Acupuncture has been used therapeutically in China for thousands of years and is growing in prominence in Europe and the United States. In a recent review of complementary and alternative medicine use in the US population, an estimated 2.1 million people or 1.1% of the population sought acupuncture care during the past 12 months. Four percent of the US population used acupuncture at any time in their lives. We reviewed 31 different published journal articles, including 23 randomized controlled clinical trials and 8 meta-analysis/systematic reviews. We found evidence of some efficacy and low risk associated with acupuncture in pediatrics. From all the conditions we reviewed, the most extensive research has looked into acupuncture's role in managing postoperative and chemotherapy-induced nausea/vomiting. Postoperatively, there is far more evidence of acupuncture's efficacy for pediatrics than for children treated with chemotherapy. Acupuncture seems to be most effective in preventing postoperative induced nausea in children. For adults, research shows that acupuncture can inhibit chemotherapy-related acute vomiting, but conclusions about its effects in pediatrics cannot be made on the basis of the available published clinical trials data to date. Besides nausea and vomiting, research conducted in pain has yielded the most convincing results on acupuncture efficacy. Musculoskeletal and cancer-related pain commonly affects children and adults, but unfortunately, mostly adult studies have been conducted thus far. Because the manifestations of pain can be different in children than in adults, data cannot be extrapolated from adult research. Systematic reviews have shown that existing data often lack adequate control groups and sample sizes. Vas et al, Alimi et al, and Mehling et

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BACKGROUND: A majority of people in the United States use alternative or complementary therapy at some point in their lives, and acupuncture is among the most frequently used modalities. Many United States medical schools offer courses in alternative medicine, and a growing number of insurers offer coverage for alternative therapies. This paper critically reviews our current knowledge about the safety and efficacy of acupuncture for neurologic conditions. REVIEW SUMMARY: Acupuncture is a safe procedure when performed by trained professionals. Complications from acupuncture are rare and mainly related to negligence of sterile technique. Studies of the therapeutic value of acupuncture are fraught with challenging methodologic problems, including the choice of a placebo, a suitable control treatment, and the technique of stimulation applied. Clinical trials of the use of acupuncture for pain syndromes (headache, neck, and back pain), stroke rehabilitation, Parkinson's disease, multiple sclerosis, and substance abuse are reviewed. CONCLUSIONS: Based on the current literature, no definitive recommendation can be made regarding the efficacy of acupuncture for common pain syndromes including headache, and neck and back pain. Better quality clinical trials fail to demonstrate efficacy for the use of acupuncture as part of a rehabilitation program following stroke or as a treatment for drug addiction. Acupuncture may have a role in the treatment of sleep disturbance associated with Parkinson's disease but was not efficacious for the primary symptoms of either Parkinson's disease or multiple sclerosis. In light of increasing public interest and use of alternative therapies, this review may be helpful in promoting more discussion between patients and physicians about the use of acupuncture.

Neurologist. 2003 May;9(3):137-48. Rabinstein AA, Shulman LM. Department of Neurology, University of Miami School of Medicine, Florida, USA.

Full Title: The relationship between patient and practitioner expectations and preferences and clinical outcomes in a trial of exercise and acupuncture for knee osteoarthritis

We investigated the relationship between patient and therapist preferences and expectations and clinical outcomes in a trial of exercise and acupuncture for clinical knee osteoarthritis. 352 Patients were randomised to advice and exercise or advice and exercise plus true or non-penetrating acupuncture. Before randomisation, patients recorded their general outcome expectations, treatment-specific preferences and expectations. Clinical outcome was (a) change scores on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) and (b) treatment response according to the OMERACT-OARSI criteria. Physiotherapists recorded their treatment expectations and preferences for each patient following an assessment prior to randomisation. We investigated the relationship between (a) patient, (b) therapist and (c) matched patient-therapist preferences and expectations on clinical outcomes using univariate and multivariate analyses. There was no significant relationship between patients' treatment preferences and clinical outcomes at 6 or 12months nor between patients' expectations and pain (WOMAC) at 6 or 12months. Using our secondary outcome (OMERART-OARSI), those who received the treatment for which they had high expectations of benefit were almost twice as likely to be classified as a treatment responder at 6months (odds ratio (OR) 1.7 (95% Confidence Interval 1.06, 2.79)) and 12months (OR) 1.9 (1.13, 3.13). Therapists' preferences and expectations for individual patients did not add further explanation of outcomes. There was no evidence of a relationship between patients' treatment preferences or expectations and pain reduction. We found weak evidence, from secondary outcomes, that patients' expectations, both general and treatment-specific, are related to clinical outcome from exercise and acupuncture.

Eur J Pain. 2009 Aug 6. Foster NE, Thomas E, Hill JC, Hay EM. Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom.

OBJECTIVE: To evaluate the clinical studies of acupuncture for treatment of depressive neurosis, collect the high quality evidence relative to clinical acupuncture practice for clinical decision-making reference. METHODS: Around crucial common questions of acupuncture clinical practice, the documents of clinical study were comprehensively retrieved. According to 5-grade criterion of evidence-based medicine, the evidence from high to low level were selected to answer corresponding clincal questions and RevMan 5.0.20 was used to analyze the final indicator. RESULTS: Nineteen documents of clinical study accord with the inclusive criterion were retrieved. Level-A evidence showed effectiveness of acupuncture. Acupuncture might be superior or equal to fluoxetine, with little adverse effect and high safety. Level-C evidence showed acupuncture might be superior or equal to Amitriptyline, with little adverse effect and high safety. And no relative clinicial evidence compared effect of acupuncture with that of psychotherapy or behavior therapy. Only one level-C evidence showed there was no effect difference between acupuncture combined with bloodletting therapy and bloodletting alone. Two level-C evidence showed the effect of acupuncture combined with western medicine was superior to that of medicine alone, eg. catgut embedding therapy combined with Fluoxetine, electroacupuncture combined with Seroxat. CONCLUSION: Acupuncture for depressive nerosis has a positive effect. Acupuncture has an equal effect compared with western medicine, while strictly designed equivalent and non-inferior studies are demanded. The effect of acupuncture combined with medicine has some advantage, but need high quality studies to verify.

Zhongguo Zhen Jiu. 2010 Mar;30(3):235-40. Xiong J, Du YH, Liu JL, Lin XM, Sun P, Xiao L, Gao X, Chen YW. Graduate School, Tianjin University of TCM, Tianjin 300193, China.

Full Title: Acupuncture-ameliorated menopausal symptoms: single-blind, placebo-controlled, randomized trial

Objectives To evaluate the effects of acupuncture and sham-acupuncture on women with menopausal symptoms as reflected in the intensity of their hot flushes and the Kupperman Menopausal Index (KMI). Method This was a randomized, single-blind, placebo-controlled, cross-over trial with 81 patients assigned to two groups: Group 1 received 12 months of acupuncture, then 6 months of sham-acupuncture treatment (n = 56) and Group 2 received 6 months of sham-acupuncture, then 12 months of acupuncture treatment (n = 25). The needles were inserted in a harmonic craniocaudal manner at a depth of about 2 cm, and each session lasted approximately 40 min. The efficacy of acupuncture in ameliorating the climacteric symptoms of patients in postmenopause was determined through the KMI and the intensity of hot flushes. The analysis of variance method for two factors and repeated measures was applied. Results The baseline values of the women in both groups were similar for the KMI score and number of hot flushes. At the end of 6 months, the values for the KMI and hot flushes for the women in Group 1 were lower than those of the women in Group 2 (p < 0.05). After 12 months, the KMI and hot flush data were similar in both groups. After 18 months, the values of the KMI and hot flushes for the women in Group 2 for were lower than those of the women in Group 1 (p < 0.05). Conclusion Acupuncture treatment for relieving menopausal symptoms may be effective for decreasing hot flushes and the KMI score in postmenopausal women.

