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PubMed2003

Clinical trial of acupuncture for patients with spinal cord injuries.

OBJECTIVE: To examine whether electrical acupuncture therapy through adhesive surface electrodes and concomitant auricular acupuncture therapy could improve the neurologic or functional recovery in acute traumatic spinal cord injury patients. DESIGN: A total of 100 acute traumatic spinal cord injury patients with American Spinal Injury Association (ASIA) impairment grading of A and B were recruited into this study. They were randomly divided into the acupuncture and control groups. In the acupuncture group, electrical acupuncture therapy via the adhesive surface electrodes were applied to the bilateral Hou Hsi (SI3) and Shen Mo (B62) acupoints. In auricular acupuncture, four acupoints related to the spinal cord were selected for stimulation at the antihelix, helix, and lower portion of the ear-back areas. Acupuncture therapy was initiated early in the emergency room setting or soon after spinal surgical intervention. Rehabilitation therapy was also provided to the patients during acupuncture therapy. In the control group, only rehabilitation therapy was provided to the patients. Neurologic and functional scores were assessed during the time of admission, hospital discharge, and 1-yr postinjury follow-up. RESULTS: There were significant improvements in neurologic (sensory and motor), functional, and FIM scores in the acupuncture group compared with the initial admission period when assessed during the time of hospital discharge and the 1-yr postinjury follow-up. A greater percentage of patients in the acupuncture group recovered to a higher ASIA impairment grading. CONCLUSION: The use of concomitant auricular and electrical acupuncture therapies, when implemented early in acute spinal cord injury, can contribute to significant neurologic and functional recoveries.

Activities of Daily Living↗
PubMedDate not supplied

Can acupuncture ease the symptoms of menopause?

In a randomized, 2-group clinical study, acupuncture was used for the relief of menopausal hot flushes, sleep disturbances, and mood changes. The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms. The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i (energy). Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture. The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase. Sleep disturbances in the experimental acupuncture treatment group declined over the study. Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study. Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances.

Acupuncture Points↗
PubMed2002

Validating a new non-penetrating sham acupuncture device: two randomised controlled trials.

For clinical trials of acupuncture, it would be desirable to have a sham procedure that is indistinguishable from the real treatment, yet inactive. A sham needle has been designed which telescopes instead of penetrating the skin. The Park Sham Device involves an improved method of supporting the sham needle and requires validation. The objective of these studies was to test whether the sham procedure using the new device was 1) indistinguishable from the same procedure using real needles in acupuncture naïve subjects, and 2) inactive, where the specific needle sensation (de qi) is taken as a surrogate measure of activity. The studies were designed as subject and assessor blind, randomised controlled trials. Study 1) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke. Study 2) included 63 healthy, acupuncture naïve, adult volunteers. The interventions used were real or sham acupuncture using the Park Sham Device. Study 1) was set in a district general hospital, and study 2) in a university laboratory. The outcome measure in study 1) was the form of treatment that patients believed they had received. In study 2) the outcome measure was experience of de qi, as judged by three acupuncture experts. No patient in either group(study 1) believed he or she had been treated with the sham needle. In 40 volunteers (study 2) for whom experts achieved consensus, the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 (95% CI 2.26 to 104.86). The inter-rater reliability of all 13 experts (study 2), calculated from their judgements on 10 subjects selected by randomisation, was 0.52 (95% CI 0.19 to 0.61). In conclusion, the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects, and is inactive, where the specific needle sensation (de qi) is taken as a surrogate measure of activity. It is therefore a valid control for acupuncture trials. The findings also lend support to the existence of de qi, a major concept underlying traditional Chinese acupuncture.

Acupuncture Points↗
PubMed2000

Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects.

