Full title: Changes of gene expression profiles in the cervical spinal cord by acupuncture in an MPTP-intoxicated mouse model: Microarray analysis.

It has been shown that acupuncture at acupoints GB34 and LR3 inhibits the degeneration of nigrostriatal neurons in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson's disease. The degeneration of spinal cord was reported to be induced in the MPTP-treated pre-symptomatic mouse. In this study, the gene expression profile changes following acupuncture at the acupoints were investigated in the cervical spinal cord of an MPTP-induced parkinsonism model using a whole transcript array (Affymetrix GeneChip mouse gene 1.0 ST array). It was shown that 8 of the probes up-regulated in MPTP, as compared to the control, were down-regulated after acupuncture at the acupoints. Of these 8 probes, 6 probes (4 annotated genes in 6 probes: Ctla2a, EG383229, Ppbp and Ube2l6) were exclusively down-regulated by acupuncture at the specific acupoints except for 2 probes as these 2 probes were commonly down-regulated by acupuncture at both the acupoints and the non-acupoints. In addition, 11 of the probes down-regulated in MPTP, as compared to the control, were up-regulated by acupuncture at the acupoints. Of these 11 probes, 10 probes (5 annotated genes in 10 probes: EG665033, ENSMUSG00000055323, Obox6, Pbp2 and Tmem150) were exclusively up-regulated by acupuncture at the specific acupoints except for the Fut11 because the Fut11 was commonly up-regulated by acupuncture at both the acupoints and the non-acupoints. The expression levels of the representative genes in the microarray were validated by real-time RT-PCR. These data suggest that the expression of these exclusively regulated 16 probes (9 genes) may be, at least in part, affected by acupuncture at the acupoints in the cervical spinal cord which can be damaged by MPTP intoxication.

Gene. 2011 Jul 15;481(1):7-16. Epub 2011 Apr 1. Choi YG, Yeo S, Hong YM, Kim SH, Lim S. Research Group of Pain and Neuroscience, WHO Collaborating Center for Traditional Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea; Department of Basic Oriental Medical Science, College of Oriental Medicine, Kyung Hee University, Seoul, Republic of Korea.

Full Title: Acupuncture as an adjunct therapy in the treatment of eating disorders: a randomised cross-over pilot study.

OBJECTIVE: This study examines the role of acupuncture as an adjunct therapy in the treatment of eating disorders in female patients. DESIGN: A randomised cross-over study was used in this study. The two treatments phases were the private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia, only (referred to as their treatment as usual) and a continuation of their treatment as usual supplemented by acupuncture. PARTICIPANTS: Patients receiving treatment at a private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia were asked to participate in the study. Nine consenting women (5 with Anorexia Nervosa, 4 with Bulimia Nervosa), aged (mean and SD) 23.7 (9.6) years, participated in the study. MAIN OUTCOME MEASURES: The main outcome measure was the Eating Disorder Inventory-3. Secondary outcome measures were the Becks Depression Inventory-2, State Trait Anxiety Inventory and the Eating Disorder Quality of Life Scale. RESULTS: There was evidence that acupuncture improved the participants' Quality of Life as measured by the physical/cognitive and psychological components of the Eating Disorder Quality of Life scale. There was also evidence of decreases in anxiety (both State and Trait as measured by the State Trait Anxiety Intervention) and perfectionism (as measured by the Eating Disorder Inventory-3). CONCLUSION: This pilot study shows potential of the benefit of acupuncture as an adjunct therapy in the treatment of eating disorders particularly in the area of quality of life.

Complement Ther Med. 2010 Dec;18(6):233-40. Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Victoria University, Melbourne, Australia. sarah.fogarty@live.vu.edu.au

In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) "top down" as multi-component "whole-system" interventions and (2) "bottom up" as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.

Evid Based Complement Alternat Med. 2011;2011:180805. Langevin HM, Wayne PM, Macpherson H, Schnyer R, Milley RM, Napadow V, Lao L, Park J, Harris RE, Cohen M, Sherman KJ, Haramati A, Hammerschlag R. Department of Neurology, University of Vermont, Burlington, VT 05405, USA.

Full Title: Ethnic differences in complementary and alternative medicine use among patients with diabetes.