Climacteric. 2010 May 24. Castelo Branco de Luca A, Maggio da Fonseca A, Carvalho Lopes CM, Bagnoli VR, Soares JM, Baracat EC. Medical School of University of São Paulo, Obstetrics and Gynecology, São Paulo.

Full Title: Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial

The present study investigated the immediate efficacy of acupuncture compared to sham acupuncture and placebo laser acupuncture on strength performance. A total of 33 recreational athletes (25.2 +/- 2.8 years; 13 women) were randomized to receive acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser acupuncture (deactivated laser device) in a double-blind crossover fashion with 1 week between trials. Assessment included bipedal drop jumps for maximum rebound height and quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface electromyography (EMG) was used to measure the EMG activity of the rectus femoris muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF) analysis was applied to characterize muscular endurance. Measurements were performed at baseline and immediately after treatment by a blinded investigator. Repeated measures ANOVA and post hoc paired-sample t test with Bonferroni-Holm correction were used for statistical analysis. The difference in the mean change in MIVF from baseline between acupuncture (46.6 N) and sham laser acupuncture (19.6 N) was statistically significant (p < 0.05), but no significant difference was found between acupuncture (46.6 N) and sham acupuncture (28.8 N). ANOVA did not show statistically significant treatment effects for drop jump height or MPF. The present study shows that a single acupuncture treatment was efficacious for improving isometric quadriceps strength in recreational athletes. These results might have implications not only for athletic performance enhancement, but also for rehabilitation programs aimed at restoring neuromuscular function.

Eur J Appl Physiol. 2010 May 25.Hübscher M, Vogt L, Ziebart T, Banzer W. Department of Sports Medicine, Goethe-University Frankfurt, Ginnheimer Landstrasse 39, 60487, Frankfurt, Germany, m.huebscher@sport.uni-frankfurt.de.

Full Title: A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication.

OBJECTIVES: There is conflicting evidence on the efficacy of Traditional Chinese Acupuncture (TCA), and the role of placebo effects elicited by acupuncturists' behavior has not been elucidated. We conducted a 3-month randomized clinical trial in patients with knee osteoarthritis to compare the efficacy of TCA to sham acupuncture, and examine the effects of acupuncturists' communication style. METHODS: Acupuncturists were trained to interact in one of two communication styles: 'high' or 'neutral' expectations. Patients were randomized to one of 3 groups: waiting list, 'high' or 'neutral', and nested within style, TCA or sham acupuncture over 6 weeks. Sham acupuncture was performed in non-meridian points, with shallow needles and minimal stimulation. Primary outcome measures were: Joint-specific Multidimensional Assessment of Pain (J-MAP), Western Ontario McMaster Osteoarthritis Index (WOMAC), and satisfaction. RESULTS: 455 patients who received treatment (TCA or sham) and 72 controls were included. No statistically significant differences were observed between TCA or sham acupuncture, but both groups had significant reductions in J-MAP and WOMAC pain compared to the waiting group (-1.1, -1.0, and -0.1, p<0.001; -13.7, -14, -1.7, p<0.001). Statistically significant differences were observed in J-MAP pain reduction and satisfaction, favoring the 'high' expectations group. Fifty-two percent and 43% in the TCA and sham groups thought they had received TCA (kappa=0.05), suggesting successful blinding. CONCLUSION: TCA was not superior to sham acupuncture. However, acupuncturists' style had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist's behavior.

Arthritis Care Res (Hoboken). 2010 Apr 21. Suarez-Almazor ME, Looney C, Liu Y, Cox V, Pietz K, Marcus DM, Street RL Jr. Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care - University of Texas M.D. Anderson Cancer Center (MSA, CL, VC).

PURPOSE: This study investigated the influence of manual acupuncture on heart rate variability and the role which anxiety can play in modifying physiological outcomes. METHOD: Analysis of heart rate variability (HRV) was used as a sensitive and a reliable indicator of the balance between sympathetic and parasympathetic regulation of the heartbeat. Two groups of healthy female subjects were recruited into the study. The control group (n=30) attended one experimental session where no acupuncture treatment was used. The experimental group (n=30) attended three sessions in which unilateral manual stimulation of acupuncture points LU7 and KD6 was performed. RESULTS: The stimulation of the acupuncture points LU7 and KD6 was not associated with significant changes in HRV. Previous familiarity with acupuncture did not influence the outcomes but level of anxiety had a strong impact on physiological outcomes. Stimulation of LU7 acupuncture point counterbalanced naturally occurring sympathetic increase over time and had relaxing and harmonizing effect on the heart rhythm without influencing subjective perception of increased anxiety. Stimulation of KD6 acupuncture point had sympathetic influence on HRV in subjects with low "trait" anxiety and this influence was nullified by simultaneous stimulation of LU7 acupuncture point. CONCLUSIONS: It seems likely that the level of anxiety can modify HRV during acupuncture treatment and up to 40 min after the treatment. Psychological factors such as anxiety level should be considered as having important influence on physiological response to acupuncture.

Complement Ther Clin Pract. 2009 Aug;15(3):124-8. Epub 2009 Mar 10. Vickland V, Rogers C, Craig A, Tran Y. Department of Medical and Molecular Biosciences, University of Technology, Sydney, NSW 2007, Australia. victor.vickland@unsw.edu.au

Full Title: The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses

In the present study, the effects of acupuncture on the behavioral and physiological responses induced by chronic mild stress (CMS) were evaluated. Sprague-Dawley rats were exposed to a variety of chronic unpredictable, mild stressors for 8 weeks. The effects of acupuncture on stress-induced anxiety and anhedonia were investigated using the elevated plus maze (EPM) and sucrose intake test. In addition, c-fos expression, as an early neuronal marker in the brain was also examined utilizing Fos-like immunohistochemistry (FLI). CMS rats significantly reduced the consumption of sucrose intake and latency in the open arms of the EPM, and gained body weight more slowly, compared to non-stressed normal rats. Exposure to CMS also significantly increased FLI in the paraventricular nucleus (PVN) of the hypothalamus. Acupuncture stimulation at point PC6 on the pericardium channels (3 min), but not at other point (TE5), restored stress-induced decrease in the latency in the open arms and significantly attenuated FLI in the PVN produced by CMS. Acupuncture stimulation also tended to restore stress-induced decrease in the sucrose intake. The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.

Neurosci Lett. 2009 Aug 21;460(1):56-60. Epub 2009 May 7. Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I. Division of Brain Disease, Center for Biomedical Science, National Institute of Health, Seoul, 122-701 Republic of Korea.

