Acupuncture and Dry Needling - Medical Clinic Policy Bulletins (2023)

Number: 0135

Policy

Observation: Aetna's standard plans extend acupuncture coverage to medically necessary indications when administered by a health professional who practices within the scope of their license. Some Aetna plans limit coverage of acupuncture when it is used instead of other anesthesia for a surgical or dental procedure covered by the health benefits plan, and the administering health care provider is a legally qualified physician acting within the scope of your license. Some other plans may extend acupuncture coverage for medically necessary indications, but only when administered by a health professional who is a legally qualified licensed physician. See benefit plan descriptions for more details.

Acupuncture

1. Aetna considers needle acupuncture (manual or electroacupuncture) to be medically necessary foranyof the following indications:
   1. chronic neck pain (lasting at least 12 weeks);o
   2. Chronic headache (lasting at least 12 weeks);o
   3. Back pain;o
   4. morning sickness;o
   5. pain from osteoarthritis of the knee or hip (adjuvant therapy);o
   6. Postoperative and chemotherapy-induced nausea and vomiting;o
   7. Postoperative dental pain;o
   8. Temporomandibular distortion (DTM).
2. Maintenance treatment, when extremity symptoms do not regress or improve, is not considered medically necessary. If no clinical benefit is seen after four weeks of acupuncture, the treatment plan should be re-evaluated. Additional acupuncture treatment is not considered medically necessary if the extremity does not demonstrate significant improvement in symptoms.
3. Aetna considers acupuncture experimental and experimental for all other indications, including, but not limited to, any of the following conditions, because there is no adequate scientific research evaluating the efficacy of acupuncture compared to placebo, sham acupuncture, or other modalities of treatment in these conditions:

   Acne acute pancreatitis Addiction HOW alcohol withdrawal syndrome allergies Alzheimer disease Amblyopia Asma Attention Deficit Hyperactivity Disorder (ADHD) autism spectrum disorders bell's palsy benign prostatic hypertrophy Hot flashes related to breast cancer Breast cancer-related lymphedema burning mouth syndrome Cancer induced bone pain Cancer-related dyspnea cancer related fatigue Cardiovascular diseases (eg, angina pectoris, heart failure, hypertension) Carpal tunnel syndrome paralisis cerebral Chemotherapy-induced leukopenia Chemotherapy-induced neuropathic pain chronic hepatitis B Chronic pain syndrome (eg, RSD, facial pain) Chronic Obstructive Pulmonary Disease (COPD) chronic constipation Chronic Fatigue Syndrome cognitive decline diabetic gastroparesis diabetic peripheral neuropathy dry eyes dysmenorrhea endometriosis pain Epilepsy Erectile dysfunction facial spasm fetal breech presentation fibromyalgia fibrotic contractures Gastric ulcer Glaucoma hypoxic-ischemic encephalopathy labor induction infant colic infant diarrhea Infertility (eg, to assist in oocyte retrieval and embryo transfer during the IVF treatment cycle) Inflammatory bowel diseases (Crohn's disease and ulcerative colitis) Insomnia (including cancer-related insomnia) Hemorragia intracerebral Irritable bowel syndrome Vasomotor symptoms associated with menopause

   hot flashes of menopause Menstrual cramps/dysmenorrhea Multiple sclerosis Mumps Dolor miofascial Myopia Neuropathic pain night urine while sleeping Nonalcoholic fatty liver disease Obesity/weight loss Obstructive sleep apnea oligoastenozoospermia osteoporosis painful neuropathies Parkinson disease Parkinson's disease-related fatigue peptic ulcer Peripheral arterial disease (eg, intermittent claudication) phantom leg pain plantar fasciitis polycystic ovary syndrome neuralgia postherpética postoperative ileus postprandial sickness syndrome shoulder pain after stroke post traumatic stress disorder premature ejaculation PMS/PMDD itching Soriasis Psychiatric disorders (eg, anxiety, depression, and schizophrenia) Raynaud's disease pain respiratory disorders restless leg syndrome Rheumatoid arthritis rhinitis sensorineural deafness sexual dysfunction shoulder bursitis Quit smoking Spasticity after a stroke Stroke rehabilitation (for example, dysphagia) Tennis Elbow/Epicondylitis Tic disorders (eg, Tourette syndrome) Buzz urinary incontinence Fibroids vascular dementia xerostomia Whip

4. Aetna considers acupuncture point injection (also known as acupuncture point injection therapy, biopuncture) to be experimental and experimental for the following conditions (not a comprehensive list) because the effectiveness of this approach has not been established:
   1. amyotrophic lateral sclerosis
   2. cancer related pain
   3. Espondilosis cervical
   4. Chronic daily headache
   5. Dysmenorrhea (menstrual pain)
   6. Lateral elbow pain (tennis elbow).
5. Aetna is considering the use of the Teding Dianci Pu (TDP) lamp as an adjunct to trial and experimental acupuncture due to insufficient evidence of its effectiveness.

dry needling

Below

Acupuncture

Acupuncture as a therapeutic intervention is widely practiced in the United States. The general theory of acupuncture is based on the premise that there are patterns of energy (Qi) flow through the body that are essential for health. Interruptions in this flow are believed to be responsible for disease. Acupuncture can correct flow imbalances at identifiable points near the skin. Basic research findings have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central and peripheral nervous system and changes in neuroendocrine function.

Although there have been many studies of its potential utility, the vast majority of articles studying acupuncture in the biomedical literature consist of case reports, case series, or intervention studies. One of the difficulties in drawing conclusions from the existing literature is that the term acupuncture is used to describe a variety of treatments that differ in many important ways depending on the level of effect (eg, local, segmental, systemic) and the type of effect. of treatment. acupuncture. g., manual acupuncture versus electrical acupuncture). Many of these studies provide mixed results due to design, sample size, and other factors. The problem is further complicated by the difficulties inherent in using appropriate controls, such as placebos and sham acupuncture groups, and the lack of studies comparing acupuncture with conventional biomedical treatments. Some factors that need investigation include frequency, number and duration of treatments, needling depth, number of acupuncture points used, combination with other therapies, sample size, setting, risk factors, etc. blinding and needle size. Be that as it may, promising results have emerged regarding the efficacy of acupuncture on postoperative and chemotherapy nausea and vomiting in adults and on postoperative dental pain.

There is not enough evidence for the effectiveness of acupuncture as a treatment for fibromyalgia. The US Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality (AHRQ) conducted a technology assessment (2003) onAcupuncture for the treatment of fibromyalgia; stated that "[at] this time, therefore, there is insufficient evidence to conclude that acupuncture has efficacy for the treatment of fibromyalgia."

There is evidence to support the use of acupuncture in migraine. In a large randomized controlled trial (n = 401), Vickers et al (2004) examined the effects of an 'acupuncture use' policy on headache (predominantly migraine), health status, sick days and drug use. headache compared to an "avoid acupuncture" policy. Patients were randomly assigned to receive up to 12 acupuncture treatments over 3 months or to a control intervention providing usual care. Headache score, SF-36 health status, and medication use were assessed at baseline, 3, and 12 months. The use of resources was evaluated every 3 months. Headache score at 12 months, the primary endpoint, was lower in the acupuncture group (16.2, SD 13.7, n=161, 34% reduction from baseline) than controls (22.3, SD 17.0, n=140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval [CI] 2.2 to 7.0, p = 0.0002). This result is robust to sensitivity analysis incorporating imputation of missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer headache days per year (8 to 38). The SF-36 data favored acupuncture, although the differences reached significance only for physical role functioning, energy, and health change. Compared with controls, patients randomized to acupuncture used 15% less medication (p = 0.02), made 25% fewer GP visits (p = 0.10), and had a 15% fewer days off due to illness (p = 0.2). The authors concluded that acupuncture produces persistent and clinically relevant benefits for primary care patients with chronic headache, particularly migraine.

The results of the study by Vickers et al (2004) are in line with the recent findings of Allais et al (2003), who reported that acupuncture is effective in reducing the frequency of migraine attacks, as well as those of Linde et al. al (2009). who reported that acupuncture was more effective than a placebo injection in the early treatment of an acute migraine attack.

Facco and colleagues (2008) examined the effectiveness of a traditional Chinese medicine (TCM) real acupuncture treatment in migraine without aura, comparing it with a standard sham acupuncture protocol, a precise acupuncture sham healing ritual, and untreated controls. . A prospective, randomized and controlled study was carried out in 160 patients with migraine without aura, evaluated according to the ICD-10 classification. The patients were divided into the following 4 groups:

1. TA group, treated with true acupuncture (according to TCM) plus rizatriptan;
2. RMA group, treated with ritualized sham acupuncture plus rizatriptan;
3. SMA group, treated with standard sham acupuncture plus rizatriptan; Is
4. group R, without prophylactic treatment, only with rescue therapy (rizatriptan).

The MIDAS Questionnaire was applied before treatment (T0), 3 (T1) and 6 months (T2) after the start of treatment, and the MIDAS Index (MI) was calculated. Rizatriptan intake was also controlled in all patient groups at T0, T1 and T2. The TA and RMA group were also evaluated according to TCM; then the former underwent real acupuncture and the latter a TA-like sham acupuncture treatment. Statistical analysis was performed using factorial ANOVA and multiple tests with Bonferroni adjustment. A total of 127 patients completed the study (33 dropouts): 32 belonged to the TA group, 30 to the RMA group, 31 to the SMA group, and 34 to the R group. Before treatment, MI (T(0)) was moderate to severe, without significant differences between groups. All groups experienced a decrease in MI at T(1) and T(2), with a significant difference between groups at T(1) and T(2) compared to T(0) (p < 0.0001) . Only TA provided a significant improvement in T(1) and T(2) compared to R (p < 0.0001). Patients in the RMA group experienced a transient improvement in MI at T(1). Rizatriptan intake followed the MI in all groups. The authors concluded that TA was the only treatment capable of providing a consistent improvement in outcome compared to rizatriptan alone, whereas RMA showed a transient placebo effect at T1.

There is insufficient evidence for acupuncture as a treatment for insomnia. Sok and colleagues (2003) stated that more research is needed, using a randomized clinical trial design, to determine the efficacy of acupuncture for the treatment of insomnia. In addition, additional work is also needed to promote the long-term therapeutic effects of acupuncture and to compare it with other therapies for insomnia.

There is limited and insufficient evidence for acupuncture in the treatment of dysmenorrhea, infertility, and other female reproductive indications. White (2003) conducted a review of controlled trials of acupuncture for women's reproductive health care. The author concluded that, in view of the small number of studies and their variable quality, questions remain about the efficacy of acupuncture for gynecological conditions. Acupuncture appears promising for dysmenorrhea and infertility, and further study is warranted.

There is insufficient evidence that acupuncture improves the results of IVF. In a Cochrane review, Cheong et al (2008) determined the effectiveness of acupuncture on assisted reproductive treatment (ART) outcomes. Randomized controlled trials ( RCTs ) of acupuncture for couples undergoing ART that compared treatment with acupuncture alone or acupuncture with concomitant ART versus no treatment, placebo, or sham acupuncture plus ART for the treatment of primary and secondary infertility were selected. Women with conditions considered contraindications to ART or acupuncture were excluded. A total of 16 RCTs involving acupuncture and assisted conception were identified; Thirteen studies were included in the review and 3 were excluded. Two reviewers independently performed quality assessment and data extraction. Meta-analysis was performed using the odds ratio (OR) for dichotomous outcomes. Outcome measures were live birth rate, ongoing clinical pregnancy rate, miscarriage rate, and any reported side effects of treatment. There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET) on live birth rate (OR 1.89, 95% CI 1.29 to 2.77), but not when performed 2 to 3 days after TE (OR 1.79). , 95% CI: 0.93 to 3.44). There is no evidence of benefit on pregnancy outcomes when acupuncture is performed at the time of oocyte collection. The authors concluded that acupuncture performed on the day of ET has a beneficial effect on the live birth rate; however, with the current evidence, this can be attributed to the placebo effect and the small number of women included in the studies. They stated that acupuncture should not be offered during the luteal phase in routine clinical practice until more adequately powered RCT evidence is available. This is in line with the observation of El-Toukhy et al (2008), who stated that the currently available literature does not provide sufficient evidence that adjunctive acupuncture improves the IVF clinical pregnancy rate. Additionally, Ng et al (2008) noted that although acupuncture has gained popularity in the treatment of subfertility, its effectiveness remains controversial.

There is some evidence to support the use of acupuncture in the treatment of osteoarthritis of the hip and knee. An earlier review of AHRQ (2003) technology onAcupuncture for osteoarthritisconcluded that "the currently available evidence is insufficient to determine whether acupuncture has a specific beneficial effect in osteoarthritis." However, a Cochrane review of acupuncture for peripheral joint osteoarthritis (Manheimer et al, 2010) concluded that sham-controlled trials show statistically significant benefits; the authors stated, however, that these benefits are small, do not meet the authors' predefined thresholds for clinical relevance, and are probably due, at least in part, to placebo effects of incomplete blinding. The authors found that wait-list controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, many of which may be due to expectations or placebo effects.

Acupuncture has also been used to relieve pain and improve movement in people with osteoarthritis (OA) of the knee. In the largest clinical trial of acupuncture reported to date, Berman et al (2004) studied 570 patients with a mean age of 65 years who had OA of the knee. Subjects were randomly assigned to receive one of three treatments for 26 weeks, in addition to standard care, such as anti-inflammatory drugs and pain relievers:

1. 190 received acupuncture,
2. 191 underwent sham acupuncture and
3. 189 participants participated in 6 2-hour group sessions over 12 weeks based on the Arthritis Foundation Arthritis Self-Help Course.

Patient progress was assessed at 4, 8, 14, and 26 weeks. At week 8, patients who received acupuncture began to show a significant increase in function and at week 14 a significant decrease in pain, compared with the control and placebo groups. Overall, those who received acupuncture had a 40% reduction in pain and nearly 40% improvement in function compared to baseline evaluations. The authors concluded that acupuncture appears to provide better function and pain relief as an adjunctive therapy for knee osteoarthritis compared with reliable sham acupuncture and educational control groups. This finding is in line with recent observations by Vas et al (2004), Tukmachi et al (2004), as well as Stener-Victorin et al (2004).

In a randomized, controlled, single-blind study of the use of acupuncture as adjunctive therapy to drug treatment of osteoarthritis of the knee (n = 97), Vas and colleagues (2004) concluded that acupuncture plus diclofenac is more effective than acupuncture placebo plus diclofenac for the symptomatic treatment of osteoarthritis of the knee. Tukmachi and associates (2004), in a randomized controlled trial (n = 30), reported that manual electroacupuncture and electroacupuncture caused a significant improvement in knee osteoarthritis symptoms, alone or as adjunctive therapy, with no loss of benefit afterwards. of one month.

In a randomized controlled trial, Stener-Victorin et al (2004) evaluated the therapeutic effect of electroacupuncture (EA) and hydrotherapy, both in combination with patient education and patient education alone, in the treatment of OA of hip (n = 45). These investigators found that EA and hydrotherapy, both in combination with patient education, induce lasting effects, demonstrated by reduction in pain and increase in functional activity and quality of life, as evidenced by before and after differences. of the treatment. This finding is in agreement with that of Haslam (2001), who reported that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip (n = 32), as well as that of Fink et al ( 2001). who found that acupuncture needle placement in the affected hip area is associated with improvement in OA symptoms (n = 67).

The American College of Physicians guidelines (Qaseem, et al., 2017) recommend the use of acupuncture in the treatment of acute and subacute low back pain. The guidelines state that, "[since] most patients with acute or subacute low back pain improve over time, regardless of treatment, clinicians and patients should select non-pharmacological treatment with superficial heat (moderate-quality evidence). , massage, acupuncture or spinal manipulation therapy (low-quality evidence).If drug treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence).(Grade: strong recommendation ). The guidelines also recommend acupuncture for low back pain. For patients with chronic low back pain, clinicians and patients should initially select non-drug treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control, progressive therapy relaxation exercises, biofeedb electromyographic examination, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Note: strong recommendation).

There is evidence to support the use of acupuncture in the treatment of chronic low back pain (LBP). In a prospective cohort study, Kukuk et al (2005) observed long-term effects 3 and 6 months after completing acupuncture treatment for chronic low back pain or chronic pain caused by knee osteoarthritis. A total of 1096 eligible patients with chronic low back pain or knee osteoarthritis (68.1% women) were identified and invited by letter to participate in the study. In the end, 249 patients remained, without loss of representativeness. Two telephone interviews were conducted 3 and 6 months after the last acupuncture session using standardized questionnaires, available as electronic case report forms. Primary endpoints were self-assessed pain tolerability before acupuncture initiation and after completion of treatment and pain intensity (GCPS) over time. Secondary endpoints were changes in functional impairment (HFAQ for chronic low back pain, WOMAC for gonarthrosis), quality of life (SF12), depression (CES-D), and patient global assessment of efficacy. of treatment (PGA). For the chronic low back pain indication, pain-related fear avoidance beliefs (FABQ) were also questioned. These investigators found that pain tolerance was significantly improved after acupuncture and remained so for up to 6 months after treatment. The mean scores of almost all the questionnaires did not change significantly between 3 and 6 months. They concluded that acupuncture had a long-term effect on important aspects of cognitive and emotional pain management.

In a multicenter, randomized, controlled trial, Thomas et al (2005) examined whether patients with persistent nonspecific low back pain, when offered access to traditional acupuncture care in conjunction with conventional primary care, achieved greater pain relief than long-term than those who were offered conventional care. only, at equal or less cost. The safety and acceptability of acupuncture care to patients and the heterogeneity of the results were also tested. Patients in the experimental arm were offered the option of being referred to the acupuncture service made up of 6 acupuncturists. The control group received usual care from their general practitioner (GP). Eligible patients were randomized in a 2:1 ratio to the acupuncture offer to allow effects among acupuncturists to be assessed. Patients were 18 to 65 years of age with non-specific low back pain of 4 to 52 weeks' duration and were assessed as fit for primary care treatment by their primary care physician. The experimental protocol allowed for up to 10 individualized acupuncture treatments per patient. The acupuncturist determined the content and number of treatments according to the needs of the patient. Key outcome measures included the Short Form 36 (SF-36) Body Pain dimension (range 0 to 100 points), assessed at baseline and at 3, 12, and 24 months. Cost-utility analysis was performed at 24 months using the 5 EuroQoL dimensions (EQ-5D) and a preference-based single index measure derived from the SF-36 (SF-6D). Secondary outcomes included McGill current pain index (PPI), Oswestry pain disability index (ODI), all other SF-36 dimensions, medication use, pain-free months in the past year, concern about back pain, satisfaction with the care received, as well as the safety and acceptability of acupuncture care. A total of 159 patients were in the acupuncture offer arm and 80 in the usual care arm. The 159 patients randomized to offer acupuncture treatment opted to receive acupuncture treatment and received an average of 8 acupuncture treatments during the study. These investigators found that traditional acupuncture care provided in a primary care setting was safe and acceptable for patients with nonspecific low back pain. Acupuncture care and usual care were associated with clinically significant improvement at 12 and 24 month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits related to function or disability were identified. They concluded that referring the GP to a service offering traditional acupuncture care offers a cost-effective intervention to reduce low back pain over a 2-year period.

In a meta-analysis, Manheimer et al (2005) evaluated the efficacy of acupuncture in the treatment of low back pain. These researchers concluded that acupuncture effectively relieves chronic low back pain. However, no evidence suggests that acupuncture is more effective than other active therapies. This is in line with the findings of a Cochrane review of acupuncture for low back pain by Furlan et al (2005), which indicated that the data do not allow firm conclusions about the effectiveness of acupuncture for acute low back pain. For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and only in the short term. Acupuncture is no more effective than other conventional and alternative treatments. They concluded that the data suggest that acupuncture may be a useful adjunct to other therapies for chronic low back pain.

Standaert et al (2011) sought to answer the following clinical questions:

1. Is structured exercise more effective for treating chronic low back pain than spinal manipulative therapy (SMT)?
2. Is structured exercise more effective for treating chronic low back pain than acupuncture?
3. Is TMS more effective for treating chronic low back pain than acupuncture?
4. Do certain subgroups respond more favorably to specific treatments? Is
5. Are any of these treatments more profitable than the others?