OBJECTIVE: To evaluate the effect of ethnicity as a predictor of the use of complementary and alternative medicine (CAM) among patients with diabetes. DESIGN AND SETTINGS: A 16-item questionnaire investigating CAM use was distributed among patients attending the Taking Control of Your Diabetes (TCOYD) educational conferences during 2004-2006. Six TCOYD were held across the United States. Information of diabetes status and sociodemographic data was collected. CAM use was identified as pharmacologic (herbs and vitamins) and nonpharmacologic CAMs (e.g., prayer, yoga, and acupuncture). RESULTS: The prevalence of pharmacologic and non-pharmacologic CAMs among 806 participants with diabetes patients was 81.9% and 80.3%, respectively. Overall, CAM prevalence was similar for Caucasians (94.2%), African Americans (95.5%), Hispanics (95.6%) and Native Americans (95.2%) and lower in Pacific Islanders/others (83.9%) and Asians (87.8%). Pharmacologic CAM prevalence was positively associated with education (p=0.001). The presence of diabetes was a powerful predictor of CAM use. Several significant ethnic differences were observed in specific forms of CAM use. Hispanics reported using frequently prickly pear (nopal) to complement their diabetes treatment while Caucasians more commonly used multivitamins. CONCLUSIONS: Treatment with CAM widely used in persons with diabetes. Ethnic group differences determine a variety of practices, reflecting groups' cultural preferences. Future research is needed to clarify the perceived reasons for CAM use among patients with diabetes in clinical practice and the health belief system associated with diabetes by ethnic group.

Complement Ther Med. 2010 Dec;18(6):241-8. Villa-Caballero L, Morello CM, Chynoweth ME, Prieto-Rosinol A, Polonsky WH, Palinkas LA, Edelman SV. Family and Preventative Medicine Department, School of Medicine, University of California, San Diego, CA, United States.

Full Title: Does acupuncture improve quality of life for patients with pain associated with the spine? A systematic review.

This paper aimed to evaluate the effectiveness of acupuncture for qualities of life (QoL) in patients suffering from pain associated with the spine (PAWS). Acupuncture has been shown to reduce pain severity, but its effect on QoL is unknown. PubMed, CINAHL, and Cochrane Central Register of Controlled Trials as well as EMBASE were searched. Published randomized controlled trials on PAWS comparing acupuncture with waiting-list or sham interventions were considered. Eight out of 186 trials were included. For physical functioning, acupuncture was better than waiting-list at immediate and short-term followups; and was better than sham interventions at immediate assessment (SMD?=?0.40. 95% CI 0.06 to 0.74). For mental functioning, acupuncture was better than waiting-list at short-term followup and sham interventions at intermediate-term followup (SMD?=?0.27. 95% CI 0.03 to 0.51). A similar effect was observed on pain reduction. Discrepancies in point selection for relieving anxiety and insufficient training of trial acupuncturists were also identified. Acupuncture has a moderate effect on the improvement of physical functioning and pain for PAWS patients in the short term; but the effect for mental functioning is small and delayed. Future trials should address point selection and consistency in the qualifications of trial acupuncturists.

Evid Based Complement Alternat Med. 2011;2011:301767. Lu SC, Zheng Z, Xue CC. Traditional & Complementary Medicine Research Program, Health Innovations Research Institute and Discipline of Chinese Medicine, School of Health Sciences, RMIT University, Bundoora, VIC 3083, Australia.

Full Title: A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus.

The aim of this study was to examine the effects of manual/electrical acupuncture treatment on tinnitus in a randomised, single-blinded, placebo-controlled design. Fifty patients (46 males, 4 females) suffering from tinnitus were investigated. The patients were randomly assigned to three groups: a manual acupuncture group (MA), an electrical acupuncture group (EA), and a placebo group (PL). The frequency of tinnitus occurrence, tinnitus intensity, and reduction of life quality were recorded before treatment (Baseline), after 6 treatments (After-Treatment), and 1 month after the completion of treatment (1-Month-After). Standard audiometric tests were conducted on each patient at Baseline and After-Treatment. The patients also provided an overall subjective evaluation of treatment effectiveness at each stage. Eight to ten acupoints were selected at each treatment by an experienced acupuncturist. Six treatments were performed, each separated by an interval of 1 week. Analysis of variance and t-tests were used to statistically compare the data. The frequency of tinnitus occurrence and the tinnitus loudness were significantly decreased After-Treatment compared with Baseline in the EA group (P<0.009). Life quality was improved After-Treatment and at 1-Month-After compared with Baseline in both MA and EA groups (P<0.038). However, no significant differences were detected among the three groups (P>0.079). The audiogram did not show any significant changes after treatment in either group (P>0.091). The overall subjective evaluation indicated significant improvements After-Treatment compared with Baseline in both MA and EA groups (P<0.011). Furthermore, After-Treatment subjective evaluation was significantly better in the EA group compared with either the MA or PL group (P<0.011). These results indicate that there is no statistically significant differential effect of manual or electrical acupuncture on tinnitus treatment efficacy, however, electrical acupuncture does confer some relative advantages.