Full Title: Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs)

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of 4 weeks. Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.

Neuroimage. 2009 Sep;47(3):1077-85. Epub 2009 Jun 6. Harris RE, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA. reharris@med.umich.edu

Full Title: Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion

Summary Aim: To further investigate the effect of acupuncture in postoperative pain and emergence agitation in children undergoing bilateral myringotomy and tympanostomy tube (BMT) placement. Background: BMT insertion surgery in children is routinely performed under general anesthesia and is associated with a high incidence of postoperative pain and agitation upon emergence from anesthesia. Various medications have been investigated to alleviate the pain and agitation, which have been accompanied by high incidence of adverse effects. In children, anecdotal reports suggest that acupuncture may offer postoperative analgesia. Methods/Materials: This prospective randomized controlled trial is to evaluate the effectiveness of acupuncture to control pain and agitation after initial bilateral myringotomy tube placement in 60 nonpremedicated children. Acupuncture was applied at points LI-4 (he gu) and HT-7 (shen men) immediately after induction of anesthesia. A single-blinded assessor evaluated postoperative pain and agitation using CHEOPS and emergence agitation scale. Pain and agitation scores were significantly lower in the acupuncture group compared to those in the control group at the time of arrival in the post anesthesia care unit and during the subsequent 30 min. Results: Acupuncture treatment provided significant benefit in pain and agitation reduction. The median time to first postoperative analgesic (acetaminophen) administration was significantly shorter in the control group. The number of patients who required analgesia was considerably fewer in the acupuncture group than that in the control. No adverse effects related to acupuncture treatment were observed. Conclusion: Our study suggests that acupuncture therapy may be effective in diminishing both pain and emergence agitation in children after BMT insertion without adverse effects.

Paediatr Anaesth. 2009 Aug 26. Lin YC, Tassone RF, Jahng S, Rahbar R, Holzman RS, Zurakowski D, Sethna NF. Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.

Acupuncture modulation of activity in the human brainstem is not well known. This structure is plagued by physiological artifact in neuroimaging experiments. In addition, most studies have used short (<15 min) block designs, which miss delayed responses following longer duration stimulation. We used brainstem-focused cardiac-gated fMRI and evaluated time-variant brain response to longer duration (>30 min) stimulation with verum (VA, electro-stimulation at acupoint ST-36) or sham point (SPA, non-acupoint electro-stimulation) acupuncture. Our results provide evidence that acupuncture modulates brainstem nuclei important to endogenous monoaminergic and opioidergic systems. Specifically, VA modulated activity in the substantia nigra (SN), nucleus raphe magnus, locus ceruleus, nucleus cuneiformis, and periaqueductal gray (PAG). Activation in the ventrolateral PAG was greater for VA compared to SPA. Linearly decreasing time-variant activation, suggesting classical habituation, was found in response to both VA and SPA in sensorimotor (SII, posterior insula, premotor cortex) brain regions. However, VA also produced linearly time-variant activity in limbic regions (amygdala, hippocampus, and SN), which was bimodal and not likely habituation--consisting of activation in early blocks, and deactivation by the end of the run. Thus, acupuncture induces different brain response early, compared to 20-30 min after stimulation. We attribute the fMRI differences between VA and SPA to more varied and stronger psychophysical response induced by VA. Our study demonstrates that acupuncture modulation of brainstem structures can be studied non-invasively in humans, allowing for comparison to animal studies. Our protocol also demonstrates a fMRI approach to study habituation and other time-variant phenomena over longer time durations.

Neuroimage. 2009 Aug 1;47(1):289-301. Epub 2009 Apr 1. Napadow V, Dhond R, Park K, Kim J, Makris N, Kwong KK, Harris RE, Purdon PL, Kettner N, Hui KK. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA. vitaly@nmr.mgh.harvard.edu

Acupuncture, which originated with traditional Chinese medicine, has been increasingly used in Western medicine over the last three decades. A huge body of scientific literature reports the physiological and clinical effects of acupuncture. In Germany, about 30,000 physicians apply acupuncture at least occasionally, and German health insurances reimburse acupuncture treatment for chronic low back pain and osteoarthritis of the knee. This overview discusses the most important historical, theoretical, practical, and scientific aspects of acupuncture in general, with a special look at anaesthesia. Regarding anaesthesia, supportive acupuncture treatment is performed for postoperative pain, anxiolysis, and postoperative nausea and vomiting, based on promising results of rigorous randomised trials. However, many unresolved questions remain, such as regarding specificity of concepts, indications, and optimum dose.

Schmerz. 2009 Aug;23(4):405-17; quiz 418. Stör W, Irnich D. Icking, Klinikum der Ludwig-Maximilians-Universität, Campus Innenstadt, München. stoer@daegfa.de

Previous work has shown that acupuncture stimulation evokes deactivation of a limbic-paralimbic-neocortical network (LPNN) as well as activation of somatosensory brain regions. This study explores the activity and functional connectivity of these regions during acupuncture vs. tactile stimulation and vs. acupuncture associated with inadvertent sharp pain. Acupuncture during 201 scans and tactile stimulation during 74 scans for comparison at acupoints LI4, ST36 and LV3 was monitored with fMRI and psychophysical response in 48 healthy subjects. Clusters of deactivated regions in the medial prefrontal, medial parietal and medial temporal lobes as well as activated regions in the sensorimotor and a few paralimbic structures can be identified during acupuncture by general linear model analysis and seed-based cross correlation analysis. Importantly, these clusters showed virtual identity with the default mode network and the anti-correlated task-positive network in response to stimulation. In addition, the amygdala and hypothalamus, structures not routinely reported in the default mode literature, were frequently involved in acupuncture. When acupuncture induced sharp pain, the deactivation was attenuated or became activated instead. Tactile stimulation induced greater activation of the somatosensory regions but less extensive deactivation of the LPNN. These results indicate that the deactivation of the LPNN during acupuncture cannot be completely explained by the demand of attention that is commonly proposed in the default mode literature. Our results suggest that acupuncture mobilizes the anti-correlated functional networks of the brain to mediate its actions, and that the effect is dependent on the psychophysical response.

Brain Res. 2009 Sep 1;1287:84-103. Epub 2009 Jun 25. Hui KK, Marina O, Claunch JD, Nixon EE, Fang J, Liu J, Li M, Napadow V, Vangel M, Makris N, Chan ST, Kwong KK, Rosen BR. Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St., Charlestown, MA 02129, USA. hui@nmr.mgh.harvard.edu

Full Title: The role of acupuncture and transcutaneous-electrical nerve stimulation for postoperative pain control

PURPOSE OF REVIEW: Both patients and care providers are concerned about the adverse events associated with pharmaceutical approaches used in postoperative pain management. Acupuncture and transcutaneous-electrical nerve stimulation (TENS) are complementary treatment techniques and are very popular in the management of a variety of painful conditions. Therefore, their use might help to reduce opioid requirements and decrease the incidence of medication-related adverse events. The aim of this review is to summarize the latest findings on the use of acupuncture and TENS in postoperative pain management. RECENT FINDINGS: The number of recent high-quality trials on acupuncture and TENS in postoperative pain is limited. Evidence of efficacy in acupuncture studies is contradictory although some high-quality studies clearly found positive effects. Differences in setting and methodology might explain the variability in the results. Findings of the few recent trials using TENS are consistently positive. SUMMARY: Evidence of efficacy in recent studies on acupuncture and TENS in management of postoperative pain is limited. However, some high-quality studies clearly show positive results for both methodologies. As these techniques cause no harm, their use as adjunct to conventional pharmaceutical approaches could be considered particularly for patients in whom conventional techniques fail and/or are accompanied by severe medication-related adverse events.

