Literature Watch

Comparative analysis of two laser wavelengths in the stimulation of acupuncture points for analgesic effects in an animal model.

Teixeira MA, Papini JZB, Garcez A, Tofoli GR. J Biophotonics. 2021;17:e202100213.

This study compared the effectiveness of 2 laser wavelengths for stimulating acupoints in an animal experimental model of acute postoperative pain. Forty-five Wistar rats were assigned randomly to receive the treatment on their left hind paws, contralateral to a surgical procedure in their right paws.

Laser treatments were performed with a green laser (GL; 532 nm, 70 mW, and 7 J/cm² of energy), a red laser (660 nm, 100 mW, and 7 J/cm² of energy), or with a laser off. After each application, the rats were evaluated with a Von Frey Anesthesiometer to check for painful sensitivity on their right (with surgery) and left (without surgery) hind paws. Neuropeptides and cytokine levels in the incision-site tissues of the right paws were measured by enzyme-linked immunosorbent assay after 1, 6, and 24 hours.

Both lasers promoted analgesia in the rats, and the GL altered their levels of tumor-necrosis factor–α and interleukin-1β.

The therapeutic effects of acupuncture and electroacupuncture on cancer-related symptoms and side-effects.

Han QQ, Fu Y, Le JM, et al.. J Cancer. 2021;12(23):7003–7009.

In addition to cancer-related death, malignant progression also causes a series of symptoms and side-effects that influence patients' quality of life detrimentally, influence their adherence to treatments adversely, and, thus, affect their long-term survival negatively. Needle acupuncture and electroacupuncture (EA).

This review summarized the clinical application of needle acupuncture and EA for alleviating cancer symptoms, reducing cancer treatment–related side-effects, and relieving cancer-related pain. The symptoms and side-effects discussed in this review included fatigue, insomnia, chemotherapy-associated dyspepsia syndrome, pain, xerostomia, anxiety, and depression. The authors suggested that the underlying mechanisms of the therapeutic effects of needle acupuncture and EA might be related to regulation of mitochondrial function, coordination of nervous system activity, adjustment of neurotransmitters' production, and alleviation of immune responses.

The reviewers concluded that needle acupuncture and EA have proven to be beneficial for patients who have cancer. However, more research is required to clarify the potential mechanisms behind needle acupuncture and EA for widespread use in clinical settings.

Electroacupuncture could balance the gut microbiota and improve the learning and memory abilities of Alzheimer's disease animal model.

Jiang J, Liu H, Wang Z, Tian H, Wang S, Yang J, Ren J. PLoS One. 2021;16(11):e0259530.

Alzheimer's disease (AD), as one of most-common forms of dementia, mainly affects older people worldwide. Researchers from China explored a possible mechanism for improving cognitive function with electroacupuncture (EA) as well as its ability to protect neurons. The researchers used senescence-accelerated mouse prone 8 (SAMP8) mice as an AD animal model. A Morris water maze, hematoxylin and eosin staining, 16S rDNA amplicon sequencing of gut microbiota, and an enzyme-linked immunosorbent assay were used test this hypothesis.

EA improved the SAMP8 mice's learning and memory abilities (P < 0.05) and protected the frontal-lobe cortices and hippocampi of the SAMP8 mice. EA also significantly decreased expression of interleukin (IL)–1β (P < 0.01), IL-6 (P < 0.01), and tumor necrosis factor–α in hippocampi (P < 0.01) and in sera (P < 0.05). In addition, EA balanced the quantity and composition of the gut microbiome, especially the relative abundance of Δ-proteobacteria (P < 0.05) and E-proteobacteria (P < 0.05).

In conclusion, EA treatment could inhibit the peripheral and central nerve systems' inflammatory responses by balancing the gut microbiota.

Effects of acupuncture and acupressure on burnout in health care workers: a randomized trial.

Afrasiabi J, McCarty R, Hayakawa J, Barrows J, Lee K, Plouffe N, Schomberg J. J Trauma Nurs. 2021;28(6):350–362.

Health care workers face occupational stressors that may lead to burnout and secondary traumatic stress. Strategies to mitigate these negative psychologic impacts on frontline workers are needed urgently. This study evaluated the effect of auricular acupuncture or acupressure, compared to ear massage, on anxiety, burnout, and caring capacity in health care workers. This prospective randomized trial had an open parallel-group design and was conducted at a 334-bed Level II pediatric trauma center. Participants were randomized to 1 of 3 groups: (1) auricular acupuncture; (2) auricular seed acupressure; or (3) auricular massage.

Interventions were delivered over 3 weeks. Self-reported State-Trait Anxiety Inventory (STAI), Professional Quality of Life (ProQoL), and Caring Ability Inventory (CAI) scores were analyzed using a pre/post-test design. Univariate analysis, Fisher's exact test, and an analysis of variance (ANOVA) were performed to assess group differences.

The results were stratified based on each subject's level of belief in Traditional Chinese Medicine. A total of 117 (36%) of 325 eligible participants consented to participate in the study. Seed acupressure treatment (n = 14, 35.9%, 1 male, 13 females) was associated with a reduction in burnout (ANOVA, P = 0.04) and secondary traumatic stress (P = 0.03). This effect remained significant after adjusting for individual pretest scores (ANOVA; P = 0.05). The interventions did not have significant effects on STAI, ProQoL, or CAI scores.

Auricular acupressure, according to the researchers, is a safe, effective, and practical strategy for reducing burnout and secondary traumatic stress and may support health care workers' ability to develop caring relationships with patients and families.

Effect of Qigong exercise and acupressure rehabilitation program on pulmonary function and respiratory symptoms in patients hospitalized with severe COVID-19: a randomized controlled trial.

