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Acupuncture Research
 

Highlights

 

  • Acupuncture may provide a safe and effective complementary/alternative treatment method.

  • Review of RCTs assessing the effectiveness of acupuncture in manage myofascial pain was systematically conducted.

  • Moderate quality evidence suggests that acupuncture is a safe and effective modality.

  • Optimization of study designs and standardization of outcome measures are needed for future RCTs.

 

Abstract

Persistent head and neck myofascial pain is among the most frequently reported pain complaints featuring major variability in treatment approaches and perception of improvement. Acupuncture is one of the least invasive complimentary modalities that can optimize conventional treatment. The aim of this review was to determine the evidence for the effectiveness of acupuncture in the management of localized persistent myofascial head and neck pain. Only randomized controlled clinical trials (RCTs) were included. The search was conducted in PubMed, Ovid Medline, Embase, Google Scholar, and Cochrane Library in addition to manual search. The main outcome measure was the comparison of the mean pain intensity score on VAS between acupuncture and sham-needling/no intervention groups. Safety data and adherence rate were also investigated. Six RCTs were identified with variable risk of bias. All included studies reported reduction in VAS pain intensity scores in the groups receiving acupuncture when compared to sham needling/no intervention. Meta-analysis, using a weighted mean difference as the effect estimate, included only 4 RCTs, revealed a 19.04 point difference in pain intensity between acupuncture and sham-needling/no intervention (95 %CI: -29.13 to -8.95). High levels of safety were demonstrated by the low rates of side effects/withdrawal. Inconsistency in reporting of outcomes was a major limitation. In conclusion, moderate-quality evidence suggests that acupuncture may be an effective and safe method in relieving persistent head and neck myofascial pain. Optimizing study designs and standardizing outcome measures are needed for future RCTs.

Keywords: Head and neck pain, Myofascial pain, Acupuncture, Randomized clinical trials

Abstract
IMPORTANCE: Up to 51%of patients with psoriasis report the use of complementary and alternative medicine (CAM) in their treatment regimen, although it is unclear which CAM therapies are effective for treatment of psoriasis.

 

OBJECTIVE: This review compiles the evidence on the efficacy of the most studied CAM modalities for treatment of patients with plaque psoriasis and discusses those therapies with the most robust available evidence.


EVIDENCE REVIEW: PubMed, Embase, and ClinicalTrials.gov searches (1950-2017) were used to identify all documented CAM psoriasis interventions in the literature. The criteria were further refined to focus on those treatments identified in the first step that had the highest level of evidence for plaque psoriasis with more than 1 randomized clinical trial supporting their use. This excluded therapies lacking randomized clinical trial (RCT) data or showing consistent inefficacy.

FINDINGS: One meta-analysis of 13 RCTs examined the association of acupuncture with improvement in psoriasis and showed significant improvement with acupuncture compared with placebo.

CONCLUSIONS AND RELEVANCE: The CAM therapies with the most robust evidence of efficacy for treatment of psoriasis are indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture. This review will aid practitioners in advising patients seeking unconventional approaches for treatment of psoriasis.

Abstract

Objective: Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery.

 

Methods: The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis.


Results: The acupuncture and control groups included 50,171 and 128,556 neck pain patients, respectively. A total of 50,161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to
gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group.

 

Conclusions: A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.

 

Keywords: acupuncture, epidemiology, musculoskeletal disorders, spinal neck pain

Abstract
Objective. Our aim was to assess the efficacy and safety of acupuncture for Obstructive sleep apnea (OSA) patients with various severities of the disorder.

Methods.  Eight  databases  including  PubMed,  Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible  for  inclusion.  Studies  were  selected  for  inclusion,  and data were extracted by two authors independently.  The Cochrane Collaboration’s Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. 

 

Results.  Nine RCTs with 584 participants  were  included.  The  trials covered  acupuncture and electropuncture.  Acupuncture caused clinically significant reductions in apnea-hypopnea index (AHI)  (MD: -6.18;  95% CI:  -9.58  to  -2.78;  Z = 3:56,  P = 0:0004)  as  well  as  in Epworth Sleepiness Score (ESS) (MD: -2.84;  95%  CI:  -4.80  to  -0.16,  Z = 2:09,  P= 0:04).  AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z = 6:18, P < 0:00001) and severe OSA patients (MD:  -10.09;  95%  CI:  -12.47  to  -7.71;  Z = 8:31,  P < 0:00001).  ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z = 3:83, P= 0:0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z = 12:72, P < 0:00001). Besides, acupuncture had a beneficial effect on lowest oxygen saturation (LSaO2) (MD: 5.29; 95% CI: 2.61 to 7.97; Z = 3:86, P = 0:0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low.

 

Conclusions. Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.