Acupuncture, an ancient therapeutic technique, is emerging as an important modality of complementary medicine in the United States. The use and efficacy of acupuncture treatment are not yet widely accepted in Western scientific and medical communities. Demonstration of regionally specific, quantifiable acupuncture effects on relevant structures of the human brain would facilitate acceptance and integration of this therapeutic modality into the practice of modern medicine. Research with animal models of acupuncture indicates that many of the beneficial effects may be mediated at the subcortical level in the brain. We used functional magnetic resonance imaging (fMRI) to investigate the effects of acupuncture in normal subjects and to provide a foundation for future studies on mechanisms of acupuncture action in therapeutic interventions. Acupuncture needle manipulation was performed at Large Intestine 4 (LI 4, Hegu) on the hand in 13 subjects [Stux, 1997]. Needle manipulation on either hand produced prominent decreases of fMRI signals in the nucleus accumbens, amygdala, hippocampus, parahippocampus, hypothalamus, ventral tegmental area, anterior cingulate gyrus (BA 24), caudate, putamen, temporal pole, and insula in all 11 subjects who experienced acupuncture sensation. In marked contrast, signal increases were observed primarily in the somatosensory cortex. The two subjects who experienced pain instead of acupuncture sensation exhibited signal increases instead of decreases in the anterior cingulate gyrus (BA 24), caudate, putamen, anterior thalamus, and posterior insula. Superficial tactile stimulation to the same area elicited signal increases in the somatosensory cortex as expected, but no signal decreases in the deep structures. These preliminary results suggest that acupuncture needle manipulation modulates the activity of the limbic system and subcortical structures. We hypothesize that modulation of subcortical structures may be an important mechanism by which acupuncture exerts its complex multisystem effects.

Acupuncture Therapy↗
PubMed2001

Acupuncture for idiopathic headache.

BACKGROUND: Acupuncture is widely used for the treatment of headache, but its effectiveness is controversial. OBJECTIVES: To determine whether acupuncture is: - more effective than no treatment - more effective than 'sham' (placebo) acupuncture - as effective as other interventions used to treat idiopathic (primary) headaches. SEARCH STRATEGY: Electronic searches were performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the database of the Cochrane Field for Complementary Medicine. We also contacted researchers in the field and checked the bibliographies of all articles obtained. SELECTION CRITERIA: Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of idiopathic (primary) headaches were included. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, methods, and results was extracted by at least two independent reviewers using a pre-tested standard form. Results on headache frequency and intensity were summarized descriptively. Responder rate ratios (responder rate in treatment group/responder rate in control group) were calculated as a crude indicator of results for sham-acupuncture-controlled trials. Quantitative meta-analysis was not possible due to trial heterogeneity and insufficient reporting. MAIN RESULTS: Twenty-six trials including a total of 1151 patients (median, 37; range, 10-150) met the inclusion criteria. Sixteen trials were conducted among patients with migraine, six among patients with tension-type headache, and four among patients with various types of headaches. The majority of trials had methodological and/or reporting shortcomings. In eight of the 16 trials comparing true and sham (placebo) acupuncture in migraine and tension-type headache patients, true acupuncture was reported to be significantly superior; in four trials there was a trend in favor of true acupuncture; and in two trials there was no difference between the two interventions. (Two trials were uninterpretable.) The 10 trials comparing acupuncture with other forms of treatment yielded contradictory results. REVIEWER'S CONCLUSIONS: Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.

Acupuncture Therapy↗
PubMed2006

Acupuncture for stroke rehabilitation.

BACKGROUND: Stroke is the third leading cause of death in Western society; in China it is the second most common cause of death in cities and the third in rural areas. It is also a main cause of adult disability and dependency. Acupuncture for stroke has been used in China for hundreds of years and is increasingly practiced in some Western countries. OBJECTIVES: To assess the efficacy and safety of acupuncture for patients with stroke in the subacute or chronic stage. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (November 2005), the Cochrane Complementary Medicine Field Trials Register (November 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), CINAHL (1982 to November 2005), AMED (1985 to November 2005), the Chinese Stroke Trials Register (November 2005), the Chinese Acupuncture Trials Register (November 2005), the Chinese Biological Medicine Database (1977 to November 2005), the National Center for Complementary and Alternative Medicine Register (November 2005), and the National Institute of Health Clinical Trials Database (November 2005). We handsearched four Chinese journals and checked reference lists of all papers identified for further trials. SELECTION CRITERIA: Truly randomised unconfounded clinical trials among patients with ischemic or hemorrhagic stroke, in the subacute or chronic stage, which compared acupuncture involving needling with either placebo acupuncture, sham acupuncture or no acupuncture. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed quality, extracted and cross-checked the data. MAIN RESULTS: Five trials (368 patients) met the inclusion criteria. Methodological quality was considered inadequate in all trials. Although the overall estimate from four trials suggested the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group (odds ratio (OR) 6.55, 95% confidence interval (CI) 1.89 to 22.76), this estimate may not be reliable since there was substantial heterogeneity (I(2 )= 68%). One trial showed no significant improvement of motor function between the real acupuncture group and the sham acupuncture group (OR 9.00, 95% CI 0.40 to 203.30), but the confidence interval was wide and included clinically significant effects in both directions. No data on death, dependency, institutional care, change of neurological deficit score, quality of life or adverse events were available. AUTHORS' CONCLUSIONS: Currently there is no clear evidence on the effects of acupuncture on subacute or chronic stroke. Large, methodologically-sound trials are required.

