Abstract
Different acupuncture therapies for allergic rhinitis: overview of systematic reviews and network meta-analysis.
Zhang J, Zhang Y, Huang X, Lan K, Hu L, Chen Y, Yu H. Evid Based Complement Alternat Med. 2020;2020:8363027.
The goal of this study was to evaluate the quality of methodologies used in previous systematic reviews and to compare efficacy of different acupuncture therapies for treating allergic rhinitis. Seven electronic databases were searched for systematic reviews performed on different acupuncture therapies for allergic rhinitis from inception to November 15, 2019. Eligible randomized controlled trials (RCTs) were selected from the included systematic reviews. The Cochrane risk of bias tool was utilized to determine risk of bias of these included RCTs. Pairwise meta-analyses were performed using a random-effects model. Network meta-analysis of the included RCTs was carried out using a frequentist framework.
The authors identified 2 systematic reviews with low quality and 18 with very-low quality; both groups of RCTs comprised 33 eligible RCTs (N = 3769). Most of these studies had unclear risks of bias. On the basis of ranking probability, Network meta-analysis showed that acupuncture at the sphenopalatine ganglion acupoint had the highest probability of reducing global allergic rhinitis symptoms, followed by San-Fu-Tie, and manual acupuncture compared with conventional Western medicine treatment. Moreover, direct comparison showed that the clinical outcomes of acupuncture and related therapies at 3-month, 6-month, and 12-month follow-ups were better than those of conventional Western medicine.
These results indicated that, for patients with allergic rhinitis whose conventional Western medicine fails as well as those who cannot tolerate the side-effects, acupuncture at the sphenopalatine ganglion acupoint is an effective alternative therapy. Further studies are advocated to explore the methodological quality systematic reviews of acupuncture deeply by incorporating high-quality RCTs in these reviews.
The selection of dermatomes for sham (placebo) acupuncture points is relevant for the outcome of acupuncture studies: a systematic review of sham (placebo)-controlled randomized acupuncture.
Ots T, Kandirian A, Szilagyi I, DiGiacomo SM, Sandner-Kiesling A. Acupunct Med. 2020;February 6:e-pub ahead of print.
Many randomized controlled trials (RCTs) of acupuncture have revealed no significant differences between verum acupuncture and so-called “placebo” acupuncture. There is a strong tendency to replace the term placebo by the term sham, because any needling stimulates a certain physiologic response. However, neither concept accounts for the great diversity of results in RCTs comparing verum acupuncture and sham acupuncture. Some trials have shown little or no difference, while other studies have found statistically significant differences. Verum acupuncture and sham acupuncture might achieve similar results to the extent that they share active constituents. These authors, from Europe, identified these common active constituents as dermatomes: comprising the segmental structure of the human body.
The current study was performed to test the hypothesis that the more verum and sham acupuncture share the same dermatomes, the closer the clinical outcomes will be, and vice versa. All major databases were searched for RCTs that tested acupuncture versus sham acupuncture. The dermatome charts of Hansen and Schliack were used to verify verum and sham needling locations. Reported clinical outcomes were assessed in relation to the percentage of overlap between the dermatomes stimulated by acupuncture and acupuncture.
This literature search yielded a total of 1738 references. Thirty-four studies met the current review's inclusion criteria. The effects of sham acupuncture varied according to the dermatomes stimulated: high overlap with those stimulated by verum acupuncture resulted in almost identical efficacy, while low overlap resulted in significant differences in efficacy. Clinical outcomes were similar when verum acupuncture and sham acupuncture shared the same dermatomes (P < 0.01). Thus, this review confirmed the hypothesis of the authors. Acupuncture studies that used verum and sham locations on overlapping dermatomes helped to create a mediocre-to-negative picture of acupuncture's efficacy.
The segmental structure of the body, with its interconnected reflex system, offers an additional neurophysiologic explanation for the effectiveness of acupuncture applied to structures segmentally innervated by the spinal and visceral nervous systems. Further comparative acupuncture studies should be based on knowledge of segmental anatomy. In testing verum acupuncture versus sham acupuncture, the sham acupuncture needling locations chosen should be situated on nonoverlapping dermatomes.
Efficacy and safety of moxibustion for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials.
Chen FQ, Ge JF, Leng YF, Li C, Chen B, Sun ZL. Complement Ther Clin Pract. 2020;39:101130.
The goal of this study was to systematically review and meta-analyze the efficacy of moxibustion for treating patients with chronic low back pain (cLBP). A systematic search of the Cochrane Library, Web of Science, PubMed, Embase, EBSCO, CBM, Wanfang, CNKI and VIP (until November, 2019) identified studies reporting pain intensity (visual analogue [VAS] scale or numeric rating scale), disability (Oswestry Disability Index or Roland Morris Disability Questionnaire), Japanese Orthopaedic Association (JOA) score, and quality of life (Short Form–36 [SF-36]) in patients with cLBP. Two reviewers independently and critically performed study selection, data extraction. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology was applied to test the quality of evidence from the quantitative analysis.
Ten randomized controlled trials (RCTs)—including 987 patients—met the inclusion criteria. Moxibustion had a superior effect on VAS score, compared with Western medicine, but failed, compared with core-stability training. Moxibustion plus other active treatments (including Western medicine, massage, acupuncture, and core-stability training) produced better effects on low-back pain, providing relief, compared with active treatments alone. Moxibustion had favorable effects on disability indices as well as JOA and SF-36 scores. The evidence level of the results from the 10 studies was determined to be very low-to-low. It was difficult to draw firm conclusions that moxibustion is an effective intervention for treating cLBP due to the small sample sizes of eligible trails and the high risk of bias among the available articles. Rigorously designed large-scale RCTs are required to confirm the results of this review further.
Alternative treatments of tinnitus: alternative medicine.
Luetzenberg FS, Babu S, Seidman MD. Otolaryngol Clin North Am. 2020;April 30:e-pub ahead of print.
Because Western medicine has been largely unsuccessful for treating tinnitus symptoms, many physicians and patients have turned to alternative treatment options to decrease suffering and improve quality of life. These authors comment that, although research in complementary/integrative medicine continues to be scarce and inconclusive, studies are pointing toward the positive effects of acupuncture, herbal remedies, dietary supplements, antioxidants, melatonin, and hypnosis on tinnitus. Although the efficacies of these treatments are inconsistent and might depend on a patient's unique circumstances, these researchers have acknowledged that each treatment is worth trying in light of its potential benefits and because it is both noninvasive and well-tolerated.
Observation for clinical effect of acupuncture combined with conventional therapy in the treatment of acne vulgaris.
Kou L, Yu N, Ren J, Yang BY, Tao Y. Medicine (Baltimore). 2020;99(18):e19764.
Acne vulgaris, a chronic inflammatory disease of the sebaceous glands, affects both adolescent men and women. The incidence of acne has increased recently, year by year, so a precise and effective treatment is needed and further exploration of its possible mechanism of action is warranted. This study will explore a treatment method that will have Traditional Chinese Medicine characteristics and that could produce significant effects, while offering a higher level of evidence for acupuncture as a treatment for acne vulgaris. This would give patients more treatment options.
The study will be a randomized controlled trial (RCT) with patients that will be divided into 2 parallel groups. This RCT will be pragmatic, recruiting 66 patients diagnosed with acne vulgaris. In an intervention group, patients will receive 30 minutes of acupuncture. In addition, all study participants will receive conventional treatment. Outcomes will be determined according to a skin-lesions score scale. This trial might provide evidence of the clinical effectiveness, safety, and cost-effectiveness of acupuncture for patients with acne vulgaris.
Trial Registration Number: CTR2000030427.