A systematic review of the literature was carried out to identify RCTs comparing a structured exercise programme, SMT or acupuncture with each other in people with chronic low back pain. Two studies comparing the use of structured exercises with SMT were identified that met the inclusion criteria. Although these studies used different approaches for the exercise and TMS treatment groups, patients in both groups improved in terms of pain and function in both studies. Using random effects models, there were no differences between the exercise and SMT groups when data from these studies were pooled. These investigators were unable to identify studies that met the inclusion criteria that compared acupuncture with structured exercises or SMT or that addressed the cost-effectiveness of these approaches in the treatment of patients with chronic low back pain. The authors concluded that the identified studies indicate that structured exercise and SMT appear to offer equivalent benefits in terms of pain and functional improvement for those with chronic LBP, with clinical benefits evident at 8 weeks of treatment. However, the level of evidence is low. There is insufficient evidence to comment on the relative benefit of acupuncture compared to structured exercise or SMT or to address the differential effects of structured exercise, SMT or acupuncture for specific subgroups of subjects with chronic low back pain. There is also insufficient evidence on the cost-effectiveness of structured exercise, TMS or acupuncture in the treatment of chronic low back pain. Structured exercise and SMT appear to offer equivalent benefits in pain management and function for patients with nonspecific chronic low back pain. If no clinical benefit is appreciated after using one of these approaches for 8 weeks, the treatment plan should be re-evaluated and modification of the treatment approach or use of alternative forms of treatment should be considered. There is insufficient evidence on the relative benefits of acupuncture compared to structured exercise or SMT in the treatment of chronic low back pain. There is insufficient evidence to address the differential effects of structured exercise, SMT or acupuncture for specific subgroups of people with chronic low back pain. There is insufficient evidence on the cost-effectiveness of structured exercise, TMS or acupuncture in the treatment of chronic low back pain.

There is insufficient evidence that acupuncture, alone or in combination with moxibustion, can be effective in treating fetal breech presentation. Moxibustion refers to a type of Chinese medicinal practice that involves burning an herb next to the skin at the acupuncture point: urinary bladder 67 (BL67, Chinese name Zhiyin), located at the tip of the fifth toe. Available guidelines have produced conflicting recommendations regarding the use of moxibustion in fetal breech presentation.

The evidence-based clinical guidelines of the New Zealand Guideline Group (2004) state that "[m]oxybustion is an acupuncture technique that involves burning herbal preparations to stimulate the acupuncture point on the fifth toe. It can be offered to women with breech presentation. Their conclusions were based primarily on a study by Cardini and Weixin (1998), which evaluated the safety and efficacy of moxibustion at the BL67 acupoint to increase fetal activity and correct breech presentation in a randomized, controlled clinical trial. and open (n = 260). The 130 primiparous women at 33 weeks gestation with normal pregnancy and ultrasonographic diagnosis of pelvic presentation randomized to the intervention group received stimulation of acupoint BL 67 with moxa (Japanese term for Artemisia vulgaris) rollers for 7 days, with treatment for another 7 days. days if the fetus persisted in breech presentation. The 130 subjects randomized to the control group received routine care but no intervention for breech presentation. Patients with persistent breech presentation after 2 weeks of treatment can undergo external cephalic version (ECV) at any time between 35 weeks' gestation and delivery. The intervention group experienced a mean of 48.45 fetal movements versus 35.35 in the control group (p < 0.001). During week 35 of gestation, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic versus 62 (47.7%) of the 130 fetuses in the control group (p < 0.001). Although 24 subjects in the control group and 1 subject in the intervention group underwent CVS, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth versus 81 (62.3%). %) of the 130 fetuses in the intervention group control group group (p = 0.02). The authors concluded that among primiparae presenting breech during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.

Kanakura et al (2001) discussed their findings on the use of moxibustion or electrical stimulation for the treatment of the buttocks. Only patients with breech pregnancy at 28 weeks or more were included in the study. With moxibustion treatment, the control group had a spontaneous correction rate of 165/224 (73.7%) and the treatment group had a correction rate of 123/133 (92.5%) (p < 0 .0001). With low-frequency percutaneous electrical stimulation, the correction rate was 20/941 (83.9%) in the control group and 171/191 (89.5%) in the treatment group (p = 0.094). Controls in the moxibustion study received neither exercise nor external manipulation to correct pelvic presentation, whereas those in the electrical stimulation study experienced both. Acupuncture stimulation, especially moxibustion, is expected to serve as a safe and effective modality in the management of breech presentation in a clinical setting.

Habek et al (2003) evaluated the value of acupuncture in converting fetal breech presentation to vertex presentation in a prospective randomized controlled clinical trial that included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual acupuncture ( Zhiyin) and a control group that included 33 women with a singleton pregnancy without acupuncture treatment. The acupuncture treatment lasted 30 minutes a day and was performed during and after 34 weeks of gestation with simultaneous cardiotocography. The success rate for acupuncture correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without acupuncture to vertex presentation is observed in 15 women (45.4%; p < 0.001). The authors concluded that the correction of fetal malpresentation using acupuncture is a relatively simple, effective, and inexpensive method, associated with a lower percentage of surgical deliveries, which is definitely reflected in better vital and perinatal statistics parameters.

In a controlled trial by Neri et al (2004), a total of 240 women at 33 to 35 weeks' gestation with a breech fetus were randomly assigned to receive active treatment (acupuncture plus moxibustion) or to be assigned to the breech group. observational. . Bilateral acupuncture plus moxibustion was applied at acupoint BL67. The primary outcome of the study was fetal presentation at delivery. Fourteen cases dropped out. The final analysis was performed on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active treatment group (53.6%) (p = 0.01). Thus, the proportion of cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% versus 66.7%, p = 0.03). The authors concluded that acupuncture plus moxibustion is more effective than observation in rotating fetuses in breech presentation. Such a method seems to be a valid option for women who wish to have a natural birth.

Although most evidence supports the use of acupuncture/moxibustion to correct fetal breech presentation, recent publications are less clear as to its role in the treatment of this condition. In a single-blind randomized controlled trial, Cardini et al (2005) evaluated the efficacy of moxibustion for the correction of fetal breech presentation in a non-Chinese population. Healthy non-Chinese nulliparous pregnant women at 32 to 33 weeks + 3 days gestational age with the fetus in breech presentation were randomly assigned to treatment or observation. The treatment consisted of moxibustion (heat stimulation of an Artemisia vulgaris stick) in the Zhiyin for 1 or 2 weeks. Control group subjects did not receive moxibustion but were observed. Two weeks after enrollment, each participant underwent a presenting fetal ultrasonic examination. The main outcome measure was the number of participants with cephalic presentation at week 35. The study was stopped when 123 participants (46% of the planned sample) had been enrolled. Interim data follow-up revealed a high number of treatment interruptions. At this point, no differences in cephalic presentation were found at week 35 (treatment group: 22/65, 34%; control group: 21/58, 36%). The authors stated that the results highlight methodological problems in evaluating a traditional treatment transferred from a different cultural context. They do not support the efficacy or ineffectiveness of moxibustion in correcting fetal breech presentation.

In a Cochrane review, Coyle and colleagues (2005) examined the safety and efficacy of moxibustion in changing a fetus from breech presentation, the need for CVD, mode of delivery, and perinatal morbidity and mortality to breech presentation. These investigators concluded that there is insufficient evidence from randomized controlled trials to support the use of moxibustion to correct a breech presentation. The authors stated that moxibustion may be beneficial in reducing the need for CVD and decreasing the use of oxytocin; however, well-designed randomized clinical trials are needed to evaluate moxibustion for breech presentation to report clinically relevant results as well as the safety of the intervention.

Women with breech presentation in the third trimester often receive cesarean delivery as the first-choice mode of delivery, especially when CVD has failed to render the fetus cephalic (Tiran, 2004). According to the American College of Obstetricians and Gynecologists (ACOG, 2002), ECV may not be indicated for some women and may present risks such as preterm labor, placental abruption, umbilical cord entanglement, premature rupture of membranes, as well as severe maternal discomfort. . ACOG does not currently have a policy statement/recommendation regarding the use of acupuncture/moxibustion for the management of fetal breech presentation.

The Royal College of Obstetricians and Gynecologists concluded that "moxibustion should not be recommended as a method of promoting spontaneous release over ECV." The guidelines explain that moxibustion, burning on the tip of the fifth toe (acupuncture point BL67) has been used to promote spontaneous breech release, with some success, and appears to be safe. However, citing the Cochrane systematic review of evidence (Coyle et al, 2005) and the study by Cardini et al (2005), the RCOG concluded that pooled and recent data conclude that "there is insufficient evidence to support its use, which which highlights the need for good quality studies".

A randomized controlled trial by Smith et al (2008) found that acupuncture is not effective in inducing labor. Women who were scheduled for postterm induction with a singleton pregnancy and cephalic presentation were eligible for the study. Subjects received 2 sessions of acupuncture or sham acupuncture over a 2-day period prior to the planned medical/pharmacological induction. The main primary outcomes were related to the need for induction methods and the time from delivery of the intervention to delivery. A total of 364 women were randomly assigned to the study (treatment n = 181 and control n = 183). Subjects did not differ in the need for induction methods between groups: prostaglandin induction: relative risk (RR) 1.20, 95% CI 0.96 to 1.51, p = 0.11; artificial rupture of membranes only: RR 0.93, 95% CI 0.72 to 1.20, p = 0.57; oxytocin alone: ​​RR 0.89, 95% CI 0.60 to 1.32, p = 0.55; artificial rupture of membranes plus oxytocin: RR 0.87, 95% CI 0.57 to 1.33, p = 0.52; prostaglandins, artificial rupture of membranes and oxytocin: RR 0.84, 95% CI 0.37 to 1.91, p = 0.68. The median time from acupuncture to delivery was 68.6 hours (interquartile range 53.9 to 79.5) compared with 65 hours (interquartile range 49.3 to 76.3) for women in the group of control. The authors concluded that 2 sessions of manual acupuncture, using local and distal acupuncture points, administered 2 days before a scheduled induction of labor, did not reduce the need for induction methods or the duration of labor for pregnant women. postterm.

A systematic review found no reliable evidence of the effectiveness of acupuncture in the treatment of xerostomia. Jedel (2005) evaluated the effectiveness of acupuncture in the treatment of xerostomia. Articles from controlled clinical trials evaluating the efficacy of acupuncture in the treatment of xerostomia were obtained by searching MEDLINE and the Cochrane Central Register of Controlled Trials databases. Three articles met the inclusion criteria and a list of criteria was used to assess the quality of these studies. Studies were considered to be of high or low quality based on the list of criteria used. Test results were judged positive, negative, or indifferent based on statistically significant differences between groups. The list of criteria used indicates that one of the three studies was of high quality and presented indifferent results. One of two low-quality studies shows positive results and one shows indifferent results. A degree of evidence analysis of the results did not result in evidence of the effectiveness of acupuncture in the treatment of xerostomia. The authors concluded that this systematic review showed that there is no evidence for the efficacy of acupuncture in the treatment of xerostomia and that future high-quality randomized clinical trials are needed.

A Cochrane review found insufficient evidence for acupuncture in irritable bowel syndrome. Lim et al (2006) examined whether acupuncture is more effective than no treatment, more effective than 'sham' (placebo) acupuncture, and as effective as other interventions used to treat irritable bowel syndrome. The authors concluded that most of the studies included in this review were of low quality and heterogeneous in terms of interventions, controls and measured outcomes. Therefore, it is not yet conclusive whether acupuncture is more effective than sham acupuncture or other interventions in treating irritable bowel syndrome.

A systematic review of the evidence found no clear evidence of the effectiveness of acupuncture in allergic rhinitis and asthma. Passalacqua et al (2006) noted that complementary alternative medicines (CAM) are widely used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. These investigators conducted a systematic review of CAM for these two indications. The meta-analyses did not provide clear evidence of the effectiveness of acupuncture in rhinitis and asthma. Some positive results with homeopathy have been reported in good quality rhinitis trials, but several negative studies were also found. Therefore, it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and more studies are needed. A limited number of studies of herbal remedies have shown some efficacy in rhinitis and asthma, but the studies have been too few to make any recommendations. There are also unresolved security issues. The authors concluded that the efficacy of CAM (eg, acupuncture) for rhinitis and asthma is not supported by currently available evidence.

There is insufficient evidence for the effectiveness of acupuncture for chemotherapy-induced leukopenia and neutropenia. Lu et al (2007) stated that chemotherapy-induced leukopenia and neutropenia are common side effects during cancer treatment. Acupuncture has been reported as a complementary therapy for this complication. These investigators reviewed randomized controlled trials of the effect of acupuncture and explored the acupuncture parameters used in these trials. Study populations were cancer patients who were receiving or had just completed chemotherapy or chemoradiation, randomly assigned to acupuncture therapy or usual care. Trials were assessed for methodological quality. Of 33 articles reviewed, 682 patients from 11 eligible studies were included in the analyses. All trials were published in non-PubMed journals in China. The methodological quality of these trials was considerably poor. The average sample size of each comparison group was 45 and the average duration of the trial was 21 days. The frequency of acupuncture treatment was once daily, with an average of 16 sessions in each trial. In the seven studies for which white blood cell (WBC) counts were available, the use of acupuncture was associated with an increase in white blood cells in patients during chemotherapy or chemoradiotherapy, with a weighted mean difference of 1221 WBC/mL. on average (95% CI: 636 to 1807; p < 0.0001). Acupuncture for chemotherapy-induced leukopenia is an intriguing clinical question. However, the lower quality and publication bias present in these studies may lead to a false positive estimate. Meta-analysis based on these published studies should only be treated in an exploratory manner.

In a review of the safety and efficacy of various interventions for the treatment of neck pain, Binder (2008) stated that, compared with sham treatment, inactive treatment, or wait-list control, acupuncture may be more effective than some types of sham treatment (no longer defined) or inactive treatment (no longer defined) in improving pain relief at the end of treatment or in the short term (less than 3 months), but not in the medium term (not defined) or long-term (not defined)) in people with chronic mechanical disorders. The author also noted that acupuncture may be more effective than sham TENS in improving pain 1 week after treatment and 6 months in people with chronic neck pain. Needle acupuncture may be more effective than no acupuncture in improving a composite outcome of neck pain and disability (no longer defined) at three months in people with chronic neck pain (very low-quality evidence). Furthermore, compared with sham treatment, inactive treatment, or waiting list control, acupuncture with needles may be more effective than no acupuncture in improving quality of life (as measured by the SF-36) at 3 months. in people with chronic neck pain (very low quality evidence).

There is no evidence of the benefit of acupuncture in alleviating dyspnea in cancer patients. Ben-Aharon and associates (2008) conducted a systematic review of RCTs evaluating all pharmacological and non-pharmacological interventions to alleviate breathlessness in cancer patients. Two reviewers independently assessed trial quality and extracted data. The search resulted in 18 attempts; 14 evaluated pharmacological interventions: 7 evaluated opioids (n = 256 patients), 5 evaluated oxygen (n = 137 patients), 1 evaluated helium-enriched air, and 1 evaluated furosemide. Four studies evaluated non-pharmacological interventions (n ​​= 403 patients). Subcutaneous morphine administration resulted in a significant reduction in visual analogue scale (VAS) dyspnea compared with placebo. No difference in VAS dyspnoea score was observed when nebulized morphine was compared with subcutaneous morphine, although patients preferred the nebulized route. The addition of benzodiazepines to morphine was significantly more effective than morphine alone, with no additional adverse effects. Oxygen was not superior to air in relieving dyspnea, except in patients with hypoxemia. Nurse-led interventions improved shortness of breath. Acupuncture was not beneficial. The authors concluded that their review supports the use of opioids for the relief of breathlessness in cancer patients. The use of supplemental oxygen to relieve dyspnea can only be recommended in patients with hypoxemia. Non-pharmacological nurse-led interventions seem valuable. Only a few studies have been conducted that address this issue. Therefore, the researchers concluded, more studies are needed evaluating interventions to alleviate breathlessness.

A systematic review of the evidence by Bausewein et al (2008) reached similar conclusions about the lack of adequate evidence to support the use of acupuncture for dyspnea associated with cancer.

There is a lack of reliable evidence for acupuncture treatment of Parkinson's disease. Lam et al (2008) evaluated the safety and efficacy of acupuncture therapy (monotherapy or adjunctive therapy) compared with placebo, conventional interventions, or no treatment in the treatment of patients with idiopathic Parkinson's disease (IPD). All RCTs of any duration comparing monotherapy and adjunctive acupuncture with placebo or no intervention were included. Data were abstracted independently by two investigators on standardized forms and disagreements were resolved by discussion. A total of ten trials were included, each with a different set of acupuncture points and needle manipulation. None of them reported allocation concealment. Only 2 studies mentioned the number of dropouts; 2 used an unblinded method while others did not mention their blinding methods. Nine studies claimed a statistically significant positive effect of acupuncture compared to its control; only 1 indicated that there were no statistically significant differences for all the variables measured. Only 2 studies described details on adverse events. The authors concluded that there is evidence indicating the potential efficacy of acupuncture in the treatment of PID. However, the results were limited by methodological flaws, allocation concealment unknowns, number of dropouts and methods of blinding between studies. They stated that large, well-designed, placebo-controlled RCTs with rigorous methods of randomization and adequate blind allocation, as well as intention-to-treat data analysis, are needed to determine the clinical value of acupuncture in the treatment of PID.

There is insufficient evidence for the use of acupuncture in polycystic ovary syndrome. Stener-Victorin et al. (2008) described the etiology and pathogenesis of polycystic ovarian syndrome (PCOS) and evaluated the use of acupuncture to prevent and reduce PCOS-related symptoms. This syndrome is the most common female endocrine disorder and is strongly associated with hyperactive-androgenism, ovulatory dysfunction, and obesity. It increases the risk of metabolic disorders such as hyperinsulinemia and insulin resistance, which can lead to type 2 diabetes, hypertension, and an increased chance of developing cardiovascular risk factors and impaired mental health later in life. Despite extensive research, little is known about the etiology of PCOS. The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Therefore, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS. Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Therefore, it is necessary to evaluate non-pharmacological treatment strategies. Acupuncture may affect PCOS through modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine system, and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS have suggested that acupuncture exerts long-lasting beneficial effects on the metabolic and endocrine systems and on ovulation.

In a randomized controlled trial, Stener-Victorin et al. (2009) examined the effect of low-frequency electroacupuncture (EA) and physical exercise on sympathetic nerve activity in women with PCOS. A total of 20 women with PCOS were randomly assigned to one of 3 groups:

1. Low frequency AE (n = 9),
2. physical exercise (n = 5), or
3. untreated control (n=6) over a 16-week study period.

Direct recordings of multiple unit efferent muscle postganglionic sympathetic nerve activity (MSNA) were made in a peroneal nerve muscle fascicle before and after 16 weeks of treatment. Biometric, hemodynamic, endocrine and metabolic parameters were measured. Low-frequency AEs (p = 0.036) and physical exercise (p = 0.030) decreased the frequency of ANMS rupture compared to the untreated control group. The low-frequency AS group reduced sagittal diameter (p = 0.001), while the exercise group reduced body weight (p = 0.004) and body mass index (p = 0.004) compared to the control group. No treatment. The sagittal diameter was related to the frequency of rupture of the MSNA (Rs = 0.58, p < 0.005) in the AS group. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in the hemodynamic, endocrine and metabolic variables. For the first time, these investigators demonstrated that low-frequency EA and physical exercise reduce high sympathetic nerve activity in women with PCOS. Therefore, treatment with low-frequency AEs or physical exercise with the aim of reducing ANSM may be important for women with PCOS.

There is insufficient evidence for the effectiveness of acupuncture for toxic neuropathy. Zhou et al (2009) found thalidomide and bortezomib to be effective in the treatment of multiple myeloma. Unfortunately, its use can cause sensory neuropathy which often limits the dose and duration of treatment. Although the relationship between peripheral neuropathy and therapeutic dose is controversial, many investigators have shown a positive correlation between neuropathy and cumulative dose, dose intensity, and duration of therapy. Peripheral neuropathic pain is the most bothersome symptom of neuropathy. Spontaneous pain, allodynia, hyperalgesia and hyperpathy are often associated with decreased physical activity, increased fatigue, mood and sleep problems. The symptoms are often difficult to control and the available treatment options rarely provide complete relief. In addition, the adverse effects of these treatments often limit their use. Several studies have reported the efficacy of acupuncture, with fewer adverse effects than analgesic drugs, in the treatment of painful diabetes and human immunodeficiency virus-related neuropathy. However, the effectiveness of acupuncture in the treatment of toxic neuropathy has not been evaluated. Although its putative mechanisms remain elusive, acupuncture has great potential as an adjunctive therapy in painful neuropathy induced by thalidomide or bortezomib, and better understanding may guide its use in the treatment of chemotherapy-induced neuropathic pain. The authors concluded that well-designed clinical trials with adequate sample size and power are needed.