Acupuncture Therapy↗
PubMed2001

Acupuncture for osteoarthritis of the knee: a systematic review.

OBJECTIVE: To evaluate trials of acupuncture for osteoarthritis (OA) of the knee, to assess the methodologic quality of the trials and determine whether low-quality trials are associated with positive outcomes, to document adverse effects, to identify patient or treatment characteristics associated with positive response, and to identify areas of future research. METHODS: Eight databases and 62 conference abstract series were searched. Randomized or quasi-randomized trials of all languages were included and evaluated for methodologic quality using the Jadad scale. Outcomes were pain, function, global improvement, and imaging. Data could not be pooled; therefore, a best-evidence synthesis was performed to determine the strength of evidence by control group. The adequacy of the acupuncture procedure was assessed by 2 acupuncturists trained in treating OA and blinded to study results. RESULTS: Seven trials representing 393 patients with knee OA were identified. For pain and function, there was limited evidence that acupuncture is more effective than being on a waiting list for treatment or having treatment as usual. For pain, there was strong evidence that real acupuncture is more effective than sham acupuncture; however, for function, there was inconclusive evidence that real acupuncture is more effective than sham acupuncture. There was insufficient evidence to determine whether the efficacy of acupuncture is similar to that of other treatments. CONCLUSION: The existing evidence suggests that acupuncture may play a role in the treatment of knee OA. Future research should define an optimal acupuncture treatment, measure quality of life, and assess acupuncture combined with other modalities.

Acupuncture Analgesia↗
PubMed1995

Long-lasting facilitation and depression of periurethral skeletal muscle following acupuncture-like stimulation in anesthetized rats.

The effects of acupuncture-like stimulation on the tone of the partially filled bladder and on the periurethral electromyogram (EMG) were examined in urethane-anesthetized rats. Acupuncture-like stimuli were usually applied to the skin and underlying muscles (or other structures), either separately or together, for a period of 1 min; the effects were studied in spinal cord intact and in spinalized animals. Maps have been constructed showing the effects of acupuncture-like stimulation at different sites on the body surface and of similar stimulation applied to individual muscles, the urethra and the testis. When acupuncture-like stimuli were applied to the skin and underlying structures, in the rostral half of the body and the hindpaw, testis or urethra, these stimuli usually induced excitation of periurethral EMG activity. Depression of EMG activity was seen predominantly during stimulation of structures close to the urethra, but not opposed to it. When acupuncture-like stimuli were applied only to structure beneath the skin, depression of EMG activity usually occurred. Acupuncture-like stimulation of the bulbocavernosus, which partly overlies the proximal urethra produced depression of EMG activity in 50% of trials, but the incidence of similar effects from the more distant pubococcygeus, or the dorsal or ventral sacrococcygeal muscles was about 90-100%. Acupuncture-like stimulation for 1 min could produce either excitation or depression of periurethral EMG activity lasting about 5 or 6 min, depending on the site of insertion and rotation of the acupuncture needles. Excitation of short duration (less than 3 min) was consistently observed from areas of the body distant to the bladder, i.e. the nose, forepaw, forelimb, chest, abdominal wall and hindpaw. Longer lasting excitation of EMG activity was often seen from the penile urethra, perineal area and hindlimb. Depression of EMG activity with a duration of more than 3 min was consistently seen from the muscles at the base of the tail (sacrococcygeus) and perineal area (pubococcygeus and bulbocavernosus). The bladder was partially filled in these experiments, so that micturition contractions were never seen; acupuncture-like stimulation of the perineal area induced some increase in bladder tone in 40% of trials. In spinalized animals, the pattern of activity induced by acupuncture-like stimulation was similar to that seen in spinal cord intact animals and the durations of the effects were not significantly different in these two groups. The distribution of sites from which acupuncture-like stimuli can influence the activity of the lower urinary tract is discussed.