Complement Ther Med. 2010 Dec;18(6):249-55. Wang K, Bugge J, Bugge S. Center for Sensory-Motor Interaction, Orofacial Pain Laboratory, Aalborg University, Fredrik Bajers Vej 7 D-3, DK-9220 Aalborg, Denmark. kelun@smi.auc.dk

Full Title: Acupuncture for promoting intelligence of children--an observation on 37 cases with mental retardation.

OBJECTIVE: To observe the effect of acupuncture on intelligence quotient (IQ) in children with mental retardation (MR). METHODS: One hundred children with MR were randomly divided into an acupuncture group and a control group, 50 in each. There were 37 and 36 cases with complete data in the former and latter group respectively. Four-week treatment constituted a course, the comprehensive therapeutic effect of two groups was compared after 3 courses of treatment, and the influence of acupuncture on IQ was estimated. RESULTS: The total effective rate in the acupuncture group was 78.4%, better than 30.56% in the control group, the difference being significant (P < 0.01). Both groups were improved in IQ but the effect of the former group was better than that of the latter group (P < 0.05). CONCLUSION: Acupuncture can obviously improve IQ of children suffering from MR.

J Tradit Chin Med. 2010 Sep;30(3):176-9. Tian YP, Qi R, Li XL, Wang YL, Zhang Y, Ji T, Hou CY, Wang LJ. Affiliated Hospital of Gansu College of TCM, Lanzhou, Gansu 730020, China. tianypw@126.com

Full Title: Acupuncture reduces symptoms of dry eye syndrome: a preliminary observational study.

OBJECTIVE: The aim of this study was to evaluate the effect of acupuncture treatment on dry eye syndrome. DESIGN: This was a prospective observational study. SETTING: The study was conducted at a clinical evaluation center for acupuncture and moxibustion of the Korean Institute of Oriental Medicine, Republic of Korea. SUBJECTS: The subjects were patients with dry eye disease (N?=?36), defined by Schirmer test scores of <10?mm/5?min and tear film break-up times (BUTs) of <10 seconds. TREATMENTS: Participants were treated with acupuncture three times per week for 4 weeks. MEASURE OF EFFECTIVENESS: Schirmer test scores, BUTs, symptom scores, ocular surface disease index (OSDI) scores and dry eye symptom questionnaires were compared before and after treatment to evaluate the efficacy of acupuncture treatment. RESULTS: After treatment, symptom scores, OSDI scores and the number of dry eye symptoms were all significantly lower (p? J Altern Complement Med. 2010 Dec;16(12):1291-4. Jeon JH, Shin MS, Lee MS, Jeong SY, Kang KW, Kim YI, Choi SM. Acupuncture, Moxibustion, and Meridian Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea.

Full Title: A study on the basic drugs and points for point application in summer to treat the diseases with attacks in winter.

OBJECTIVE: To study the basic prescriptions of drugs and points for point application in summer to treat the diseases with attacks in winter and the law governing their compatibility. METHODS: A database was set up by collecting and sorting out the relevant literature, and the analysis was made with the complex network. RESULTS: It was found that Bai Jie Zi (Semen Sinapis Albae), Xi Xin (Herba Asari), Gan Sui (Radix Euphorbiae Kansui) and Yan Hu Suo (Rhizoma Corydalis) were used as the basic prescriptions of drugs, Feishu (BL 13), Dazhui (GV 14) and Shanzhong (CV 17) were selected as the basic prescription of points. CONCLUSION: The knowledge obtained from the complex networks on the basic prescriptions of drugs and points for point-application in summer to treat diseases with attacks in winter can provide a data support for working out operation norms and carrying on verification research.

J Tradit Chin Med. 2010 Sep;30(3):180-4. Fang YG, Zhou XZ, Liu BY, Wang YY. Institute of TCM China Clinical Basic Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.

Acupuncture is often advocated as a treatment for depression, and several trials have tested its effectiveness. Their results are contradictory and even systematic reviews of these data do not arrive at uniform conclusions. The aim of this review is to critically evaluate all systematic reviews of the subject with a view of assisting clinical decisions. Thirteen electronic databases were searched to identify all relevant articles. Data of these systematic reviews and the primary studies they included were extracted independently by the two authors according to predefined criteria. Eight systematic reviews including seventy-one primary studies were found. Five of the reviews arrived at positive conclusions and three did not. All the positive reviews and most of the positive primary studies originated from China. There are reasons to believe that these reviews are less than reliable. In conclusion, the effectiveness of acupuncture as a treatment of depression remains unproven and the authors' findings are consistent with acupuncture effects in depression being indistinguishable from placebo effects.