There is no reliable evidence for the use of acupuncture as a treatment for erectile dysfunction. Lee and colleagues (2009) reviewed the current evidence on the use of acupuncture to treat erectile dysfunction (ED). Systematic searches of 15 electronic databases were performed, without language restrictions. Handsearches included conference proceedings and our archives. All clinical trials of acupuncture as a treatment for erectile dysfunction were considered for inclusion and their methodological quality was assessed using the Jadad score. Of the 4 included studies, 1 randomized controlled trial ( RCT ) showed beneficial effects of acupuncture compared to sham acupuncture in terms of response rate, while another RCT found no effect of acupuncture. The remaining studies2 were uncontrolled clinical trials. Taken together, these data show that RCTs of acupuncture for erectile dysfunction are feasible but scarce. Most of the investigations had methodological flaws (eg, inadequate study design, poor reporting of results, small sample size, and publication without an adequate peer review process). The authors concluded that there is insufficient evidence to suggest that acupuncture is an effective intervention in the treatment of erectile dysfunction. They stated that more research is needed to investigate whether there are specific benefits of acupuncture for men with erectile dysfunction.

A Cochrane review found insufficient evidence for the effectiveness of acupuncture in Bell's palsy. Chen et al (2010) examined the efficacy of acupuncture in speeding recovery and reducing long-term morbidity from Bell's palsy. These investigators updated searches of the Cochrane Neuromuscular Disorders Group Trials Register (24 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (2010 issue 2), MEDLINE (January 1966 to May 2010). 2010), EMBASE (January 1980 to May 2010). 2010), AMED (January 1985-May 2010), LILACS (January 1982-May 2010), and the Chinese Biomedical Retrieval System (January 1978-May 2010) for RCTs using "Bell's palsy" and its synonyms, "idiopathic facial palsy" or "facial paralysis", as well as search terms including "acupuncture". We handsearched Chinese journals where the investigators thought they might find RCTs relevant to their study. These investigators reviewed bibliographies of randomized trials and contacted authors and recognized experts in the field to identify additional published or unpublished data. They included all RCTs that included needle acupuncture in the treatment of Bell's palsy, regardless of language restrictions. Two reviewers identified potential articles from the literature search, extracted data, and independently assessed the quality of each trial. All disagreements were resolved by discussion between the reviewers. The bibliographic search and the manual search identified 49 potentially relevant articles. Of these, 6 RCTs with 537 participants with Bell's palsy were included. Two more potential studies were identified in the update than in the previous version of this systematic review, but both were excluded as they were not true RCTs. Of the 6 included studies, 5 used acupuncture while the other used acupuncture combined with drugs. No study reported the outcomes specified for this review. No harmful side effects were reported in any of the trials. Poor quality caused by flaws in study design or reporting (including unclear method of randomisation, allocation concealment and blinding) and clinical differences between trials prevented reliable conclusions about the efficacy of acupuncture . The authors concluded that the quality of the included studies was inadequate to allow a conclusion about the efficacy of acupuncture. They stated that more research with high-quality trials is needed.

There is insufficient evidence for the effectiveness of acupuncture for respiratory symptoms. Gibson and colleagues (2010) noted that anecdotal evidence from physicians and patients suggests that there may be some beneficial effect of acupuncture in the treatment of respiratory symptoms such as bronchospasm, shortness of breath, and hyperventilation syndromes. Some respiratory physicians are introducing acupuncture as a treatment modality for the management of respiratory symptoms, despite a lack of available objective evidence to support this practice. The authors reviewed the available evidence on the use of acupuncture in respiratory disorders and discussed the methodological problems that are evident in this literature. In addition, they highlighted the reasons for the lack of objective evidence to support acupuncture for respiratory conditions and the difficulties acupuncture researchers face when designing randomized placebo-controlled trials. The authors concluded that there is currently insufficient evidence to support a recommendation on the use of acupuncture in respiratory disorders.

There is insufficient evidence for the effectiveness of acupuncture for the treatment of uterine fibroids. Zhang et al (2010) evaluated the benefits and harms of acupuncture in women with uterine fibroids. All RCTs comparing acupuncture treatment with sham acupuncture, no treatment, Chinese medication, Western medication, or other treatments for uterine fibroids were considered for inclusion. Acupuncture management included traditional acupuncture or contemporary acupuncture, regardless of stimulation source (eg, body, electro, scalp, stretch, fire, hand, fine needle, moxibustion). Needleless acupuncture management was excluded. Two review authors assessed the risk of bias of the study according to their a priori criteria. No studies were included in this version of the review, therefore no data was collected. No double-blind randomized controlled trials met the inclusion criteria. The authors concluded that the efficacy of acupuncture for the treatment of uterine fibroids remains uncertain. They stated that more evidence is needed to establish the safety and efficacy of acupuncture for uterine fibroids. There is a continuing need for well-designed RCTs with long-term follow-up.

In a randomized, controlled, evaluator-blinded sham acupuncture study, Shin et al (2010) evaluated the safety and efficacy of acupuncture for ocular symptoms, tear film stability, and tear secretion in patients with dry eye A total of 42 subjects with moderate to severe dry eye underwent acupuncture treatment 3 times per week for 3 weeks. Seventeen standard points (GV23; bilateral BL2, GB14, TE23, Ex1, ST1, and GB20; and unilateral SP3, LU9, LU10, and HT8 on the left for men and on the right for women) with "qi" manipulation for the acupuncture group verum and seventeen superficial penetration sham points were applied without other manipulation for the sham group during acupuncture treatment. Differences were measured using the ocular surface disease index (OSDI), VAS of ocular discomfort, tear film breakup time (TFBUT), and the Schimer I test under anesthesia. In addition, adverse events were recorded. There were no statistically significant differences between the OSDI, VAS, TFBUT, or Schimer I test scores from baseline between the real and sham acupuncture groups. However, the results of the within-group analysis showed that OSDI and VAS in both groups and TFBUT in the real acupuncture group were significantly improved after 3 weeks of treatment. No adverse events were reported during this study. The authors concluded that both types of acupuncture improved signs and symptoms in patients with dry eye after a 4-week treatment. However, real acupuncture did not give better results than sham acupuncture.

Lee and colleagues (2011) evaluated the effectiveness of acupuncture as a treatment option to treat dry eye condition. These investigators searched the literature using 14 databases from inception to December 3, 2009, without language restrictions. They included RCTs comparing acupuncture with conventional treatment. Their risk of bias was assessed using the Cochrane criteria. A total of 6 RCTs met all the inclusion criteria. Three RCTs compared the effects of acupuncture with artificial tears in people with xerophthalmia or Sjögren's syndrome. A meta-analysis of these data showed that acupuncture improved tear breakup times (p < 0.0001), Schirmer test scores (p < 0.00001), response rates (p = 0.002), and fluorescent staining region of the cornea (p = 0.0001) significantly more than artificial tears. The other 3 RCTs compared the effects of acupuncture plus artificial tears with artificial tears alone: ​​2 of these studies failed to show significant effects of acupuncture, while 1 reported significant effects. For Schirmer test scores and frequency of artificial tear use, 2 RCTs reported superior effects of acupuncture plus artificial tears, while 1 RCT did not. The authors concluded that these findings provide limited evidence for the effectiveness of acupuncture in the treatment of dry eye. However, the total number of RCTs, the total sample size, and the methodological quality were too low to draw firm conclusions.

In a prospective, randomized, controlled, crossover study, Lam et al (2011) evaluated the safety and adjunctive effect of acupuncture added to refractive correction for anisometropic amblyopia in younger children. A total of 83 children aged 3 to less than 7 years with untreated anisometropic amblyopia and baseline best-corrected visual acuity (BCVA) of 20/40 to 20/200 in the amblyopic eye were enrolled in this study. Participants were randomized to receive spectacles alone (group 1; n=42) or spectacles + acupuncture (group 2; n=41) for 15 weeks and then crossed over to receive the other regimen for an additional 15 weeks. BCVA in both eyes was measured at baseline and every 5 (+/- 1) weeks for the initial 45 weeks and at 60 (+/- 1) weeks. The main outcome measures were BCVA in the amblyopic eye at 15, 30 and 60 weeks. The mean baseline BCVA in the amblyopic eye was 0.50 and 0.49 log minimum angle of resolution (logMAR) in groups 1 and 2, respectively. After 15 weeks of treatment, BCVA improved by an average of 2.2 lines in group 1 and 2.9 lines in group 2. The mean difference in BCVA between groups was 0.77 lines (CI of 95%: 0.29 to 1.3, p = 0.0020) with initial setting. A BCVA less than or equal to 0.1 logMAR was achieved in 14.6% of the patients in group 1 and in 57.5% of group 2 (p < 0.00010). After crossing regimens at 30 weeks, group 1 had a mean of 1.2 (95% CI 0.98 to 1.48) lines of further improvement over the 15-week BCVA, while group 1 2 the mean improvement was 0.4 (95% CI 0.98 to 1.48). : 0.19 to 0.63) lines. The proportions of responders, resolvers, and participants achieving a BCVA of less than or equal to 0.1 logMAR at 30 weeks were similar between groups. After completing acupuncture, only 1 participant experienced reduction of more than 1 AV line up to 60 weeks. Acupuncture was well tolerated by all children and no serious adverse effects were found. The authors concluded that acupuncture is a potentially useful adjunctive treatment modality that may provide a sustainable adjunct to refractive correction for anisometropic amblyopia in young children. They stated that acupuncture has good potential to become a complementary therapeutic modality for amblyopia, and further large-scale studies appear to be necessary.

In a Cochrane review, Cheuk et al (2011) examined the efficacy of acupuncture in people with autism spectrum disorders (ASD) in improving key autistic features, as well as communication, cognition, general functioning, and quality of life. , and established if it has any adverse effects. These investigators searched the following databases up to 30 September 2010: CENTRAL (The Cochrane Library, 2010, Issue 3), MEDLINE (1950 to September 2010, week 2), EMBASE (1980 to 2010, week 38 ), PsycINFO, CINAHL, China Journal: Full-Text Database, China Master's Thesis Full-Text Database, China Medical Dissertation Full-Text Database, China Conference Proceedings Database , Taiwan Periodical Literature System Index, China Controlled Trials Meta-Registry and Clinical Trials Registry. We also searched AMED (26 February 2009) and Dissertation Abstracts International (3 March 2009), but these were no longer available to the authors or editorial base at the date of the most recent search. TCMLARS (Traditional Chinese Medical Literature Analysis and Retrieval System) was last searched on March 3, 2009. These searchers included RCTs and quasi-RCTs. They included studies that compared an acupuncture group with at least one control group that used no treatment, placebo, or sham acupuncture in people with ASD. They excluded studies that compared different forms of acupuncture or compared acupuncture with another treatment. Two review authors independently extracted trial data and assessed trial risk of bias. They used relative risk (RR) for dichotomous data and mean difference (MD) for continuous data. The authors included 10 studies with 390 children with ASD. The age range was from 3 to 18 years and the duration of treatment varied from 4 weeks to 9 months. The studies were carried out in Hong Kong, mainland China and Egypt. Two studies compared needle acupuncture with sham acupuncture and found no difference in the primary outcome of key autistic features (RFRLRS total score: MD 0.09, 95% CI -0.03 to 0.21, p = 0 ,16), although the results suggest that needle acupuncture may be associated with improvement in some aspects of the secondary outcomes of communication and language ability, cognitive function, and global functioning. Six studies compared needle acupuncture plus conventional treatment with conventional treatment alone. Studies used different primary outcome measures and most were unable to demonstrate the effectiveness of acupuncture in improving general core autistic features, although 1 study reported that patients in the acupuncture group were more likely to have improvement on List of Autism Behavior Check (RR 1.53; 95% CI: 1.09 to 2.16, p = 0.02) and had slightly better total scores after treatment (MD -5.53; 95% CI: -10 .76 to -0.31, p = 0.04). There was no evidence that acupuncture was effective for the secondary outcome of communication ability and language, although there appeared to be some benefit for the secondary outcomes of cognitive function and global functioning. Two studies compared acupressure plus conventional treatment with conventional treatment alone and did not report the primary outcome. Results from individual studies have suggested that there may be some benefit of acupressure for certain aspects of the secondary outcomes of language and communication ability, cognitive function, and global functioning. Four trials reported some adverse effects, although there was little quantitative information, and intervention and control groups sometimes experienced them. Adverse effects included bleeding, crying out of fear or pain, irritability, sleep disturbances, and increased hyperactivity. None of the studies reported quality of life. There are a number of problems with the evidence base: the trials were few and included only children; 6 of the trials were at high risk of bias; they were heterogeneous in terms of participants and intervention; they were of short duration and follow-up; reported inconsistent and inaccurate results and, due to performing a large number of tests, were at risk of false positives. The authors concluded that current evidence does not support the use of acupuncture for the treatment of ASD. There is no conclusive evidence that acupuncture is effective for the treatment of ASD in children and there have been no RCTs in adults. They stated that more high-quality, larger studies with longer follow-up are needed.

In a Cochrane review, Wei et al (2011) evaluated the safety and efficacy of acupuncture in delaying the progression of myopia in children and adolescents. These investigators searched CENTRAL (containing the Cochrane Eyes and Vision Group's Trials Register) (The Cochrane Library 2011, Issue 7), MEDLINE (January 1950 to July 2011), EMBASE (January 1980 to July 2011). 2011), the Complementary and Allied Medicine Database (AMED) (January 1985 to July 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to July 2011), metaRegistry of Controlled Trials (mRCT), ClinicalTrials.gov, National Center for Complementary and Alternative Medicine (NCCAM) Trials (first edition Aug 2010), Chinese Biological Medicine (CBM) Database (1978 to April 2011), China National Knowledge Infrastructure (CNKI) (1994 to April 2011), and VIP (1989 to April 2011). There were no date or language restrictions on electronic trial searches. CENTRAL, MEDLINE, EMBASE, AMED, LILACS, mRCT and ClinicalTrials.gov were last searched on 9 July 2011. NCCAM was searched up to August 2010 and CBM, CNKI and VIP were searched on 6 April 2011. These investigators included RCTs involving any type of acupuncture treatment for myopia in children and adolescents. Two authors independently assessed the search results according to the inclusion and exclusion criteria. Two authors independently extracted and assessed data. The study investigator was contacted about the missing data. The authors included 2 RCTs conducted in Taiwan with a total of 131 participants. They did not perform a meta-analysis because the studies evaluated different outcomes. None of the trials met the pre-defined primary outcome criteria of myopia progression defined as a mean change of 1 diopter. Only one study reported changes in axial length with no non-significant difference between groups and both studies reported that several children experienced mild pain during acupuncture stimulation. Two studies were included in this review, but no conclusions can be made about the benefit of coacupressure in delaying the progression of myopia in children. The authors concluded that more evidence in the form of RCTs is needed before recommendations can be made for the use of acupuncture treatment in clinical use. These trials should compare acupuncture with placebo and have large samples. Other types of acupuncture (such as auricular acupuncture) should be further explored, as well as adherence to treatment for at least 6 months or longer. Elongation of the axial length of the eye should be investigated for at least 1 year. The potential to reduce/eliminate the pain of acupuncture experienced by children should also be reviewed.

The Canadian Thoracic Society clinical practice guideline on "Management of breathlessness in patients with advanced chronic obstructive pulmonary disease" (Marciniuk et al, 2011) noted that breathlessness is a cardinal symptom of chronic obstructive pulmonary disease (COPD), and its severity and magnitude increase as the disease progresses, leading to significant disability and a negative effect on quality of life. Refractory dyspnea is a frequent symptom that is difficult to treat in patients with advanced COPD. There are many questions about optimal management, and specifically whether various therapies are effective in this setting. These investigators addressed these important clinical questions through an evidence-based systematic review process conducted by a representative interprofessional panel of experts. Evidence has supported the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids, and pursed-lip breathing in the treatment of dyspnoea in individual patients with advanced COPD. Oxygen is recommended for COPD patients with hypoxemia at rest, but its use for the specific treatment of dyspnea in this setting should be reserved for patients receiving symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytics, nebulized opioids, acupuncture, acupressure, distracting auditory stimuli (music), relaxation, fans, counseling programs, or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce breathlessness in nonhypoxaemic patients with advanced COPD.

Williams et al (2012) stated that acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, impaired keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, neck, and neck. chest and back by Propionibacterium acnes. Although early colonization with P. acnes and family history may play an important role in the disease, what exactly triggers acne and how treatment affects the course of the disease remains unclear. Other factors, such as diet, have been implicated but not proven. Facial scars due to acne affect up to 20% of adolescents. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen can be found to reduce lesions in most patients. Good-quality evidence on the comparative effectiveness of common topical and systemic therapies for acne is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics, when used in combination, often improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne often need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side effects. Availability, adverse effects, and cost limit the use of photodynamic therapy. More research is needed on the comparative therapeutic efficacy and safety of the many products available and to better understand the natural history, subtypes, and triggers of acne. Furthermore, the authors stated that complementary and alternative medicine (including acupuncture) cannot be recommended for the treatment of acne because it is not supported by strong evidence.

Yan et al (2012) noted that burning mouth syndrome (BAS) is a common chronic pain condition that lacks a satisfactory treatment approach. These investigators examined the effects of acupuncture or acupuncture point injection in the treatment of SAB and evaluated the evidence supporting the use of acupuncture therapy for SAB in clinical practice. We searched the following databases for relevant articles: Cochrane Oral Health Group Trials Register (July 2011), Cochrane Central Register of Controlled Trials (Issue 7, 2011), MEDLINE (1966 to June 2011) and China National Knowledge Infrastructure Electronic Medical Database (1979 to June 2011). Articles were reviewed and the quality of included studies was assessed independently by 2 reviewers. After selection, 9 studies with 547 randomized patients were included in this review. All 9 articles were published in Chinese and were clinical trial studies with a Jadad score of less than 3. Their results showed that acupuncture/acupuncture point injection can benefit patients with SAB. Evidence supported the effectiveness of acupuncture injection/acupuncture point therapy in reducing SAB pain and related symptoms. The authors concluded that, in light of the reported positive results, the use of acupuncture therapy for patients with BMS warrants further investigation.

Bo and colleagues (2012) evaluated the qualities of RCT reporting of acupuncture treatment in diabetic peripheral neuropathy (DPN). A total of 8 databases, including The Cochrane Library (1993 to September 2011), PubMed (1980 to September 2011), EMbase (1980 to September 2011), SCI Expanded (1998 to September 2011), China Biomedicine Database Disc (CBMdisc, 1978-Sep 2011), China National Knowledge Infrastructure (CNKI, 1979-Sep 2011), VIP (a Chinese full-text question database, 1989-Sep 2011), Wan Fang (another full-text question database questions from China 1998 to September 2011) were systematically searched. A hand search for additional references was performed. The language was limited to Chinese and English. These investigators identified 75 RCTs using acupuncture as an intervention and assessed the quality of these reports using the statement of the Consolidated Standards for Trial Reporting 2010 (CONSORT2010) and the Standards for Reporting Interventions of Controlled Trials of Acupuncture 2010 (STRICTA2010) statement. A total of 24 articles (32%) applied the random sequence assignment method. No article provided the description of the allocation concealment mechanism, no experiment applied the method of blinding. Only 1 article (1.47%) could be directly identified by title as being about RCTs, and only 4 articles gave a description of the experimental design. No article mentioned the number of cases lost or eliminated. For 1 exp.
ment, acupuncture syncope led to temporary interruption of therapy. Two articles (2.94%) recorded the number of needles and 8 articles (11.76%) mentioned the depth of needle insertion. None of the articles reported the basis for calculating the sample size, nor do they have any analysis about the metaphase of an experiment or an explanation of its interruption. One (1.47%) mentioned intentional analysis (ITT). The authors concluded that the quality of the reports on RCTs of acupuncture for diabetic peripheral neuropathy is moderate to low. They stated that CONSORT2010 and STRICTA2010 should be used to standardize the reporting of RCTs of acupuncture in the future.

