Acupuncture & Moxibustion
Background
Pain associated with cancer is one of the greatest causes of reduced quality of life in patients. Acupuncture is one of the treatments used to address this issue, with the great advantage of having little or no side effects, especially when compared with pharmacological pain-killers.
Objective
The aim of this systematic review and meta-analysis was to evaluate the current evidence regarding the efficacy of acupuncture for cancer pain.
Search strategy
Six electronic databases (PubMed, EBSCO, Cochrane Library, Scielo, b-On and Scopus) were searched for relevant articles about pain relief in cancer patients from their beginning until 2022 using MeSH terms such as “acupuncture,” “electroacupuncture,” “ear acupuncture,” “acupuncture analgesia,” ‘‘oncological pain,” and “cancer pain.”
Inclusion criteria
Studies included were randomized controlled trials (RCTs) where acupuncture was compared with no treatment, placebo acupuncture or usual care.
Data extraction and analysis
Three independent reviewers participated in data extraction and evaluation of risk of bias, and a meta-analysis was conducted. The primary outcome was pain intensity, measured with the visual analog scale, numeric rating scale, or brief pain inventory. Secondary outcomes also assessed were quality of life, functionality, xerostomia, pain interference, and analgesic consumption. Results were expressed as standardized mean difference (SMD) with 95% confidence interval (CI).
Results
Sixteen RCTs with a total of 1124 participants were included in the meta-analysis, with the majority of the studies presenting a low or unclear risk of bias. Acupuncture was more effective in reducing pain than no treatment (SMD = –0.90, 95% CI [–1.68, –0.12]), sham acupuncture (SMD = –1.10, 95% CI [–1.59, –0.61]) or usual care (SMD = –1.16, 95% CI [–1.38, –0.93]).
Conclusion
The results of this study suggest that acupuncture may be an effective intervention to reduce pain associated with cancer. Despite some limitations due to the low quality and small sample size of some included studies, as well as the different types and stages of cancer, acupuncture might provide an effective and safe treatment to reduce cancer pain.
Design, setting, participants and interventions
This study was conducted using a randomized, controlled, three-arm, parallel-group and multi-center design. Patients diagnosed with AP were randomly and equally assigned to EA1, EA2 or control groups. All participants received conventional standard-of-care therapy for AP. Local EA alone was administered in EA1, and local plus distal EA was given in EA2. Local EA included two abdominal acupoints, while distal EA included twelve peripheral acupoints. EA groups underwent one session of EA daily for 4 days (days 1–4), or until pain was resolved or discharged.
Main outcome measures
The primary outcome measure was the change in the visual analogue scale (VAS; 0–100) pain score between baseline and day 5.
Abnormalities in the gut microbiota and intestinal short-chain fatty acid (SCFA) levels are implicated in the pathogenesis of functional constipation (FC). Electro-acupuncture (EA) has been shown to improve constipation-related symptoms and rebalance the gut microbiota. However, it is currently unknown whether the gut microbiota is a key mechanistic target for EA or how EA promotes gut motility by regulating the gut microbiota and SCFAs. Therefore, we assessed the effects of EA in FC mice and pseudo-germfree (PGF) mice to address these questions.
Methods
Forty female Kunming mice were randomly separated into a normal control group (n = 8), an FC group (n = 8), an FC + EA group (n = 8), a PGF group (n = 8) and a PGF + EA group (n = 8). The FC group and FC + EA group were treated with diphenoxylate to establish the FC model; the PGF group and PGF + EA group were given an antibiotic cocktail to initiate the PGF model. After maintaining the model for 14 d, mice in the FC + EA and PGF + EA groups received EA stimulation at the ST25 and ST37 acupoints, once a day, 5 times per week, for 2 weeks. Fecal parameters and intestinal transit rate were calculated to assess the efficacy of EA on constipation and gastrointestinal motility. Colonic contents were used to quantify gut microbial diversity using 16S rRNA sequencing, and measure SCFA concentrations using gas chromatography-mass spectrometry.