Acupuncture Therapy↗
PubMed1996

Increase of locomotor activity by acupuncture on Bai-Hui point in rats.

The effect of acupuncture on locomotor activity was investigated in rats. Stimulation with acupuncture inserted in Bai-Hui point, which is located at the vertex of the head, increased the spontaneous locomotor activity of rats measured in ANIMEX meter. This effect was obtained in rats which received acupuncture significantly at 60 min later as compared with sham-treated control. The sleeping time induced by hexobarbital was also reduced markedly in rats receiving acupuncture. An activation of the central nervous system by acupuncture at Bai-Hui point can thus be considered. This action was unrelated to opioids because naloxone failed to modify it. Increase in locomotor activity was abolished by an intraperitoneal (i.p.) injection of alpha-methyl-p-tyrosine (200 mg/kg) at 2 h before insertion of acupuncture. Deprenyl at the dose sufficient to elevate monoamine enhanced this action of acupuncture. Mediation of cerebral monoamines can also be considered. This view was supported by the dose-dependent inhibition of chlorpromazine. Action of acupuncture was not observed in apomorphine (0.5 mg/kg, i.p.)-treated rats, probably due to an activated receptor of dopamine. Otherwise, action of acupuncture was enhanced by para-chlorophenylalanine, the depleter of endogenous 5-hydroxytryptamine (5-HT), and eliminated by 5-hydroxytryptophan, the precursor of 5-HT, in the initial stage of insertion. Participation of 5-HT can be considered as an initial way in rats that received acupuncture at Bai-Hui point. These results suggested that stimulation of Bai-Hui point with acupuncture can activate central neurotransmission of monoamines to increase the spontaneous locomotor activity in rats.

Acupuncture Points↗
PubMed2006

Acupuncture for patients with chronic neck pain.

Acupuncture is widely used by patients with neck pain, but there is a lack of information about its effectiveness in routine medical care. The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone. We performed a randomized controlled multicentre trial plus non-randomized cohort in general practices in Germany. 14,161 patients with chronic neck pain (duration >6 months). Patients were randomly allocated to an acupuncture group or a control group receiving no acupuncture. Patients in the acupuncture group received up to 15 acupuncture sessions over three months. Patients who did not consent to randomization received acupuncture treatment. All subjects were allowed to receive usual medical care in addition to study treatment. Neck pain and disability (NPAD Scale by Wheeler) after three months. Of 14,161 patients (mean age 50.9+/-13.1 years, 68% female) 1880 were randomized to acupuncture and 1886 to control, and 10,395 included into the non-randomized acupuncture group. At three months, neck pain and disability improved by 16.2 (SE: 0.4) to 38.3 (SE: 0.4); and by 3.9 (SE: 0.4) to 50.5 (SE: 0.4), difference 12.3 (p<0.001) in the acupuncture and control group, respectively. Treatment success was essentially maintained through six months. Non-randomized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to randomized patients. Treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone.

Activities of Daily Living↗
PubMed2006

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

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

Acupuncture Analgesia↗
PubMed2001

Is there an effect of acupuncture on the resting EEG?