In a meta-analysis, Wang et al (2012) evaluated the efficacy of acupuncture in facial spasm. The research team classified the results of each of the reviewed studies in 2 ways:

1. the number of participants who showed a positive response to the therapy (total efficacy rate) and
2. the number of participants who achieved a full recovery (clinical cure rate).

The research team reviewed a total of 13 studies involving 1,262 participants with facial spasm. Investigators in China conducted all the studies and most of the studies were of poor methodological quality. All studies reported that acupuncture was superior to other treatments, including carbamazepine, mecobalamin, and massage, and meta-analysis of these low-quality studies produced similar results. The authors concluded that current studies evaluating the effectiveness of acupuncture in the treatment of facial spasm are mostly of poor methodological quality. These studies demonstrated that acupuncture was superior to other treatments for facial spasm; however, in their meta-analysis, the research team was unable to draw an affirmative conclusion regarding the benefits of acupuncture due to the poor methodological quality and localized population of the included studies. The authors concluded that the field needs large, well-conducted international RCTs.

In a Cochrane review, He and colleagues (2012) evaluated the safety and efficacy of acupuncture for children with mumps. These investigators searched CENTRAL (2012, Issue 4), MEDLINE (1950 to April 2012 Week 4), EMBASE (1974 to May 2012), CINAHL (1981 to May 2012), AMED (1985 to May 2012) , Chinese Biomedicine (CBM) Database (1979 to May 2012), China National Knowledge Infrastructure (CNKI) (1979 to May 2012), Chinese Technology Periodic Database (CTPD) (1989 to May 2012). 2012) and WANFANG (1982 to May 2012). They also handsearched several journals (from the first issue to the current issue). These investigators included RCTs comparing acupuncture with placebo acupuncture, no treatment, Chinese medication, Western medication, or other mumps treatments. Acupuncture included traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation (body, electro, scalp, fire, hand, fine needle, moxibustion). Two reviewers independently extracted data and assessed the quality of included studies. They calculated hazard ratios (RR) with their 95% CI for percent effective and standardized mean differences (SMD) with 95% CI for time to cure. Only 1 study with 239 participants met the inclusion criteria. There were a total of 120 participants in the acupuncture group, of whom 106 recovered, the temperature returned to normal, and there was no swelling or pain in the parotid gland; The condition of 14 participants improved, with a decrease in temperature and relief of parotid gland swelling or pain. There were 119 participants in the Western medicine group, of whom 56 recovered and 63's condition improved. The acupuncture group had a higher recovery rate than the control group. The relative RR of recovery was 1.88 (95% CI: 1.53 to 2.30). However, the acupuncture group took longer to heal than the control group. The mean was 4.20 days and the standard deviation (SD) 0.46 in the acupuncture group, while in the control group the mean was 3.78 days and the SD 0.46. There was a potential risk of bias in the study due to poor methodological quality. The authors concluded that they could not reach any reliable conclusions about the safety and efficacy of acupuncture based on 1 study. They stated that more high-quality research is needed.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guideline on "Bell's palsy" (Baugh et al, 2013) stated that "no recommendation can be made regarding the effect of acupuncture in patients with Bell's disease palsy". ".

Zhang et al (2014) systematically reviewed published reviews and meta-analyses to determine if and when acupuncture is an effective treatment for stroke and related disorders. These researchers also hoped to identify the best directions for future research in this area. Systematic reviews and meta-analyses of RCTs and quasi-RCTs evaluating the effectiveness of acupuncture in the treatment of stroke or stroke-related conditions were included. Electronic searches of the Cochrane Database of Systematic Reviews, Ovid MEDLINE, CINAHL, Ovid EMBASE, EBSCO Allied and Complementary Medicine (AMED) Database, Chinese Biological Medicine Database, and Infrastructure Database were performed. of Chinese national knowledge. Two authors independently assessed study compliance with the eligibility criteria and extracted data from included studies. The quality of systematic reviews was assessed according to the General Quality Assessment Questionnaire. A total of 24 systematic reviews were included, of which 4 (16.7%) were Cochrane systematic reviews and 20 (83.3%) were non-Cochrane reviews. Acupuncture was reviewed as an acute stroke intervention in 3 reviews (12.5%), as an approach to stroke rehabilitation in 6 (25%), and as an intervention to treat various stroke-related disorders in the remaining 15 (62.5%). . Reviews that considered death or dependence/disability as the primary endpoint reported no statistically significant difference between acupuncture and non-acupuncture control treatments. In contrast, reviews in which the outcome was improvement in global neurological deficit scores or performance on the videofluoroscopic swallow study test or the water swallow test generally reported that acupuncture was superior to control treatment. . The quality of 10 reviews was "poor", 6 reviews were "moderate", and 8 were "good". The authors concluded that the available evidence suggests that acupuncture may be effective in treating post-stroke neurological impairment and dysfunction, such as dysphagia, although these reported benefits need to be verified in large, well-controlled studies. On the other hand, the available evidence does not clearly indicate that acupuncture can help prevent post-stroke death or disability, or improve other aspects of stroke recovery, such as post-stroke motor dysfunction. These findings suggest that researchers should focus on the potential application of acupuncture to treat post-stroke neurological impairment and dysfunction and on developing more precise tools to assess these post-stroke improvements.

Zeng and associates (2014) evaluated the efficacy of acupuncture for cancer-related fatigue (CRF). Five databases (Medline, CINAHL, Scopus, Cochrane Library, and CAJ Full-text Database) were searched up to May 2013. Randomized clinical trials of acupuncture for the treatment of CKD were considered for inclusion. A total of 7 RCTs were included for meta-analysis, with a total of 689 subjects. Three studies compared acupuncture with sham acupuncture for CKD at 10-week follow-up; the standardized mean difference (SMD) for overall FRC change values ​​was -0.82 (95% CI -1.90 to 0.26). When acupuncture plus educational intervention was compared with usual care, there was a statistically significant difference for overall CRF change score (SMD = -2.12, 95% CI -3.21 to -1.03) . The SMD for overall CRF change scores between no-treatment acupuncture or waiting list control was -1.46 (95% CI -3.56 to 0.63). Finally, the SMD for overall CRF change scores between acupressure acupuncture or autoacupuncture was -1.12 (95% CI -3.03 to 0.78). Three studies reported data on general quality of life and functional status, reported data sufficient for statistical pooling but did not show statistically significant differences (: score = 1.15, : = 0.25, SMD = 0.99, CI of 95%: -0.70 to 2.68 and: score = 1.13, : = 0.26, SMD = 1.38, 95% CI: -1.02 to 3.79, respectively). Statistics: 2 of all statistically pooled data were greater than 50%, indicating heterogeneity between trials. The authors concluded that there were 4 sets of comparisons for the effectiveness of acupuncture for CRF; statistical pooling of the reduction in CRF from baseline to follow-up was in favor of acupuncture. However, 3 comparison sets for pooled estimates of effect sizes were not statistically significant. Although one set of comparisons (acupuncture plus educational interventions versus usual care) had statistically significant differences, it is unclear whether this pooled positive result is attributable to the effects of acupuncture or the educational intervention. Furthermore, the duration of follow up in these included studies was up to 10 weeks and some RCTs had methodological flaws. They stated that more rigorously designed RCTs adhering to acceptable standards of testing methodology are needed to determine the effectiveness of acupuncture and its long-term effects on FRC.

Cao and colleagues (2013) evaluated the safety and efficacy of acupuncture for patients with vascular mild cognitive impairment (VMCI). A total of 7 electronic databases investigating the effects of acupuncture compared to no treatment, placebo, or conventional therapies on cognitive function or other clinical outcomes in people with MVCI were searched for RCTs. The quality of selected studies was assessed using the 'Risk of bias' assessment provided by the Cochrane Handbook for Systematic Reviews of Interventions. RevMan V.5.1 software was used for data analysis. A total of 12 trials with 691 participants were included. The methodological quality of all included studies was unclear and/or at high risk of bias. Meta-analysis showed that acupuncture in conjunction with other therapies can significantly improve Mini-Mental State Examination scores (mean difference 1.99, 95% CI 1.09 to 2.88, randomized design, p < 0.0001 , 6 trials). No included study mentioned any adverse events of treatment. The authors concluded that the current clinical evidence is not of sufficient quality to recommend the broader application of acupuncture for the treatment of VMCI; they stated that larger, rigorously designed studies are needed.

Yang et al (2013) conducted a systematic review of RCTs to assess the effectiveness of acupuncture for diabetic gastroparesis (PGD). These investigators searched PubMed, EMbase, the Cochrane Central Register of Controlled Trials (CENTRAL), and 4 Chinese databases, including the China National Knowledge Infrastructure (CNKI), the VIP database for Chinese technical journals, the from Chinese Biomedical Literature (CBM) data and WanFang Data. as of January 2013 without language restriction. Eligible RCTs designed to examine the effectiveness of acupuncture in improving dyspeptic symptoms and gastric emptying in PGD were selected for analysis. Risk of bias , study design and results were extracted from the trials. Relative risk (RR) was calculated for dichotomous data. Mean difference (MD) and standardized mean difference (SMD) for continuous data were selected to pool the overall effect. These investigators searched for 744 studies, among which 14 RCTs were considered eligible. Overall, acupuncture treatment had a higher response rate than controls (RR, 1.20 [95% CI 1.12 to 1.29], p < 0.00001) and significantly improved dyspeptic symptoms compared to the control group. There was no difference in solid gastric emptying between acupuncture and control. Acupuncture improved a single dyspeptic symptom, including nausea and vomiting, loss of appetite, and stomach fullness. Most of the studies were unclear and at high risk of bias and with a small sample size (median = 62). Most of the RCTs reported a positive effect of acupuncture in improving dyspeptic symptoms. The authors concluded that the results suggested that acupuncture may be effective in improving dyspeptic symptoms in PGD, while a definitive conclusion cannot be drawn as to whether acupuncture was effective for PGD due to the poor quality of the trials and the lack of evidence. possibility of publication bias. They stated that more large-scale, high-quality RCTs are needed to validate this claim and translate this result into clinical practice.

In a prospective, randomized, controlled, and blind validated multicenter study, Skjeie et al (2013) tested the hypothesis that acupuncture treatment has a clinically relevant effect for infantile colic. Research assistants and parents were blinded. The intervention consisted of 3 days of bilateral puncture of the ST36 acupoint, without treatment as a control. A total of 113 patients were recruited; 23 patients were excluded and 90 randomized; 79 diaries and 84 interviews were analyzed. The main outcome measures were the difference in changes in crying time during the experimental period between the intervention and control groups. Blinding validation questions were randomized with p = 0.41 and 0.60, indicating true blinding. These investigators found no statistically significant differences in the reduction in crying time between acupuncture and the control group at any of the measured intervals, nor in the main analysis of differences in changes over time (p = 0, 26). There was a trend in favor of the acupuncture group, with a non-significant baseline corrected total difference of 13 minutes (95% CI -24 to +51) difference in crying time between groups. This was not considered clinically relevant according to the protocol. The authors concluded that this trial of acupuncture treatment for infantile colic had no statistically significant or clinically relevant effect; suggested that acupuncture for infantile colic should be limited to clinical trials.

Zhang et al (2013) reviewed the efficacy of acupuncture point application therapy for childhood diarrhea. The authors of this article performed a literature retrieval using the China National Knowledge Infrastructure (CNKI) database, the Chinese Biomedical Database, and the Wanfang Database covering the period from 1 January 1990 and June 30, 2012, and performed a systemic evaluation of the retrieved RCTs of acupuncture point therapy for childhood diarrhea using the Cochrane system evaluation method. After excluding repetitive, irrelevant, and uncontrolled RCTs, those meeting RCT standards were collected. Study quality was assessed using the Jadad score, which assesses the randomization process, blinding, and description of dropouts or dropouts. RevMan 5.1 software was used for statistical analysis. A total of 16 articles (2151 patients) were included in the meta-analysis. The homogeneity test was better (chi2 = 8.09, p = 0.92, I2 = 0%), showing homogeneity in most studies. Meta-analysis showed amount of fusion effect OR = 4.68 and 95% CI 3.41 to 6.42, and Z-test fusion effect value = 9.58, p < 0.00001 . The statistical difference indicates a better therapeutic effect of the acupuncture point application group than the control group, providing evidence in favor of acupuncture point application therapy for childhood diarrhea. The funnel plot shows that the distribution of the investigated object is symmetric, with a smaller bias. But there is still a possible publication bias. The authors concluded that acupuncture point therapy for childhood diarrhea has some advantages, which need further confirmation due to the lower quality of the collected literature. They stated that high-quality RCTs and larger samples are strongly recommended.

Zhu and colleagues (2013) reviewed the safety and efficacy of acupuncture for pain in endometriosis. These investigators searched the Cochrane Menstrual Disorders and Subfertility Group (MSDG) Specialized Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI, and TCMDS. (since early 2010) and reference lists of retrieved articles. Single- or double-blind randomized clinical trials in women of reproductive age with a laparoscopically confirmed diagnosis of endometriosis were selected and compared acupuncture (body, scalp, or ear) with placebo or placebo, no treatment, conventional therapies, or Chinese herbal medicines. analysis. Three authors independently assessed risk of bias and extracted data; they contacted the study authors for additional information. No meta-analyses were performed as only 1 study was included. The primary outcome was decreased pain from endometriosis. Secondary outcome measures included improvement in quality of life scores, pregnancy rate, adverse effects, and endometriosis recurrence rate. A total of 24 studies that included acupuncture for endometriosis were identified; however, only 1 study, with 67 participants, met all the inclusion criteria. The only study included pain scores and cure rates according to the Guide for Clinical Research in New Chinese Medicine. Dysmenorrhea scores were lower in the acupuncture group (mean difference -4.81 points, 95% CI -6.25 to -3.37, p < 0.00001) using the 15-point scale. the Guide for Clinical Research in New Chinese Medicine for the Treatment of the Pelvic. endometriosis. The total effective rate ("cured", "significantly effective", or "effective") for auricular acupuncture and Chinese herbal medicine was 91.9% and 60%, respectively (hazard ratio 3.04, 95% CI). %: 1.65 to 5.62, p = 0.0004). The rate of improvement did not differ significantly between auricular acupuncture and Chinese herbal medicine for mild to moderate dysmenorrhea, while auricular acupuncture significantly reduced pain in severe dysmenorrhea. Data were not available for the secondary outcome measures. The authors concluded that the evidence to support the efficacy of acupuncture for pain in endometriosis is limited, based on the results of a single study included in this review. This review highlighted the need to develop future studies that are well-designed double-blind RCTs evaluating various types of acupuncture in comparison with conventional therapies.

acupuncture point injection

Acupuncture point injection (also known as acupuncture point injection therapy, biopuncture) involves injecting small amounts of saline or other substances (eg, Chinese herbal extracts, medicines, homeopathic substances, vitamin B12, and b12 vitamin). points by qualified acupuncturists. Similar to acupuncture, thin needles are inserted into acupuncture points/trigger points just under the skin or into the muscles. However, there is not enough evidence to support the effectiveness of this approach.

In a Cochrane review, Green et al (2002) evaluated the efficacy of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement of function, grip strength, and pain relief. Adverse effects. These investigators searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and Musculoskeletal Review Group database of specialist studies from 1966 to June 2001. Keywords and authors identified in an effort to retrieve as many studies as possible. . Two independent reviewers assessed all identified studies against the predetermined inclusion criteria. Randomized and pseudo-randomised clinical trials in all languages ​​were included in the review provided they tested acupuncture versus placebo or another intervention in adults with lateral elbow pain (tennis elbow). Outcomes of interest were pain, function, disability, quality of life, strength, participant satisfaction with treatment, and adverse effects. For continuous variables, means and standard deviations were extracted or imputed to allow weighted mean difference analysis, while for binary data, numbers of events and the total population were analyzed and interpreted as relative risks. Trial results were pooled only in the absence of clinical and statistical heterogeneity. A total of 4 small RCTs were included, but due to flaws in study designs (particularly small populations, unclear allocation concealment, and substantial loss to follow up) and clinical differences between trials, trial data could not be determined. combined into one endpoint. .-analysis. One RCT found that needle acupuncture produces significantly longer pain relief than placebo (weighted mean difference (WMD) = 18.8 hours, 95% CI 10.1 to 27.5) and is more likely resulting in a pain reduction of 50% or more after 1 treatment (RR 0.33, 95% CI 0.16 to 0.69) (Molsberger 1994). A second RCT demonstrated that needle acupuncture is more likely to produce participant-reported overall improvement than placebo in the short term (RR = 0.09, 95% CI 0.01 to 0.64) (Haker 1990a ). No significant differences were found in the long term (after 3 or 12 months). An RCT of laser acupuncture versus placebo demonstrated no difference between laser acupuncture and placebo in overall benefit (Haker 1990b). A fourth included RCT, published in Chinese, showed no difference between vitamin B12 injection plus acupuncture and vitamin B12 injection alone (Wang 1997). The authors concluded that there is insufficient evidence to support or refute the use of acupuncture (needle or laser) in the treatment of lateral elbow pain. This review demonstrated that needle acupuncture is beneficial for pain in the short term, but this finding is based on the results of two small studies, the results of which could not be combined in the meta-analysis. No benefit lasting more than 24 hours after treatment has been shown. No study evaluated or commented on the potential adverse effect. They stated that more studies are needed, using appropriate methods and adequate sample sizes, before any conclusions can be drawn about the effect of acupuncture on tennis elbow.

In a prospective observational pilot study, Wang et al (2004) examined the effects of acupuncture point injection of vitamin K on menstrual pain in young women aged 14 to 25 years from different countries and cultural settings who had severe primary dysmenorrhea not relieved at 6 months. or more. All subjects were treated with bilateral vitamin K acupoint injection on the first or second day of menstrual pain. Pain intensity, total duration and average intensity of menstrual discomfort, hours spent in bed, restrictions in normal daily activity, and number of analgesic pills taken for pain relief were recorded before treatment and during the 4 subsequent menstrual cycles. Marked pain relief was observed 2 minutes after treatment and subsequent pain reduction occurred within 30 minutes (p < 0.001). Participants reported significantly fewer restrictions on daily life, fewer hours in bed, less pain pill use, and lower scores for menstrual pain duration and intensity (p < 0.001). There were no adverse events. Some women have experienced mild, self-limited pain at the injection site. The authors concluded that vitamin K acupuncture point injection relieved acute menstrual pain and the relief was extended through follow-up cycles without treatment in this uncontrolled pilot study conducted in 2 countries. They stated that further research using controlled experimental designs is warranted.

Liang et al (2011) reported the findings of 2 patients with amyotrophic lateral sclerosis (ALS) who were treated with 4 weeks of acupuncture point injection therapy using Enercel. These patients received 0.25 to 0.5 cc of Enercel Plus IM at specific acupuncture points 5 days a week for 4 weeks. Patient 1 had flaccid paralysis of all 4 extremities and difficulty speaking and swallowing. At week 4, he demonstrated significant improvement in his motor strength in all 4 limbs (R > L) and improved speech and swallowing. However, he did not continue to receive the Enercel acupuncture point injections and subsequently demonstrated a slow and progressive loss of neurological function over the next 3 months, as demonstrated by follow-up examinations. Patient 2 had significant speech disturbances and mild motor loss in the upper limbs and left leg. After 4 weeks of treatment, his voice had improved significantly to the point where his speech was understandable and his motor functions had returned to normal. He continued to receive Enercel acupuncture point injections during the 3-month follow-up period and his clinical improvements were maintained. Therefore, these 2 ALS patients showed clinical improvement after 4 weeks of Enercel acupoint injection therapy. Follow-up data suggested that continued therapy may be required to maintain these positive effects. The authors concluded that the results of this preliminary study deserve further study and confirmation.