EA significantly shortened the first black stool defecation time (P < 0.05) and increased the intestinal transit rate (P < 0.01), and fecal pellet number (P < 0.05), wet weight (P < 0.05) and water content (P < 0.01) over 8 h, compared with the FC group, showing that EA promoted gut motility and alleviated constipation. However, EA treatment did not reverse slow-transit colonic motility in PGF mice (P > 0.05), demonstrating that the gut microbiota may play a mechanistic role in the EA treatment of constipation. In addition, EA treatment restored the Firmicutes to Bacteroidetes ratio and significantly increased butyric acid generation in FC mice (P < 0.05), most likely due to the upregulation of Staphylococcaceae microorganisms (P < 0.01).
EA-mediated resolution of constipation occurs through rebalancing the gut microbiota and promoting butyric acid generation.
Low-back pain (LBP) in nurses is a major health concern that affects their quality of life and ability to work, with consequences for their economic status.
This study evaluates the effect of low-level laser acupuncture combined with auricular acupressure (LAA) on pain intensity, pain interference and quality of life in nurses with LBP.
This randomized controlled trial recruited a convenience sample of hospital-based nurses from one teaching hospital in Taiwan, China. Participants were randomly assigned to the LAA group (n = 38) receiving low-level laser acupuncture and auricular acupressure for 4 weeks, and the control group (n = 38) receiving only sham laser acupuncture treatment without laser energy output.
Data were collected for the primary pain outcome using the Short Form of the Brief Pain Inventory, while the secondary outcome, quality of life, was evaluated using the Roland-Morris Disability Questionnaire. Both primary and secondary outcomes were scored before the intervention, and after 2-week and 4-week intervention. The rate of LBP recurrence was evaluated at the 4th week and 8th week after the end of intervention.
After controlling for prior pain, the result of linear mixed model analysis showed trends in significant between-group differences in the level of current pain occurring in week 4 (P < 0.001), worst pain in week 2 (P < 0.001) and week 4 (P < 0.001), least pain in week 2 (P = 0.032) and week 4 (P < 0.001), pain interference in week 2 (P = 0.009) and week 4 (P < 0.001), and in the life dysfunction in week 2 (P < 0.001) and week 4 (P < 0.001). Recurrence rates of LBP at the 4th and 8th weeks after the end of intervention were 0% and 36.89% in the LAA group, and 69.44% and 36.11% in the control group.
This study shows that 4-week LAA intervention reduced pain intensity and pain interference, and improved quality of life for hospital-based nurses with LBP. These effects were maintained continuously for at least 4 weeks after the intervention. The nonpharmacological intervention, LAA, may be another efficacious, feasible, noninvasive, analgesic intervention for LBP.
Trial registration
This study is registered at Clinicaltrials.gov (registration number NCT04423445).
The study explores the effects of electroacupuncture (EA) at the governing vessel (GV) on proteomic changes in the hippocampus of rats with cognitive impairment.
Healthy male rats were randomly divided into 3 groups: sham, model and EA. Cognitive impairment was induced by left middle cerebral artery occlusion in the model and EA groups. Rats in the EA group were treated with EA at Shenting (GV24) and Baihui (GV20) for 7 d. Neurological deficit was scored using the Longa scale, the learning and memory ability was detected using the Morris water maze (MWM) test, and the proteomic profiling in the hippocampus was analyzed using protein-labeling technology based on the isobaric tag for relative and absolute quantitation (iTRAQ). The Western blot (WB) analysis was used to detect the proteins and validate the results of iTRAQ.
Compared with the model group, the neurological deficit score was significantly reduced, and the escape latency in the MWM test was significantly shortened, while the number of platform crossings increased in the EA group. A total of 2872 proteins were identified by iTRAQ. Differentially expressed proteins (DEPs) were identified between different groups: 92 proteins were upregulated and 103 were downregulated in the model group compared with the sham group, while 142 proteins were upregulated and 126 were downregulated in the EA group compared with the model group. Most of the DEPs were involved in oxidative phosphorylation, glycolipid metabolism and synaptic transmission. Furthermore, we also verified 4 DEPs using WB technology. Although the WB results were not exactly the same as the iTRAQ results, the expression trends of the DEPs were consistent. The upregulation of heat-shock protein β1 (Hspb1) was the highest in the EA group compared to the model group.
