:

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.

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

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.

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.

Shoulder Pain References:

Cheing, G.L., So, E.M. and Chao, C.Y., 2008. Effectiveness of electroacupuncture and interferential electrotherapy in the management of frozen shoulder. Journal of rehabilitation medicine, 40(3), pp.166-170.

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.

Ma, T., Kao, M.J., Lin, I.H., Chiu, Y.L., Chien, C., Ho, T.J., Chu, B.C. and Chang, Y.H., 2006. A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder. The American journal of Chinese medicine, 34(05), pp.759-775.

Sun KO; K C Chan, S L Lo, D Y Fong. Acupuncture for frozen shoulder. Hong Kong Med J 2001; 7: 381-91.

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.

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.

Helen
Posted on: May-16-2016 9:19 am
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Shaftesbury Clinic Star of Conditions

Fibromyalgia – 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.

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.

Acupuncture and Fibromyalgia

A systematic review and meta-analysis of randomized controlled trials (Zhang et al, 2019) looked at this area, examining 12 trials comparing acupuncture to sham. The researchers found acupuncture superior to sham for fibromyalgia patients in terms of pain relief and quality of life, with low-to-moderate evidence quality.  This is a positive trend warranting further high-quality trials and an indication that acupuncture may be a useful approach for these patients. Acupuncture was also found to be very safe and low in side effects.

Another systematic review and meta-analysis (Kim et al, 2019 : 10 RCT trials; n=690) found acupuncture more effective than sham for short-term pain relief, improving sleep quality, and quality of life in fibromyalgia patients, but were unable to verify effects of fatigue. They also noted that: “evidence quality of moderate level in pain relief made our confidence in the effect estimate limited”, echoing the need for further study in this promising area.

The most recent systematic review and meta analysis (Zheng at al, 2022) looked at 12 studies (n=715), and concluded that for fibromyalgia patients: “Low to moderate quality of evidence suggests that real acupuncture is more effective than control treatment in alleviating pain and improving well-being in both the short- and long-term. Furthermore, we believe that manual acupuncture with at least 10 sessions can achieve better analgesic effect”. They called for future large-scale rigorous studies to corroborate this. They were unable to verify the effect of acupuncture on fatigue, sleep quality, physical function, and stiffness for this patient group.

A small RCT (Mist & Jones, 2018; n=30) randomised female fibromyalgia patients who had moderate to severe pain levels to either acupuncture or group education (no acupuncture).  The researchers concluded that group acupuncture improved global symptom impact, pain, and fatigue more than did group education; and was well-tolerated and safe.

An RCT study in 76 fibromyalgia patients (Mawla at al, 2021) looked at outcomes as well as mechanisms of action, using pain scores as well as MRI brain imaging and measures of neurotransmitters in the body.  After 8 treatments the acupuncture group had a greater reduction in pain than control, visible difference in the part of the brain related to the somatosensory part of the leg stimulated by acupuncture, and increased GABA (a neurotransmitter – more information in the following section on Pain, below) in the anterior insula of the brain.

A 3-armed Spanish RCT (Garrido-Ardila et al, 2020: n=135) compared acupuncture, physio core stability training and control for women with fibromyalgia.  They found comparable improvements in the two intervention groups versus control, such that statistically significant improvements were seen at 6 weeks in both acupuncture and physiotherapy groups vs. the control group on the Berg Balance Scale, 10-m walk test at comfortable speed, and timed up and go test.  Their conclusion was “core stability-based physiotherapy and acupuncture improve dynamic balance and postural control in women with Fibromyalgia.” 

Di Carlo et al (2020: n=96) demonstrated the short-term efficacy of an eight-week course of acupuncture, (in addition to ongoing drug therapy), in patients with severe fibromyalgia.  Of note is that the study did not have a control group, but an area of interest in the way they did this study was to look at features of pain catastrophising and neuropathic issues, which form a part of this disease picture, so future studies should include this but also a control group.  A positive effect was found on pain catastrophising, as well as improvement in pain that was of a neuropathic quality.

A Brazilian RCT (Targino et al, 2008) randomized 58 female patients to acupuncture plus tricyclic antidepressants or exercise plus tricyclic antidepressants.  After 20 sessions, there was a significant improvement for the acupuncture group in pain measures and the number of tender points; which lasted for 3 months after the end of treatment.