Eval Health Prof. 2010 Dec 7. Ernst E, Lee MS, Choi TY.

OBJECTIVE: To observe clinical therapeutic effect of acupuncture plus cupping for treating insomnia in college students. METHODS: Ninety two college students suffering from insomnia were randomly divided into a treatment group (52 cases) and a control group (40 cases). Acupuncture plus cupping was used for profiting the brain and tranquilizing the mind in the treatment group, and conventional differentiation of symptoms and signs was used in the control group. Therapeutic effect, number of treatment, self-rating sleeping scaling (SRSS), and subtracted rate were evaluated after one month of treatment. RESULTS: There was a significant difference in effective rate between the two groups (P < 0.05). For the cases with moderate insomnia, the effective rate was obviously better in the treatment group than that in the control group (P < 0.05), and for the cases with slight and moderate insomnia, the average treatment number was remarkably less in the former than that in the latter (P < 0.01). SRSS was reduced in both groups (P < 0.01, P < 0.05) with a significant difference between the two groups (P < 0.05). The subtracted rate in the former was more than that in the latter (P < 0.05). Conclusion: The therapeutic effect in the treatment group was better than that in the control group, showing superiority in the cases with moderate insomnia with less treatments and more improved and cured rates.

J Tradit Chin Med. 2010 Sep;30(3):185-9. Zhang YF, Ren GF, Zhang XC. Hospital of Liaocheng University, Liaocheng, Shandong 252059, China.

Full Title: Acupuncture effect on thermal tolerance and electrical pain threshold: a randomised controlled trial.

OBJECTIVE: The aim of this study was to test whether acupuncture could modify the threshold of tolerance to thermal and electrical stimuli. METHODS: A randomised placebo-controlled single-blind trial was conducted in 36 healthy volunteers randomly distributed to control (no treatment), conventional acupuncture and sham acupuncture groups. The subjects were blind to the group allocation. The authors measured before and after treatment the pain threshold with the Painmatcher (Cefar Medical AB, Lund, Sweden) and the cold tolerance with the cold pressor test, together with the Visual Analogue Scale pain score. RESULTS: Electrical stimulation threshold and cold pressor tolerance both increased significantly in the control and the true acupuncture groups, but not the sham group. The changes in the true acupuncture group were highly statistically significant and amounted to 24% (pain threshold) and 44% (cold tolerance) increases in threshold. The changes in the true group were significantly greater than the control group but not significantly different from the sham group. The changes in the sham and control groups were not significantly different from each other. CONCLUSION: Acupuncture at true, appropriate points was more effective than no intervention in raising pain threshold and tolerance in volunteers, and acupuncture at inappropriate points had an intermediate effect which was not significantly different from either. Thus acupuncture analgesia may not be a point specific effect.

Acupunct Med. 2010 Dec 7. Amand M, Nguyen-Huu F, Balestra C. Department of Environmental & Occupational Physiology, Haute École Paul-Henri Spaak, I.S.E.K. (Institut Supérieur d'Ergothérapie et de Kinésithérapie), Brussels, Belgium.

Metabolomics represent a global understanding of metabolite complement of integrated living systems and dynamic responses to the changes of both endogenous and exogenous factors and has many potential applications and advantages for the research of complex systems. As a systemic approach, metabolomics adopts a "top-down" strategy to reflect the function of organisms from the end products of the metabolic network and to understand metabolic changes of a complete system caused by interventions in a holistic context. This property agrees with the holistic thinking of Traditional Chinese Medicine (TCM), a complex medical science, suggesting that metabolomics has the potential to impact our understanding of the theory behind the evidence-based Chinese medicine. Consequently, the development of robust metabolomic platforms will greatly facilitate, for example, the understanding of the action mechanisms of TCM formulae and the analysis of Chinese herbal (CHM) and mineral medicine, acupuncture, and Chinese medicine syndromes. This review summarizes some of the applications of metabolomics in special TCM issues with an emphasis on metabolic biomarker discovery.

Planta Med. 2010 Dec;76(17):2026-35. Zhang A, Sun H, Wang Z, Sun W, Wang P, Wang X. National TCM Key Lab of Serum Pharmacochemistry, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin, China.

