Full title: Acupuncture therapy for infants: a preliminary report on reasons for consultation, feasibility, and tolerability.

Objectives/aims: The aim of this retrospective review was to determine the feasibility, safety, and potential therapeutic effects of acupuncture in an inpatient infant population and to obtain data that would support the design of a randomized, controlled trial of acupuncture in infants. Background:? Hospitalized infants are often exposed to sedative and analgesic medications to facilitate intensive and invasive medical care. With increasing concern about the potential neurotoxic effects of common analgesic and sedative medications, minimizing an infant's exposure to such agents is desirable. Acupuncture can be therapeutic in adults and children, but data in infants are lacking. Methods/materials: We performed a retrospective chart review of infants who received acupuncture during hospitalizations between 2008 and 2010. Demographic data, diagnoses, reason for acupuncture consult, ventilator settings, sedative/analgesic medication regimens, details of acupuncture therapy, and adverse effects were among data collected. Results:? Ten infants were identified in this review, seven of whom had agitation issues, two of whom had feeding difficulties, and one had both symptoms. Six of the eight infants with agitation had a decrease in the use of sedative and analgesic medications over the acupuncture therapy period, and four of five initially requiring mechanical ventilation were successfully weaned. One of the three infants with oral aversion transitioned rapidly to oral intake. Acupuncture therapy was well tolerated, and there were no complications observed. Conclusions: In this small group of hospitalized infants, acupuncture was found to be safe, well tolerated, and therapeutic. More studies are warranted to define the role of acupuncture in this population.

© 2011 Blackwell Publishing Ltd.

Paediatr Anaesth. 2011 Dec 6. doi: 10.1111/j.1460-9592.2011.03743.x. Gentry KR, McGinn KL, Kundu A, Lynn AM. Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA, USA ?Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA.

Abstract Although dyspnea is frequently encountered in the palliative care setting, its optimal management remains uncertain. Clinical approaches begin with accurate assessment, as delineated in part one of this two-part series. Comprehensive dyspnea assessment, which encompasses the physical, emotional, social, and spiritual aspects of this complex symptom, guide the clinician in choosing therapeutic approaches herein presented as part two. Global management of dyspnea is appropriate both as complementary to disease-targeted treatments that target the underlying etiology, and as the sole focus when the symptom has become intractable, disease is maximally treated, and goals of care shift to comfort and quality of life. In this setting, current evidence supports the use of oral or parenteral opioids as the mainstay of dyspnea management, and of inhaled furosemide and anxiolytics as adjuncts. Nonpharmacologic interventions such as acupuncture and pulmonary rehabilitation have potential effectiveness, although further research is needed, and use of a simple fan warrants consideration given its potential benefit and minimal burden and cost.

J Palliat Med. 2012 Jan;15(1):106-14. Kamal AH, Maguire JM, Wheeler JL, Currow DC, Abernethy AP. 1 Department of Medicine, Division of Medical Oncology, Duke University Medical Center , Durham, North Carolina.

OBJECTIVES: Chemotherapy-induced peripheral neuropathy (CIPN) can produce severe neurological deficits and neuropathic pain and is a potential reason for terminating or suspending chemotherapy treatments. Specific and effective curative treatments are lacking. METHODS: A pilot study was conducted to evaluate the therapeutic effect of acupuncture on CIPN as measured by changes in nerve conduction studies (NCS) in six patients treated with acupuncture for 10 weeks in addition to best medical care and five control patients who received the best medical care but no specific treatment for CIPN. RESULTS: In five of the six patients treated with acupuncture, NCS improved after treatment. In the control group, three of five patients did not show any difference in NCS, one patient improved and one showed impaired NCS. CONCLUSION: The data suggest that acupuncture has a positive effect on CIPN. The encouraging results of this pilot study justify a randomised controlled trial of acupuncture in CIPN on the basis of NCS.

Acupunct Med. 2011 Dec 5. Schroeder S, Meyer-Hamme G, Epplée S. 1HanseMerkur Center for TCM at the University Medical Centre, Hamburg, Germany.

OBJECTIVE: To familiarize oncology nurses about the theory and research related to Traditional Chinese Medicine (TCM) for management of cancer-related symptoms. DATA SOURCES: Peer-reviewed journal articles, TCM texts, professional experience. CONCLUSION: The increasing integration of TCM into mainstream medicine mandates that oncology professionals be familiar with the benefits as well as risks. Clinical research on acupuncture in cancer care is growing and demonstrates it is safe for cancer patients, although results on efficacy across symptoms have been mixed. IMPLICATIONS FOR NURSING PRACTICE: Informed oncology nurses can assist patients by making appropriate referrals to licensed acupuncturists and qualified TCM practitioners to help alleviate unpleasant symptoms associated with cancer and conventional cancer treatment.

Copyright © 2012 Elsevier Inc. All rights reserved.

Semin Oncol Nurs. 2012 Feb;28(1):64-74. Smith ME, Bauer-Wu S.

Background. There has been lack of reviews of evidence on efficacy, methodology, and/or safety of acupuncture in autism spectrum disorders. This paper examines the emerging evidence of the effects of acupuncture in the treatment of autistic children. Method. A literature review was completed via Medline and three Chinese search engines. A total of 31 studies were evaluated for acupuncture methodology, study design, treatment effects, and tolerability. Results. The acupoints used, the duration of needling, the frequency of treatment, the choice of stimulation, and the course of the treatment were highly variable amongst the studies. Behavioral and/or developmental improvements were reported in all acupuncture treatment studies. All studies reported general tolerability. Weakness of experimental designs was discussed. Conclusions. Vigorously controlled double-blinded clinical trials are needed to evaluate the efficacy and safety of acupuncture in children with autism spectrum disorders.

Evid Based Complement Alternat Med. 2012;2012:679845. Ming X, Chen X, Wang XT, Zhang Z, Kang V, Zimmerman-Bier B. Department of Neurosciences and Neurology, UMDNJ-New Jersey Medical School, 90 Bergen Street, DOC 8100, Newark, NJ 07103, USA.

