State of the Art / Acupuncture

Welcome to our new blog feature – State of the Art

In this series, we’ll be looking at the latest developments in an area of practise at Bedford Consulting Rooms, sharing the research and news from that particular therapy.

We’ll speak to the colleagues practising the therapy and give you the newest insights. Enjoy!

State of the Art / Acupuncture

We promise we aren’t doing this alphabetically, but for this first blog we just so happen to be starting with A for Acupuncture!

Let’s start with a round-up the 3 studies that hit the top spots today in a search for “acupuncture research”:

About the research: It is worth noting that in research, randomised controlled studies (RCT) which are published in a peer-reviewed and reputable journal, are the most reliable in terms of quality of evidence as they compare an intervention with a control group and and these are matched and blinded to which intervention they receive. Next up, a systematic review or meta analysis of numerous such studies is the best way of seeing the overall picture of the state of the evidence by aggregating a number of RCTs together in a scientific manner. The n= figure tells you how many people were participants in the study, and a larger study is able to more powerfully predict whether an intervention is effective, as the statistics are more robust; smaller studies can be pilots, or give ideas of trends to be explored in later ones.

Effectiveness of Acupuncture for Anxiety Among Patients With Parkinson Disease – A Randomized Clinical Trial

Around a third of Parkinson’s patients report anxiety symptoms, which impacts upon their quality of life. Fan and colleagues (2022) looked at n=64 patients with Parkinson’s disease (PD) using a double-blind randomised controlled trial. They compared real acupuncture (RA) with sham (SA) as a control group. Their scores on a number of scales measuring anxiety, Parkinson’s disease rating scale and questionnaires were compared before and after the treatment course, and 8 weeks post treatment (HAM-A; UPDRS; PDQ-39. Measures of blood levels of cortisol (stress hormone) and adrenocorticotropic hormone (the hormone that stimulates the adrenal glands to release cortisol) were also taken before and after the treatment course, and again 8 weeks after the end of the treatment course (CORT & ACTH).

Findings: Whilst both groups showed clinical improvements in anxiety by the end of the treatment, only the real acupuncture group maintained an improvement after the 8 weeks. This is interesting from the placebo perspective in that that sham acupuncture may produce a short term effect based on expectation, the real acupuncture arm was the one which had an enduring effect after the end of the treatment course.

In terms of the blood levels of the stress/anxiety related hormones, the researchers has this to say “The serum ACTH levels in the RA group were lower than in the SA group. It may be preliminarily confirmed that acupuncture can reduce the level of ACTH in serum, a finding that is in line with previous results, where the authors have proved that acupuncture can alleviate increased stress hormone levels and mitigate anxiety“. The previous research they refer to is Seo and colleagues, (2021), another recent study using an animal model to look at the effects acupuncture has on specific neurotransmitters and hormones in a stress model.

Thoughts: What is interesting about some of the more recent research is that there is not just a comparison of patient- or practitioner- rated outcomes between two groups of patients with the same symptom/disease, but increasingly a measurable and objective aspect to studies where they use blood samples and measurements, or brain scans and other biomedical ways to measure changes in the body as brought about by acupuncture, linking the subjective and objective sides of the patient’s experience and what the researcher can measure and demonstrate in outcomes. We look forward to more of this type of research. The present research has some limitations in size of cohort, and the researchers recommend a larger, multi centre study to gain a bigger perspective.

Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial

The researchers, Qi and colleagues (2022) were looking at the potential biological mechanism of action whereby acupuncture is thought to benefit IBS patients by reducing “visceral hypersensitivity” and modulating the gut-brain axis. This was a pilot, multicentre RCT with n=90, across 4 Chinese hospitals comparing 3 group: Specific acupuncture (using real points); non-specific; and sham acupuncture. All received 12 sessions of acupuncture over 4 weeks.

Measurements of abdominal pain scores and types of stool were compared.

Findings: Both the specific and non-specific groups showed meaningful improvement in the IBS-D symptoms from baseline. There was a 20% difference between specific acupuncture and sham outcomes. The researchers recommended a larger multi-centre trial to further investigate this.

Thoughts: The non-specific treatment approach was interesting as there is a debate about what we should use to compare to active treatment, knowing that the use of real points, even out of context nonetheless has a real effect. Within the acupuncture model, points have a number of connections and influences so it would be useful to know exactly which points they decided were non-specific, and which nonetheless have had an impact.

This would possibly help us to tease out the level of the placebo effect, which we know is present to some degree in every type of treatment, including western and drug treatment. The tell between placebo and genuine effect is often the most obvious after the end of the treatment, at review a few weeks on, which indeed they have looked at here, finding the real acupuncture group with specific points had the more enduring outcome.

A large number of trials have looked at IBS and acupuncture in the past, with promising results. Shaftesbury Clinic’s website has a page about this specifically

A number of large, systematic reviews is expected quite imminently, the protocols for which came out in 2020/2021 (Li et al, 2021, 2021b; Guo et al, 2020), which will be of interest to add to the research.