OBJECTIVE: To investigate if acupuncture has a measurable effect on the resting electron EEG. SUBJECTS: 14 healthy volunteers with no neurological condition took part in the study. METHODS: Using a digital storage EEG recorder and quantitative frequency analysis techniques data were obtained before, during and after acupuncture stimulation. To minimize the effect of artefacts all data were collected with the subject alert, but with eyes closed. Manual stimulation of the LI 4 acupuncture site was undertaken for periods of 0.5, 1.0 and 2.0 min. Frequency analysis of the EEG data from each acupuncture event was compared to the baseline data to show any significant changes over the bandwidth 0.3 to 30 Hz. Only changes greater than 2 standard deviations were considered significant. RESULTS: In 10 subjects the frequency spectra remained unchanged during acupuncture, but in three significant increases were recorded in the amplitude of very low frequencies between 0.5 and 2 Hz and in one subject there was an increase in the amplitude of the alpha band during acupuncture. All spectra returned to their baseline values immediately after acupuncture. OUTCOME: The changes recorded in the delta band of individuals during acupuncture were large but highly variable. They arose at a frequency that is on the limit of the recording equipment and where recording and physiological artefacts are known to occur, although there was no evidence of artefactual contamination of the data. The one case in which there was an increase in the alpha band is attributed to suppression of the dominant rhythm initially brought about by anxiety concerning the procedure which subsequently disappeared during acupuncture as the subject relaxed. CONCLUSION: It is clear that there are no changes brought about by acupuncture in the resting EEG in the frequency range 2-30 Hz and no evidence to attribute changes below 2Hz to a direct affect of acupuncture.

Acupuncture Therapy↗
PubMed2000

[Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study].

In a placebo-controlled, randomized, modified double-blind study we investigated the effects of body needle acupuncture (n = 10) in 43 patients with minor depression (ICD 10 F32.0, F32.1) and 13 patients with generalized anxiety disorders (ICD10 F41.1). The severity of the disease was assessed by the Clinical Global Impression Scale (CGI). Treatment response was defined as a significant improvement in CGI. An intent-to-treat analysis was performed to compare treatment responses between verum- and placebo acupuncture. After completing an total of 10 acupuncture sessions the verum acupuncture group (n = 28) showed a significantly larger clinical improvement compared to the placebo group (Mann-Whitney test, p < 0.05). There were significantly more responders in the verum-compared to the placebo group (60.7% vs. 21.4%; chi-square test, p < 0.01). In contrast, no differences in the response rates were evident just after 5 acupuncture sessions. A multivariate analysis with the independent factor acupuncture (verum vs. placebo) and the results of the results of the additional rating scales (total score of HAMA, HAMD, Bf-S, BL) as dependent variables (ANOVA, 1:54 D.F.) revealed a clear trend towards lower HAMA scores in the verum group after completing 10 acupunctures (F3.29, p = 0.075). This corresponds well to the high response rate of 85.7% in patients with generalized anxiety disorders, in whom verum acupuncture was applied. Our results indicate that needle acupuncture (Du.20, Ex.6, He.7, Pe.6, Bl.62) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders. The total sum of acupuncture sessions and the specific location of acupuncture needle insertions might be important factors for bringing about therapeutic success.

Acupuncture Therapy↗
PubMed2006

Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience.

BACKGROUND: The use of complementary and alternative medicine (CAM), including Traditional Chinese Medicine (TCM) and acupuncture, has substantially increased in western countries in the past decade. However, informative data concerning large-scale investigations of acupuncture used in the Chinese society remain rare so far. DESIGN AND OUTCOME MEASURE: The complete datasets of acupuncture outpatient reimbursement claims from 1996 to 2002 were supplied by the National Health Insurance Research Database, Taiwan, and the usage frequencies and characteristics of the acupuncture users, as well as the disease categories that were treated by acupuncture in Taiwan were analyzed. RESULTS: At the end of 2002, among the 21,869,478 total valid beneficiaries of National Health Insurance (NHI), 1,362,351 subjects (6.2%) used acupuncture during this year, but 4,948,464 subjects (22.6%) had used it for the whole 7-year period since 1996. A mean increment of 1,191,164 (53.6%) new users had been involved yearly. Among all those acupuncture users, a female predominance was observed (female:male = 1.12:1), and the age distribution displayed a peak at around the 40s, followed by the 30s and 50s. Private TCM clinics provided more acupuncture usage (82.0%) than did private TCM hospitals (13.7%). The disease categories treated mostly by acupuncture were diseases of the musculoskeletal system (46.2%); injury (41.8%); diseases of the nervous system (3.5%); and symptoms, signs, and ill-defined conditions (2.7%). CONCLUSIONS: Twenty-three percent (23%) of people in Taiwan had used acupuncture during this 7-year period. Musculoskeletoal and neurologic disorders were two major categories commonly treated with acupuncture.