ABSTRACT: Traditional Chinese medicine (TCM) is widely used in the European Union (EU) and attracts intense research interests from European scientists. As an emerging area in Europe, TCM research requires collaboration and coordination of actions. Good Practice in Traditional Chinese Medicine Research in the Post-genomic Era, also known as GP-TCM, is the first ever EU-funded 7th Framework Programme (FP7) coordination action, aiming to inform the best practice and harmonise research on the safety and efficacy of TCM through interdisciplinary exchange of experience and expertise among clinicians and scientists. With its increasingly large pool of expertise across 19 countries including 13 EU member states, Australia, Canada, China, Norway, Thailand and the USA, the consortium provides forums and collaboration platforms on quality control, extraction technology, component analysis, toxicology, pharmacology and regulatory issues of Chinese herbal medicine (CHM), as well as on acupuncture studies, with a particular emphasis on the application of a functional genomics approach. The project officially started in May 2009 and by the time of its conclusion in April 2012 a Europe-based academic society dedicated to TCM research will be founded to carry on the mission of GP-TCM.

Chin Med. 2010 Dec 14;5(1):42. Uzuner H, Fan TP, Dias A, Guo DA, El-Nezami HS, Xu Q.

Full Title: How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials.

BACKGROUND: While several recent large randomized trials found clinically relevant effects of acupuncture over no treatment or routine care, blinded trials comparing acupuncture to sham interventions often reported only minor or no differences. This raises the question whether (sham) acupuncture is associated with particularly potent nonspecific effects. We aimed to investigate the size of nonspecific effects associated with acupuncture interventions. METHODS: MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials and reference lists were searched up to April 2010 to identify randomized trials of acupuncture for any condition, including both sham and no acupuncture control groups. Data were extracted by one reviewer and verified by a second. Pooled standardized mean differences were calculated using a random effects model with the inverse variance method. RESULTS: Thirty-seven trials with a total of 5754 patients met the inclusion criteria. The included studies varied strongly regarding patients, interventions, outcome measures, methodological quality and effect sizes reported. Among the 32 trials reporting a continuous outcome measure, the random effects standardized mean difference between sham acupuncture and no acupuncture groups was -0.45 (95% confidence interval, -0.57, -0.34; I2 = 54%; Egger's test for funnel plot asymmetry, P = 0.25). Trials with larger effects of sham over no acupuncture reported smaller effects of acupuncture over sham intervention than trials with smaller nonspecific effects (? = -0.39, P = 0.029). CONCLUSIONS: Sham acupuncture interventions are often associated with moderately large nonspecific effects which could make it difficult to detect small additional specific effects. Compared to inert placebo interventions, effects associated with sham acupuncture might be larger, which would have considerable implications for the design and interpretation of clinical trials.

BMC Med. 2010 Nov 23;8:75. Linde K, Niemann K, Schneider A, Meissner K. Institute of General Practice, Technische Universität München, Orleansstrasse 47, D-81667 Munich, Germany. klaus.linde@lrz.tum.de

OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP) in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta's primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline. METHODS: English language studies, published from 1996 to 2008, comparing the clinical practice patterns of primary care practitioners with guideline recommendations were identified by systematically searching literature databases, the websites of various health technology assessment agencies and libraries, and the Internet. Data were synthesized qualitatively. RESULTS: The literature search identified 14 relevant studies. Knowledge gaps were reported among various primary care practitioner groups in the assessment of red flags, use of diagnostic imaging, provision of advice regarding sick leave and continuing activity, administration of some medications (muscle relaxants, oral steroids and opioids) and recommendation of particular treatments (acupuncture, physiotherapy, spinal manipulation, traction, ultrasound, transcutaneous electrical nerve stimulation and spinal mobilization). CONCLUSIONS: A know-do gap clearly exists among primary care practitioners with respect to the diagnosis and treatment of LBP. The information on know-do gaps will be used to construct a survey tool for unearthing the local knowledge gaps extant among Alberta's primary care practitioners, and to develop a dissemination strategy for a locally produced multidisciplinary LBP guideline, with the aim of ensuring that the know-do gaps inherent within each primary practice discipline are specifically targeted.

Pain Res Manag. 2010 Nov-Dec;15(6):392-400. Scott NA, Moga C, Harstall C.

Full Title: Biomedical engineering meets acupuncture - development of a miniaturized 48-channel skin impedance measurement system for needle and laser acupuncture.

BACKGROUND: Due to controversially discussed results in scientific literature concerning changes of electrical skin impedance before and during acupuncture a new measurement system has been developed. METHODS: The prototype measures and analyzes the electrical skin impedance computer-based and simultaneously in 48 channels within a 2.5×3.5 cm matrix. Preliminary measurements in one person were performed using metal needle and violet laser (405 nm) acupuncture at the acupoint Kongzui (LU6). The new system is an improvement on devices previously developed by other researchers for this purpose. RESULTS: Skin impedance in the immediate surroundings of the acupoint was lowered reproducibly following needle stimulation and also violet laser stimulation. CONCLUSIONS: A new instrumentation for skin impedance measurements is presented. The following hypotheses suggested by our results will have to be tested in further studies: Needle acupuncture causes significant, specific local changes of electrical skin impedance parameters. Optical stimulation (violet laser) at an acupoint causes direct electrical biosignal changes.