In a Cochrane review, Paley et al (2011) evaluated the efficacy of acupuncture in relieving cancer-related pain in adults. We searched CENTRAL , MEDLINE , EMBASE , PsycINFO , AMED , and SPORTDiscus up to November 2010, including articles in languages ​​other than English. Randomized controlled trials evaluating any type of invasive acupuncture for pain directly related to cancer in adults aged 18 years and over were selected for analysis. It was planned to pool the data to provide an overall measure of effect and to calculate the number needed to treat for benefit, but this was not possible due to heterogeneity. Two review authors independently extracted data by adding them to data extraction worksheets. Quality scores were given to the studies. The data sheets were compared and discussed with a third reviewer who acted as referee. A total of 3 RCTs (204 participants) were included. One high-quality study investigated the effect of auricular acupuncture compared with auricular acupuncture at the 'placebo' points and with non-invasive vaccaria seeds attached to the 'placebo' points. Participants in 2 acupuncture groups were blinded, but blinding was not possible in the ear seed group because the seeds were taped together. This may have biased results in favor of the acupuncture groups. Participants in the real acupuncture group had lower pain scores at the 2-month follow-up than either the placebo or ear seed groups. There was a high risk of bias in 2 studies due to low methodological quality. A study comparing acupuncture with medication concluded that both methods were effective in controlling pain, although acupuncture was the most effective. The second study compared acupuncture, localized injections, and medications in participants with stomach cancer. Long-term pain relief was reported with acupuncture and localized injection compared with medication during the last 10 days of treatment. Although both studies had positive results in favor of acupuncture, they should be viewed with caution due to methodological limitations, small sample sizes, poor reporting, and inadequate analyses. The authors concluded that there is insufficient evidence to judge whether acupuncture is effective in treating cancer-related pain in adults.

In a pilot study, Park et al (2011) examined the possibility of injection of Carthami-Semen (CS, safflower seed) acupoints as a promising new treatment for chronic daily headache (CDH). A total of 40 CDH subjects were recruited and randomized to a CS acupoint injection group or a normal saline (NS) acupoint injection group. Acupuncture point injections were applied twice a week for a period of 4 weeks to bilateral Fengchi (GB20), Jianjing (GB21) and Taiyang (EX-HN5) acupoints with CS or NS extract. The primary outcome was headache-related quality of life (QoL), assessed using the Headache Impact Test (HIT). Secondary outcome measures were changes in the number of headache-free days and health status as assessed with the Short Form Health Survey (36) (SF-36). HIT scores decreased by 14.9 points in the CS acupoint injection group compared with 7.9 points in the NS acupoint injection group (p = 0.013). Headache-free days increased by 32.6% in the CS acupoint injection group compared with 17.4% in the NS acupoint injection group (p = 0.045). There were significant increases in SF-36 scores compared to baseline in both groups, but the mean improvement was greater in the CS acupuncture point injection group. There were no serious events reported. The authors stated that these findings suggest that CS acupuncture point injection may be a safe and promising new treatment for CDH. They stated that a larger, longer-term follow-up study is needed to more definitively determine the efficacy of CS acupuncture point injection and elucidate how long the effect lasts.

Zhang et al (2012) examined the effects of acupuncture point injection on cervical spondylosis. Electronic retrieval was performed on the literature from May 1, 2006 to June 1, 2011 in PubMed, ISI web of Knowledge, and CNKI databases. The selected literature was summarized and classified based on 3 aspects of acupuncture point selection, drug selection, and manipulations. The authors noted that the cervical Jiaji (EX-B 2), Fengchi (GB 20), and Ashi points are common acupuncture points. The medicines contain simple Chinese herbs (eg Danggui injection etc.) combined with vitamin B12). Disposable syringes were used as injection equipment. The authors stated that although injection into acupuncture points in the treatment of cervical spondylosis is effective, studies of the mechanism are still lacking, as most investigations focus on clinical observation. They concluded that the manipulation of acupuncture point injections is not standardized; the laws of clinical effect are unclear. Thus, they affirmed that "the aforementioned defects still need to be improved."

Bae et al (2014) conducted a meta-analysis of several studies appropriate to assess the preoperative anxiolytic efficacy of acupuncture therapy. We searched four electronic databases (MEDLINE, EMBASE, CENTRAL, and CINAHL) up to February 2014. Data from RCT studies comparing groups receiving preoperative acupuncture treatment with control groups were included in the meta-analysis. who received placebo for anxiety. A total of 14 publications (n ​​= 1034) were included. Six publications, using the State-Trait-State Anxiety Inventory (STAI-S), reported that acupuncture interventions led to greater reductions in preoperative anxiety relative to sham acupuncture (mean difference = 5.63, p < 0.00001, 95% CI 4.14 to 7.11). Eight other publications, using VAS, also reported significant differences in improvement in preoperative anxiety between acupuncture and sham acupuncture (MD = 19.23, p < 0.00001, 95% CI 16.34 to 22.12). ). The authors concluded that acupuncture therapy aimed at reducing preoperative anxiety has a statistically significant effect over placebo or no treatment conditions. They stated that well-designed, rigorous studies using large samples are needed to corroborate this finding.

Ryu et al (2014) stated that to explore the mechanism of pain, several animal models were developed to simulate specific human pain conditions, including cancer-induced bone pain (CIBP). In this study, these researchers reviewed the current research methodology of acupuncture for the treatment of CIBP. They electronically searched the PubMed database for animal studies published since 2000 using these search terms: (bone cancer OR cancer) AND (pain OR analgesia) AND (acupuncture OR pharmacopuncture OR bee venom). They selected articles that described cancer pain in animal models. These investigators reviewed the methods used to induce cancer pain and the outcome measures used to assess the effects of acupuncture on CIBP in animal models. They reviewed the articles that met the inclusion criteria. Injection of breast cancer cells into the tibial cavity was the most widely used method to induce CIBP in animal models. Among the 8 selected studies, 5 demonstrated the effects of electroacupuncture on CIBP. The effects of acupuncture were assessed by measuring behavior related to pain. The authors concluded that further research is needed to verify the efficacy of acupuncture in the treatment of CIBP and to explore the specific mechanism of CIBP in animal models.

In a Cochrane review, Shen et al (2014) examined the effects of acupuncture, alone or in combination treatments, compared with placebo (or no treatment) or any other treatment for people with schizophrenia or related psychoses. These investigators searched the Cochrane Schizophrenia Group Trials Register (February 2012), which was based on periodic searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and clinical trials registries. . They also inspected the references of the identified studies and contacted the relevant authors for additional information. They included all relevant RCTs involving people with schizophrenia-like illnesses, comparing acupuncture added to standard-dose antipsychotics with standard-dose antipsychotics alone, acupuncture added to low-dose antipsychotics with standard-dose antipsychotics, acupuncture with antipsychotics, acupuncture added to Traditional Chinese Medicine (TCM) medication with TCM medicine, acupuncture with TCM medicine, electric acupuncture convulsive therapy with electroconvulsive therapy. These investigators reliably extracted data from all included studies, discussed any disagreements, documented decisions, and contacted study authors where necessary. They analyzed binary outcomes using a standard estimate of RR and its 95% CI. For continuous data, they calculated MDs with a 95% CI. For homogeneous data, they used the fixed effects model. They assessed the risk of bias of the included studies and created 'Summary of findings' tables using the Recommendation, Assessment, Development and Evaluation (GRADE) grid. After an updated search in 2012, the review included 30 studies testing different forms of acupuncture in 6 different comparisons. All studies were at moderate risk of bias. When acupuncture plus standard antipsychotic treatment was compared with standard antipsychotic treatment alone, people were at less risk of 'not getting better' (n=244, 3 RCTs, medium term RR 0.40 CI 0.28 to 0, 57, very low-quality evidence). Mental state findings were consistent with this finding, as was time in hospital (n=120, 1 RCT, days MD -16.00 CI -19.54 to -12.46, moderate-quality evidence) . At a minimum, adverse effects were minor for the acupuncture group (eg, central nervous system, insomnia, short term, n=202, 3 RCTs, RR 0.30 CI 0.11 to 0.83, low-quality evidence). When acupuncture was added to low dose antipsychotics and compared with standard dose antipsychotics, relapse was lower in the experimental group (n=170, 1 RCT, RR long term 0.57 CI 0.37 to 0.89 , very low quality evidence), but there was no difference for the outcome 'not improved'. Again, the mental state findings were consistent with the latter. The incidence of extrapyramidal symptoms, akathisia, was lower for those in the acupuncture plus low dose antipsychotic group (n=180, 1 RCT, CI 0.03, short term RR 0.00 to 0.49, low-quality evidence), such as dry mouth, blurred vision, and rapid heartbeat. When acupuncture was compared with antipsychotic drugs of known efficacy at standard doses, there were equivocal data for outcomes such as 'no improvement' using different global state criteria. Traditional acupuncture added to TCM had benefits over TCM alone (n=360, 2 RCTs, RR clinically important change 0.11 CI 0.02 to 0.59, low-quality evidence ), but when traditional acupuncture was directly compared with traditional Chinese medicine there was no significant difference in the short term. However, these investigators found that participants receiving electroacupuncture were significantly less likely to experience worsening of general condition (n=88, 1 RCT, short term CI 0.52 RR 0.34 to 0.80, evidence from low quality). In the 1 study comparing electrical acupuncture seizure therapy with electroconvulsive therapy, there were significantly different rates of spinal fracture between groups (n=68, 1 RCT, short term RR 0.33 CI 0.14 to 0.81, low-quality evidence) . Attrition in all studies was minimal. No study reported death, commitment to services, satisfaction with treatment, quality of life, or economic outcomes. The authors concluded that limited evidence suggested that acupuncture may have some antipsychotic effects measured on global and mental state with few adverse effects. They said larger, better-designed studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.

Park et al (2014) reviewed the available literature on the use of acupuncture as a treatment for spasticity in stroke patients. Randomized trials evaluating the effects of acupuncture for the treatment of post-stroke spasticity were identified by searching the Cochrane Library, PubMed, ProQuest, EBSCOhost, SCOPUS, CINAHL, EMBASE, Alternative Medicine Database, and medical literature databases. chinese and korean Two review authors independently extracted data on study characteristics, patient characteristics, and spasticity outcomes. A total of 8 studies with 399 patients met all the inclusion criteria. Compared with controls without acupuncture, acupuncture had no effect on improving clinical outcomes (as measured by validated instruments such as the modified Ashworth Scale) or physiological outcomes (assessed by measures such as the H-reflex/M- response [M/M ] at the end of the treatment period); M/F ratios decreased significantly immediately after the first acupuncture treatment. The methodological quality of all evaluated studies was considered inadequate. The authors concluded that the effect of acupuncture on spasticity in stroke patients remains uncertain, mainly due to the low quality of the available studies. They stated that larger and more methodologically sound studies are needed to confirm or refute any effect of acupuncture as a treatment for spasticity after stroke.

Li et al (2014) noted that spontaneous intracerebral hemorrhage (ICH) is the most devastating subtype of stroke, but no evidence-based treatment strategy currently exists. Acupuncture is a well-known traditional Chinese therapy for stroke-induced disability, and GV20 is the commonly used acupuncture point. These investigators evaluated the efficacy of GV20-based acupuncture in animal models of acute ICH. Studies of GV20-based acupuncture in animal models of acute ICH were identified in 6 databases up to July 2013. Study quality for each included article was assessed according to the CAMARADES 10-item checklist. Outcome measures were neurological deficit scores and brain water content. All data were analyzed using RevMan V.5.1 software. A total of 19 studies describing procedures involving 1628 animals were identified. The study quality score ranged from 3 to 6, with a mean of 4.6. The overall effect estimate of acupuncture based on GV20 was a 0.19 (95% CI 0.13 to 0.25, p < 0.001) SD improvement in outcome compared to controls. In subgroup analyses, the effect size was greater when the outcome was measured as a neurological deficit score than brain water content or both (p < 0.001). The authors concluded that these findings showed the potential efficacy of GV20-based acupuncture in animal models of acute ICH, suggesting it as a candidate therapy for acute ICH.

Other Experimental and Investigational Indications for Acupuncture

Ji et al. (2013) noted that inflammatory bowel disease (IBD) is recurrent and refractory; includes Crohn's disease (CD) and ulcerative colitis (UC). Clinical research on acupuncture and moxibustion treatments for IBD is increasing, while systematic reviews of their efficacy remain sparse. These investigators evaluated the effectiveness of acupuncture and moxibustion for IBD. We searched a total of 7 significant national and international databases for RCTs comparing acupuncture and moxibustion as the main intervention with pharmacotherapy in the treatment of IBD. A meta-analysis was performed. A total of 43 RCTs were included. Among the 43 included studies, ten studies compared oral sulfasalazine (SASP) with acupuncture or moxibustion treatments. A meta-analysis of the 10 studies indicated that acupuncture and moxibustion therapy was superior to oral SASP. The authors concluded that acupuncture and moxibustion demonstrated better efficacy than oral SASP in the treatment of IBD. However, given the limitations of this systematic review and the included literature, no definitive conclusions can be made about the exact efficacy of acupuncture and moxibustion treatment for IBD. They stated that existing RCTs cannot yet provide sufficient evidence and double-blind multicentre RCTs with large sample sizes are needed to provide higher quality evidence.

Kim et al (2013) evaluated the current evidence on the effectiveness of acupuncture for post-traumatic stress disorder (PTSD) in the form of a systematic review. These researchers conducted a systematic literature search of 23 electronic databases. The gray literature was also searched. The main search terms were "acupuncture" and "PTSD". There were not imposed idiom restrictions. They included all RCTs or prospective clinical trials that evaluated acupuncture and its variants against a wait list, sham acupuncture, conventional PTSD therapy control, or no control. A total of 4 RCTs and 2 uncontrolled clinical trials (UCT) out of a total of 136 articles were systematically reviewed. One high quality RCT reported that acupuncture was superior to waiting list control and that the therapeutic effects of acupuncture and cognitive behavioral therapy (CBT) were similar based on effect size. One RCT showed no statistical difference between acupuncture and selective serotonin reuptake inhibitors (SSRIs); 1 RCT reported a favorable effect of acupuncture point stimulation plus CBT versus CBT alone. A meta-analysis of acupuncture plus moxibustion versus SSRIs favored acupuncture plus moxibustion for 3 outcomes. The authors concluded that this systematic review and meta-analysis suggested that the evidence for the effectiveness of acupuncture for PTSD is encouraging but not convincing. They stated that more qualified studies are needed to confirm whether acupuncture is effective for PTSD.

Yang et al (2015) stated that acupuncture has become increasingly integrated into pediatric health care in recent years. It has been used in approximately 150,000 children (0.2%). The authors updated the evidence on the safety and efficacy of acupuncture for children and assessed the methodological qualities of these studies to improve future research in this area. They included 24 systematic reviews, comprising 142 RCTs with 12,787 participants. Only 25% (6/24) of the reviews were judged to be of high quality (10.00 ± 0.63). High-quality systematic reviews and Cochrane systematic reviews tend to produce neutral or negative results (p = 0.052, 0.009, respectively). The efficacy of acupuncture for 5 diseases (cerebral palsy (CP), nocturnal enuresis (EN), tics, amblyopia, and pain reduction) is promising. It was unclear for hypoxic ischemic encephalopathy, attention deficit hyperactivity disorder, mumps, autism spectrum disorder (ASD), asthma, nausea/vomiting, and myopia. Acupuncture is not effective for epilepsy. Only 6 reviews reported adverse events (AEs) and no fatal side effects were reported. The authors concluded that the efficacy of acupuncture for some diseases is promising and there were no reports of fatal side effects. They stated that more high-quality studies are warranted, with 5 diseases in particular as research priorities.

Lv and colleagues (2015) stated that NE is recognized as a widespread health problem in children and adolescents. Clinical research on acupuncture therapy for NE is increasing, while systematic reviews evaluating the effectiveness of acupuncture therapy are still lacking. These investigators evaluated the effectiveness of acupuncture therapy for NE. An exhaustive bibliographic search of 8 databases was carried out up to June 2014; RCTs comparing treatment with acupuncture and treatment with placebo or pharmacotherapy were identified. A meta-analysis was performed. This review included 21 RCTs and a total of 1590 subjects. General methodological qualities were low. The results of the meta-analysis showed that acupuncture therapy was more effective for clinical efficacy compared to placebo or drug treatment; AEs associated with acupuncture therapy have not been documented. The authors concluded that, based on the results of this study, they cautiously suggested that acupuncture therapy might improve clinical efficacy. However, they stated that the beneficial effect of acupuncture may be overestimated due to poor methodological qualities; Rigorous, high-quality RCTs are required.

Yu et al. (2015) pointed out that pruritus is a sensitive state that provokes the desire to scratch. It is not only a common symptom of skin diseases, but also occurs in some systemic diseases. Clinical studies on the effectiveness of acupuncture therapy in relieving itch are increasing, while systematic reviews evaluating the effectiveness of acupuncture therapy are still lacking. These researchers evaluated the effectiveness of acupuncture therapy for itching. A comprehensive literature search of 8 databases was performed up to June 2014 and identified RCTs comparing acupuncture therapy and placebo acupuncture or no treatment group. Therefore, a meta-analysis was performed. This review included 3 RCT articles out of a total of 2530 articles. The results of the meta-analysis showed that acupuncture therapy was effective in relieving itch compared to the sham and no-treatment group. The authors concluded that, based on the findings of this systematic review, they cautiously suggested that acupuncture treatment might improve the clinical efficacy of pruritus. However, they stated that this conclusion needs further studies in various ethnic samples to confirm the final conclusion.

acute pancreatitis

In a systematic review and meta-analysis, Zhang and colleagues (2019) examined the safety and efficacy of acupuncture plus routine care (RT) for the treatment of acute pancreatitis (AP). These researchers conducted a literature search in 8 databases up to October 31, 2018; RCTs comparing acupuncture plus RT with RT alone for AP were included. A total of 12 eligible studies were ultimately included. Meta-analysis showed that acupuncture plus RT compared with RT alone could significantly improve total effective rate and gastrointestinal (GI) function and reduce acute physiology, age, chronic health assessment II, necrosis factor count. alpha tumor (TNF-α), time to return to diets, and length of stay. Only 3 of the studies reported AEs or reactions. The authors concluded that the results of this study suggested that acupuncture combined with RT may be effective for PA. However, these investigators stated that more rigorously designed RCTs are needed to confirm these findings.

Alcohol withdrawal syndrome

Li et al (2018) noted that acupuncture has been used as a potential therapy for alcohol withdrawal syndrome (ABS), but evidence of its effects in this condition is limited. These investigators examined the safety and efficacy of acupuncture for AWS. We searched the Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cochrane Library, PsycINFO, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), and the Wan-Fang database from inception. until August 2016; RCTs of drugs plus acupuncture or acupuncture alone for the treatment of AWS were included. Continuous data were expressed as MD with 95% CI. Dichotomous data were expressed as RR with 95% CI. A total of 11 RCTs with 875 participants were included. In the acute phase, 2 studies reported no difference between drug plus acupuncture and drug plus sham acupuncture in reducing alcohol cravings; however, 2 positive trials reported that medication plus acupuncture was superior to medication alone in relieving psychological symptoms. In the extended phase, 1 study reported that acupuncture was superior to sham acupuncture in reducing alcohol cravings, 1 study reported no difference between acupuncture and drug (disulfiram), and 1 study reported that acupuncture was superior to acupuncture simulated to relieve alcohol cravings. symptoms; adverse effects were tolerable and not serious. The authors concluded that there were no significant differences between acupuncture (plus medication) and sham acupuncture (plus medication) on the primary outcome measure of craving for alcohol among participants with AWS, and no difference in completion rates ( pooled results). There was limited evidence from individual trials that acupuncture may reduce cravings in the prolonged phase and help alleviate psychological symptoms; however, given concerns about the quantity and quality of included studies, more large-scale, well-conducted RCTs are needed.

Alzheimer disease

In an exploratory, randomized, controlled, parallel group study, Jia and colleagues (2017) examined the safety and efficacy of acupuncture in patients with mild to moderate Alzheimer's disease (AD) at a baseline of 4 weeks (T0 ), a 12-week treatment phase (T1) and a 12-week follow-up period (T2). Patients with mild to moderate AD who met the inclusion criteria were randomly assigned to

1. acupuncture or
2. donepezil hydrochloride groups.