Placebos are an essential tool in randomised clinical trials, where they are used to control for bias and contextual healing effects. Placebos and their effects are also studied from multiple diverse perspectives, but the perspectives of placebo recipients are seldom considered. Research shows that people form cognitive and affective representations of active treatments such as medicines, and that they use these representations to guide their behaviour; it seems reasonable to suggest that people might also think about and develop representations of placebos. We adopted a qualitative approach to examine in detail how participants in one RCT, conducted in the USA, conceptualised placebos. 12 people were interviewed 3 times each, at the start, middle, and end of a trial of placebo effects and acupuncture for Irritable Bowel Syndrome (IBS). The interview data were analysed inductively and we identified four ways in which the participants conceptualised placebos: placebos are necessary for research; placebo effects are fake; placebo acupuncture is not real acupuncture; placebos have real effects mediated by psychological mechanisms. Participants' conceptualisations of placebos were dynamic and situated in a broader psychological and socio-cultural context. Seeing placebo effects as legitimate seemed to be facilitated by having more holistic models of healing, viewing IBS as psychological, and seeing treatment as multifactorial. However, some participants maintained a negative view of placebo effects (e.g. as illusions) that was apparently inconsistent with their other beliefs (e.g. in mind-body healing mechanisms). This may indicate a dominance of negative discourses around placebos at a socio-cultural level. Negative views of placebos are inconsistent with evidence that placebo treatments can have positive effects on symptoms. RCT participants should be informed about potential benefits of placebo treatments to avoid misunderstandings and unease. Future work should improve methods of providing participants with full accurate information about placebos and their effects.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Soc Sci Med. 2012 Jan 18. Bishop FL, Jacobson EE, Shaw JR, Kaptchuk TJ. University of Southampton School of Medicine, Southampton, Hampshire SO16 5ST, United Kingdom.

Full title: Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma.

BACKGROUND: Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients. Quality of life (QOL) is impaired, and available treatments are of little benefit. This trial determined the feasibility of conducting a sham-controlled trial of acupuncture and whether acupuncture could prevent xerostomia among head/neck patients undergoing radiotherapy. METHODS: A sham controlled, feasibility trial was conducted at Fudan University Shanghai Cancer Center, Shanghai, China among patients with nasopharyngeal carcinoma undergoing radiotherapy. To determine feasibility of a sham procedure, 23 patients were randomised to real acupuncture (N=11) or to sham acupuncture (N=12). Patients were treated three times/week during the course of radiotherapy. Subjective measures were the Xerostomia Questionnaire (XQ) and MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN). Objective measures were unstimulated whole salivary flow rates (UWSFR) and stimulated salivary flow rates (SSFR). Patients were followed for 1 month after radiotherapy. RESULTS: XQ scores for acupuncture were significantly lower than sham controls starting in week 3 and lasted through the 1-month follow-up (all P's <0.001 except for week 3, which was 0.006), with clinically significant differences as follows: week 6 - RR 0.28 [95% confidence interval, 0.10, 0.79]; week 11 - RR 0.17 [95%CI, 0.03, 1.07]. Similar findings were seen for MDASI-HN scores and MDASI-Intrusion scores. Group differences for UWSFR and SSFR were not found. CONCLUSIONS: In this small pilot study, true acupuncture given concurrently with radiotherapy significantly reduced xerostomia symptoms and improved QOL when compared with sham acupuncture. Large-scale, multi-centre, randomised and placebo-controlled trials are now needed.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Eur J Cancer. 2012 Jan 27. Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Wu C, Zhao Q, Zhao G, Liu L, Spelman A, Lynn Palmer J, Wei Q, Cohen L. Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.

Hot flashes are a common complaint among women as they transition through menopause. This article reviews the evidence of lifestyle alterations for the amelioration of hot flashes including obesity, exercise, smoking, relaxation techniques, and acupuncture. Further randomized controlled trials regarding these lifestyle alterations are needed to determine their full potential benefits regarding hot flashes.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Maturitas. 2012 Jan 27. Fisher TE, Chervenak JL. Albert Einstein College of Medicine and Montefiore Medical Center, New York, NY, USA.

Randomised controlled trials (RCTs) of acupuncture often find equivalent responses to real and placebo acupuncture despite both appearing superior to no treatment. This raises questions regarding the mechanisms of acupuncture, especially the contribution of patient expectancies. We systematically reviewed previous research assessing the relationship between expectancy and treatment responses following acupuncture, whether real or placebo. To be included, studies needed to assess and/or manipulate expectancies about acupuncture and relate these to at least one health-relevant outcome. Nine such independent studies were identified through systematic searches of Medline, PsycInfo, PubMed, and Cochrane Clinical Trials Register. The methodology and reporting of these studies were quite heterogeneous, meaning that meta-analysis was not possible. A descriptive review revealed that five studies found statistically significant effects of expectancy on a least one outcome, with three also finding evidence suggestive of an interaction between expectancy and type of acupuncture (real or placebo). While there were some trends in significant effects in terms of study characteristics, their generality is limited by the heterogeneity of study designs. The differences in design across studies highlight some important methodological considerations for future research in this area, particularlyregarding whether to assess or manipulate expectancies and how best to assess expectancies.

Evid Based Complement Alternat Med. 2012;2012:857804. Epub 2011 Nov 14. Colagiuri B, Smith CA. Centre for Complementary Medicine Research, University of Western Sydney, NSW 2751, Australia.