EA can effect proteomic changes in the hippocampus of rats with cognitive impairment. Hspb1 may be involved in the molecular mechanism by which acupuncture improves cognitive impairment.
Filiform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis (AR).
We aim to comprehensively evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.
Eight electronic databases were systematically searched from inception to October 14, 2021. Additional studies were acquired from clinical trial registration platforms and reference lists.
RCTs were included if they compared FNA with either sham acupuncture, no treatment, or conventional medications for AR.
Two researchers extracted data independently of each other using a predesigned data acquisition form, and results were cross-checked after completion. The primary outcome was symptom score (Total Nasal Symptom Score or Visual Analog Scale), and the secondary outcomes were the AR control questionnaire, quality of life (QoL) score (Different versions of Rhinoconjunctivitis Quality of Life Questionnaires), medication score (use of rescue medication), mental health score, total IgE, adverse event rate, clinical economic indicators, and patient satisfaction score. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) was used to calculate the effect size for continuous data, while risk ratio with 95% Cis was used for dichotomous data.
Thirty studies were included in this review. Compared with sham acupuncture, FNA significantly reduced the symptom score (SMD: –0.29 [–0.43, –0.15]), AR’s impact on QoL (SMD: –0.23 [–0.37, –0.08]) and medication score (SMD: –0.3 [–0.49, –0.11]). Compared with no treatment, FNA dramatically reduced the symptom score (SMD: –0.8 [–1.2, –0.39]) and AR’s impact on QoL (SMD: –0.82 [–1.13, –0.52]). There were no increased rates of adverse event with FNA compared to sham acupuncture and no treatment. FNA increased patient satisfaction and may be cost-effective. Most pieces of evidence from the above two comparisons were of high confidence. Moreover, FNA significantly outperformed conventional medication in reducing the symptom score (SMD: –0.48 [–0.85, –0.1]) and displayed a lower rate of adverse events, but the quality of evidence was very low.
FNA is an effective and safe intervention for AR and can help with symptom relief, QoL improvement, reducing medication usage, and increasing patient satisfaction. Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies.
Low-level LA gradually reduced older patients’ postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care.
ClinicalTrials.gov registration number NCT03995446.
Acupuncture has been widely used to relieve migraine-related symptoms. However, the findings of previous systematic reviews (SRs) and meta-analyses (MAs) are still not completely consistent. Their quality is also unknown, so a comprehensive study is needed.
Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.
In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.
The search strategy was structured by medical subject headings and search terms such as “acupuncture therapy” and “functional constipation.” Electronic searches were conducted in eight databases from their inception to September 2020.
SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.
Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.
Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as “critically low” confidence and one study as “low” confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have “low risk” of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as “moderate” quality, 57.5% (23/40) as “low” quality, and 20.0% (8/40) as “very low” quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.
Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.
Systematic review registration
PROSPERO CRD42020189173.