A Spanish RCT in a primary care setting (Vas et al, 2016: n=164), split fibromyalgia patients into individualised acupuncture or sham acupuncture groups; reviewing pain intensity at 10 weeks.  The individualised acupuncture group had a marked improvement in painful symptoms, functional capacity and quality of life versus the control, and the effect persisted to 1 year follow up.

A small Turkish study (Yüksel et al, 2019: n=42) looked at the effect of acupuncture and transcutaneous electric nerve stimulation (TENS) on the brain scans of two groups: fibromyalgia patients vs healthy volunteers.  Decreased pain and increased inhibitor activity were seen in the TENS and acupuncture groups, both of which were concluded to be beneficial of fibromyalgia patients.

An RCT (Martin et al, 2006) randomized 50 fibromyalgia patients to acupuncture or sham, using measures of Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory , and found that acupuncture improved total fibromyalgia symptoms, (vs placebo), and notably fatigue and anxiety were the most improved symptoms.  Activity and physical function levels did not change, however.

A recent review of studies from the USA, lead by researchers from Harvard Medical School (Berger et al, 2021), found that whilst more research is needed into acupuncture for fibromyalgia, there was “positive evidence in most studies examining the use of acupuncture as an adjunct to exercise, physical therapy, or pharmacological treatment, and in light of the safety and availability of the treatment, there seems to be increasing evidence supporting the incorporation of acupuncture as part of multi-modality treatment plans for fibromyalgia.” [page 7].

Acupuncture and Pain in general

“Acupuncture has been widely applied to alleviate several pain diseases and incorporated into guidelines, and it is an effective method of coping with the opioid crisis and is widely respected due to its safety, low price, and low addiction” – Zhang et al, 2022

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).

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).

Very specific effects have been seen on a number of neurotransmitters, when acupuncture treatment is given, and to investigate this, a large and growing body of evidence has accumulated from clinical experiments with animal models, where levels of neurotransmitters and their effects are measured objectively; and because the animal is not aware of the intended outcomes, this drastically reduces any influence of placebo effect, as a cause of pain relief. 

Human trials, where measurable in an ethical and objective way, are also employed through fMRI (brain scans showing which areas are stimulated or downregulated in acupuncture treatment), measuring blood levels of neurotransmitters as well as pain ratings for an objective approach.

The role of acupuncture in modulating neurotransmitters involved in pain has been well discussed. Zhang et al (2022) outlined the research on each of the main observed neurotransmitter roles that have been researched in acupuncture for pain: those are opioid peptides; γ-Aminobutyric acid (GABA); Norepinephrine; 5-Hydroxytryptamine (5-HT – aka serotonin); and glutamate.  Overall for these neurotransmitters (in turn), the following are the highlights from the research body per Zhang and colleagues:

  • Endogenous opioid peptides are produced in the body as a direct result of acupuncture, and have a positive effect on analgesia (pain relief).  By name, these are enkephalins, endomorphins, dynorphins, and nociceptin, and these are the body’s own natural painkilling substances, types of neurotransmitters, or chemical messengers of the nervous system
  • γ-Aminobutyric acid (GABA) is an inhibitory neurotransmitter in the central nervous system.  It has a painkilling effect, and it has been demonstrated that acupuncture can upregulate GABA expression; another part of how acupuncture helps with pain
  • Norepinephrine (noradrenalin in the UK), is a neurotransmitter, the release of which is enhances by acupuncture; this influences pain because norepinephrine is also capable of inhibiting pain in the body
  • 5-Hydroxytryptamine (5-HT), or serotonin; is a neurotransmitter that is involved in analgesia (pain relief).  5-HT is secreted in the brain during acupuncture administration, making it another known mechanism of action for acupuncture’s ability to help pain
  • Glutamate is a central nervous system neurotransmitter (chemical messenger), and is involved in the transmission of pain signals in the spinal cord.  Acupuncture downregulates glutamate, as part of how it provides pain relief

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)

Animal Models

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.

Overall, per the research it can be seen that a combination of demonstratable mechanisms is at play; as measured and observed to be the cause of why acupuncture has been shown in so many practical studies to help a number of different types of pain. 