Liu ST, Zhan C, Ma YJ, Guo CY, Chen W, Fang XM, Fang L. Integr Med Res. 2021;10(suppl):100796.

There are several effective complementary and integrative therapies for patients with severe COVID-19. This study evaluated the efficacy and advantages of a Qigong exercise and acupressure rehabilitation program (QARP) for treating patients with severe COVID-19. A total of 128 patients with COVID-19, ages 20–80, were recruited and allocated randomly in a 1:1 ratio to receive QARP + standard therapies or standard therapies alone.

QARP consisted of acupressure therapy and Qigong exercise (Liu Zi Jue). The primary outcome was measured with the modified Medical Research Council (mMRC) dyspnea scale, and the secondary outcomes included the modified Borg dyspnea scale, Fatigue Scale-14 (FS-14), Patient Health Questionnaire–9 scale, duration of respiratory symptoms, and vital signs.

In total, 128 patients completed the clinical trial. The QARP group + standard therapies and the standard therapies–alone group had significant improvements in vital signs (except blood pressure) and clinical scale scores compared with baseline (P < 0.05). The QARP + standard therapies group had more-significant improvements in mMRC dyspnea scale scores (−1.8 [–2.1, −1.6]; P = 0.018) and in modified Borg dyspnea scale scores (−3.7 [95% confidence interval (CI): −4.3, −3.1]; P = 0.045). Duration of cough was 14.3 days (95% CI: 12.6, 16.1; P = 0.046) and the length of hospital stay was 18.5 days (95% CI: 17.0, 20.0; P = 0.042) in the QARP + standard therapies group, both of which were significantly reduced, compared with the standard therapies–alone group (P < 0.05).

In patients with severe COVID-19, QARP + standard therapies improved lung function, reduced such symptoms as dyspnea and cough, and shortened the length of hospital stay. Therefore, QARP may be considered an effective additional treatment option for patients with severe COVID-19.

Acupuncture for retinitis pigmentosa: study protocol for a randomised, sham-controlled trial.

Huang H, Wang J, Li H, et al. BMJ Open. 2021;11(11):e049245.

Primary retinitis pigmentosa (RP) is a common hereditary retinal disease of the eyes that has a considerable impact on quality of life, but there are few effective therapeutic strategies for helping patients with this condition. This study will be conducted to determine the efficacy and safety of verum acupuncture versus sham acupuncture (SA) for addressing RP. The protocol will be a randomized, participant-blinded sham-controlled trial in which 64 eligible patients with RP will be divided randomly into a verum acupuncture group and an SA group. Both groups will receive 48 sessions over 3 months. Participants will complete the trial by visiting the research center at 6 and at 9 months for follow-up assessments.

The primary outcome sought will be visual-field mean sensitivity and visual-field mean deviation at 3, 6, and 9 months, compared with baseline. Secondary outcomes will include best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, Traditional Chinese Medicine syndrome score, and a scale of life quality for diseases with visual impairment at 3, 6, and 9 months, compared with baseline. Adverse events and safety indices will be recorded throughout the study. SPSS, version 25.0, statistical software will be used for analysis, and measurement data will be expressed as mean ± standard deviation.

Ethics approval has been obtained from the Ethics Committee of the Chinese Clinical Trial Registry (approval No: ChiECRCT20200460).

The preventive value of acupoint sensitization for patients with stable angina pectoris: a randomized, double-blind, positive-controlled, multicentre trial.

Huang S, Li L, Liu J, et al. Evid-Based Complement Alternat Med. 2021;2021:7228033.

Acupoint sensitization is considered an important factor in the efficacy of acupoint therapy. This study evaluated the efficacy of acupressure for preventing stable angina pectoris, using acupoints with different pressure–pain sensitivities. A total of 202 patients were enrolled and assigned randomly to a high-sensitivity group (HSG; n = 109) in which patients received acupressure at the 5 acupoints with the highest sensitivity to pain or to a low-sensitivity group (LSG; n = 93) in which patients received acupressure at the 5 acupoints with the lowest sensitivity to pain. The duration of acupressure treatment was 4 weeks, and the patients were evaluated at baseline, week 4, and week 8.

The primary outcome was a change in the frequency of angina attacks from baseline. The secondary outcomes included nitroglycerin consumption, Canadian Cardiovascular Society classification, and Seattle Angina Questionnaire score. Adverse events, such as bleeding and subcutaneous hemorrhage, were recorded in both groups.

Acupressure, compared with baseline, for preventing angina pectoris episodes in the HSG was better than that in the LSG at week 4 (incidence rate ratio [IRR]: 0.691 and 95% confidence interval [CI]: 0.569, 0.839) and week 8 (IRR: 0.692 and 95% CI: 0.569, 0.839). No significant differences between the groups were found in frequency of nitroglycerin consumption at week 4 (odds ratio [OR] = 0.863 and 95% CI: 0.147, 5.077) or week 8 (OR = 1.426 and 95% CI: 0.211, 9.661).

Two themes in the questionnaire showed significantly different changes from baseline between the 2 groups. Scores on the angina frequency subscale had changed more from the baseline in the HSG at week 8 than in the LSG (mean difference [MD] = 3.807 and 95% CI: 0.673, 6.942). Scores on the treatment satisfaction subscale had also changed more in the HSG than in the LSG at week 4 (MD = 3.651 and 95% CI: 0.327, 7.327) and week 8 (MD = 4.220 and 95% CI: 0.347, 7.346). One patient in the LSG reported bruising at an acupoint. No unexpected safety problems arose.

This study showed that acupressure at acupoints with high sensitivity to pain may reduce the frequency of stable angina pectoris episodes effectively. This trial was registered as NCT03975140.