Randomised controlled trials (RCTs) of acupuncture often find equivalent responses to real and placebo acupuncture despite both appearing superior to no treatment. This raises questions regarding the mechanisms of acupuncture, especially the contribution of patient expectancies. We systematically reviewed previous research assessing the relationship between expectancy and treatment responses following acupuncture, whether real or placebo. To be included, studies needed to assess and/or manipulate expectancies about acupuncture and relate these to at least one health-relevant outcome. Nine such independent studies were identified through systematic searches of Medline, PsycInfo, PubMed, and Cochrane Clinical Trials Register. The methodology and reporting of these studies were quite heterogeneous, meaning that meta-analysis was not possible. A descriptive review revealed that five studies found statistically significant effects of expectancy on a least one outcome, with three also finding evidence suggestive of an interaction between expectancy and type of acupuncture (real or placebo). While there were some trends in significant effects in terms of study characteristics, their generality is limited by the heterogeneity of study designs. The differences in design across studies highlight some important methodological considerations for future research in this area, particularlyregarding whether to assess or manipulate expectancies and how best to assess expectancies.

Evid Based Complement Alternat Med. 2012;2012:857804. Epub 2011 Nov 14. Colagiuri B, Smith CA. Centre for Complementary Medicine Research, University of Western Sydney, NSW 2751, Australia.

Randomised controlled trials (RCTs) of acupuncture often find equivalent responses to real and placebo acupuncture despite both appearing superior to no treatment. This raises questions regarding the mechanisms of acupuncture, especially the contribution of patient expectancies. We systematically reviewed previous research assessing the relationship between expectancy and treatment responses following acupuncture, whether real or placebo. To be included, studies needed to assess and/or manipulate expectancies about acupuncture and relate these to at least one health-relevant outcome. Nine such independent studies were identified through systematic searches of Medline, PsycInfo, PubMed, and Cochrane Clinical Trials Register. The methodology and reporting of these studies were quite heterogeneous, meaning that meta-analysis was not possible. A descriptive review revealed that five studies found statistically significant effects of expectancy on a least one outcome, with three also finding evidence suggestive of an interaction between expectancy and type of acupuncture (real or placebo). While there were some trends in significant effects in terms of study characteristics, their generality is limited by the heterogeneity of study designs. The differences in design across studies highlight some important methodological considerations for future research in this area, particularlyregarding whether to assess or manipulate expectancies and how best to assess expectancies.

Evid Based Complement Alternat Med. 2012;2012:857804. Epub 2011 Nov 14. Colagiuri B, Smith CA. Centre for Complementary Medicine Research, University of Western Sydney, NSW 2751, Australia.

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China Chinese Medicine Department, Hong Kong Hospital Authority, Hong Kong SAR, China Asia Diabetes Foundation, Hong Kong SAR, China Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China Li Ka-shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China. Obesity is a major health hazard and despite lifestyle modification, many patients frequently regain any lost body weight. The use of western anti-obesity drugs has been limited by side effects including mood changes, suicidal thoughts, and gastrointestinal or cardiovascular complications. The effectiveness and safety of traditional Chinese medicine including Chinese herbal medicine (CHM) and acupuncture provide an alternative established therapy for this medical challenge. In this systematic review, we used standard methodologies to search, review, analyse and synthesize published data on the efficacy, safety and relapse of weight regain associated with use of CHM and acupuncture. We also examined the rationale, mechanisms and potential utility of these therapies. A total of 12 electronic databases, including Chinese, English, Korean and Japanese, were searched up to 28 February 2010. Randomized controlled trials (RCTs) for CHM and/or acupuncture with comparative controls were considered. We used the Jadad scale to assess methodological qualities, the random effect model in the pooled analysis of therapeutic efficacy to adjust for heterogeneity and funnel plots to explore publication bias. After screening 2,545 potential articles from the electronic databases, we identified 96 RCTs; comprising of 49 trials on CHM treatment, 44 trials on acupuncture treatment and 3 trials on combined therapy for appraisal. There were 4,861 subjects in the treatment groups and 3,821 in the control groups, with treatment duration ranging from 2 weeks to 4 months. Of the 77 publications written in Chinese, 75 had a Jadad score <3, while 16 of the 19 English publications had a Jadad score of >3. Efficacy was defined as body weight reduction ?2?kg or body mass index (BMI) reduction ?0.5?kg/m(2) . Compared with placebo or lifestyle modification, CHM and acupuncture exhibited respective 'risk ratio' (RR) of 1.84 (95% CI: 1.37-2.46) and 2.14 (95% CI: 1.58-2.90) in favour of body weight reduction, with a mean difference in body weight reduction of 4.03?kg (95% CI: 2.22-5.85) and 2.76?kg (95% CI: 1.61-3.83) and a mean difference in BMI reduction of 1.32?kg?m(-2) (95% CI: 0.78-1.85) and 2.02?kg?m(-2) (95% CI: 0.94-3.10), respectively. Compared with the pharmacological treatments of sibutramine, fenfluramine or orlistat, CHM and acupuncture exhibited an RR of 1.11 (95% CI: 0.96-1.28) and 1.14 (95% CI: 1.03-1.25) in body weight reduction, mean difference in body weight reduction of 0.08?kg (95% CI: -0.58 to 0.74) and 0.65?kg (95% CI: -0.61 to 1.91), and mean difference in BMI reduction of 0.18?kg?m(-2) (95% CI: -0.39 to 0.75) and 0.83?kg?m(-2) (95% CI: 0.29-1.37), respectively. There were fewer reports of adverse effects and relapses of weight regain in CHM intervention studies conducted in China than studies conducted outside China. CHM and acupuncture were more effective than placebo or lifestyle modification in reducing body weight. They had a similar efficacy as the Western anti-obesity drugs but with fewer reported adverse effects. However, these conclusions were limited by small sample size and low quality of methodologies.

© 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

Obes Rev. 2012 Feb 1. doi: 10.1111/j.1467-789X.2011.00979.x. Sui Y, Zhao HL, Wong VC, Brown N, Li XL, Kwan AK, Hui HL, Ziea ET, Chan JC.

Full title: Acupuncture stimulation alleviates corticosterone-induced impairments of spatial memory and cholinergic neurons in rats.