Curr Opin Anaesthesiol. 2009 Oct;22(5):623-6. Meissner W. Department of Anesthesiology and Intensive Care, Friedrich Schiller University Jena, Erlanger Allee, Jena, Germany. meissner@med.uni-jena.de

Certain clinical reports and researches have shown that acupuncture effects can sustain a period during the post-stimulation state, and modulate the default mode network (DMN). In this study, partial correlation approach was utilized to investigate whether or not electro-acupuncture stimulation (EAS) at the three acupoints (GB37 (Guangming), BL60 (Kunlun) and KI8 (Jiaoxin)) and one sham point on the left leg modulated the DMN and how to change the intrinsic connectivity of the DMN. The results indicated that DMN could be modulated after EAS, and there existed different modulation patterns of the four points. Meanwhile, we found that the posterior cingulate cortex and precuneus (PCC/pC) strongly interacted with other nodes during the pre- and post-stimulation states. The correlation was interrupted between the PCC/pC and anterior cingulate cortex (ACC). The orbital prefrontal cortex (OFC) negatively interacted with the left medial temporal cortex (lMTC) at the acupoints. We suggested that the distinct modulation patterns to the DMN attributed to the different effects evoked by the three acupoints and one sham point.

Neurosci Lett. 2009 Oct 25;462(3):183-7. Epub 2009 Jul 10. Liu P, Zhang Y, Zhou G, Yuan K, Qin W, Zhuo L, Liang J, Chen P, Dai J, Liu Y, Tian J. School of Sino-Dutch Biomedical and Information Engineering, Northeastern University, Shenyang, Liaoning 110004, China.

BACKGROUND: Acupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs). METHODS: Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. RESULTS: Eleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal. CONCLUSIONS: The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.

Alcohol Clin Exp Res. 2009 Aug;33(8):1305-13. Cho SH, Whang WW. Department of Neuropsychiatry, Hospital of Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea. chosh@khu.ac.kr

Full Title: Acupuncture in acute herpes zoster pain therapy (ACUZoster) - design and protocol of a randomised controlled trial

ABSTRACT: BACKGROUND: Acute herpes zoster is a prevalent condition. One of its major symptoms is pain, which can highly influence patient's quality of life. Pain therapy is limited. Acupuncture is supposed to soften neuropathic pain conditions and might therefore act as a therapeutic alternative. Objective of the present study is to investigate whether a 4 week semi-standardised acupuncture is non-inferior to sham laser acupuncture and the anticonvulsive drug gabapentine in the treatment of pain associated with herpes zoster. METHODS: Three-armed, randomised, placebo-controlled trial with a total follow-up time of 6 months. Up to estimated 336 patients (interim analyses) with acute herpes zoster pain (VAS > 30 mm) will be randomised to one of three groups (a) semi-standardised acupuncture (168 patients); (b) gabapentine with individualised dosage between 900 3600 mg/d (84 patients); (c) sham laser acupuncture. Intervention takes place over 4 weeks, all patients will receive analgesic therapy (non-opioid analgesics: metamizol or paracetamol and opioids: tramadol or morphine). Therapy phase includes 4 weeks in which group (a) and (c) consist of 12 sessions per patient, (b) visits depend on patients needs. Main outcome measure is to assess the alteration of pain intensity before and 1 week after treatment sessions (visual analogue scale VAS 0-100 mm). Secondary outcome measure are: alteration of pain intensity and frequency of pain attacks; alteration of different aspects of pain evaluated by standardised pain questionnaires (NPI, PDI, SES); effects on quality of life (SF 36); analgesic demand; alteration of sensoric perception by systematic quantitative sensory testing (QST); incidence of postherpetic neuralgia; side effects and cost effectiveness. Credibility of treatments will be assessed. DISCUSSION: This study is the first large-scale randomised placebo controlled trial to evaluate the efficacy of acupuncture compared to gabapentine and sham treatment and will provide valuable new information about the clinical and physiological effects of acupuncture and gabapentine in the treatment of acute herpes zoster pain. The study has been pragmatically designed to ensure that the study findings can be implemented into clinical practice if acupuncture can be shown to be an effective treatment strategy in acute herpes zoster pain. Trial registration: NCT00885586.

BMC Complement Altern Med. 2009 Aug 12;9(1):31. Fleckenstein J, Kramer S, Hoffrogge P, Thoma S, Lang PM, Lehmeyer L, Schober GM, Pfab F, Ring J, Weisenseel P, Schotten KJ, Mansmann U, Irnich D.

Full Title: Acupuncture as a treatment for functional dyspepsia: design and methods of a randomized controlled trial

ABSTRACT: BACKGROUND: Acupuncture is widely used in China to treat functional dyspepsia (FD). However, its effectiveness in the treatment of FD, and whether FD-specific acupoints exist, are controversial. So this study aims to determine if acupuncture is an effective treatment for FD and if acupoint specificity exists according to traditional acupuncture meridians and acupoint theories. DESIGN: This multicenter randomized controlled trial will include four acupoint treatment groups, one non-acupoint control group and one drug (positive control) group. The four acupoint treatment groups will focus on: (1) specific acupoints of the stomach meridian; (2) non-specific acupoints of the stomach meridian; (3) specific acupoints of alarm and transport points; and (4) acupoints of the gallbladder meridian. These four groups of acupoints are thought to differ in terms of clinical efficacy, according to traditional acupuncture meridians and acupoint theories. A total of 120 FD patients will be included in each group. Each patient will receive 20 sessions of acupuncture treatment over 4 weeks. The trial will be conducted in eight hospitals located in three centers of China. The primary outcomes in this trial will include differences in Nepean Dyspepsia Index scores and differences in the Symptom Index of Dyspepsia before randomization, 2 weeks and 4 weeks after randomization, and 1 month and 3 months after completing treatment. DISCUSSION: The important features of this trial include the randomization procedures (controlled by a central randomization system), a standardized protocol of acupuncture manipulation, and the fact that this is the first multicenter randomized trial of FD and acupuncture to be performed in China. The results of this trial will determine whether acupuncture is an effective treatment for FD and whether using different acupoints or different meridians leads to differences in clinical efficacy. Trial registration number: Clinical Trials.gov Identifier: NCT00599677.

Trials. 2009 Aug 23;10(1):75. Zheng H, Tian XP, Li Y, Liang FR, Yu SG, Liu XG, Tang Y, Yang XG, Yan J, Sun GJ, Chang XR, Zhang HX, Ma TT, Yu SY.