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.

Also of Interest

See also our blog about a BBC Morning Live feature discussing many aspect of fibromyalgia and complementary approaches, where Dr Punam recommended acupuncture as part of a patient-centred approach.

References:

Berger AA, Liu Y, Nguyen J, et al. Efficacy of acupuncture in the treatment of fibromyalgia. Orthopedic Reviews. 2021;13(1). doi:10.52965/001c.25085Di Carlo, M., Beci, G. and Salaffi, F., 2020. Acupuncture for fibromyalgia: an open-label pragmatic study on effects on disease severity, neuropathic pain features, and pain catastrophizing. Evidence-Based Complementary and Alternative Medicine, 2020.

Garrido-Ardila, Elisa María, María Victoria González-López-Arza, Maria Jiménez-Palomares, Agustín García-Nogales, and Juan Rodríguez-Mansilla. “Effectiveness of acupuncture vs. core stability training in balance and functional capacity of women with fibromyalgia: A randomized controlled trial.” Clinical Rehabilitation 34, no. 5 (2020): 630-645.

Kim, J., Kim, S.R., Lee, H. and Nam, D.H., 2019. Comparing verum and sham acupuncture in fibromyalgia syndrome: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2019.Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

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.

Martin, D.P., Sletten, C.D., Williams, B.A. and Berger, I.H., 2006, June. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. In Mayo Clinic Proceedings (Vol. 81, No. 6, pp. 749-757). Elsevier.

Mawla, Ishtiaq, Eric Ichesco, Helge J. Zöllner, Richard AE Edden, Thomas Chenevert, Henry Buchtel, Meagan D. Bretz et al. “Greater Somatosensory Afference With Acupuncture Increases Primary Somatosensory Connectivity and Alleviates Fibromyalgia Pain via Insular γ‐Aminobutyric Acid: A Randomized Neuroimaging Trial.” Arthritis & Rheumatology 73, no. 7 (2021): 1318-1328.

Mist, S.D. and Jones, K.D., 2018. Randomized controlled trial of acupuncture for women with fibromyalgia: group acupuncture with traditional Chinese medicine diagnosis-based point selection. Pain Medicine, 19(9), pp.1862-1871.

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.

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.

Targino, R.A., Imamura, M., Kaziyama, H.H., Souza, L.P., Hsing, W.T., Furlan, A.D., Imamura, S.T. and Neto, R.S.A., 2008. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. Journal of Rehabilitation Medicine, 40(7), pp.582-588.

Vas, J., Santos-Rey, K., Navarro-Pablo, R., Modesto, M., Aguilar, I., Campos, M.Á., Aguilar-Velasco, J.F., Romero, M., Párraga, P., Hervás, V. and Santamaría, O., 2016. Acupuncture for fibromyalgia in primary care: a randomised controlled trial. Acupuncture in Medicine, 34(4), pp.257-266.

Yüksel, M., Ayaş, Ş., Cabıoğlu, M.T., Yılmaz, D. and Cabıoğlu, C., 2019. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture effectiveness in treatment of fibromyalgia syndrome. Evidence-based complementary and alternative Medicine, 2019.

Zhang, X.C., Chen, H., Xu, W.T., Song, Y.Y., Gu, Y.H. and Ni, G.X., 2019. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Journal of pain research, 12, p.527

Zhang, M., Shi, L., Deng, S., Sang, B., Chen, J., Zhuo, B., Qin, C., Lyu, Y., Liu, C., Zhang, J. and Meng, Z., 2022. Effective oriental magic for analgesia: acupuncture. Evidence-Based Complementary and Alternative Medicine, 2022.

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

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)

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.

Resources:

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

Helen
Posted on: May-16-2016 9:17 am
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Eye Health – 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.

References:

Helen
Posted on: May-16-2016 9:08 am
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Endocrine System & Hormones – Condition Resources

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Our Diabetes page may also be of interest

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.

Research on Pre-Diabetes:

Zhang et al (2022) examined the effects and safety of acupuncture-related therapy (AT) on glycaemic control for prediabetes, through a systematic review and meta-analysis of 31 RCTs were. They found that compared to conventional care, sham interventions, or conventional medicine, AT treatments gave significantly greater reductions in fasting plasma glucose.  The authors suggest that AT holds potential as a strategy for better glycaemic control in the management of prediabetes. This is interpreted with caution, warranting further research to be conducted, particularly with regards to different ethnic groups and long-term effectiveness.