Acupuncture Therapy↗
PubMed2007

Acupuncture treatment for chronic knee pain: a systematic review.

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

Acupuncture Analgesia↗
PubMedDate not supplied

Statistical reanalysis of four recent randomized trials of acupuncture for pain using analysis of covariance.

OBJECTIVES: Acupuncture has been promoted for the treatment of chronic pain. Though many randomized trials have been conducted, these have been criticized for deficiencies of methodology, acupuncture technique, and sample size. Somewhat less emphasis has been placed on methods of statistical analysis. This paper describes 4 recent randomized trials of acupuncture for musculoskeletal or headache pain. Each trial used statistical methods that did not adjust for baseline pain scores and were thus of suboptimal power. The objective of this study is to reanalyze the trials using analysis of covariance (ANCOVA). METHODS: Raw data for the 4 trials were obtained from the original authors. Data were reanalyzed by ANCOVA. RESULTS: For 2 trials--acupuncture versus placebo for chronic headache and acupuncture versus transcutaneous electric nerve stimulation for back pain--reanalysis did not change the conclusion of no difference between groups, but showed that clinically significant differences between groups could not ruled out. Reanalysis of a trial of acupuncture versus placebo for shoulder pain slightly strengthened the evidence of acupuncture effectiveness. Reanalysis of the fourth trial, which compared acupuncture to placebo acupuncture and massage for neck pain, reversed the results of the original paper: reanalysis found acupuncture to be effective and that its effectiveness could not be ascribed to a placebo effect. DISCUSSION: Future trials of acupuncture and other modalities for pain should use efficient statistical methods. ANCOVA is more efficient than unadjusted analysis where used appropriately.

Acupuncture↗
PubMed1999

The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the efficacy and effectiveness of acupuncture for the management of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Acupuncture is one of the oldest forms of therapy, but little is known about the effectiveness of acupuncture for low back pain. METHODS: Randomized controlled trials were done to assess the effectiveness of all types of acupuncture treatment, which involves needling for subjects with nonspecific low back pain. Two reviewers blinded with respect to authors, institution, and journal independently assessed the methodologic quality of the studies. Because data were statistically and clinically too heterogeneous, a qualitative review was performed. The evidence was classified into four levels: strong, moderate, limited, or no evidence. RESULTS: Eleven randomized controlled trials were included. Overall, the methodologic quality was low. Only two studies met the preset "high quality" level for this review. No study clearly evaluated acupuncture for acute low back pain. The results indicate that there was no evidence showing acupuncture to be more effective than no treatment. There was moderate evidence indicating that acupuncture is not more effective than trigger-point injection or transcutaneous electrical nerve stimulation, and there was limited evidence that acupuncture is not more effective than placebo or sham acupuncture for the management of chronic low back pain. CONCLUSIONS: Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials.

Acupuncture Analgesia↗
PubMed2005

Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects.

Acupuncture at the Neiguan (P6) point has been shown to lessen nausea and vomiting which are related to vagal modulation. This study investigated whether acupuncture at the P6 point could improve vagal modulation by using heart rate variability analysis. We compared the heart rate variability measures of 39 subjects receiving acupuncture at the P6 point, 38 subjects receiving sham acupuncture, and 34 subjects receiving no treatment at all. The normalized high-frequency power was used as the index of vagal modulation, and the low-/high-frequency power ratio was used as the index of sympathovagal balance. The normalized high-frequency power after acupuncture increased significantly from 28.1 +/- 12.6 nu (mean +/- SD) to 30.7 +/- 14.1 nu in the P6 acupuncture group, but not in the sham acupuncture (30.6 +/- 13.7 nu versus 31.8 +/- 13.8 nu) or no-treatment group (30.1 +/- 15.0 nu versus 30.1 +/- 15.7 nu). In both the P6 and sham acupuncture groups, the mean RR interval (the intervals between consecutive R waves in the electrocardiogram) increased significantly after acupuncture. In the no-treatment group, there was no statistical difference in all heart rate variability measures in the initial and later sessions. In conclusion, acupuncture at the P6 point can increase vagal modulation of the subjects. This result may be helpful in the understanding of the mechanism underlying the effect of acupuncture or acupressure at P6 on the lessening of nausea and vomiting in clinic.

Acupuncture↗