Full Title: A single point acupuncture treatment at large intestine meridian: a randomized controlled trial in acute tonsillitis and pharyngitis

OBJECTIVES: One out of 4 patients visiting a general practitioner reports of a sore throat associated with pain on swallowing. This study was established to examine the immediate pain alleviating effect of a single point acupuncture treatment applied to the large intestine meridian of patients with sore throat. PATIENTS AND METHODS: Sixty patients with acute tonsillitis and pharyngitis were enrolled in this randomized placebo-controlled trial. They either received acupuncture, or sham laser acupuncture, directed to the large intestine meridian section between acupuncture points LI 8 and LI 10. The main outcome measure was the change of pain intensity on swallowing a sip of water evaluated by a visual analog scale 15 minutes after treatment. A credibility assessment regarding the respective treatment was performed. RESULTS: The pain intensity for the acupuncture group before and immediately after therapy was 5.6+/-2.8 and 3.0+/-3.0, and for the sham group 5.6+/-2.5 and 3.8+/-2.5, respectively. Despite the articulation of a more pronounced improvement among the acupuncture group, there was no significant difference between groups (Delta=0.9, confidence interval: -0.2-2.0; P=0.12; analysis of covariance). Patients' satisfaction was high in both treatment groups. The study was prematurely terminated due to a subsequent lack of suitable patients. DISCUSSION: A single acupuncture treatment applied to a selected area of the large intestine meridian was no more effective in the alleviation of pain associated with clinical sore throat than sham laser acupuncture applied to the same area. Hence, clinically relevant improvement could be achieved. Pain alleviation might partly be due to the intense palpation of the large intestine meridian. The benefit of a comprehensive acupuncture treatment protocol in this condition should be subject to further trials.

Clin J Pain. 2009 Sep;25(7):624-31. Fleckenstein J, Lill C, Lüdtke R, Gleditsch J, Rasp G, Irnich D. Multidisciplinary Pain Center, Department of Anesthesiology, University of Munich, Pettenkoferstr 8A, 80336 München, Germany.

BACKGROUND: Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States, and postoperative nausea (PON) is a prevalent problem in this patient population. The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both. METHODS: Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery, or both, were recruited for this study. Patients were randomly assigned to receive either one preoperative acupuncture and standard postoperative care (acupuncture group) or solely standard postoperative care (control group). Acupuncture was performed 0.5 to 3 hours before surgery. The PON incidence and severity on postoperative day (POD) 2 and POD 3 were measured with validated nausea tools. RESULTS: The acupuncture group had a significantly lower incidence of nausea compared with the control group (POD 2, odds ratio [OR], 0.38; p = 0.05; and POD 3, OR, 0.26; p = 0.01). The acupuncture group also had a significantly lower score of nausea severity than the control group (POD 2, OR, 0.29; p = 0.01; and POD 3, OR, 0.25; p = 0.01). No adverse effects due to acupuncture treatment were reported. Antiemetics, pain medications, and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results. CONCLUSIONS: A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both, and caused no adverse effects.

Ann Thorac Surg. 2009 Aug;88(2):537-42. Korinenko Y, Vincent A, Cutshall SM, Li Z, Sundt TM 3rd. Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

Full Title: Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial

BACKGROUND: Although evidence of its effects is tentative, acupuncture has long been used in the treatment of multiple maladies. So far, it has not been possible to discriminate the effects of the venue from specific results of needling itself, thus physicians merely depend on patients' statements. The authors investigated the efficacy of infrared thermography in distinguishing response to true acupuncture as compared to nonacupoint cutaneous and muscular needling (sham or minimal acupuncture), as well as without manipulation. METHODS: Thermographic imaging was performed in 50 healthy volunteers randomly assigned to four groups: Acupuncture of Hegu (LI 4), needling of a cutaneous and a muscular point where no acupuncture point has been described yet, and without manipulation. In a crossover protocol, each proband completed all four arms of the protocol in a random order. Infrared thermograms were gathered at defined points in each group. RESULTS: A significant increase in surface temperature occurred within 2 min after needling the acupuncture point Hegu (from 30.1 +/- 2.7 degrees C [SD] to 31.2 +/- 3.0 degrees C and to 31.9 +/- 2.5 degrees C after 10 min, P < 0.001), whereas needling of the cutaneous and muscular point, as well as without any manipulation resulted in a decrease of temperature in the monitored area. CONCLUSION: Contact-free infrared thermographic imaging is a reliable and easy-to-handle tool to distinguish between needling at Hegu and needling of a nonacupoint ("sham" acupuncture).

Anesthesiology. 2009 Sep;111(3):632-9. Agarwal-Kozlowski K, Lange AC, Beck H. Center for Palliative Care and Pain Management, Doerenberg Medical Center, Bad Iburg, Germany. kagarwal@doerenberg-klinik.de

OBJECTIVE: The objective of this study was to investigate the effects of acupuncture on diabetic bladder dysfunction (DBD). METHODS: This study compared 30 cases in the acupuncture group with 15 cases in the sham acupuncture group (n = 45 total). The effects of acupuncture were observed on urodynamic measurements, as well as a variety of symptoms associated with DBD. RESULTS: In the acupuncture group, five of the six urodynamic measures (maximal detrusor pressure, bladder compliance, maximal bladder capacity, bladder volume at desire to void and urge to void) demonstrated significant improvement (p < 0.05, 0.01) over the 15-day treatment period. Only one measure (bladder volume at urge to void) significantly improved (p < 0.05) in the sham acupuncture group. There were significant differences after therapy in four measures (bladder compliance, maximal bladder capacity, bladder volume at desire to void, and urge to void) between the groups (p < 0.05, 0.01). A significant difference of the changes in symptoms compared with pretreatment in the acupuncture group was observed (p < 0.05, 0.01). In 25 subjects in the acupuncture group, incontinence improved from 2.4 to 1.4. In the sham acupuncture group, incontinence deteriorated from 2.2 to 2.3. CONCLUSIONS: Our pilot study has provided evidence that acupuncture may be clinically useful for the radical treatment of DBD.

J Altern Complement Med. 2009 Aug;15(8):905-9. Tong Y, Jia Q, Sun Y, Hou Z, Wang Y. Department of Nephrology, The First Affiliated Hospital to Changchun University of Chinese Medicine, Changchun City, Jilin Province, China. tyq1229@yahoo.com.cn

Full Title: Evaluation of manual acupuncture at classical and nondefined points for treatment of functional dyspepsia: a randomized-controlled trial.

PURPOSE: Acupuncture has been used traditionally as a treatment for functional dyspepsia (FD). The goal of this trial was to examine the efficacy of acupuncture at classical points and nondefined points as a treatment for functional dyspepsia. METHODS: Sixty-eight (68) patients with functional dyspepsia, as defined by Rome-II criteria, were randomized into two groups: classical six-point acupuncture and nondefined-point acupuncture. Acupuncture was conducted three times per week for 2 weeks in a single-blind setting. To assess the effects of acupuncture, symptoms and quality of life were scored according to the Nepean Dyspepsia Index before and after acupuncture treatments. RESULTS: Acupuncture treatment significantly decreased the dyspepsia symptoms and improved the quality of life. There was no statistical difference between the acupuncture groups treated at classical and nondefined points. CONCLUSIONS: Our data show that both acupunctures at classical points and nondefined points improved the symptoms of patients with FD. However, we cannot rule out the possibilities of placebo effect in this trial.