Biomed Eng Online. 2010 Nov 23;9:78. Litscher G, Wang L. Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and TCM Research Center Graz, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria. gerhard.litscher@medunigraz.at.

Acupuncture is used widely in oriental medicine. But it is difficult to stimulate continuously or intermittently in daily life with conventional acupuncture. An acupoint stimulation device using focused ultrasound has been developed. Because the device size is about 6 mm in diameter, it can be easily put on the skin during daily life. Appropriate stimulation intensity and pattern can be chosen by changing driving voltage and pattern. In this paper, we stimulated acupoints with this device and measured the blood flow volume of brachial artery. As a result, the blood flow volume increased significantly as well as acupuncture. Because the device stimulate acupoints with intactness of skin, advantages of this device is free from infection and fear and pain by insertion of acupuncture needles.

Conf Proc IEEE Eng Med Biol Soc. 2010;1:1258-61. Tsuruoka N, Watanabe M, Seki T, Matsunaga T, Hagaa Y. Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan.

Full Title: Involvement of the mechanoreceptors in the sensory mechanisms of manual and electrical acupuncture.

The modalities of acupuncture can be broadly classified into manual acupuncture (MA) and electroacupuncture (EA). Although MA has been reported to cause winding of tissue around the needle and subsequent activation of the sensory mechanoreceptors and nociceptors, the sensory mechanisms of acupuncture stimulation are not fully understood. To test the hypothesis that the involvement of the mechanoreceptors in the sensory mechanism is different in MA and EA, we examined the effects of a stretch-activated channel blocker gadolinium on the hemodynamic responses to hind limb MA and EA in anesthetized rats (n=9). Gadolinium significantly attenuated the MA-induced bradycardic response (-22±5 vs. -10±3bpm, P<0.05) and tended to attenuate the MA-induced depressor response (-30±5 vs. -18±4mmHg, P=0.06). On the other hand, gadolinium significantly attenuated both the EA-induced bradycardic (-22±5 vs. -9±4bpm, P<0.01) and depressor responses (-32±6 vs. -15±5mmHg, P<0.01). These results indicate that the mechanoreceptors are involved in the sensory mechanisms for both MA and EA.

Auton Neurosci. 2010 Dec 15. Yamamoto H, Kawada T, Kamiya A, Miyazaki S, Sugimachi M. Division of Cardiology, Department of Medicine, Faculty of Medicine, Kinki University, Osaka, Japan.

Full Title: An investigation into the effectiveness of traditional Chinese acupuncture (TCA) for chronic stress in adults: A randomised controlled pilot study.

AIMS: The aim of this exploratory, pragmatic randomised controlled trial was to investigate the effectiveness of traditional Chinese acupuncture (TCA), using an individually targeted treatment protocol delivered by a traditionally trained Chinese acupuncturist. The trial examined the treatment of chronic stress as perceived and reported by the participants, with all its diversity of presenting symptoms, rather than using a cohort approach based on a single stress-related symptom. METHODS: Participants (n=18) with high self-reported stress levels were randomised into 3 groups. Group 1 received weekly TCA for 5 weeks; group 2 received weekly attention only (practitioner present and participant supine) for 5 weeks and group 3 acted as a waiting list control. The Perceived Stress Scale 14 (PSS-14) and the Measure Yourself Medical Outcome Profile (MYMOP) were completed before and after a 5-week intervention. RESULTS: After 5 weeks, group 1 reported significant changes in MYMOP profile score and both MYMOP reported symptoms (p<0.05); group 2 had significant changes in MYMOP profile score and 1 symptom (p<0.05); group 3 showed no changes. The PSS-14 scores decreased in all 3 groups, but the difference between pre- and post-study within and between the groups did not reach significance in this small study. In addition, there were self-reports of improvements for group 1 for other health problems encountered during treatment. LIMITATIONS AND CONCLUSIONS: The lack of clarity concerning the definition of stress makes it complex to investigate. This pilot study suggests that TCA may be successful in treating the symptoms of stress, through a combination of specific and non-specific effects; but may not relate directly to how a person perceives their stress.

Complement Ther Clin Pract. 2011 Feb;17(1):16-21. Huang W, Howie J, Taylor A, Robinson N. London South Bank University, London SE1 OAA, UK.