The purpose of this study was to examine whether acupuncture improves spatial cognitive impairment induced by repeated corticosterone (CORT) administration in rats. The effect of acupuncture on the acetylcholinergic system was also investigated in the hippocampus. Male rats were subcutaneously injected with CORT (5?mg/kg) once daily for 21 days. Acupuncture stimulation was performed at the HT7 (Sinmun) acupoint for 5?min before CORT injection. HT7 acupoint is located at the end of transverse crease of ulnar wrist of forepaw. In CORT-treated rats, reduced spatial cognitive function was associated with significant increases in plasma CORT level (+36%) and hippocampal CORT level (+204%) compared with saline-treated rats. Acupuncture stimulation improved the escape latency for finding the platform in the Morris water maze. Consistently, the acupuncture significantly alleviated memory-associated decreases in cholinergic immunoreactivity and mRNA expression of BDNF and CREB in the hippocampus. These findings demonstrate that stimulation of HT7 acupoint produced significant neuroprotective activity against the neuronal impairment and memory dysfunction. Evid Based Complement Alternat Med. 2012;2012:670536. Lee B, Sur BJ, Kwon S, Jung E, Shim I, Lee H, Hahm DH. Acupuncture and Meridian Science Research Center, College of Oriental Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Republic of Korea.

Full title: Prediction of gastric ulcers based on the change in electrical resistance of acupuncture points using fuzzy logic decision-making.

Many theories of reflexology use ancient concepts which do not coincide with the modern medical terminology of anatomy, physiology and biophysics. This substantially reduces the trust of physicians in reflexology methods. During this research, several mathematical models for the interaction of the internal and biological active points of meridian structures have been proposed. The analysis of these models allows the specification of a list of gastric diseases for which reflex diagnostics and reflex therapy methods are most effective and also allows increasing the effectiveness of these procedures. It is shown that good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

Comput Methods Biomech Biomed Engin. 2012 Jan 31. Al-Kasasbeh R, Korenevskiy N, Alshamasin M, Ionescou F, Smith A. a Faculty of Engineering Technology, Al-Balqa Applied University , Amman , Jordan.

Aim: The aim of this review is to examine the evidence for acupuncture's effectiveness as a depression intervention. Unlike other reviews, which consider methodological concerns relevant to all experimental evaluations, this review focuses on the scope of studies, and uses a PICO (patients, intervention, comparison, and outcome) structure to determine what can potentially be learned from primary studies that have already been screened for methodological quality by reviewers. Discussion: The review identified a number of study limitations. (i) Patients: majority of trial reports have not described a rationale for the selection of patients or inclusion/exclusion criteria. Prognostic indicators were not reported and there were also concerns about the generalizability of study populations. (ii) Intervention: most trials investigate poorly rationalized standardized acupuncture protocols thus quality of care may be an issue and generalizability to routine clinical practice is a main concern. In trials using other methods generalizability is also poor. (iii) Comparisons: concerns were raised about using therapeutically inappropriate acupuncture. (iv) Outcomes: short-term focus and the narrow range of outcomes explored. According to more recent systematic review evidence it is probable the shortcomings identified in the PICO review have not been addressed by subsequent research. The concept of model validity, proposed by other researchers, is discussed, and suggestions put forward about complex intervention evaluation methods, which may be better suited to evaluating acupuncture care. Conclusion: Uncertainty remains about the value of acupuncture care, as it is routinely practiced in the West, and this uncertainty has not been resolved by trials to date. Existing evaluations may however be useful for guiding decisions about the value of specific techniques for patients with depression.

CNS Neurosci Ther. 2011 Oct;17(5):398-410. doi: 10.1111/j.1755-5949.2010.00159.x. Schroer S, Adamson J. Health Sciences Department, ARRC Building, University of York, Heslington, York YO10 5DD, UK.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and by both systemic and airway inflammation. In COPD, acupuncture has been shown to improve quality-of-life scores and decrease breathlessness; similar findings have also been reported after pulmonary rehabilitation (PR). The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone. METHODS:: The design was a randomized prospective study; all subjects had COPD. There were 19 controls, 25 who underwent PR, and 16 who had both acupuncture and PR. The primary outcome measure was a change in measures of systemic inflammation at the end of PR and at 3 month followup. Lung function, including maximum inspiratory pressure (PiMax), quality-of-life scores, functional capacity including steps taken, dyspnea scores, and exercise capacity, were secondary endpoints. RESULTS: After PR, both groups had significantly improved quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and PiMax, but no change in measures of systemic inflammation compared with the controls. There were no differences in most of the outcome measures between the 2 treatment groups except that subjects who had both acupuncture and PR remained less breathless for a longer period. CONCLUSION: The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.

J Cardiopulm Rehabil Prev. 2011 Oct 5. Deering BM, Fullen B, Egan C, McCormack N, Kelly E, Pender M, Costello RW. Departments of Respiratory Medicine, Beaumont Hospital and the associated Education and Research Centre (Mss Deering, Egan, and McCormack and Drs Kelly and Costello), and School of Public Health, Physiotherapy, and Population Science,University College of Dublin (Mss Fullen and Pender), Dublin, Ireland.

Data sourcesMedline, PubMed, The Cochrane Library 2010, CINAHL, Embase, seven Korean Medical Databases and a Chinese Medical Database (China Academic Journal, www.cnki.co.kr).Study selectionParallel or cross-over RCTs that assessed the efficacy of acupuncture regardless of blinding, language and type of reporting published in English, Chinese and Korean were included. Dissertations and abstracts were included provided they contained sufficient detail. Complex interventions in which acupuncture was not a sole treatment and studies with no reported clinical data were excluded.Data extraction and synthesisAll RCTs were obtained and read in full by two independent reviewers and data extracted according to pre-defined criteria. Quality was assessed using the Cochrane risk of bias criteria. Meta-analysis was conducted using random effect models if excessive statistical heterogeneity did not exist. Additional subgroup analysis or sensitivity analysis additionally was conducted to explore heterogeneity. Publication bias was assessed by funnel plot using the Cochrane software.ResultsSeven RCTs (including 141 patients) met our inclusion criteria. Six studies comparatively tested needle acupuncture against penetrating sham acupuncture, non-penetrating sham acupuncture or sham laser acupuncture, whilst the remaining study tested laser acupuncture against sham laser acupuncture. Five studies were considered to be at low risk of bias. Outcomes were reported for pain intensity, facial pain, muscle tenderness and mouth opening.Conclusions: This systematic review produced limited evidence that acupuncture is more effective than sham acupuncture in alleviating pain and masseter muscle tenderness in TMD. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication.