J Altern Complement Med. 2009 Aug;15(8):879-84. Park YC, Kang W, Choi SM, Son CG. Department of Internal Medicine, Oriental Medical College of Daejeon University, Daejeon, South Korea.

BACKGROUND AND OBJECTIVE: The current pharmacological management of depression remains limited. The aim of this study was to assess the efficacy and safety of acupuncture in combination with fluoxetine as an intervention for major depressive disorder (MDD). SUBJECTS AND INTERVENTIONS: A total of 80 patients with MDD (DSM-IV) were randomized to two groups: VA group received verum acupuncture, 10 mg/day fluoxetine and placebo; SA group received sham acupuncture and 20-30 mg/day fluoxetine. Acupuncture was applied 5 times a week over a period of 6 weeks. DESIGN AND SETTINGS: A randomized, double-blind, double-dummy, sham-controlled trial was conducted in Dehong Prefecture Traditional Chinese Medicine Hospital. OUTCOME MEASURES: All subjects were assessed in a double-blind fashion at four time points (i.e., baseline, the end of the second, fourth, and sixth week of treatment. The primary outcome measure was the therapeutic response rate based on the rate of total score change in the 17-item Hamilton Rating Scale for Depression (HRSD). Anxious symptoms, antidepressant side-effects, and acupuncture adverse effects were also measured additionally. RESULTS: At the end of the treatment period, the therapeutic response rates were not statistically significant between groups (80.0% for the VA group and 77.5% for the SA group, respectively). No statistical significance was found between the 2 groups in the rate of HRSD score change (z = 1.80, p = 0.07), but patients in the VA group showed better improvement than the SA group in symptoms of anxiety and side-effects of antidepressant (z = 2.60, p = 0.01 and z = 23.60, p < 0.001, respectively). The overall rate of adverse events due to acupuncture was 8.75%. CONCLUSIONS: Additionally applied standardized acupuncture to low-dose fluoxetine for depression is as effective as a recommended dose of fluoxetine treatment. Depressive patients with severe anxious symptoms and/or intolerable side-effects of antidepressants can benefit from it.

J Altern Complement Med. 2009 Aug;15(8):837-44. Zhang WJ, Yang XB, Zhong BL. Beijing MeiTan General Hospital, Beijing, People's Republic of China.

BACKGROUND: The objective of this study was to assess repeated needle acupuncture in the treatment of postoperative pain and nausea after visceral surgery. MATERIAL AND METHODS: Sixty-six patients undergoing visceral surgery (hysterectomy, cholecystectomy) were randomly assigned to group A (three sessions of needle acupuncture, n=21), group M (3x1000 mg metamizole, n=20), or group K (control, n=25). All patients received patient-controlled analgesia (PCA) using piritramide. To adjust for nonspecific effects due to physician-patient interaction during acupuncture sessions in group A, patients in groups M and K also received three standardized visits. Primary outcome parameters were defined as pain intensity, analgesic consumption, and frequency of nausea and vomiting in a period up to the morning of the second postoperative day. RESULTS: Patients in group A reported significant less pain, nausea, and vomiting compared to patients in group K. Mean cumulative piritramide consumption was significantly lower in group A (25.0 mg) than in group M (34.5 mg) and group K (55.2 mg). CONCLUSION: Repeated needle acupuncture may be effective in postoperative pain relief and the treatment of nausea and vomiting in the postoperative period. These effects seem not to be due solely to interaction between the acupuncturist and the patient.

Schmerz. 2009 Aug;23(4):370-6. Grube T, Uhlemann C, Weiss T, Meissner W. Kreiskrankenhaus Greiz, GmbH, Wichmannstrasse 12, 07973, Greiz, Deutschland. t.grube@hospital-greiz.de

Full Title: Traditional needle acupuncture treatment for insomnia: a systematic review of randomized controlled trials

OBJECTIVES: Previous reviews regarding traditional needle acupuncture (TNA) treatment for insomnia were limited to English scientific literature. A comprehensive review including Chinese and English literature has therefore been conducted to examine the efficacy of TNA for insomnia. METHODS: We performed systematic review of randomized controlled trials (RCTs) of TNA as intervention for insomnia against placebo, Western medication, and non-treated controls. The methodological quality of the studies was assessed by the modified Jadad score and the acupuncture procedure was appraised by the STRICTA criteria. RESULTS: Twenty RCTs were identified for detailed analysis. Majority of the RCTs concluded that TNA was significantly more effective than benzodiazepines for treating insomnia, with mean effective rates for acupuncture and benzodiazepines being 91% and 75%, respectively. In two more appropriately conducted trials, TNA appeared to be more efficacious in improving sleep than sleep hygiene counseling and sham acupuncture. Standardized and individualized acupuncture had similar effective rates. Despite these positive outcomes, there were methodological shortcomings in the studies reviewed, including imprecise diagnostic procedure, problems with randomization, blinding issues, and insufficient safety data. Hence, the superior efficacy of TNA over other treatments could not be ascertained. CONCLUSION: Since the majority of evidence regarding TNA for insomnia is based on studies with poor-quality research designs, the data, while somewhat promising, do not allow a clear conclusion on the benefits of TNA for insomnia. Moreover, the results support the need for large scale placebo-controlled double-blinded trials.

Sleep Med. 2009 Aug;10(7):694-704. Epub 2009 Mar 19. Yeung WF, Chung KF, Leung YK, Zhang SP, Law AC. Department of Psychiatry, University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.

Full Title: The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis

BACKGROUND: Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined. The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD). METHODS: Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs). RESULTS: Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n=1998) and 15 of PSD (n=1680) identified for high-quality protocol (Jadad score >/=3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants. CONCLUSIONS: Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined.

J Affect Disord. 2009 Jul 24. Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China.

BACKGROUND: Allergic rhinitis is one of the most common health complaints worldwide. Complementary and alternative medical approaches have been employed to relieve allergic rhinitis symptoms and to avoid the side effects of conventional medication. Acupuncture has been widely used to treat patients with allergic rhinitis, but the available evidence of its effectiveness is insufficient. Our objective is to evaluate the effectiveness of acupuncture in patients in Korea and China with persistent allergic rhinitis compared to sham acupuncture treatment or waitlist control. METHODS: This study consists of a multi-centre (two centres in Korea and two centres in China), randomised, controlled trial with three parallel arms (active acupuncture, sham acupuncture, and waitlist group). The active acupuncture and sham acupuncture groups will receive real or sham acupuncture treatment, respectively, three times per week for a total of 12 sessions over four weeks. Post-treatment follow-up will be performed a month later to complement these 12 acupuncture sessions. Participants in the waitlist group will not receive real or sham acupuncture treatments during this period but will only be required to keep recording their symptoms in a daily diary. After four weeks, the same treatment given to the active acupuncture group will be provided to the waitlist group. DISCUSSION: This trial will provide evidence for the effectiveness of acupuncture as a treatment for persistent allergic rhinitis. The primary outcome between groups is a change in the self-reported total nasal symptom score (i.e., nasal obstruction, rhinorrhea, sneezing, and itching) from baseline at the fourth week. Secondary outcome measures include the Rhinitis Quality of Life Questionnaire score and total non-nasal symptom score (i.e., headache, itching, pain, eye-dropping). The quantity of conventional relief medication used during the follow-up period is another secondary outcome measure. TRIAL REGISTRATION: Current Controlled Trials ISRCTN90807007.