背景: 针刺所产生的感知刺激能够激活许多传出（神经）路径,这些传出的信号能够使众多神经系统中的神经活动发生改变。针刺治疗在中国被广泛地接受,同时在西方国家,也有越来越多的患者和家属要求接受针刺治疗。目的 对针刺治疗急性中风患者的临床效果以及安全性进行评价。检索策略：我们检索了Cochrane脑卒中组临床试验注册库（Cochrane Stroke Group Trials Register, CSGTR）（最后检索时间为2003年8月）,中国脑卒中试验注册库（Chinese Stroke Trials Register, CSTR）（2003年8月）以及中国针灸试验注册库（Chinese Acupuncture Trials Register, CATR）（2003年8月）。电子检索了Cochrane对照试验中心注册库（Cochrane图书馆,2003年第3期）,MEDLINE（1996年~2003年）,EMBASE（1980年~2003年）,替代医学资料库（Alternative Medicine Database, AMED）（1985年~2003年）,护理与医疗相关文献资料库（CONAHL）（1982年~2003年）以及中国生物医学资料库（Chinese Biology Medicine, CBM）（1981年~2003年）。手工检索了系统综述以及鉴定的临床试验所附录的参考文献。纳入标准：中风发病30 d以内启动针刺治疗的随机和半随机对照试验,与安慰针或假针刺比较,或者与急性缺血性和（或）急性出血性中风患者的开放性对照进行对比。针刺治疗是指将治疗用的针刺入皮肤。数据收集和分析：两名作者独立地进行试验的纳入、质量评价以及数据提取工作。同时我们也联系了试验报告的作者以取得漏失的数据。主要结果：共纳入14篇试验报告,涉及1 208名患者。其中有10个试验仅纳入急性缺血性中风患者。与假针刺或开放性对照比较,接受针刺治疗的患者死亡或功能丧失的情况呈现减少的趋势,统计学上界于显著与非显著的边缘\[比值比（odds ratio, OR）0.66,95%可信区间（confidential interval, CI）0.43~0.99）\];同时,3个月或者更长时间的随访结果表明,针刺治疗组的患者死亡或需要长期医疗照看的结局明显减少（OR 0.58, 95% CI 0.35~0.96)。在治疗期间,整体神经缺损评分（global neurological deficit score, GNDS）的均值差异具有统计学意义,针刺治疗组优于对照组\[标准化均差（standard mean differences, SMD）=1.17,95% CI 0.03~2.04\]。针刺治疗组与假针刺组比较,在死亡或者需要医疗照看的结局方面的差异具有统计学意义（OR 0.49, 95% CI 0.25~0.96),然而,对于死亡或功能丧失的结局（OR 0.67, 95% CI 0.40~1.12）或者GNDS变化的差异则无统计学意义（SMD 0.01, 95% CI –0.55~0.57）。与针刺相关的严重不良反应（如眩晕、难以忍受的疼痛和针刺部位感染）则十分罕见,发生率仅为1.55%（6/386)。结论：针刺疗法是安全的,然而疗效方面的证据仍然不足。主要体现在参与试验的患者数量较少,不足以确定针刺治疗急性缺血性或急性出血性中风是否有效。仍需要样本量更大的、方法学设计更严谨的临床试验。
目的 研究电针、补阳还五汤对大鼠坐骨神经损伤后的再生作用。方法 采用手术造成大鼠坐骨神经损伤模型,电针、补阳还五汤治疗,进行神经电生理和HRP追踪观察。结果 电针组、补阳还五汤组的神经传导速度和诱发动作电位振幅恢复率高、脊髓前角和脊神经节标记细胞数多,与西药组、空白组比较有显著性差异,其中电针组优于补阳还五汤组。结论 电针、补阳还五汤均能更好地促进神经早期的功能恢复,是一种促进周围神经损伤后神经再生的有效手段。
目的
探讨模糊聚类法在不同参数电针治疗佐剂性关节炎（adj uvant-induced arthritis,AA)大鼠总体疗效分 析中的应用。 方法