Evid Based Dent. 2011;12(3):89. doi: 10.1038/sj.ebd.6400816. Türp JC. Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Switzerland.

Full Title: Synthesis of fuzzy logic for prediction and medical diagnostics by energy characteristics of acupuncture points.

A great number of reflexologies use ancient concepts that do not coincide with modern medical terminology of anatomy, physiology, and biophysics, substantially reducing the trust of today's physicians in this direction of their profession. Recently, several mathematical models of internal and biological active points of meridian structures interaction have been proposed. These models allowed specification of diseases for which reflex diagnostics and reflex therapy methods are most effective and also increased the efficacy of these procedures. Good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

J Acupunct Meridian Stud. 2011 Sep;4(3):175-82. Al-Kasasbeh R, Korenevskiy N, Ionescou F, Alshamasin M, Kuzmin A. Faculty of Engineering Technology, Al-Balqa Applied University, Jordan.

Full Title: Complementary and Alternative Medicine for Patients with Chronic Fatigue Syndrome: a Systematic Review.

ABSTRACT: BACKGROUND: Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown etiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. METHODS: Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. RESULTS: A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. CONCLUSIONS: The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

BMC Complement Altern Med. 2011 Oct 7;11(1):87. Alraek T, Lee MS, Choi TY, Cao H, Liu J.

Full Title: Complementary and Alternative Medicine for Patients with Chronic Fatigue Syndrome: a Systematic Review.

ABSTRACT: BACKGROUND: Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown etiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. METHODS: Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. RESULTS: A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. CONCLUSIONS: The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

BMC Complement Altern Med. 2011 Oct 7;11(1):87. Alraek T, Lee MS, Choi TY, Cao H, Liu J.

Full Title: Attitudes towards complementary and alternative medicine in chronic pain syndromes: A questionnaire-based comparison between primary headache and low back pain.

ABSTRACT: BACKGROUND: Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM. METHODS: Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients. RESULTS: In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p= 0.006), "take action against the disease" (56.8% vs. 43.2%; p= 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience. CONCLUSION: Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdensfor daily life.

BMC Complement Altern Med. 2011 Oct 7;11(1):89. Gaul C, Schmidt T, Czaja E, Eismann R, Zierz S.

Full Title: Methodological issues in evaluating auricular acupuncture therapy for problems arising from the use of drugs and alcohol.

Auricular acupuncture is an accessible, non-confrontational therapy that appears to be effective when used in drug and alcohol treatment facilities, hospitals and prisons in the UK, Europe and the USA. Despite being popular, research evidence on its effectiveness is lacking, and as a result services are underfunded and risk being withdrawn. There are methodological problems in researching auricular acupuncture. In these days of evidence-based medicine, most studies in this area are explanatory randomized controlled trials, which is limited in capturing the complete benefits of the intervention. Furthermore, there is lack of consensus over definitions of the concept of 'addiction' and whether or not this should be perceived as a 'disease' that can be 'cured' by an intervention such as auricular acupuncture. Basic concepts such as these need to inform development of outcome measures, which should include retention of clients in treatment as an indicator of success. It is argued here that the best approach will integrate research on physical effects with research on subjective experience of those with drug and alcohol problems. The challenge is to design large scale, high quality, pragmatic randomized controlled trials to assess the effectiveness of auricular acupuncture over the longer term in settings that mimic the delivery of treatment in practice and are informed by acupuncture's own diagnostic traditions, using a combination of objective, quantitative methods and subjective, qualitative methods.

Cowan D. Faculty of Healthand Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK. david.cowan@lsbu.ac.uk

Full Title: Management of primary chronic headache in the general population: the Akershus study of chronic headache.

Primary chronic headaches cause more disability and necessitate high utilization of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30-44 years.

Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalized. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalized. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication over use and increased use of prophylactic medication may improve the management of primary chronic headaches in the future.

J Headache Pain. 2011 Oct 13. Kristoffersen ES, Grande RB, Aaseth K, Lundqvist C, Russell MB. Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Oslo, Norway.

Full Title: De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea.

OBJECTIVE: To study the impact of De-qi (, obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea, with an attempt to explore the relationship among De-qi, psychological factors, and clinical efficacy. METHODS: The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation (manipulation group, n=67) and an acupuncture group without manipulation (non-manipulation group, n=64). Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment. De-qi, the sensations a patient experienced during the acupuncture treatment, was scored on a 4-point scale by the subjects. In addition, the psychological factors, including belief in acupuncture, the level of nervousness, anxiety, and depression, were quantitatively assessed. The personality of the subject was assessed using the Eysenck personality questionnaire (EPQ) and 16 personality factor questionnaire (16PF). RESULTS: Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity (W=2410.0, P<0.01) and pain duration (W=3181.0, P<0.01) between the two groups. The number of De-qi acupoints (W=1150.5, P<0.01) and the average intensity of De-qi (W=1141.0, P<0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy. CONCLUSIONS: Compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

Chin J Integr Med. 2011 Oct 12. Xiong J, Liu F, Zhang MM, Wang W, Huang GY. Institute of Integrated Traditional and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

Full title: Subjective Well-being in Patients With Chronic Tension-type Headache: Effect of Acupuncture, Physical Training, and Relaxation Training.