Trials. 2009 Jul 14;10:54. Kim JI, Lee MS, Jung SY, Choi JY, Lee S, Ko JM, Zhao H, Zhao J, Kim AR, Shin MS, Kang KW, Jung HJ, Kim TH, Liu B, Choi SM. Medical Research Centre, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea. hann8400@hanmail.net

Neuroimaging studies of acupuncture have demonstrated extensive signal attenuations in the core regions of a "default mode" network as well as signal potentiations in the regions of a "central-executive" network. We proposed that this acupuncture-related dichotomy may represent the anticorrelation in these intrinsic brain networks showing spontaneous fluctuations during rest. According to a plentiful clinical report, acupuncture can provide pain relief beyond the time it is being administrated; therefore, imaging its sustained effect (rather than acute effect) on the brain networks may further help elucidate the mechanisms by which acupuncture achieves its therapeutic effects. As an interface, the anterior insula (AI) has recently been shown to be a network hub, which initiates dynamic switching between these intrinsic networks. Here, we attempt to explore how acupuncture can modulate spontaneous coherences of these resting networks anchored by the AI. Using a spontaneous activity detection approach, we identified an AI-related dichotomy showing spontaneous activations in the CEN along with wide spontaneous deactivations located exclusively in the DMN. Following verum acupuncture, but not sham control, there was a prominently enhanced dichotomy in the CEN and DMN networks. More importantly, a long-lasting effect of acupuncture could further modulate intrinsic coherences of the wide interoceptive-autonomic areas, including the paralimbic regions and brainstem nuclei. These findings suggested that acupuncture may not only enhance the dichotomy of the anticorrelated resting networks, but also modulate a larger spatio-temporal extent of spontaneous activities in the salient interoceptive-autonomic network, contributing to potential actions in the endogenous pain-modulation circuits and homeostatic control mechanisms.

Brain Res. 2009 Jul 7;1279:37-49. Epub 2009 May 8. Bai L, Qin W, Tian J, Dong M, Pan X, Chen P, Dai J, Yang W, Liu Y. Life Science Research Center, School of Life Science and Technology, Xidian University, Xi' an, China.

The reduction of elevated polyamine (PA) levels in biological fluids of cancer patients were known to be correlated with remission following diverse therapeutic treatments. In this study, altered urinary PA levels from three different cancer cases were monitored at different intervals during the long-term weekday acupuncture treatments. Nine urinary PA levels from 16 normal and three cancer patients with different types were measured by gas chromatography-mass spectrometry in selected ion monitoring mode as N-ethoxycarbonyl-N-pentafluoropropionyl derivatives. Their levels measured at three follow-up stages for each patient were then normalized to the corresponding normal group means and plotted into star symbol patterns. Large alterations of PA levels were observed for each patient. Each normalized concentration displayed elevation of the PA levels in multiples (0.0-57.7) of the respective normal mean values. The normalized PA values were transformed into distorted star patterns which were characteristic of each follow-up stage and of cancer type.

Amino Acids. 2009 Jul;37(2):407-13. Epub 2008 Aug 20. Paik MJ, Kuon D, Cho J, Kim KR. Metabolomic Analysis Laboratory, Institute for Neuroregeneration and Stem Cell Research, School of Medicine, Ajou University, Suwon 443-721, Republic of Korea.

Full Title: Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial

Acupuncture has been used to treat the problem of hot flashes in healthy postmenopausal women. The object of this study was to investigate the efficacy of acupuncture in women with breast cancer suffering from hot flashes as a result of anti-oestrogen medication. In a prospective, controlled trial, 59 women suffering from hot flashes following breast cancer surgery and adjuvant oestrogen-antagonist treatment (Tamoxifen) were randomized to either 10 weeks of traditional Chinese acupuncture or sham acupuncture (SA). Mean number of hot flashes at day and night were recorded prior to treatment, during the treatment period as well as during the 12 weeks following treatment. A validated health score (Kupperman index) was conducted at baseline, at the end of the treatment period and at 12 weeks following treatment. During the treatment period mean number of hot flashes at day and night was significantly reduced by 50 and almost 60%, respectively from baseline in the acupuncture group, and was further reduced by 30% both at day and night during the next 12 weeks. In the sham acupuncture group a significant reduction of 25% in hot flashes at day was seen during treatment, but was reversed during the following 12 weeks. No reduction was seen in hot flashes at night. Kupperman index was reduced by 44% from baseline to the end of the treatment period in the acupuncture group, and largely maintained 12 weeks after treatment ended. No corresponding changes were seen in the sham acupuncture group. Acupuncture seems to provide effective relief from hot flashes both day and night in women operated for breast cancer, treated with Tamoxifen. This treatment effect seems to coincide with a general health improvement measured with the validated Kupperman index.

Breast Cancer Res Treat. 2009 Jul;116(2):311-6. Epub 2008 Oct 7. Hervik J, Mjåland O. Pain Clinic, Vestfold Hospital, Tonsberg, Norway. jill.hervik@siv.no

Full Title: Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion

The purpose of this pilot study was to assess the effect of an individualized traditional Chinese medicine (TCM) acupuncture and moxibustion (Acu/Moxa) treatment on symptom control in patients with irritable bowel syndrome (IBS) in a preliminary, randomized, sham/placebo-controlled trial. Twenty-nine men and women with IBS were randomized to either individualized Acu/Moxa (treatment group) or sham/placebo Acu/Moxa (control group). All subjects were assessed by a diagnostic acupuncturist for a TCM evaluation and individualized point prescription. Only those subjects assigned to the experimental group received the individually prescribed treatment. The diagnostic acupuncturist did not administer treatments and was blind to treatment assignments. All subjects kept a symptom diary for the duration of the study, enabling measurement of symptom frequency, severity, and improvement. The Clinical Global Impression Scale was administered preintervention to establish baseline severity and on completion of the 4-week, eight-session treatment intervention. After 4 weeks of twice-weekly Acu/Moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.

Gastroenterol Nurs. 2009 Jul-Aug;32(4):243-55. Anastasi JK, McMahon DJ, Kim GH. Columbia University School of Nursing, New York, NY 10032, USA. jka8@columbia.edu

Full Title: Efficacy of acupuncture for the treatment of fibromyalgia: systematic review and meta-analysis of randomized trials

OBJECTIVE: The study sought to ascertain the effectiveness of acupuncture as a treatment for fibromyalgia MATERIALS AND METHODS: THE FOLLOWING ELECTRONIC DATABASES WERE SEARCHED: PubMed; The Cochrane Library (CENTRAL); EMBASE; CINAHL; and Pascal Biomed (last date of search: January 2008). We analyzed pain intensity and patient withdrawals prior to termination of the study. A meta-analysis was performed, and a weighted global effect obtained using the inverse of variance. RESULTS: This review covered a total of 6 studies (323 subjects). No statistically significant differences were observed in terms of pain intensity (VAS): 0.02 (-0.24 a 0.28) or withdrawals: RR 0.91 (0.53 a 1.58) CONCLUSION: This systematic review found no evidence of benefit resulting from acupuncture versus placebo, as a treatment for fibromyalgia.