Oncology acupuncture is a new and emerging field of research. Recent advances from published clinical trials have added evidence to support the use of acupuncture for symptom management in cancer patients. Recent new developments include (1) pain and dysfunction after neck dissection; (2) radiation-induced xerostomia in head and neck cancer; (3) aromatase inhibitor-associated arthralgia in breast cancer; (4) hot flashes in breast cancer and prostate cancer; and (5) chemotherapy-induced neutropenia in ovarian cancer. Some interventions are becoming a non-pharmaceutical option for cancer patients, while others still require further validation and confirmation. Meanwhile, owing to the rapid development of the field and increased demands from cancer patients, safety issues concerning oncology acupuncture practice have become imperative. Patients with cancer may be at higher risk developing adverse reactions from acupuncture. Practical strategies for enhancing safety measures are discussed and recommended.

Curr Treat Options Oncol. 2010 Dec;11(3-4):141-6. Lu W, Rosenthal DS. Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, SW560, 44 Binney Street, Boston, MA 02115, USA. Weidong_lu@dfci.harvard.edu

Full Title: Human ultraweak photon emission and the yin yang concept of Chinese medicine.

The relationship between connective tissue and meridian function is discussed in terms of energy transmission. The network of hydrogen-bonded water molecules interspersed within the collagen fibrillar matrix is especially significant for both the sensitivity of connective tissue to weak signals of mechanical pressure, heat, or electricity and the electrical intercommunication that may correlate with the meridian acupuncture system. Special electromagnetic properties of connective tissue have similar collective properties of ultraweak photon emission. A relationship between ultraweak photon emission and yin yang dynamics is based on three types of ultraweak photon emission studies, focusing on diurnal and annual dynamics, diseased states, and acupuncture points. A novel concept explains the functional (health) integrity of physiologic systems in relation to the left-right balance in ultraweak photon emission by pointing to, (1) balanced corticoneuromusculoskeletal activities and triboluminescent aspects of ultraweak photon emission by skeletal structures, and (2) local fine-tuning in oxygen supply and the formation of radical oxygen species. This approach offers testable hypotheses for further validation utilizing a combination of human photon recording techniques and specialized metabolomics for the estimation of organ-specific oxidative states.

J Acupunct Meridian Stud. 2010 Dec;3(4):221-31. van Wijk R, van der Greef J, van Wijk E. Meluna Research, Amersfoort, The Netherlands.

Full Title: A Randomized Clinical Trial of Acupuncture Versus Oral Steroids for Carpal Tunnel Syndrome: A Long-Term Follow-Up.

We prospectively followed up patients with carpal tunnel syndrome (CTS) in our previous study for 1 year. A total of 77 consecutive patients with electrophysiologically confirmed mild-to-moderate idiopathic CTS were randomized and assigned into 2 treatment arms: 1) 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily (n = 39); and 2) acupuncture administered in 8 sessions over 4 weeks (n = 38). In the current study, the patients were further followed up at 7 and 13 months using Global symptom score (GSS) assessments and nerve conduction studies repeated again at 13 months. When comparing with baseline levels, the percentages of patients with treatment failure, moderate improvement, and good improvement were significantly different between the 2 groups at month 7 10.5, 2.6, and 86.8% for the acupuncture group and 33.3, 7.7, and 59% for the steroid group, respectively (P = .014) and month 13 15.8, 2.6, and 81.6% versus 51.3, 0, and 48.7%, respectively (P = .002). The acupuncture group had a significantly better improvement in GSS, distal motor latencies and distal sensory latencies when compared to the steroid group throughout the 1-year follow-up period (P < .01). Furthermore, significant correlation was observed between changes of GSS (month 13-baseline) and all parameters of the electrophysiological assessments except for compound muscle action potential amplitude. PERSPECTIVE: This article demonstrates that short-term acupuncture treatment may result in long-term improvement in mild-to-moderate idiopathic CTS. Acupuncture treatment can be considered as an alternative therapy to other conservative treatments for those who do not opt for early surgical decompression.

J Pain. 2010 Nov 24. Yang CP, Wang NH, Li TC, Hsieh CL, Chang HH, Hwang KL, Ko WS, Chang MH. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Nutrition, Huang-Kuang University, Taichung, Taiwan.

Full Title: Meridian electrical potential response to acupuncture stimulation between operator and subject.