Research Trends of Acupuncture Therapy on Fibromyalgia from 2000 to 2021: A Bibliometric Analysis

Yi and colleagues (2022) looked at the research trends in themselves, in a field where the popularity of research trials for fibromyalgia in increasing. The researchers wanted to look in detail at the studies published between 2000 and 2021, finding that there were 868, the rate of which has increased. Interestingly the most prolific country for these was the USA, which was possibly not what we would have assumed, as a large number of studies do understandably come from China.

In line with what we have mentioned above, there were not only studies around the efficacy of acupuncture and electroacupuncture and matters of long-term efficacy, but also animal models to detail possible mechanisms of action. The journal of Pain was the most prolific publisher of such studies, with JAMA, the Annals of Internal Medicine following.

It is interesting when considering the research body, to also look at the range of literature and where future studies need to be done, in order to see where the gaps are, and what is needed, as well as what we already have.

In terms of the general literature on Fibromyalgia, for which there are numerous RCTs and at least 3 systematic reviews, Shaftesbury Clinic’s website has an informational article on this.

What is on the horizon?

One way to what is up and coming in research is to look at Google Scholar for a set period with acupuncture “protocol” as the search term. Here are the top 3 upcoming studies that we’ll be keeping an eye out for in the next months or years:

The efficacy and safety of acupuncture for depression-related insomnia: protocol for a systematic review and meta-analysis (Hu et al, 2022). In the Journal of Pain Research, the authors are interested in the relationship between depression and insomnia, and how acupuncture may fit into the picture. They will use the Cochrane database to examine nine databases and synthesise data from a large number of RCTs to make a high-powered analysis of the efficacy and safety of acupuncture for depression-related insomnia. With prior evidential support for acupuncture in depression from a very large multi-centre UK study (MacPherson et at, 2017), amongst others, this is potentially a very promising area.

Efficacy and safety of acupuncture in the treatment of foot drop in post-stroke: A protocol for systematic review and meta-analysis (Gao et al, 2022). In the journal Medicine, the authors are interested in foot-drop, which is a common complication after stroke, and can cause fall-related injuries. With no systematic review in this areas so far, Cochrane register of Controlled Trials will be used, along with 7 other databases to synthesise the evidence.

Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis (Chen et al, 2022). There has been quite a body of literature in this promising area, and the researchers look to combine the data from a large number of RCTs to examine this area of application of acupuncture.

It is worth noting that synthesising data in this way is not only to decide whether and to what extent acupuncture is effective, but also to see whether we can extract information about which points, protocols and methods may be the most effective within them. In this way we can also find any gaps in our knowledge that further research can interrogate.

That’s all for now

Hopefully you enjoyed this research update, check in again next time for the latest developments.

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.

References:

Chen, C., Liu, J., Liu, B., Cao, X., Liu, Z., Zhao, T., Lv, X., Guo, S., Li, Y., He, L. and Ai, Y., 2022. Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis. PloS one, 17(4), p.e0266075.

Fan, J.Q., Lu, W.J., Tan, W.Q., Liu, X., Wang, Y.T., Wang, N.B. and Zhuang, L.X., 2022. Effectiveness of acupuncture for anxiety among patients with Parkinson disease: a randomized clinical trial. JAMA Network Open, 5(9), pp.e2232133-e2232133.

Gao, Y., Gang, X., Yuan, Y., Yin, K. and Gong, X., 2022. Efficacy and safety of acupuncture in the treatment of foot drop in post-stroke: A protocol for systematic review and meta-analysis. Medicine, 101(40), p.e30994.

Guo, J., Xing, X., Wu, J., Zhang, H., Yun, Y., Qin, Z. and He, Q., 2020. Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis. Neural plasticity, 2020.

Hu, H., Li, Z., Cheng, Y. and Gao, H., 2022. The efficacy and safety of acupuncture for depression-related insomnia: protocol for a systematic review and meta-analysis. Journal of Pain Research, pp.1939-1947.

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021a. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021b. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

MacPherson, Hugh, Andrew Vickers, Martin Bland, David Torgerson, Mark Corbett, Eldon Spackman, Pedro Saramago et al. “Acupuncture, Counselling or Usual Care for Depression (ACUDep): a randomised controlled trial.” In Acupuncture for chronic pain and depression in primary care: a programme of research. NIHR Journals Library, 2017.

Qi, L.Y., Yang, J.W., Yan, S.Y., Tu, J.F., She, Y.F., Li, Y., Chi, L.L., Wu, B.Q. and Liu, C.Z., 2022. Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial. JAMA Network Open, 5(12), pp.e2248817-e2248817.

Seo, S.Y., Bang, S.K., Kang, S.Y., Cho, S.J., Choi, K.H. and Ryu, Y.H., 2021. Acupuncture Alleviates Anxiety and 22-kHz Ultrasonic Vocalizations in Rats Subjected to Repeated Alcohol Administration by Modulating the Brain-Derived Neurotrophic Factor/Corticotropin-Releasing Hormone Signaling Pathway. International Journal of Molecular Sciences, 22(8), p.4037

Yu, G., Chen, L., Huang, H., Nie, B. and Gu, J., 2022. Research Trends of Acupuncture Therapy on Fibromyalgia from 2000 to 2021: A Bibliometric Analysis. Journal of Pain Research, pp.3941-3958.