Open Rheumatol J. 2009 Jun 16;3:25-9. Martin-Sanchez E, Torralba E, Díaz-Domínguez E, Barriga A, Martin JL. Department of Clinical Research, Castile-La Mancha Health Research Foundation (FISCAM), Toledo, Spain.

Full Title: Exploring the Evidence Base for Acupuncture in the Treatment of Meniere's Syndrome--A Systematic Review

Ménière's syndrome is a long-term, progressive disease that damages the balance and hearing parts of the inner ear. To address the paucity of information on which evidence-based treatment decisions should be made, a systematic review of acupuncture for Ménière's syndrome was undertaken. The method used was a systematic review of English and Chinese literature, from six databases for randomized, non-randomized and observational studies. All studies were critically appraised and a narrative approach to data synthesis was adopted. Twenty-seven studies were included in this review (9 in English and 18 in Chinese languages): three randomized controlled trials, three non-randomized controlled studies and four pre-test, post-test designs. All but one of the studies was conducted in China. The studies covered body acupuncture, ear acupuncture, scalp acupuncture, fluid acupuncture point injection and moxibustion. The studies were of varying quality. The weight of evidence, across all study types, is of beneficial effect from acupuncture, for those in an acute phase or those who have had Ménière's syndrome for a number of years. The review reinforces the importance of searching for studies from English and Chinese literature. The transferability of the findings from China to a Western context needs confirmation. Further research is also needed to clarify questions around the appropriate frequency and number of treatment/courses of acupuncture. The weight of evidence suggests a potential benefit of acupuncture for persons with Ménière's disease, including those in an acute phase and reinforces the importance of searching for published studies in the Chinese language.

Evid Based Complement Alternat Med. 2009 Jun 8. Long AF, Xing M, Morgan K, Brettle A. School of Healthcare, University of Leeds, Room 3.10, Baines Wing, Leeds, LS2 9UT, UK. a.f.long@leeds.ac.uk.

We report a case of pain management after a meniscal cyst excision, with the use of electroacupuncture (EA). There are a few reports which indicate that postoperative pain management is prerequisite for the patient's optimal recovery, but surveys in the UK and the USA have identified an unacceptable prevalence of poor pain control after surgery, which might increase the risk of a chronic pain state. The conventional treatment of postoperative pain includes systemic medications such as opioids, non-steroidal anti-inflammatory drugs and other non-opioid agents. In our case, the rehabilitation lasted for 6 months without significant benefit. After that period our patient was treated with EA. By the end of the first EA session the relief of pain was notable and after a course of 10 treatments the patient reported complete relief of the symptoms with no recurrence during a 2 year follow up period. In conclusion, this might indicate that EA could be useful for postoperative pain management.

Acupunct Med. 2009 Jun;27(2):79-80. Galanis N, Stavraka C, Boutsiadou T, Kirkos JM, Kapetanos G. Kerasountos 6, Thessaloniki 55131, Greece; kyros@med.auth.gr.

This case describes the treatment of severe involuntary movements in a 10-year-old boy suffering from cerebral palsy. Needling GB34 and ST36 bilaterally for 25 minutes resulted in immediate temporary cessation of involuntary extension contractions of the erector spinae muscles for the duration of the treatment, resulting in increased functionality in the patient. This response occurred regularly on repeated treatment, but was not maintained between treatments. Involuntary movements are a major disabling feature of cerebral palsy, which impair quality of life and often prove difficult to treat successfully. This case is reported with the hope that this simple technique may provide relief for other patients suffering similar symptoms.

Acupunct Med. 2009 Jun;27(2):76-8. Watson P. University of Bristol, Bristol, UK; Paul.Watson@doctors.org.uk.

During acupuncture some patients experience distinct sensations which are often referred to as needle sensation. Needle sensation may be related to treatment outcome, although what constitutes adequate acupuncture needle sensation is not known. In this paper, we debate the possibility of using the self-report of the overall intensity of needle sensation as a predictor of analgesic outcome to acupuncture. We describe how our approach to establish criteria to determine adequacy of transcutaneous electrical nerve stimulation interventions in clinical trials has been used to inform our search for markers of adequacy of procedural technique for acupuncture. We describe previous research which has focused on developing tools to capture the nature of the descriptors used by patients when they self-report needle sensation and reveal that little attention has been given to its role in outcome. We demonstrate that needle sensation is a complex phenomenon with subjects using multiple descriptors to report their experience. We argue that the intensity of the overall experience of needle sensation may prove useful as a gross marker of the adequacy of acupuncture. We briefly describe our research which isolates individual components of needling technique, such as depth of needle penetration and bidirectional needle rotation, in order to assess their contribution to overall needle sensation intensity.

Acupunct Med. 2009 Jun;27(2):65-7. Benham A, Johnson MI. Faculty of Health, Leeds Metropolitan University, Civic Quarter, Leeds LS1 3HE, UK; A.Benham@Leedsmet.ac.uk.

The acupuncture treatment formulae for some common conditions are reviewed. These conditions include low back pain, sciatica, trigeminal neuralgia, facial nerve palsy, asthma, nausea and vomiting, gastritis and dysmenorrhoea. It is found that in many cases, the acupuncture points traditionally used for the treatment have a neuroanatomical significance from the viewpoint of Western medicine. And from that one can hypothesise a plausible mechanism of action as to how acupuncture achieves its therapeutic effects in terms of contemporary Western medicine. These mechanisms of action include intramuscular stimulation for treating muscular pain and nerve stimulation for treating neuropathies. The sympathetic ganglion may be involved in the acupuncture treatment of asthma. Somato-autonomic reflex may be responsible for the acupuncture effect on gastritis.

Acupunct Med. 2009 Jun;27(2):61-4. Cheng KJ. North East Medical Services, 82 Leland Ave, San Francisco, CA 94134, USA; kjcheng@sbcglobal.net.

OBJECTIVES: This study was undertaken to describe under real-life conditions the effects of acupuncture on symptomatic dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone. METHODS: A total of 42 conventionally treated pregnant women were allocated by chance into two groups to be treated, or not, by acupuncture. They reported the severity of symptoms and the disability these were causing in daily aspects of life such as sleeping and eating, using a numerical rating scale. The study also observed the use of medications. RESULTS: Six women dropped out (one in the acupuncture group and five in the control group). Significant improvements in symptoms were found in the study group. This group also used less medication and had a greater improvement in their disabilities when compared with the control group. CONCLUSIONS: This study suggests that acupuncture may alleviate dyspepsia during pregnancy.

Acupunct Med. 2009 Jun;27(2):50-3. da Silva JB, Nakamura MU, Cordeiro JA, Kulay L Jr, Saidah R. Rua Pernambuco 3147, Sao Jose do Rio Preto, Brazil; jbgsilva@hotmail.com.