BACKGROUND: Episodic tension-type headache is a common problem affecting approximately 2 of 3 of the population. The origin of tension-type headache is multifactorial, but the pathogenesis is still unclear. In some individuals episodic tension-type headache transforms into chronic tension-type headache (CTTH). Subjective symptoms related to the central nervous system might affect patients subjective well-being and quality of life. OBJECTIVE: This study compared 3 nonpharmacologic treatments; acupuncture, relaxation training, and physical training on subjective well-being in patients with CTTH. METHODS: Ninety consecutive patients with CTTH were randomly allocated to acupuncture, relaxation training, or physical training. At baseline 88 age-matched and sex-matched healthy controls were compared with the patients with CTTH. Subjective, central nervous system-related symptoms that might affect patients' subjective well-being and quality of life were assessed with the Minor Symptom Evaluation Profile, which contains 24 self-administered standardized items with visual analog scale responses. Fifteen items are categorized into 3 dimensions: contentment, vitality, and sleep. Assessments were made before treatment, immediately after, and 3 and 6 months after the last treatment. RESULTS: Baseline values of the total score of the 24 items and the 3 dimensions were generally lower in patients with tension-type headache compared with the reference group. No significant differences were found among the 3 treatment groups during the baseline period. All treatments proportionally improved the subjective, central nervous system-related symptoms in patients with CTTH. The 3-month follow-up, the total score of the Minor Symptom Evaluation Profile was significantly improved in the physical training group compared with the acupuncture group (P=0.036). Total mean over period was also highest in the physical training group compared with the acupuncture group (P=0.025). The vitality and sleep dimension was significantly improved at the 6-month follow-up in the relaxation training group compared with the acupuncture group (P=0.04). CONCLUSIONS: Physical training and relaxation training seem to be preferable nonpharmacologic treatments for improvement of central nervous system-related symptoms and subjective well-being for patients with CTTH.

Clin J Pain. 2011 Jun;27(5):448-56. Söderberg EI, Carlsson JY, Stener-Victorin E, Dahlöf C. Departments of *Clinical Neuroscience and Rehabilitation/Physiotherapy †Physiology/Endocrinology ‡Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg §Gothenburg Migraine Clinic, Göteborg, Sweden.

Background: Sometimes pregnant women take it on themselves to hasten labor to alleviate the discomforts of pregnancy. This study sought to identify how frequently women attempt to induce labor through nonprescribed methods, and what factors are associated with the use of such methods. Methods: Surveys were distributed to postpartum women who had delivered at a Midwestern academic hospital. Women were asked what methods they had used to induce labor on their own, where they heard about these methods, and whether they had discussed it with their physician. Information about demographics and mode and timing of delivery was also collected. Results: Of the 201 women who responded, 99 (49.3%) did not try to induce labor themselves, whereas 102 (50.7%) used some type of nonprescribed method to induce labor. The most common method was walking (43.3%), followed by intercourse (22.9%), ingesting of spicy food (10.9%), and nipple stimulation (7.5%). Very few respondents used laxatives, heavy exercise, masturbation, acupuncture, or herbal preparations to induce labor. Women who used any nonprescribed method to induce labor were younger, had a lower parity, greater gestational age, and were more likely to have had a vaginal birth. Conclusions: A substantial portion of women used nonprescribed methods to induce labor, often without discussing them with a physician. Maternity caregivers may want to inquire about such issues, especially where interventions may do more harm than good. (BIRTH 38:2 June 2011).

Birth. 2011 Jun;38(2):168-71. doi: 10.1111/j.1523-536X.2010.00465.x. Epub 2011 Mar 10. Chaudhry Z, Fischer J, Schaffir J. Zaid Chaudhry is a Medical Student at the Ohio State University College of Medicine; Jane Fischer is Staff Nurse and Program Director at the Women & Infants' Program, Ohio State University Medical Center; and Jonathan Schaffir is Associate Professor of Clinical Obstetrics & Gynecology at the Ohio State University College of Medicine, Columbus, Ohio, United States of America.

Acupuncture has been used in numerous diseases and for many types of symptoms. It has been also used for obstetric complaints, such as nausea and vomiting, insomnia and low back and girdle pain. There has long been concern that some points-called forbidden-might harm pregnancy owing to a potential abortifacient effect, but it is difficult to confirm this proposition. The small number of available publications on this topic seems to show that this is not correct. Animal research examining possible harmful effects and a systematic review would be welcome to throw some light on this question.

Acupunct Med. 2011 Jun;29(2):135-6. Epub 2011 Mar 20. da Silva AV, Nakamura MU, da Silva JB. Rio Preto Medical College, Rua Pernambuco, 3147 Redentora, São José do Rio Preto,SP CEP 15015-770, Brazil; jbgsilva@hotmail.com.

Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. It can be associated with adverse events related to the small electric currents used, in addition to the adverse events related to needle penetration of tissues. This paper reports a case of minor tissue damage following high intensity EA for 30 min with a device delivering a waveform that does not appear to be completely charge-balanced. This case highlights a rare but preventable adverse event. Manufacturers should be encouraged to develop EA stimulators that use charge-balanced waveforms.

Acupunct Med. 2011 Jun;29(2):147-51. Cummings M. Medical Director, British Medical Acupuncture Society, Royal London Hospital for Integrated Medicine, 60 Great Ormond Street, London WC1N 3HR, UK; BMASLondon@aol.com.

Full title: Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study.

OBJECTIVE: The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI). Design 30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up). RESULTS: Data were analysed on an intention-to-treat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping improved significantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference on the Multidimensional Pain Inventory improved. At follow-up no significant improvements were seen. Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of acupuncture. At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a favourable effect from the treatment. Few side effects were reported and neither dropout from the study did this due to adverse events. CONCLUSION: Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.

Acupunct Med. 2011 Jun;29(2):108-15. Epub 2011 Apr 6. Norrbrink C, Lundeberg T. Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm 18288, Sweden; cecilia.norrbrink@ki.se.