1. the small sample size (n = 43 for AG; n = 44 for DG) led to poor results,
2. people who were happy to participate in this study seemed to have a positive attitude towards treatment (including acupuncture and medicine). It is possible that patients with high treatment expectations introduced a positive bias into the study results and
3. It was not clear whether the findings in the city of Tianjin could be extrapolated to other districts.

Hot flashes related to breast cancer

Salehi and colleagues (2016) evaluated the effectiveness of acupuncture in treating hot flashes in women with breast cancer. Aspects considered in this study included searching 12 databases up to April 2015 and consulting reference lists of reviews and related articles. Additional resources studied included all articles on human breast cancer patients treated with needle acupuncture with or without electrical stimulation for the treatment of hot flashes. Methodological quality was assessed using the modified Jadad score. The searches identified 12 relevant articles for inclusion. Meta-analysis without any subgroups or moderator failed to show favorable effects of acupuncture in reducing hot flash frequency after intervention (n=680, SMD= -0.478, 95% CI -0.397 to 0.241, p= 0.632); but showed marked heterogeneity of results (Q value = 83.200, p = 0.000, I^2 = 83.17, τ^2 = 0.310). The authors concluded that this meta-analysis showed conflicting results and did not produce any convincing evidence to suggest that acupuncture is an effective treatment for hot flashes in breast cancer patients. They stated that multicenter studies with large sample sizes are needed to verify the efficacy of acupuncture in the treatment of hot flashes in patients with breast cancer.

Breast cancer-related lymphedema

Chien and colleagues (2019) stated that breast cancer-related lymphedema (BCRL) is difficult to manage. Treatment may include lymphatic drainage, skin care, bandaging, or even surgery. Because acupuncture has been shown to affect neurophysiology and neuroendocrine systems, it has the potential to control BCRL. In a systematic review and meta-analysis, these investigators examined the effect of acupuncture on BCRL in RCTs. They performed a bibliographic search, following the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and without language restrictions. We searched a total of 5 databases from inception to September 2018. Only studies that met the eligibility criteria to assess the effect of acupuncture on lymphedema in breast cancer were included. The methodological quality of these studies was assessed using the Cochrane criteria and meta-analysis software (RevMan 5.3) was used for analysis. These researchers examined 178 breast cancer patients in 6 trials. All included RCTs were of medium to high quality according to the modified Jadad scale. The systematic review showed that acupuncture was safe and tended to improve symptoms, but the trials did not consistently measure outcomes. Meta-analysis showed that acupuncture did not produce a significant improvement in the extent of lymphoedema compared to the control intervention (-1.90, 95% CI -5.39 to 1.59, p = 0.29). None of the studies reported serious AEs. The authors concluded that acupuncture is safe and tends to improve breast cancer-related lymphedema, but does not significantly change BCRL arm circumference. These investigators stated that future studies should include both subjective and objective measurements and that large-scale studies are needed.

Hu and associates (2019) conducted a comprehensive review of clinical studies on acupuncture treatment for BCRL to examine the safety and efficacy of acupuncture treatment and provide evidence for clinical decision-making. We searched public databases, including mainly China Scholarly Journals Full Text Database, Chinese Sci-Tech Journal Database, Wanfang, PubMed, Embase, and Cochrane Library, from database establishment to December 2018, RCTs of acupuncture for BCRL. Clinical RCTs on the treatment of BCRL with acupuncture combined with drugs or functional exercises were included for analysis. Two investigators assessed risk of bias and quality according to the standard Cochrane Handbook 5.1.0, and Revman 5.3 software was used for meta-analysis. A total of 13 studies were enrolled, involving 747 patients (377 in the treatment group and 370 in the control group). The results of the meta-analysis showed that the acupuncture intervention could improve the total effective rate for the treatment of BCRL (OR = 4.62, 95% CI 2.61 to 8.17). Recent studies suggest that acupuncture therapy may relieve upper extremity swelling and improve subjective pain and discomfort in patients with BCRL, regardless of the control intervention used. However, the number of high-quality RCTs was low. Furthermore, most of the studies adopted inconsistent measures of efficacy. These investigators stated that additional blinded, large-sample, randomized, well-controlled studies with objective and consistent measures of efficacy are needed, especially in China, to confirm these findings.

In a systematic review and meta-analysis, Yu et al. (2020) examined whether acupuncture was a good method of treating extremity edema in women after breast cancer surgery. These investigators reviewed published RCTs to assess the effectiveness of acupuncture in preventing BCRL. The search strategies were carried out with the following keywords: "breast cancer", "acupuncture", "neoplasia" and "lymphedema" with derivations and different combinations of these keywords. The following databases were searched: PubMed, Cochrane Library, Embase, Web of Science, CNKI, WanFang, and CBM. Studies published in English and Chinese were considered for inclusion in this study. Study selection, risk of bias assessment, and data extraction were performed independently. Statistical analyzes were performed using RevMan software (version 5.3). The search strategy identified a total of 8 studies and 519 patients were included in this study. The effective rate was higher (OR: 4.23; 95% CI: 2.11 to 8.49; Z=4.07, p < 0.0001) in the experimental group than in the control group. There was no significant improvement in front flexion ( MD 0.19, 95% CI -3.68 to 4.06, Z = 0.09, p = 0.92) or back extension ( MD 0.42, 95% CI -2.22 to 3.06, Z = 0.31, p=0.75) shoulder movements between experimental and control groups. The authors concluded that acupuncture may be an effective method to improve the BCRL condition. However, due to the high risk of bias and the low quality of the available studies, more high-quality RCTs are needed to confirm the efficacy of acupuncture in people with BCRL.

cancer related fatigue

Li and Liu (2021) stated that increasing attention has been paid to acupuncture and auricular acupressure as alternative strategies to manage cancer-related fatigue (CRF). These investigators describe the protocol for a systematic review and meta-analysis that will examine the safety and efficacy of auricular acupuncture and acupressure in relieving CRF in patients (aged 18 years or older) during chemotherapy for lung cancer. They searched the Web of Science, Embase, PubMed, and Cochrane Library electronic databases from inception to August 2021, using the key phrases 'acupuncture', 'auricular acupressure' and 'lung cancer' for all relevant trials. Studies comparing acupuncture (including electroacupuncture) and auricular acupressure with acupuncture alone were included. The primary outcome was measurement of CRF symptoms; Secondary outcome measures were physical activity, quality of life, and adverse events. A value of "p" < 0.05 was considered statistically significant. It will be the first of this study and will obtain evidence for the use of acupuncture and auricular acupressure for the treatment of CKD in patients with lung cancer. The authors concluded that the combination of acupuncture and auricular acupressure may be effective in relieving CRF in patients receiving chemotherapy for lung cancer.

Cardiovascular diseases (eg, angina pectoris, heart failure, hypertension)

Lee and colleagues (2016) reviewed RCTs on acupuncture for heart failure (HF) and evaluated the clinical evidence. Electronic databases such as Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and some Chinese and Korean databases were searched up to October 2015. The main outcomes assessed were mortality, New York Heart Association (NYHA) and acupuncture-related AEs. . Details of the acupuncture intervention were also investigated. Among 4107 publications, 7 RCTs were included; most of them had considerable methodological flaws. These investigators were unable to perform a meta-analysis due to the heterogeneity of the included studies. In a study of acute HF, acupuncture shortened intensive care unit (ICU) stay by 2.2 days (95% CI 1.26 to 3.14) and reduced the RR of readmission to 0.53 (95% CI 0.28 to 0.99). However, mortality was not affected. Hemodynamic parameters also showed improvement. Another study reported an improvement in left ventricular ejection fraction (LVEF) by 9.95% (95% CI 3.24 to 16.66). In 5 chronic HF studies, acupuncture improved exercise capacity, quality of life, hemodynamic parameters, and heart rate variability parameters in the time domain. Acupuncture decreased NT-pro BNP levels by 292.20 (95% CI -567.36 to -17.04); AEs have not been reported. The author concluded that the efficacy of acupuncture as a therapy for heart failure is currently inconclusive. They stated that larger and more rigorous clinical trials are needed to establish its clinical utility.

de Lima Pimentel and colleagues (2019) stated that acupuncture, for Western countries, is an innovative and low-cost therapy for the treatment and prevention of cardiovascular diseases (CVD). However, most of its effects and mechanisms are poorly understood. These investigators systematically reviewed the literature on the clinical effects of acupuncture for the treatment and prevention of cardiovascular disease. The search for articles published in English or Portuguese in the last 20 years was carried out in the PubMed, SciELO and PEDro databases. Clinical trials conducted on the effects of acupuncture were included in this review. Two reviewers independently extracted data, leaving 17 articles after screening. The most used acupuncture point was PC6 (10 studies, 64.7%), followed by ST36 (6 studies, 35.3%) and auricular acupoints (4 studies, 23.5%). Among the clinical applications, hypertension was the most studied CVD, with acupuncture being the most reported method among the studies (70.6%). Only 3 articles did not report benefit in the treatment of CVD due to the methodology used. The authors concluded that, although several studies indicated an improvement in the response of the cardiovascular system in CVD by treatment with acupuncture, electroacupuncture or electrostimulation, the heterogeneity of the studies did not allow to standardize their application for each specific disease, making more studies necessary to that its application can be standardized, its use come true.

Shen and colleagues (2021) conducted an overview of systematic reviews/meta-analyses (SR/MA) on acupuncture for the treatment of patients with stable angina pectoris (SAP). A total of 8 databases were searched for acupuncture SR/MA in SAP. Methodological quality, quality of reporting, and quality of evidence were assessed using the Assessment of Methodological Quality of Systematic Reviews 2 (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). and the Methodological Quality Assessment checklists. and Assessment System (GRADE), respectively. A total of 7 published SR/MA met the inclusion criteria. Based on the results of the AMSTAR-2 assessment, 2 studies were judged to be of moderate quality; the remaining 5 were considered to be of very low quality. Based on the results of the PRISMA checklist assessment, only 1 study reported the checklist in its entirety, while others had underreporting. According to GRADE, a total of 18 outcome indicators drawn from the included studies were assessed. The quality of the evidence was very low in 3, low in 3, moderate in 8, and high in 4. The authors concluded that acupuncture may be beneficial for SBP based on currently published evidence; however, this conclusion should be interpreted with caution due to the generally low quality of methodology, quality of reporting and quality of evidence of the included studies. These investigators stated that more rigorous, standardized, and comprehensive SR/MA are needed to provide strong evidence for convincing conclusions.

chronic constipation

In a randomized, parallel, sham-controlled clinical trial, Liu and associates (2016) evaluated the efficacy of electroacupuncture (EA) for the treatment of severe chronic functional constipation (CSFC). Patients with CSFC and without a serious underlying pathological cause of constipation were included in this study; interventions included 28 sessions of AE at traditional acupuncture points or sham AE (SA) at non-acupuncture points over 8 weeks. The primary endpoint was change from baseline in mean weekly complete spontaneous stools (CSBM) during weeks 1 to 8; subjects were followed up to week 20. A total of 1075 patients were included (536 and 539 in the EA and SA groups, respectively). The increase from baseline in mean weekly MFCS during weeks 1 to 8 was 1.76 (95% CI 1.61 to 1.89) in the AE group and 0.87 (95% CI 1.61 to 1.89 : 0.73 to 0.97) in the AS group (group difference, 0.90 [95% CI: 0.74 to 1.10], p < 0.001). The change from baseline in mean weekly CSBMs during weeks 9 to 20 was 1.96 (95% CI: 1.78 to 2.11) in the EA group and 0.89 (95% CI: 1.78 to 2.11). 0.69 to 0.95) in the SA group (difference between groups, 1.09 [95% CI: 0.94 to 1.31]; p < 0.001). The proportion of patients with 3 or more weekly mean CSBM in the AS group was 31.3% and 37.7% during the treatment and follow-up periods, respectively, compared to 12.1% and 14.1 % in the AS group (p<0.001). Acupuncture-related AEs during treatment were infrequent in both groups and all were mild or transient. The authors concluded that 8 weeks of EA increased CSBM and was safe for the treatment of CSFC. In addition, they stated that additional studies are needed to assess treatment and long-term follow-up. The main disadvantages of this study were:

1. long-term follow-up has not been evaluated, and
2. acupuncturists could not blind themselves.

Chronic Fatigue Syndrome

Wang and colleagues (2014) stated that there is no curative treatment for chronic fatigue syndrome (CFS); and Traditional Chinese Medicine (TCM) is widely used to treat CFS in China. These investigators evaluated the efficacy and safety of TCM for CFS. The protocol for this review is registered with PROSPERO. These investigators searched 6 major TCM for CFS databases from inception to September 2013 in randomized controlled trials ( RCTs ). The Cochrane risk of bias tool was used to assess methodological quality. They used RevMan 5.1 to synthesize the results. A total of 23 RCTs with 1776 participants were identified. The risk of bias of the included studies was high. The types of TCM interventions varied and included Chinese herbal medicine, acupuncture, qigong, moxibustion, and acupuncture point application. Results from meta-analyses and several individual studies showed that TCM, alone or in combination with other interventions, significantly alleviated fatigue symptoms as measured by the Chalder Fatigue Scale, Fatigue Severity Scale, Joseph E. Schwartz, the Bell Fatigue Scale, and the Leading Clinical Research Guide. of New TCM Drugs for the Fatigue Symptom. There was insufficient evidence that TCM could improve the quality of life of people with CFS. The included studies did not report serious adverse events. The authors concluded that TCM appeared to be effective in relieving the symptom of fatigue in people with CFS. However, they stated that due to the high risk of bias in the included studies, larger, well-designed studies are needed to confirm potential benefit in the future.

In a multicenter, non-blinded, randomized controlled trial, Kim et al (2015) examined the efficacy of 2 forms of acupuncture added to usual care for CFS and idiopathic chronic fatigue (ICF) compared with usual care alone. A 3-arm, parallel, unblinded, randomized controlled trial was conducted at 4 hospitals. These investigators divided 150 participants into treatment and control groups in equal proportions. Treatment groups (Group A, body acupuncture; Group B, Sa-am acupuncture) received 10 sessions over 4 weeks. The control group (Group C) continued with usual care only. The primary outcome was the Fatigue Severity Scale (FSS) 5 weeks after randomization. Secondary outcomes were the FSS at 13 weeks and an abbreviated form of the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), Numerical Rating Scale (NRS), and EuroQol-5 Dimension (EQ -5D) at 5 and 13 weeks. Group A had significantly lower FSS scores than Group C at 5 weeks (p = 0.023); SRI scores were significantly lower in the treatment groups than in the control group at 5 (Group A, p = 0.032; B, p < 0.001) and 13 weeks (Group A, p = 0.037; B, p = 0.037; <0.001). Group B had significantly lower BDI scores than group C at 13 weeks (p = 0.007). The NRS scores of the treatment groups were significantly reduced compared to control at 5 (Group A and B, p < 0.001) and 13 weeks (Group A, p = 0.011; B, p = 0.002). The authors concluded that body acupuncture for 4 weeks, in addition to usual care, may help improve fatigue in patients with CFS and HF. This was a relatively small study (150 subjects divided into 3 groups) with short-term follow-up (13 weeks) and its findings were confounded by the combined use of acupuncture and usual care. These preliminary findings need to be validated by well-designed studies.

In addition, an UpToDate review on "Treatment of the systemic disease of exercise intolerance (chronic fatigue syndrome)" (Gluckman, 2016) does not mention acupuncture as a therapeutic option.

chronic hepatitis B

Kong and colleagues (2019) stated that chronic hepatitis B is a liver disease associated with high morbidity and mortality. Chronic hepatitis B requires long-term treatment with the aim of reducing the risks of hepatocellular inflammatory necrosis, liver fibrosis, decompensated liver cirrhosis, liver failure and liver cancer, as well as improving health-related quality of life. Acupuncture is used to decrease discomfort and improve immune function in people with chronic hepatitis B. However, the benefits and harms of acupuncture have not yet been rigorously established. In a Cochrane review, these investigators examined the benefits and harms of acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. Electronic searches of the Cochrane Hepatobiliary Group Controlled Trials Register, CENTRAL, Medline, Embase, LILACS, Science Citation Index Expanded, Conference Proceeding Citation Index - Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data were performed. and SinoMed until March 1, 2019. They also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp), ClinicalTrials.gov (www.clinicaltrials.gov/) and the China Clinical Trials Registry (ChiCTR) for trials ongoing or unpublished as of March 1, 2019. These investigators included randomized clinical trials, regardless of publication status, language, and blinding, that compared acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. They included subindividuals of any gender and age diagnosed with chronic hepatitis B as defined by study participants or according to guidelines. They allowed co-interventions when the co-interventions were delivered equally to all intervention groups. Peer review authors retrieved data from the reports individually and through correspondence with investigators. The primary outcomes were all-cause mortality, the proportion of individuals with one or more serious adverse events, and health-related quality of life. Secondary outcomes were hepatitis B-related mortality, hepatitis B-related morbidity, and non-serious AEs. These investigators presented the pooled results as RR with 95% CI. They examined the risk of bias using risk of bias domains with predefined definitions. They put more weight on the estimate closest to zero effect when the results with fixed effects and random effects models differed. These investigators assessed the certainty of the evidence using GRADE. A total of 8 RCTs with 555 randomized subjects were included in this analysis. All included studies compared acupuncture versus no intervention. These studies evaluated heterogeneous acupuncture interventions. All trials used heterogeneous co-interventions applied equally in the compared groups; 7 studies included subjects with chronic hepatitis B and 1 study included subjects with chronic hepatitis B with comorbid tuberculosis. All studies were assessed at overall high risk of bias and the certainty of the evidence for all outcomes was very low due to the high risk of bias for each outcome, imprecision of the results (CIs were large), and bias bias. publication (small size sample). of trials, and all trials were conducted in China). In addition, 79 studies lacked the necessary methodological information to ensure their inclusion in this review. None of the included studies attempted to assess all-cause mortality, serious AEs, health-related quality of life, hepatitis B-related mortality, and hepatitis B-related morbidity. These investigators were uncertain whether acupuncture, compared with any intervention, had an effect on AEs considered non-serious (RR 0.67, 95% CI 0.43 to 1.06; I² = 0%; 3 trials; 203 subjects; evidence from very low quality) or detectable hepatitis B antigen (HBeAg) (RR 0.64, 95% CI 0.11 to 3.68; I² = 98%; 2 trials; 158 subjects; very low-quality evidence). Acupuncture showed a reduction in detectable DNA of hepatite B virus (HBV) (a surrogate result not validated; RR 0.45, 95% CI 0.27 to 0.74; 1 trial, 58 individuals; quality evidence very low). These investigators were uncertain whether acupuncture had an effect on the other separately reported AEs that were considered non-serious; 3 of the 8 included studies received academic funding from government or hospital. None of the remaining 5 trials reported funding information. The authors concluded that the clinical effects of acupuncture for chronic hepatitis B remain unknown. The included studies lacked data on all-cause mortality, health-related quality of life, serious AEs, hepatitis B-related mortality, and hepatitis B-related morbidity. The large number of excluded studies lacked of clear descriptions of its design and realization. It is not known whether acupuncture influenced AEs considered non-serious. It was not clear whether acupuncture affected HBeAg and whether it was associated with a reduction in detectable HBV DNA. Based on available data from only 1 or 2 small trials on ADs considered non-serious and surrogate results for HBeAg and HBV DNA, the certainty of the evidence was very low. In view of the widespread use of acupuncture, any conclusions that may be attempted in the future must be based on clinically relevant patient data and outcomes assessed in large, high-quality, randomized, sham-controlled trials with homogeneous groups of subjects and funding. transparent.

dysmenorrhea

Liu et al (2017) stated that primary dysmenorrhea (PD) is one of the most common complaints among young women. Acupuncture has been widely applied as a therapeutic modality in China and abroad for PD; however, the evidence for its benefits is not yet convincing. These investigators conducted a systematic review of RCTs to assess the evidence for the use of acupuncture in the treatment of PD. The research team retrieved RCT reports published in 7 databases from inception to March 2016, with no language restrictions: PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the National Infrastructure for Knowledge of China, the Chinese Biomedical Database and Wanfang Database. The study was conducted at the Beijing University of Traditional Chinese Medicine (Beijing, China). Participants in the reviewed studies were women aged 14 to 49 years who received a diagnosis of PD in the absence of any visible pelvic pathology. Types of acupuncture included traditional acupuncture, electroacupuncture, auricular acupuncture, scalp acupuncture, surface acupuncture, electrosurface acupuncture, wrist and ankle acupuncture, and abdominal acupuncture. The primary outcome was pain relief as measured by a VAS, Verbal Rating Scale (VRS), or NRS. Secondary outcomes included

1. overall improvement as measured by the McGill Short Form Pain Questionnaire or Symptom Scale based on the Clinical Study Guide for Newly Developed Chinese Medicine,
2. menstrual discomfort as measured by the Menstrual Discomfort Questionnaire,
3. quality of life (QOL) measured by a validated scale (eg, the abbreviated form 36) and (iv) adverse effects.