The human body has a symmetric structure and maintains a physiological balance through the harmony of yin and yang. One of the fundamental principles of acupuncture is that unbalanced or abnormal bioenergetic conditions on the left and right meridians may be restored to a balanced, normal condition by acupuncture therapy. In this study, the electrical potential along the stomach meridian was measured to investigate the bioenergy consensus between the operator and subject during acupuncture stimulation, and the acupuncture response on opposite meridians was investigated by comparing the electric potential on the left and right stomach meridian during stimulation of the left side stomach meridian-36. When meridian electrical potential was simultaneously measured in both the operator and subject, opposite polarities were observed, which might indicate the transfer of bioenergy between operator and subject. In addition, the meridian electrical potentials of the subjects' left and right stomach meridians were also always of opposite polarity and presented three different signal patterns, which might have represented the condition of the associated meridian.

J Acupunct Meridian Stud. 2010 Dec;3(4):249-54. Lee Y, Kim S, Son T, Kang D, Jung B. Department of Biomedical Engineering, Yonsei University, Wonju, Korea; Institute of Medical Engineering, Yonsei University, Wonju, Korea.

Acupuncture, the insertion of sterile needles into acupuncture points of traditional meridians on the body, is a common and effective treatment for a number of supportive care issues in oncology including acute chemotherapy-induced nausea and vomiting. In the Integrative Oncology setting, acupuncture and Traditional Oriental Medicine have become more visible and many oncology clinics, academic health centers and comprehensive cancer centers recommend and administer acupuncture treatment. Continued basic studies on the physiologic mechanisms of acupuncture and recent clinical trials of acupuncture for cancer patients are enhancing our knowledge and informing our guidelines. While debates on methodological problems confronting the study of acupuncture remain, the most recent research demonstrates that acupuncture is safe, tolerable and effective for a range of side effects resulting from conventional cancer treatments.

Curr Treat Options Oncol. 2010 Dec;11(3-4):87-94. Capodice JL. Department of Urology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 11th Floor, New York, New York, USA. jc2346@columbia.edu

Full Title: Acupuncture for treating temporomandibular disorder: retrospective study on safety and efficacy.

This study aimed to retrospectively examine the efficacy and safety of acupuncture for the relief of pain originating from temporomandibular joint disorder and trigeminal neuralgia. Participants included patients suffering from trigeminal neuralgia or temporomandibular disorder with osseous pathology ruled out by panoramic X-rays. Participants received a series of 8-10 weekly acupuncture treatments and rated their pain via a visual analogue scale. From assessment of a total of 39 patients, analysis of pain severity before and after treatment showed that acupuncture intervention was highly beneficial for patients with temporomandibular joint disorder (88.6%, p < 0.01), compared with patients with trigeminal neuralgia in which there was only a minor effect (25%). The data also demonstrated that acupuncture was both efficacious in acute patients (91%, p < 0.01) and chronic patients (70%, p < 0.05) and elicited no side effects during the course of treatment. Acupuncture treatment was a safe and efficient methodology for relieving the pain of patients suffering from temporomandibular disorder with no detectable osseous joint component. Based on these results, a randomized clinical trial is being initiated at the Stomatologic Clinic at the Tel Aviv Sourasky Medical Center to assess the role of acupuncture in treating temporomandibular joint disorder.

J Acupunct Meridian Stud. 2010 Dec;3(4):260-6. Noiman M, Garty A, Maimon Y, Miller U, Lev-Ari S. Unit of Complementary and Integrative Medicine, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

A previous study has shown that laser acupuncture is a useful healing method for the treatment of visceral postmenopausal obesity in combination with a low-calorie diet. We observe and evaluate the therapeutic effect of laser acupuncture in subjects of simple obesity with a non-restrictive diet protocol. Subjects included 73 women and 22 men with simple obesity and body mass indices >/= 27 kg/m(2). Daily energy intake recommendations for obese females and males were 1620.0 and 1894.2 kcal in average, respectively. The gallium aluminum arsenide Handylaser Trion was used to apply 0.25 J of energy to each of the following acupuncture points three times per week for four consecutive weeks: Stomach, Hunger, ST25, ST28, ST40, SP15, and CV9. The subjects' body weights and body mass indices were recorded before treatment, and four weeks after treatment, and the percent reduction in each parameter was calculated. Statistically significant reductions in body weight and body mass index were detected after four weeks of treatment. The mean reduction and mean percent reduction in body weight were 3.17 kg and 3.80% (p < 0.0001), respectively. The corresponding values for the body mass index were 1.22 kg/m(2) and 3.78% (p < 0.0001), respectively. We concluded that laser acupuncture was found to exert a therapeutic effect on simple obesity by reducing both body weight and body mass index. Moreover, subjects showed good compliance with this comfortable and non-restrictive diet protocol.

Hu WL, Chang CH, Hung YC. Am J Chin Med. 2010;38(5):861-867. Department of Chinese Medicine, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.

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