BACKGROUND: Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. Purpose To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. METHODS: Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation. RESULTS: In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points. CONCLUSION: The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.

Acupunct Med. 2011 Jun 4. Park JJ, Akazawa M, Ahn J, Beckman-Harned S, Lin FC, Lee K, Fine J, Davis RT, Langevin H. 1Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Full title: Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs.

OBJECTIVE: To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing. METHODS: 20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes-No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions. RESULTS: The participants' discrimination accuracy between the real and sham needles was not statistically significant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t(19)=0.00, unadjusted p=1.00; combined: t(19)=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically significant from P(C)=0.5 for the upper limb acupoints alone comparison (t(19)=2.36, unadjusted p=0.03). CONCLUSIONS: This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was significantly different from chance levels.

Acupunct Med. 2011 Jun 7. Tan CW, Sheehan P, Santos D. School of Health Sciences, Queen Margaret University Edinburgh, Edinburgh, UK.

Full title: Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial.

OBJECTIVES: To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women. METHODS: The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes. RESULTS: 54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period. CONCLUSIONS: Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.

Acupunct Med. 2011 Jun 8. Kim DI, Jeong JC, Kim KH, Rho JJ, Choi MS, Yoon SH, Choi SM, Kang KW, Ahn HY, Lee MS. 1Department of Obstetrics and Gynecology, College of Traditional Korean Medicine, Dongguk University, Seoul, South Korea.

This systematic review aims to summarize all reported cases of cardiac tamponade after acupuncture. Five electronic databases and our own files were searched for reports of cardiac tamponade after acupuncture. No restrictions in time or language were imposed. Data were extracted by two independent reviewers according to predefined criteria. We found a total of 26 cases. In 14 patients, the complications were fatal. In most instances, there is little doubt about causality. We conclude that cardiac tamponade is a serious, often fatal complication after acupuncture. As it is theoretically avoidable, acupuncturists should be trained to minimize the risk.

Int J Cardiol. 2011 Jun 16;149(3):287-9. Epub 2010 Nov 19. Ernst E, Zhang J.

Full title: Placebo studies and ritual theory: a comparative analysis of Navajo, acupuncture and biomedical healing.

Using a comparative analysis of Navajo healing ceremonials, acupuncture and biomedical treatment, this essay examines placebo studies and ritual theory as mutually interpenetrating disciplines. Healing rituals create a receptive person susceptible to the influences of authoritative culturally sanctioned 'powers'. The healer provides the sufferer with imaginative, emotional, sensory, moral and aesthetic input derived from the palpable symbols and procedures of the ritual process-in the process fusing the sufferer's idiosyncratic narrative unto a universal cultural mythos. Healing rituals involve a drama of evocation, enactment, embodiment and evaluation in a charged atmosphere of hope and uncertainty. Experimental research into placebo effects demonstrates that routine biomedical pharmacological and procedural interventions contain significant ritual dimensions. This research also suggests that ritual healing not only represents changes in affect, self-awareness and self-appraisal of behavioural capacities, but involves modulations of symptoms through neurobiological mechanisms. Recent scientific investigations into placebo acupuncture suggest several ways that observations from ritual studies can be verified experimentally. Placebo effects are often described as 'non-specific'; the analysis presented here suggests that placebo effects are the 'specific' effects of healing rituals.

Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1849-58. Kaptchuk TJ. Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, , 330 Brookline Avenue, Boston, MA 02215, USA.

The purpose of this study was to investigate the use and perceived benefit of complimentary and alternative medicine (CAM) and physiotherapy treatments tried by people with chronic fatigue syndrome (CFS) to ease painful symptoms. This study used a descriptive, cross-sectional design. People with CFS who experienced pain were recruited to this study. Participants were asked during a semistructured interview about the treatments they had tried to relieve their pain. Each interview was conducted in the home of the participant. Fifty participants were recruited, of which, 10 participants were severely disabled by CFS. Eighteen participants were trying different forms of CAM treatment for pain relief at the time of assessment. Three participants were currently receiving physiotherapy. Throughout the duration of their illness 45 participants reported trying 19 different CAM treatments in the search for pain relief. Acupuncture was reported to provide the most pain relief (n=16). Twenty-seven participants reported a total of 16 different interventions prescribed by their physiotherapist. The results of this study suggest some physiotherapy and CAM treatments may help people manage painful CFS symptoms. Future research should be directed to evaluating the effectiveness of interventions such as acupuncture or gentle soft tissue therapies to reduce pain in people with CFS.

Physiother Theory Pract. 2011 Jul;27(5):373-83. Epub 2010 Nov 1. Marshall R, Paul L, Wood L. Physiotherapist, Research Assistant, Nursing & Health Care, Faculty of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom.

Full title: Patient characteristics and variation in treatment outcomes: which patients benefit most from acupuncture for chronic pain?

OBJECTIVES: The aim of this study was to identify patients' characteristics that increase or decrease their benefit from acupuncture treatment of chronic pain. METHODS: Patients with chronic low back pain, headache, neck pain, or pain due to osteoarthritis of the knee or hip, were included in 4 multicenter, randomized, controlled studies, all conducted in Germany. All patients received routine care; the patients randomized to the acupuncture group received additional acupuncture treatment. Data were pooled, and the main outcome was defined as the 3-month change from baseline of the SF-36 bodily pain subscale. To identify predictors for treatment effects and effect modifiers (ie, variables that interact with the form of treatment), patients' characteristics and their interaction with treatment were included in a mixed linear model to predict treatment outcome. RESULTS: A total of 9,990 patients who were treated by 2,781 physicians were analyzed. The outcome was markedly improved in the acupuncture group (P<0.001). Age, education, duration of illness, baseline pain, and some concomitant diseases predicted treatment outcome in both groups. Patients' characteristics that enlarged the acupuncture effect (ie, acted as effect modifiers) were being female (P=0.028), living in a multi-person household (P=0.002), failure of other therapies before the study (P=0.049), and former positive acupuncture experience (P=0.005). DISCUSSION: Future research to clarify the modifying effects with special focus on patients' expectations and other psychological variables is needed.