A total of 23 studies involving 2770 patients were included in the review. In general, most of the studies were of low quality. Among the trials, only 6 were assessed as having low risk of bias, 3 of which indicated that acupuncture was statistically more effective than sham acupuncture: mean difference (MD), -3.51; 95% CI -5.27 to -1.75; p < 0.0001; I², 0% – or no treatment – ​​MD, -21.95; 95% CI -25.45 to -18.45; p < 0.00001; I², 0% – in the VAS (0 to 100 mm). Acupuncture also showed superiority over control arms in the VRS, NRS, and McGill Pain Questionnaire, but these findings were influenced by methodological flaws. The authors concluded that the available evidence suggests that acupuncture may be effective for PD; and justified future high-quality studies.

Gastric ulcer

Wang and colleagues (2021a) noted that gastric ulcer (GU) is a clinically common disease of the digestive system that negatively affects patients' quality of life and work capacity. Although some studies have reported that acupuncture might improve the clinical symptoms of GU, the effectiveness of acupuncture has not been scientifically or methodically examined. These investigators described the protocol for a systematic review and meta-analysis that will assess the safety and efficacy of acupuncture for the treatment of patients with UG. The following electronic databases will be searched from their respective creation dates to 23 March 2021: The Cochrane Library, Web of Science, Embase, Medline, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang database, Chinese Scientific Journal Database and other sources; RCTs comparing acupuncture with other interventions or sham acupuncture were included. Two independent researchers will perform article retrieval, duplicate removal, screening, quality assessment, and data analysis by Review Manager (V.5.3.5). Meta-analyses, subgroup analyzes and/or descriptive analyzes will be performed depending on the conditions of the included data. The protocol of this study will systematically evaluate the safety and efficacy of acupuncture for patients with GU. The primary outcome is effective rate and secondary outcomes include rate of negative Helicobacter pylori infection talk, adverse effect, recurrence rate, quality of life, and symptom scores. The authors concluded that the results of this study will provide evidence that acupuncture is a safe and effective intervention for the treatment of patients with gastric ulcers.

Vasomotor symptoms associated with menopause

The 2015 North American Menopause Society position statement on "Non-hormonal management of vasomotor symptoms associated with menopause" (no authors listed) indicated that clinicians should be well informed about the level of evidence available for the wide range of non-hormonal hormonal treatment options currently available for middle-aged women to help prevent underuse of effective therapies or the use of inappropriate or ineffective therapies. He recommended cognitive behavioral therapy and, to a lesser extent, clinical hypnosis, which have been shown to be effective in reducing SVM. Paroxetine salt is the only non-hormonal drug approved by the Food and Drug Administration (FDA) for the treatment of VMS, although other selective serotonin/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine have shown evidence of efficacy. He cautiously recommended some therapies that may be beneficial in relieving VMS: weight loss, mindfulness-based stress reduction, S-equol derivatives of soy isoflavones, and stellate ganglion block; but noted that more studies of these therapies are needed. It did not recommend the following interventions to control VMS: cooling techniques, trigger prevention, exercise, yoga, rhythmic breathing, relaxation, over-the-counter supplements and herbal therapies, acupuncture, neural oscillation calibration, and chiropractic interventions because of existing data. negative, insufficient or inconclusive reports on these interventions.

Multiple sclerosis

Branes and others (2000)

1. identified current treatments for fatigue in multiple sclerosis (MS) and their evidence base, and
2. systematically reviewed the evidence for treatments that were investigated in more than 1 rigorous study, in order to determine their efficacy and cost-effectiveness.

The review was carried out in 2 stages:

1. a formal scoping review (to assess the range of interventions used by people with MS, and
2. a systematic review of treatments that have been identified as promising and have been investigated in clinical trials (as identified in the scoping review).

We also conducted a systematic review of the research on the costs and cost-effectiveness of these interventions identified as promising. Electronic databases, including Medline and Embase, were searched from 1991 to June 1999 (scope review) and from 1966 to December 1999 (systematic review). Reference lists of publications were also searched and experts contacted for any additional information not yet identified. Interventions identified for the treatment of fatigue in MS

1. behavioral counselling. This is the main element of initial clinical management and no rigorous research on its effectiveness has been identified.
2. Medications (amantadine, pemoline, potassium channel blockers, and antidepressants).
3. Training, rehabilitation and devices (cooling vests and electromagnetic fields).
4. Alternative therapies (bee venom, cannabis, acupuncture/acupressure, and yoga).

Only 2 drugs, amantadine and pemoline, met the criteria for a full systematic review. One parallel study and 3 crossover studies were found, with a total of 236 people with MS. All studies were open to bias. All studies showed a pattern in favor of amantadine compared to placebo, but there is considerable uncertainty about the validity and clinical significance of this finding. This pattern of benefits was considerably undermined when different assumptions were used in the sensitivity analysis; 1 parallel study and 1 crossover study were found with a total of 126 people with MS. Both studies were open to bias. There was no general trend in favor of pemoline over placebo and there was an excess of reporting of adverse effects with pemoline. The costs of amantadine and pemoline are modest (£200 and £80 per year, respectively). No economic valuations were identified in the systematic review, and insufficient data were available to allow cost-effectiveness modeling in this rapid review. The authors concluded that there is insufficient evidence to allow people with MS, clinicians or policy makers to make informed decisions about the appropriate use of the many treatments on offer. Only amantadine appears to have any proven ability to relieve fatigue in multiple sclerosis, although only a proportion of users will benefit, so only a few of those patients will benefit enough to take the drug long-term. The frequency, severity, and impact of fatigue, the paucity of available research, and the absence of ongoing research suggest that further research is an urgent priority. People with MS, clinicians and policy makers need to work together to ensure that the necessary evidence is collected as quickly as possible, encouraging participation in rigorous research. Research should not be limited to the two drugs discussed in depth in this report. All interventions identified in the scoping review (see above) should be considered, as well as basic scientific research on the underlying mechanism of fatigue in MS.

Campbell et al (2016) evaluated the effectiveness of physiotherapy interventions, including exercise therapy, for the rehabilitation of people with progressive MS. We searched five databases (Cochrane Library, Physiotherapy Evidence Database [PEDro], Web of Science Core Collections, Medline, Embase) and reference lists of relevant articles. Randomized experimental trials were included, including participants with progressive MS and investigating a physiotherapy intervention or an intervention containing a physiotherapy element. Data were independently extracted using a standardized form and methodological quality was assessed using the PEDro scale. A total of 13 studies (described by 15 articles) were identified and scored between 5 and 9 out of 10 on the PEDro scale; Eight interventions were evaluated: physiotherapy, multidisciplinary rehabilitation, functional electrostimulation, botulinum toxin type A injections and manual stretching, inspiratory muscle training, therapeutic posture, acupuncture, and weight-bearing treadmill training. All but 1 of the studies produced positive results on at least 1 outcome measure; however, only 1 article used a power calculation to determine the sample size and, due to dropouts, the results were subsequently suboptimal. The authors concluded that the findings of this review suggested that physiotherapy may be effective for the rehabilitation of people with progressive MS. However, they stated that more adequately powered studies are needed.

Additionally, an UpToDate review of "Adult Multiple Sclerosis Symptom Management" (Olek et al, 2016) states that "Complementary and alternative medicine: MS patients often employ a variety of treatments to manage their symptoms." complementary and alternative or alternatives such as exercise, meditation, yoga, relaxation techniques, acupuncture, marijuana, massage, dietary modifications, vitamin, herbal, and mineral supplements.However, there are few high-quality data on the usefulness of these interventions."

Neuropathic pain

In a Cochrane review, Ju and associates (2017) evaluated the analgesic efficacy and adverse effects of acupuncture treatments for chronic neuropathic pain in adults. These investigators searched CENTRAL, Medline, Embase, 4 Chinese databases, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registration Platform (ICTRP) on February 14, 2017. They also searched cross references of included studies; RCTs with treatment durations of eight weeks or longer comparing acupuncture (given alone or in combination with other therapies) with sham acupuncture, other active therapies, or usual care for neuropathic pain in adults were selected for analysis. These investigators searched for acupuncture studies based on needle insertion and somatic tissue stimulation for therapeutic purposes and excluded other non-needle methods of acupuncture point stimulation. They searched for studies of manual acupuncture, electroacupuncture, or other acupuncture techniques used in clinical practice (such as hot needling, fire needling, etc.). These investigators used the standard methodological procedures expected by Cochrane. Primary outcomes were pain intensity and pain relief. Secondary outcomes were any pain-related outcome indicating any improvement, dropouts, participants experiencing any AEs, serious adverse events (SAEs), and quality of life. For dichotomous outcomes, these investigators calculated the RR with a 95% CI, and for continuous outcomes, they calculated the MD with a 95% CI. They also calculated the number needed to treat to obtain an additional beneficial outcome (NNTB) whenever possible. These investigators pooled all data using a random effects model and assessed the quality of the evidence using GRADE to generate 'Summary of findings' tables. A total of six studies involving 462 participants with chronic peripheral neuropathic pain (442 older adults (251 men), mean age 52 to 63 years) were included in this review. The included studies recruited 403 participants from China and 59 from the UK. Most studies included a small sample size (less than 50 participants per treatment arm) and all studies were at high risk of bias due to blinding of participants and personnel. Most studies had a clear risk of bias for sequence generation (4 of 6 studies), allocation concealment (5 of 6), and selective reporting (all included studies). All studies investigated manual acupuncture and these reviewers identified no studies comparing acupuncture with usual care, nor studies investigating other acupuncture techniques (such as electroacupuncture, hot needling, fire needling). One study compared acupuncture with sham acupuncture. The review authors were uncertain if there was any difference between the 2 interventions in reducing pain intensity (n=45, MD -0.4, 95% CI -1.83 to 1.03, very strong evidence). low quality), and neither group achieved "nothing worse than mild pain" (VAS, 0 to 10) mean scores were 5.8 and 6.2 respectively in the acupuncture and sham acupuncture groups, where 0 = no pain ). There were limited data on QoL, which did not show any clear difference between groups. There was no evidence available on pain relief, AEs, or other pre-specified secondary outcomes for this comparison; 3 studies compared acupuncture alone versus other therapies (mecobalamin combined with nimodipine and inositol). Acupuncture may reduce the risk of 'clinical non-response' to pain compared to other therapies (n=209, RR 0.25, 95% CI 0.12 to 0.51); however, no evidence was available on pain intensity, pain relief, adverse effects, or any of the other secondary outcomes; Two studies compared acupuncture combined with other active therapies (mecobalamin and Xiaoke bitong capsule) versus other active therapies used alone. These reviewers found that the acupuncture combination group had a lower VAS score for pain intensity (n=104, MD -1.02, 95% CI -1.09 to -0.95) and better quality of life (n = 104, MD -2.19, 95% CI -2.39 to -1.99), than those receiving only other therapy. However, the mean VAS scores for the acupuncture and control groups were 3.23 and 4.25, respectively, indicating that neither group achieved "anything worse than mild pain." Furthermore, this evidence came from a single study with a high risk of bias and a very small sample size. There was no evidence of pain relief, and the reviewers identified no clear differences between groups in other parameters, including 'clinical non-response' to pain and withdrawals. There was no evidence of AE. The overall quality of the evidence was very low due to study limitations (high risk of performance, detection and attrition bias, and high risk of confounding bias due to small study size) or imprecision. The review authors have limited confidence in the effect estimate and the actual effect is likely to be significantly different from the estimated effect. The authors concluded that, due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition compared with sham acupuncture or other active therapies. . In addition, they noted that 5 studies are still ongoing and 7 studies are awaiting classification due to uncertain duration of treatment, and the results of these studies may influence current findings.

Nonalcoholic fatty liver disease

In a systematic review and meta-analysis of published RCTs, Chen and colleagues (2021) examined the safety and efficacy of treatment with acupuncture (TA) or acupuncture plus conventional medicine (CM) versus CM alone for the treatment of patients with uncomplicated fat. alcoholic liver disease (NAFLD). We independently searched a total of 8 databases from inception to April 30, 2020; RCTs were included if they contained reports on the use of acupuncture or the use of acupuncture combined with CM and in comparison with the use of CM. Summary OR and 95% CI were used to calculate overall clinical efficacy. Secondary endpoints, namely, aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and body mass index (BMI), were calculated as the mean difference with CI. of 95%. After the final screening, 8 RCTs with 939 patients were included. This meta-analysis showed that TA was superior to CM in improving overall clinical efficacy (OR = 3.19, 95% CI 2.06 to 4.92, p < 0.00001). In addition, TA plus CM can significantly improve overall clinical efficacy compared to CM treatment alone (OR = 5.11, 95% CI 2.43 to 10.75, p < 0.0001). In addition, benefits have also been shown in other endpoints, including indices of alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. However, AT plus CM failed to decrease BMI levels compared to CM. The safety profile of the acupuncture therapy was satisfactory. Taichong, Zusanli, Fenglong, and Sanyinjiao were the main acupuncture points in the treatment of NAFLD. The authors concluded that acupuncture may be a safe and effective approach for the treatment of NAFLD; however, due to insufficient methodological quality and sample size, large-scale, long-term RCTs with rigorous methodological data are needed to clarify the role of acupuncture in this population.

The authors stated that this systematic review had several drawbacks. First, the quality of the studies was poor because most of the studies were of low methodological quality. Due to the particularity of AT methods, the blind method was difficult to implement clinically. Only 1 study was a multicentre study and used a single blind method. Only 3 studies used random number tables to allocate participants. All included studies did not report follow-up visits and the duration of treatment ranged from 1 month to 6 months, which was insufficient to examine the safety and long-term effect of acupuncture in the treatment of NAFLD. Furthermore, none of the included studies reported a recurrence rate and only 3 studies reported adverse effects, which may have led to uncertain results and may not truly reflect overall trends. All subjects were Chinese in the included studies, this limited geographic distribution and low grade research made it difficult to perform in future large trials. There were no studies comparing acupuncture versus no intervention or placebo/sham acupuncture, so the specific effect of acupuncture for NAFLD was unclear. In addition, these investigators found that the majority of the studies were faulty according to the Cochrane Collaboration's risk of bias tool.

Obstructive sleep apnea

In a systematic review and meta-analysis, Wang and colleagues (2020) examined the safety and efficacy of acupuncture for the treatment of obstructive sleep apnea patients with varying degrees of disorder severity. We searched a total of 8 databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) up to July. from 2019; RCTs evaluating acupuncture in the treatment of OSA were eligible for inclusion. Two authors selected studies for inclusion and extracted data independently. The Cochrane Collaboration risk of bias assessment tool and RevMan software (version 5.3) were used to assess trial quality and perform statistical analyses. A total of 9 RCTs with 584 subjects were included. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in AHI (MD -6.18, 95% CI -9.58 to -2.78, Z = 3.56, p = 0.0004) as well as ESS (MD : -2.84, 95% CI: -4.80 to -0.16, Z = 2.09, p = 0.04). The AHI was further reduced in the subgroup analysis of patients with moderate OSA (MD: -9.44, 95% CI: -12.44 to -6.45, Z = 6.18, p < 0.00001) and patients with severe OSA (MD: -10.09; 95% CI: -12.47 to -7.71; Z = 8.31, p < 0.00001). The ESS was also further reduced in the subgroup analysis of patients with moderate OSA (MD: -2.40, 95% CI: -3.63 to -1.17, Z = 3.83, p = 0.0001 ) and patients with severe OSA (MD: -4.64; 95% CI: -5.35 to -3.92, Z = 12.72, p < 0.00001). In addition, acupuncture had a beneficial effect on LSaO2 (MD: 5.29, 95% CI: 2.61 to 7.97, Z = 3.86, p = 0.0001). The AHI and LSaO2 result produced consistent results after sensitivity analysis; however, the direction of the ESS result was reversed; and the quality of the evidence was mostly low to very low. The authors concluded that acupuncture therapy was effective for OSA patients in reducing AHI and ESS and improving LSaO2 to varying degrees, especially in patients with moderate and severe OSA. Furthermore, these investigators stated that more high-quality RCTs are needed to confirm the safety and efficacy of acupuncture in patients with OSA.

The authors stated that this review had several drawbacks. First, acupuncture treatment for OSA had some bias and heterogeneity. The reasons could be the various acupuncture interventions. Second, in this review, patients with OSA were classified as mild, moderate, and severe based on the AHI prior to treatment. The AHI is an important measure used to diagnose and categorize disease severity in patients with OSA. However, there are inherent limitations to using the AHI calculated from 1 night of sleep to categorize disease severity, because the AHI is influenced by many factors and can vary over time and even on consecutive nights. Third, the methodological quality of the included RCTs was generally low (eg most included studies were at high risk of performance bias).

oligoastenozoospermia

You and your colleagues (2020) noted that oligoasthenozoospermia is a common factor leading to male infertility. Acupuncture has been applied in the treatment of male infertility for several thousand years in China, but clinical evidence for its safety and efficacy in the treatment of oligoasthenozoospermia has not yet been established. These investigators systematically reviewed the evidence for the effect of acupuncture in men with oligoasthenozoospermia. Databases (PubMed, Embase, SINOMED, ​​CNKI, Wanfang Database, and Cochrane Library) were searched to identify related studies published before June 30, 2019. The Cochrane Risk of Bias and Score tool were adopted. Jadad to assess the methodological quality of those included. studies. A total of 12 RCTs with 1088 subjects were included in this review. These investigators attempted to perform a meta-analysis, but this was not possible due to considerable clinical heterogeneity between the included studies. Based on narrative analysis, acupuncture or acupuncture combined with another intervention was effective in improving semen quality based on the included studies. However, this result should be interpreted with caution due to the high risk. The methodological quality of most of the included studies was low. The authors concluded that the current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a firm conclusion due to poor methodological quality. These investigators stated that rigorous, large-scale RCTs are needed to validate the safety and efficacy of acupuncture in the treatment of oligoasthenozoospermia.

osteoporosis

Luo et al (2018) stated that warm needle acupuncture (WNA) is commonly used in the treatment of primary osteoporosis (PO) in China. The evidence of its effectiveness needs to be systematically reviewed. In a meta-analysis, these investigators examined whether the use of WNA alone or in combination with conventional medicine benefits primary OP. We searched PubMed, Embase, Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang, and VIP databases from inception to June 30, 2016; RCTs that applied WNA independently or as an adjunct to conventional medicine, compared to conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle, and greater trochanter. The secondary outcome was chronic pain as measured by the VAS score. Meta-analysis was performed using RevMan V.5.3 software. A total of 9 RCTs with 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favor of increased BMD of the lumbar vertebrae (MD = 0.06, 95% CI 0.03 to 0.08, p < 0.001); WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, p < 0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, p < 0.001) when used alone and also decreased VAS scores (MD = -1.10,  95% CI -1.14 to -1.06, p < 0.001) when used as an adjunct to conventional medicine . However, WNA security was not specifically reported. The authors concluded that WNA may have beneficial effects on BMD and VAS scores in patients with primary OP. However, all included studies were at high risk of bias and of low quality. They stated that more rigorous studies are needed to determine the efficacy of WNA for the primary treatment of OP.

The authors stated that this study had several drawbacks. First, all included studies inadequately reported randomisation, and none of them reported details of randomisation or allocation concealment, which may have led to selection bias. Second, none of the included studies mentioned whether a method of blinding was used, although it can be assumed that there was no blinding given the absence of a sham acupuncture control capable of blinding participants. Third, all trials used a small sample size and had significant methodological limitations. Fourth, only 1 of them mentioned EA. Therefore, these investigators were unable to draw a definitive conclusion as to whether WNA could be a promising (ie, safe and effective) method for attenuating osteoporotic syndromes such as low BMD and related chronic pain.