Abstract

Anxiety disorders are one of the most common mental health concerns with a major contribution to the global burden of disease. When not treated, anxiety can be aggravated to more serious and complicated health problems. Pharmacology and psychotherapy stand for the conventional treatment for anxiety disorders but these present limited efficacy, especially in the case of chronic anxiety, with high relapse rates and often causing adverse side effects. Clinical research studies render acupuncture as a valid treatment therapy for anxiety disorders without significant adverse effects.

The objective of this paper is to review the literature on the effectiveness of acupuncture and electroacupuncture for the treatment of patients with anxiety disorders in order to find strong scientific evidence for its regular practice in Western culture.

The systematic review of the clinical research was focused on published clinical trials (controlled, randomized and non-randomized) regarding the treatment of anxiety with acupuncture. Only clinical trials where anxiety was treated as the therapeutic target, and not as a secondary measurement or being associated with other health condition or disease, were considered. Two authors extracted the data independently and exclusion and inclusion criteria were set. The search rendered 1135 papers addressing anxiety as a primary therapeutic target. After review, 13 papers were identified to match exclusion and inclusion criteria and were selected for this analysis. Methodology, design, and quality of the research were highly variable and are discussed and compared.

Overall, there is good scientific evidence encouraging acupuncture therapy to treat anxiety disorders as it yields effective outcomes, with fewer side effects than conventional treatment. More research in this area is however needed.

Keywords: Acupuncture, Electroacupuncture, Anxiety disorders, Anxiety, Systematic review

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Qigong & Tai Chi Research
 

Purpose of Review

To investigate the effectiveness and safety of Tai Chi for essential hypertension (EH).

 

Recent Findings

A total of 9 databases were searched from inception to January 1, 2020. Randomized controlled trials (RCTs) investigating the effectiveness and safety of Tai Chi for EH were included. Study selection, data extraction, and quality assessment were performed independently by 2 reviewers. A total of 28 RCTs involving 2937 participants were ultimately included in this systematic review. Meta-analysis showed that, compared with health education/no treatment, other exercise or antihypertensive drugs (AHD), Tai Chi showed statistically significant difference in lowering systolic blood pressure (SBP) and diastolic blood pressure (DBP). The trial sequential analysis suggested that the evidence in our meta-analysis was reliable and conclusive. Subgroup analyses of Tai Chi vs. AHD demonstrated Tai Chi for hypertension patients < 50 years old showed greater reduction in SBP and DBP. Intervention of 12–24 weeks could significantly lower SBP and DBP. Among 28 included RCTs, 2 RCTs reported that no adverse events occurred. The quality of evidence for the blood pressure (BP) of Tai Chi vs. AHD was moderate, and DBP of Tai Chi vs. health education (HE)/ no treatment (NT) was high. Other outcome indicators were considered low or very low quality according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

 

Summary

Tai Chi could be recommended as an adjuvant treatment for hypertension, especially for patients less than 50 years old. However, due to poor methodological qualities of included RCTs and high heterogeneity, this conclusion warrants further investigation.

Highlights

  • This systematic review and meta-analysis strengthen that Tai Chi has a positive effect on improving sleep quality.

  • The 24-form and 8-form Yang style Tai Chi show significant effectiveness on improving sleep quality.

  • Our article illuminated the future systematic research needs on different duration and other styles of Tai Chi.

Background 

Exercise-based cardiac rehabilitation is safe and effective for adults with chronic heart failure (CHF), yet services are greatly underutilized. However, tai chi is a popular and safe form of exercise among older adults with chronic health conditions.

Objective 

A systematic review and meta-analysis was conducted to examine the benefits of tai chi exercise among persons with CHF.

 

Methods 

An electronic literature search of 10 databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004, to August 1, 2019. Clinical trials that examined tai chi exercise, were published in English or German languages, and conducted among participants with CHF were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc) was used to calculate effect sizes (ie, Hedges g) and 95% confidence intervals using random effects models.

 

Results 

A total of 6 studies met the inclusion criteria, enrolling 229 participants (mean age, 68 years; 28% women; mean ejection fraction = 37%). At least 3 studies reported outcomes for exercise capacity (n = 5 studies), quality of life (n = 5 studies), depression (n = 4 studies), and b-type natriuretic peptide (n = 4 studies), allowing for meta-analysis. Compared with controls, tai chi participants had significantly better exercise capacity (g = 0.353; P = .026, I2 = 32.72%), improved quality of life (g = 0.617; P = .000, I2 = 0%), with less depression (g = 0.627; P = .000, I2 = 0%), and decreased b-type natriuretic peptide expression (g = 0.333; P = .016, I2 = 0%).

 

Conclusion 

Tai chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with rigorous study designs and larger samples before widespread recommendations can be made.

Highlights

 

  • Tai chi significantly improves overall quality of life at 3 months compared to conventional therapy.

  • Tai chi+conventional therapy is more effective in improving fatigue at 3 months than conventional therapy alone.

  • Tai chi+conventional therapy im