Clin J Pain. 2011 Jul-Aug;27(6):550-5. Witt CM, Schützler L, Lüdtke R, Wegscheider K, Willich SN. *Institute for Social Medicine, Epidemiology, and Health Economics, Charité Medical Center, Berlin †Carstens-Foundation, Essen ‡Institute for Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.

Abstract Background: Several systematic reviews of acupuncture as a treatment of insomnia have recently emerged. Their results are far from uniform. Aim: To summarize and critically evaluate these reviews with a view of defining the reasons for their discrepant conclusions and providing an overall verdict about the therapeutic value of acupuncture for insomnia. Methods: Thirteen electronic databases (Medline, Embase, Amed, CINHAL, Health Technology Assessments, DARE, Cochrane, six Korean/Chinese databases) were searched for relevant articles and data from the included reviews were extracted according to pre-defined criteria. Their methodological quality was assessed using the 'Overview Quality Assessment Questionnaire'. Results: Ten systematic reviews of acupuncture for insomnia were published between 2003 and 2010. They differed in numerous respects. Several reviews draw strongly positive conclusions. Owing to these several caveats, the best evidence is, however, not clearly positive. Conclusion: The evidence for acupuncture as a treatment of insomnia is plagued by important limitations, e.g. the poor quality of most primary studies and some systematic reviews. Those that are sensitive to such limitations, fail to arrive at a positive verdict about the effectiveness of acupuncture.

Eur J Gen Pract. 2011 Jun;17(2):116-23. Epub 2011 Apr 4. Ernst E, Lee MS, Choi TY. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK.

To identify the effect of acupuncture on skin sympathetic nerve activity (SSNA), 17 healthy subjects (7 male and 10 female) underwent LI4 acupuncture and sham needle insertion during resting or elevated SSNA conditions. In Protocol 1 (resting SSNA), subjects received a 10min sham followed by 10min of LI4 acupuncture during resting conditions. In Protocol 2 (elevated SSNA), subjects performed 10min of submaximal intermittent handgrip (2:4s work to rest interval at 37±3% of maximal voluntary contraction) during sham and LI4 acupuncture conditions. SSNA (peroneal nerve microneurography), heart rate (ECG), and mean arterial blood pressure (finger photoplethysmography) were measured and normalized to baseline. SSNA, heart rate, and mean arterial blood pressure were not significantly altered during resting conditions (Protocol 1). During handgrip (Protocol 2), SSNA significantly increased with the sham treatment (+15.3±8.8, +11.1±5.9, and +24.3±13.0% at minutes 1, 5, and 10, respectively), while LI4 acupuncture attenuated this increase (-1.6±7.6, 0.0±4.3, and +2.2±11.2% at minutes 1, 5, and 10, respectively). Heart rate and mean arterial blood pressure increased during handgrip (Protocol 2), but no differences were observed between sham and LI4 acupuncture treatments. These results suggest that acupuncture does not affect resting SSNA in healthy subjects, however if SSNA is acutely elevated above baseline levels, acupuncture has the capacity to attenuate the increased SSNA.

Auton Neurosci. 2011 Jul 5;162(1-2):84-8. Epub 2011 May 26. Toma K, Walkowski S, Metzler-Wilson K, Wilson TE. Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.

PURPOSE OF REVIEW: Complementary and alternative medicine (CAM) is widely used for the treatment of infertility; however, few reviews have evaluated the quality of evidence underlying the use of CAM fertility treatments. This review summarizes and evaluates the evidence underlying the use of these therapies for male and female infertility. RECENT FINDINGS: A wide range of CAM treatments are used by subfertile couples. Their use depends upon the region studied and the type of fertility problems encountered. Acupuncture, the most commonly used CAM fertility treatment in the USA, has the most literature-based support. Few randomized trials have been performed to evaluate other CAM fertility treatments. SUMMARY: CAM is used commonly to treat infertility; however, additional high-quality studies need to be conducted to demonstrate the safety and effectiveness of these therapies before clear recommendations can be made by physicians about their safety and effectiveness.

Curr Opin Obstet Gynecol. 2011 Jun;23(3):195-9. Weiss DA, Harris CR, Smith JF. Department of Urology, USA bDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA.

Full title: Complementary and alternative medicine: Perception and use by physiotherapists in the management of low back pain.

BACKGROUND AND PURPOSE: The aim of this survey was to investigate complementary and alternative medicine (CAM) use by physiotherapists for the treatment of low back pain (LBP). METHODS: Questionnaires (n=1000) were distributed to physiotherapists randomly selected from the UK's Organisation of Chartered Physiotherapists in Private Practice (OCPPP). Results were analysed by SPSS. RESULTS: A response rate of 46% was obtained (n=459). 94.3% of respondents stated that they currently treated LBP; the most common CAMs used by physiotherapists were acupuncture (46.9%) and massage (2.1%). Physiotherapists perceived acupuncture, massage, osteopathy, chiropractic and yoga to be effective in the treatment of LBP, but were unsure about the effectiveness of other CAMs. DISCUSSION AND CONCLUSION: Physiotherapists in this sample often use acupuncture and massage to treat LBP, but appear to have little knowledge of other CAMs. Physiotherapists use mainstream methods such as mobilization and massage which could be perceived as CAM depending on the physiotherapists' perceptions and training, as these therapies have also been used and investigated by CAM practitioners. More research is required on the use of CAM as little is known regarding the effectiveness of these therapies on LBP.

Complement Ther Med. 2011 Jun;19(3):149-54. Epub 2011 Apr 27. Hughes CM, Quinn F, Baxter GD. School of Health Sciences, University of Ulster, Shore Road, Newtownabbey, Co., Antrim BT37 OQB, United Kingdom.