将健康雌性Wistar大鼠100只随机分为10组：正常空白对照组（简称空白组）、模型组和8个电针组, 每组10只。用不同参数的电针治疗AA大鼠。应用模糊数学方法对治疗后关节肿胀度、痛阈和炎症局部组 织中P-内啡肽和白细胞介素1(3含量等各组数据以数据极差正规法进行标准化处理,使用MATLAB编程求 解模糊相似矩阵和传递闭包的方法,对不同组别的相似性进行评价。 结果
当A =0. 72时,空白组和模型组各为一类;100 Hz、连续波、0. 2 mA电针,100 Hz、断续波、0. 1 mA电 针和100 Hz、断续波、0.2 mA电针聚为一类,这3组参数的电针治疗AA大鼠的疗效相似,消炎止痛效果较 好,余电针组疗效相似。 结论
模糊聚类法为多因素多组电针多个指标的总体疗效分析提供了一种较好的分析方法。
Methods/design
Discussion
Trial Registration:
背景: 随着对干眼症发病机制中免疫炎性反应认识的不断深入,鉴于目前治疗上使用的人工泪液对症状缓解的有限性及各种促进泪液分泌药物或治疗手段的局限性,临床医生更加关注能促进泪液主动分泌的治疗手段,针刺治疗干眼症可能符合此要求。
以人工泪液泪然滴眼液为对照治疗药物,观察针刺对干眼症患者泪液中乳铁蛋白含量及泪液分泌的影响及效应持续时间,探讨针刺治疗干眼症的作用机制。设计、场所、对象和干预措施：所有患者均为2010年8月至2011年5月在上海中医药大学附属曙光医院眼科门诊就诊的、首次诊断为干眼症的患者。采用随机对照试验的设计方法,收集干眼症患者共65例（65眼）,随机分为针刺治疗组及对照组,分别给予针刺治疗及人工泪液治疗3周。主要结局指标：采用酶联免疫吸附法测定治疗前后干眼症患者泪液中乳铁蛋白含量,来评价针刺对干眼症治疗的有效性。
结果:与治疗前比较,治疗3周后针刺组泪液中乳铁蛋白浓度升高,泪膜破裂时间延长,基础泪液分泌量增加,且均优于对照组;对照组的乳铁蛋白浓度、泪膜破裂时间、基础泪液分泌量与治疗前比较,差异无统计学意义。治疗结束后1周,针刺治疗组患者的基础泪液分泌量、泪液中乳铁蛋白含量与治疗3周时比较差异无统计学意义,而泪膜破裂时间缩短;针刺组泪液中乳铁蛋白含量、泪膜破裂时间与对照组比较,差异无统计学意义,而基础泪液分泌量仍优于对照组。
结论:针刺治疗可以增加干眼症患者泪液中的乳铁蛋白含量,促进干眼症患者泪液的分泌,延长其泪膜破裂时间。但针刺治疗对干眼症患者泪液分泌的改善及促进作用具有一定的时效性,随着治疗结束,治疗效应减弱。
本文从中医腧穴学出发,结合西医解剖学、神经学理论,探讨穴位深度与针刺靶点问题,分析了一直以来针刺和选穴操作不规范的原因及针刺神经节、神经孔的理论依据;以原发性三叉神经痛为例,提出将下关、攒竹、四白、夹承浆定位于蝶腭神经节及相应神经孔（眶上孔、眶下孔及颏孔）的针刺方法;认为规范穴位针刺靶点,既符合针刺临床试验干预措施报告标准对针刺细节的国际化要求,也有利于针灸技术的规范化研究,对于临床规避风险、提高针刺疗效具有现实意义。
目的:在针灸治疗贝尔麻痹的过程中,依据面神经麻痹程度进行面神经功能障碍评价分级,并观察该分级与疗效、疗程的关系及在判断预后方面的作用。
方法:以面瘫常用运动功能评价量表House-Brackmann量表为准,并对眼裂和唇角设定量标准,治疗前和治疗结束时,根据该量表评分对患者面部瘫痪程度进行面神经功能障碍评估分级,依次分为轻度、中度、中重度、重度功能障碍和完全麻痹5个级别。按患者疾病分期采用针刺对症治疗,不人为设定治疗时程,全程观察,以最终疗效为准。
结果:68例病例中,治愈53例,总有效率为97%。5种不同面神经功能障碍之间的治疗效果差异有统计学意义（P<0.01）;疗效与病情轻重相关,等级相关分析相关系数为0.423 (P<0.01);其疗程也随着面神经功能障碍级别加重而延长（P<0.01）。
结论:贝尔麻痹患者存在面神经功能障碍轻重的差别,针灸治疗的效果随着面神经功能障碍的加重而下降,不同级别面神经功能障碍患者治疗所需疗程不同。临床研究中非常有必要对患者进行评估分级后再做观察治疗,并依据病情轻重程度选择不同治疗方法。