References:

BAcC Diabetes, Type ii and Gestational Factsheet: also covers diabetic neuropathy

Zhang, M., Wang, C.C. and Lo, J., 2022. Should Acupuncture-Related Therapies be Considered in Prediabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Holistic Nursing Practice, 36(4), pp.198-208.

Helen
Posted on: May-16-2016 9:06 am
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Eczema & Psoriasis – 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 Eczema, Psoriasis, Dermatitis, Pruritus (itching) and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “psoriasis” yields over 9,200 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 701 results; of which 38% have been carried out since 2017 (Google Scholar). A scholarly search of the available research papers on the terms “acupuncture” + “eczema” yields over 8,300 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 719 results; of which 32% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in both these areas, leading to a growing body of research, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal.

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.

Psoriasis:

Yeh et al’s (2017) systematic review of 13 RCT’s (n=1060) concluded that acupuncture techniques could be considered as an adjuvant therapy in this field, and in particular acupressure and catgut embedding, noting limitation in methodological quality of some studies and calling for more rigorous trials to be carried out (note: catgut embedding is not generally used in the UK).

Since then, and having seen an increase in the pace of research in this area in the last 4 years, the forthcoming systematic review of Cheng at al, (protocol: 2021) may add to the understanding of this area of research. Xiao et al have also put forth a protocol for a systematic review to compare herbal medicine along with and acupuncture + herbal medicine for psoriasis, which will be of interest (protocol: Xiao et al, 2019). As far as forthcoming reviews in acupuncture adjunctive techniques, Zou et al’s systematic review of moxibustion therapy for psoriasis (protocol: Zou et al, 2021), and Zhang et al’s (protocol: 2020a) systematic review for cupping for psoriasis will be of interest when published.

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.

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.

Atopic Dermatitis:

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, 2020b).

Mechanisms of Action:

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. 

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.

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 (Pkumura et al, 2002), and lower levels of inflammatory markers (serum and ear tissue cytokines) were also lowered in the acupuncture group.

McDonald et al (2013) reviewed the pathophysiology of acupuncture, as it had been shown to improve clinical outcomes by modulating immune response and reducing inflammation.  Per the review of RCTs, acupuncture down-regulated Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF); showing some of the means by which the anti-inflammatory effect occurs.

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)

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.

Resources:

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

References:

Psoriasis References:

Cheng, X., Lai, J., Zhang, Y., Lin, L., Xu, D., Zhong, Z., Wu, Q. and Liu, J., 2021. Efficacy and safety of fire acupuncture for psoriasis vulgaris: A protocol of systematic review and meta-analysis of randomized clinical trials. Medicine, 100(12), p.e25038.

Xiao, S., Li, B., Feng, S., Liu, C. and Zhang, G., 2019. Acupuncture combined with herbal medicine versus herbal medicine alone for plaque psoriasis: a systematic review protocol. Annals of translational medicine, 7(6).

Yeh, M.L., Ko, S.H., Wang, M.H., Chi, C.C. and Chung, Y.C., 2017. Acupuncture-related techniques for psoriasis: a systematic review with pairwise and network meta-analyses of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 23(12), pp.930-940.

Zhang, J., Yu, Q., Peng, L., Zhang, F., Lin, W., Guo, J., Xiao, M. and Chen, M., 2020a. Cupping for psoriasis vulgaris: a protocol of systematic review and meta-analysis. Medicine, 99(20).

Zou, J., Huang, G., Hu, C., Yan, J., Zhang, F., Shi, H., Yuan, X., Fu, J. and Gong, L., 2021. Moxibustion therapy for treating psoriasis vulgaris: A protocol for systematic review and meta-analysis. Medicine, 100(12), p.e25250.

Atopic Eczema References

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.

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.

Atopic Dermatitis

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.

Chronic Pruritus:

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

Mechanism of Action References:

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

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.

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.

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

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-16-2016 9:02 am
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Ear Health – 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.

References:

Helen
Posted on: May-16-2016 9:01 am
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