Pain induced by osteoporotic vertebral compression fracture

Li and associates (2021) stated that osteoporotic vertebral compression fractures (OVCFs) are common health problems in the elderly; cause chronic pain in more than 1/3 of patients. In a systematic review and meta-analysis, these investigators examined the safety and efficacy of acupuncture in relieving pain caused by CFOVs. They searched 8 electronic databases for publications from inception to March 30, 2021. Eligible studies were RCTs evaluating the effect of acupuncture for the treatment of OVCF. Two investigators independently assessed the quality of the literature and extracted data. RevMan V.5.4.1 was used for data analysis, with pooled risk estimates presented as MD or RR together with the corresponding 95% CIs, as appropriate. A total of 14 RCTs with 1130 patients were included in this meta-analysis. Compared to the control group, acupuncture showed a greater benefit in reducing pain caused by OVCFs (1 week: MD = -1.26, 95% CI -1.82 to -0.70); 1 month: MD = -1.63, 95% CI -1.82 to -1.43); 6 months: MD = -1.13, 95% CI: -1.55 to -0.70). Acupuncture treatment was also associated with fewer AEs, a lower ODI index, and higher bone density than the control group (Safety: (RR 0.30, 95% CI 0.12 to 0.75) ODI: MD = -3.19, 95% CI: -5.20 to -1.19); bone density: MD = 0.15, 95% CI: 0.05 to 0.26). The GRADE quality of these results was assessed as low or very low. The authors concluded that compared to control treatment, acupuncture was safer and more effective in relieving pain caused by OVCF and showed greater improvement in the patient's ODI score and bone density. Furthermore, these investigators stated that due to the study's low level of evidence, future high-quality studies are needed to validate these findings.

The authors stated that this study had several drawbacks. First, all included studies were single center RCTs conducted in China; therefore, the results may not be generalizable to patients from other regions or countries. Second, except that the study itself was difficult to implement blinding, all studies lacked methods of allocation and assessors were blinded, and no study was pre-registered prior to conducting the study. This may have greatly reduced the quality of the evidence generated from this analysis. Third, the heterogeneity between the studies was large. Subgroup analysis and sensitivity analysis showed that acupuncture combined with different treatment methods, acupuncture retention time, and acupuncture frequency were potential sources of heterogeneity. These investigators only tested for heterogeneity at one time point and did not test for heterogeneity at other time points due to the small number of studies. Fourth, the acupuncture points used in the studies included in this meta-analysis were different. This may have led to differences in the effectiveness of acupuncture between studies and contributed to heterogeneity between studies. Finally, the level of evidence for these findings was low to very low.

Parkinson's disease-related fatigue

Kluger et al (2016) noted that fatigue is a common and debilitating non-motor symptom of Parkinson's disease (PD). As preliminary evidence suggested that acupuncture improves fatigue in other conditions, these investigators examined its effectiveness in the treatment of PD-related fatigue. A total of 94 PD patients with moderate to severe fatigue were randomized to receive 6 weeks of real or sham acupuncture every other week. The primary outcome was change on the Modified Impact of Fatigue Scale at 6 weeks; secondary outcomes included sleep, mood, quality of life, and maintenance of benefits at 12 weeks. Both groups showed significant improvements in fatigue at 6 and 12 weeks, but there were no significant differences between the groups. Improvements in mood, sleep, and quality of life were observed from baseline with no difference between groups. Overall, 63% of patients reported noticeable improvements in their fatigue; no serious adverse events were observed. The authors concluded that acupuncture may improve PD-related fatigue, but actual acupuncture provided no greater benefit than sham treatments. They stated that PD-related fatigue should be added to the growing list of conditions in which acupuncture helps primarily through non-specific or placebo effects.

Corbin et al (2016) describes:

1. Considerations for the design of a double-blind, randomized, placebo-controlled clinical trial of acupuncture for fatigue in PD, and
2. their experience in the initial implementation and conduct of this study.

Relevant literature was also reviewed to provide guidance to other investigators seeking to conduct clinical research relevant to PD and related disorders. The clinical trial design should be guided by a well-defined research question with sufficient detail to meet the criteria of the Guidelines for reporting interventions in acupuncture clinical trials when a trial is completed. Important items for the review include: randomization and blinding; recruitment and selection of participants; choice of simulated methodology; team building; and practical application of study procedures. Sample forms used for the current authors' study are shared. The authors concluded that high-quality acupuncture clinical trials can provide valuable information for clinicians, patients, and policymakers. Acupuncture trials differ critically from pharmaceutical trials and may require additional design and implementation considerations. Proper preparation for the unique challenges of acupuncture studies can improve study implementation, design, efficiency, and impact.

plantar fasciitis

Thiagarajah (2017) stated that plantar fasciitis is a commonly observed outpatient condition that has numerous therapeutic modalities of varying degrees of effectiveness. In a systematic review, these researchers examined the efficacy of acupuncture in reducing pain due to plantar fasciitis. Online literature searches of PubMed and Cochrane Library databases were performed for studies on the use of acupuncture for pain due to plantar fasciitis. Studies designed as RCTs that compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi List was used to assess the methodological quality of the retrieved studies. A total of 3 studies comparing acupuncture with standard care and 1 study on real acupuncture versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis as measured on the VAS and the plantar fasciitis pain/disability scale. These benefits were seen between 4 and 8 weeks of treatment, with no significant pain reduction beyond this duration; AEs were considered minimal. The authors concluded that although acupuncture may reduce pain from plantar fasciitis in the short term, there is insufficient evidence to make a definitive conclusion about its long-term efficacy. They stated that more research is needed to strengthen its acceptance among health professionals.

peptic ulcer

Tian and associates (2017) evaluated the clinical efficacy of acupuncture for peptic ulcer disease; We searched China National Knowledge Infrastructure (CNKI), WanFang database, Chinese journals of science and technology (VIPs), China Biomedicine (CBM), PubMed, and the Chinese National Knowledge Infrastructure (CBM) for RCTs of acupuncture for peptic ulcer disease. Cochrane Library from the establishment of the databases to September 2016 Data extraction and quality assessment of the literature meeting the inclusive criteria were implemented. RevMan 5.3 software was used to perform the meta-analysis. A total of 16 articles including 1570 patients with peptic ulcer disease were included. The results of the meta-analysis showed that there was no statistical significance between acupuncture and Western medicine in terms of effective rate, ulcer area healing rate, and H. pylori (HP) negative rate (all p > 0, 05); the recurrence rate for acupuncture was significantly lower than that for Western medicine [RR = 0.35, 95% CI 0.14 to 0.84), p < 0.05]. Acupuncture plus Western medicine was significantly different from plain Western medicine in effective rate, ulcer area healing rate, and recurrence rate [RR = 1.20, 95% CI 1.04 to 1 .38, p = 0.01; RR = 1.29, 95% CI: 1.06 to 1.58), p = 0.01; RR = 0.27, 95% CI: 0.16 to 0.45), p < 0.00001]. Grade of evidence (GRADE) analysis showed that the ulcer area healing rate and acupuncture negative PH rate were 'low grade' and others 'extremely low grade'. The authors concluded that acupuncture combined with Western medicine had some advantages for peptic ulcer compared with conventional Western medicine; these findings need to be confirmed due to the low level of evidence. They stated that larger, high-quality RCTs are strongly recommended.

postoperative ileus

In a systematic review and meta-analysis, Cheong et al (2016) examined the effectiveness of acupuncture and the selection of common acupuncture points for postoperative ileus (POI). Randomized controlled trials comparing acupuncture and non-acupuncture treatments were identified in PubMed, Cochrane, EBSCO (Academic Source Premier and Medline), Ovid (including evidence-based medicine reviews), China National Knowledge Infrastructure, and Wanfang Data. Data from eligible studies were extracted and meta-analysis was performed using a fixed effects model. Results were expressed as RR for dichotomous data and the 95% CI was calculated. Each trial was assessed using the CONSORT (Consolidated Standards for Trial Reporting) and STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) guideline. Study quality was assessed using the GRADE approach. Of the 69 selected studies, 8 RCTs were included for review. Among them, 4 RCTs (with a total of 123 patients in the intervention groups and 124 patients in the control groups) met the criteria for meta-analysis. The results of the meta-analysis indicated that acupuncture combined with usual care showed a significantly higher total effective rate than the control condition (usual care) (RR 1.09, 95% CI 1.01 to 1.18, p = 0.02). Zusanli (ST 36) and Shangjuxu (ST 37) were the most frequently selected acupuncture points. However, the quality of the studies was generally low as they did not emphasize the use of blinding. The authors concluded that the results suggested that acupuncture may be effective in improving POI; however, it was not possible to reach a definitive conclusion due to the low quality of the trials. They stated that more large-scale, high-quality RCTs are needed to validate these findings and develop a standardized treatment approach.

postprandial sickness syndrome

Yang and colleagues (2020) noted that postprandial distress syndrome (PDS) is the most common subtype of functional dyspepsia. Acupuncture is commonly used to treat PDS; however, its effect is uncertain due to the poor quality of previous studies. In a randomized 2-arm multicenter trial, these investigators examined the efficacy of acupuncture versus sham acupuncture in patients with PDS. Subjects were Chinese patients ranging in age from 18 to 65 years, who met the Rome IV criteria for PDS; received 12 sessions of acupuncture or sham acupuncture over 4 weeks. The 2 primary outcomes were the response rate based on the overall treatment effect and the clearance rate of the 3 cardinal symptoms: postprandial fullness, upper abdominal bloating, and early satiety after 4 weeks of treatment. Subjects were followed through week 16. Among 278 randomized subjects, 228 (82%) completed outcome measurements at week 16. The estimated response rate of generalized linear mixed models at week 4 was 83, 0% at week 16 acupuncture group versus 51.6% in the sham acupuncture group (31.4 percentage point difference [95% CI 20.3 to 42.5 percentage points]; p < 0.001) . The estimated clearance rate of the 3 cardinal symptoms was 27.8% in the acupuncture group vs. 17.3% in the sham acupuncture group (10.5 percentage point difference [95% CI: 0.08 to 20.9 percentage points], p = 0.034). The efficacy of acupuncture was maintained during the 12-week post-treatment follow-up. There were no serious adverse events. The authors concluded that, among patients with PDS, acupuncture resulted in a higher response rate and clearance rate of the 3 cardinal symptoms compared with sham acupuncture, with sustained efficacy for 12 weeks in patients receiving acupuncture three times a day per week for 4 weeks. The main drawbacks of this study were the lack of objective results and daily measurements, the high dropout rate, and the inability to blind the acupuncturists.

shoulder pain after stroke

Lee and Lim (2016) reviewed the evidence on the effectiveness of acupuncture in relieving post-stroke shoulder pain. A total of 7 databases were searched without language restrictions. All RCTs evaluating the effects of acupuncture for post-stroke shoulder pain compared with controls were included. The valuations were carried out mainly with the VAS, Fugl-Meyer valuation (FMA) and effective rates. In total, 188 potentially relevant articles were identified; 12 were RCTs that met the inclusion criteria. Meta-analysis showed that acupuncture combined with rehabilitation treatment appears to be more effective than rehabilitation treatment alone for VAS-assessed post-stroke shoulder pain (WMD, 1.87; 95% CI: 1.20 a 2.54, p < 0.001); FMA (ADM, 8.70; 95% CI: 6.58 to 10.82; p < 0.001); and effective rate (RR, 1.31; 95% CI: 1.18 to 1.47; p < 0.001). The authors concluded that although there is some evidence of an effect of acupuncture on post-stroke shoulder pain, the results are inconclusive. They stated that further studies with larger subjects and a rigorous study design are needed to confirm the role of acupuncture in the treatment of post-stroke shoulder pain.

premature ejaculation

Zhao and colleagues (2018) stated that premature ejaculation is a common sexual dysfunction disease in adult men. It can be divided into primary and secondary premature ejaculation. Acupuncture is widely used in the treatment of premature ejaculation in China. Many clinical trials have confirmed that acupuncture can prolong ejaculation latency in the vagina. These investigators performed a meta-analysis to assess the safety and efficacy of acupuncture for premature ejaculation. They would systematically search for all RCTs using electronic and manual searches, up to June 31, 2018. Electronic database retrieval included Medline, Embase, the Cumulative Index of Nursing and Health-Related Literature, the Medicine Database Complementary and related, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), China Journal of Science and Technology (VIP) Database, and Wanfang Database. Handsearching would retrieve gray literature, including unpublished conference papers. Primary outcomes include intravaginal ejaculatory latency time (IELT). At the same time, Premature Ejaculation Diagnostic Tool (PEDT), Arab Premature Ejaculation Index (AIPE), Premature Ejaculation Index (PEI) would be the secondary results. Two review authors would independently read the articles, extract information from the data, and assess risk of bias. Data analysis would use special software such as RevMan (version 5.3) and EndNote X7. The authors concluded that this systematic review would assess the safety and efficacy of acupuncture for premature ejaculation.

Additionally, an UpToDate review on "Male Sexual Dysfunction Treatment" (Khera & Cunningham, 2018) does not mention acupuncture as a therapeutic option.

Premenstrual Syndrome/Premenstrual Dysphoric Disorder

In a Cochrane review, Armor and colleagues (2018) evaluated the safety and efficacy of acupuncture or acupressure in women with premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). These investigators searched the Cochrane Gynecology and Fertility Specialized Register, Cochrane Central Register of Studies Online (CENTRAL CRSO), Medline, Embase, AMED, PsycINFO, CINAHL (from inception to 21 September 2017), 2 databases clinical trials database (from inception to September 21, 2017) and 4 electronic databases in China (from inception to October 15, 2017): Chinese Biomedical Literature (CBM) Database, National Biomedical Infrastructure China Knowledge (CNKI), VIP Information/Chinese Scientific Journals Database, and WANFANG. Reference lists of included articles were handsearched. These investigators included studies that randomized women with PMS and associated disorders (PMDD and Late Luteal Phase Dysphoric Disorder/LPDD) to receive acupuncture or acupressure versus placebo, wait list/usual care control, or pharmaceutical interventions mentioned by the International Society of Prenatal .-Menstrual Disorders (ISPMD). If acupuncture or acupressure was combined with another treatment, studies in which the additional treatment was the same in both groups were also included. Crossover studies were eligible for inclusion, but only data from the first phase could be used. Two review authors independently selected studies, assessed the risk of bias of eligible studies, and extracted data from each study. Study authors were contacted for missing information. The quality of the evidence was assessed using GRADE. Primary outcomes were general premenstrual symptoms and AEs; secondary outcomes included PMS-specific symptoms, response rate, and quality of life. A total of five trials (277 women) were included in this review. No study compared acupuncture or acupressure versus other active treatments. The number of treatment sessions ranged from 7 to 28. The quality of the evidence ranged from low to very low, with the main limitations being imprecision due to the small sample size and risk of bias related to detection bias and selective report. Acupuncture may provide a greater reduction in mood-related PMS symptoms ( MD -9.03, 95% CI -10.71 to -7.35, 1 RCT , n = 67, quality evidence low) and PMS symptoms (MD -9.11, 95% CI -10.82 to -7.40, 1 RCT, n = 67, low-quality evidence) than sham acupuncture, as measured by the Daily Log Severity Problem (DRSP) scale. The evidence suggested that if the women had a mood score of 51.91 points with sham acupuncture, their acupuncture score would be between 10.71 and 7.35 points lower, and if the women had a physical score of 46.11 points, your acupuncture score would be between 10.82 and 7.4 points lower. There was insufficient evidence to determine if there was any difference between the groups in the AE taxa (RR 1.74, 95% CI 0.39 to 7.76, 3 RCTs, n = 167, I2 = 0%, quality evidence very low). Symptoms specific to PMS have not been reported. There may be little or no difference between the groups in response rates. Using a fixed effects model suggested a higher response rate in the acupuncture group than in the sham group (RR 2.59, 95% CI 1.71 to 3.92; participants = 100; studies = 2; I2 = 82%), but due to high heterogeneity, the authors tested the effect of using a random effects model, which did not provide any clear evidence of benefit for acupuncture (RR 4.22, 95% CI 0 .45 to 39.88, 2 RCTs, n = 100, I2 = 82%, very low-quality evidence). Acupuncture may improve quality of life (as measured by WHOQOL-bref) compared to sham ( MD 2.85, 95% CI 1.47 to 4.23, 1 RCT , n = 67, low-quality evidence ) . Due to the very low quality of the evidence, these investigators were uncertain whether acupuncture reduces PMS symptoms compared to an untreated control ( MD -13.60, 95% CI -15.70 to - 11.50, 1 RCT, n = 14). No AEs were reported in either group. No data were available on specific PMS symptoms, response rate, or quality of life outcomes. These investigators found low-quality evidence that acupressure may reduce the number of women with moderate to severe PMS symptoms at the end of the study compared with sham acupressure (RR 0.64 95% CI 0.52 to 0 .79, 1 RCT, n = 90, low-quality evidence). The evidence suggested that if 97 women out of 100 in the sham acupressure group had moderate to severe PMS symptoms, the number of women in the acupressure group with moderate to severe symptoms would range from 50 to 76 women. Acupressure can improve both physical (MD 24.3, 95% CI 17.18 to 31.42, 1 RCT, n = 90, low-quality evidence) and mental (MD 17.17, CI 17.17, 95% evidence) health. 95%: 13.08 to 21.26, 1 RCT, n = 90, low-quality evidence) QoL. No data were available on AEs, specific symptoms, or response rates. The authors concluded that the limited available evidence suggests that acupuncture and acupressure may improve the physical and psychological symptoms of PMS compared with a sham control. There was insufficient evidence to determine if there was a difference between groups in AE rates. There was no evidence comparing acupuncture or acupressure with current ISPMD-recommended treatments for PMS, such as selective serotonin reuptake inhibitors (SSRIs). They stated that further research is needed, using validated outcome measures for PMS, adequate blinding and adequate comparison groups, reflecting current best practice.

Additionally, an UpToDate review on "Treatment of PMS and PMDD" (Casper & Yonkers, 2018) does not mention acupuncture as a therapeutic option.

restless leg syndrome

In a systematic review and meta-analysis, Huang and colleagues (2021) examined the efficacy of acupuncture in the treatment of restless legs syndrome (RLS). These investigators conducted a comprehensive literature search of electronic databases to identify studies examining the efficacy of acupuncture in the treatment of RLS. The cure, marked effect, effective, ineffective, and total effective rates of the individual studies were pooled to arrive at their respective overall estimates, and a meta-analysis of the mean change from baseline in the International Restless Legs Syndrome Rating Scale ( IRLSRS). A total of 18 studies were included in this meta-analysis, among which 640 RLS patients were treated with acupuncture alone or combined with other therapies (acupuncture group) and 447 RLS patients were treated with non-acupuncture therapies (control group). Rates of cure, marked effect and efficacy were 47.8% [95% CI 38.3% to 57.3%], 27.4% (95% CI 20.3% to 34, 8%) and 24.2% (95% CI: 16.9% to 31.5%) in patients treated with acupuncture alone or in combination with other treatments, and 21.7% (95% CI: 20, 7% to 22.7%), 28.0% (95% CI: 20.0% to 32.9%), and 22.3% (95% CI: 17.0% to 27.6%) in patients treated without acupuncture, respectively. The failure rate was 4.7% (95% CI 4.3% to 5.0%) in the acupuncture group; and 32.9% (95% CI: 22.2% to 43.7%) in the non-acupuncture groups. IRLSRS scores improved significantly after acupuncture treatment [mean change from baseline -9.45 (95% CI -18.42 to -0.49); p = 0.04]. The authors concluded that although the overall quality of the included studies was low, the results of this meta-analysis suggested that acupuncture was an effective therapeutic option for RLS. Furthermore, these investigators stated that RCTs, especially those with better designs and adequate controls with a sham acupuncture arm, are needed to confirm these findings.

The authors stated that, among the major drawbacks of this study, the reduced availability of non-Chinese literature was an important consideration. These investigators observed a high statistical heterogeneity in the pooled analysis that can be attributed to the use of many types of controls and many therapeutic combinations with acupuncture. To assess sources of heterogeneity, these investigators performed meta-regression analyses, but neither study sample size, duration of follow-up, nor year of study publication were significantly associated with total effective rate. Most of the included studies did not provide definitions of efficacy rates and there may be some bias between studies in measuring the actual effect of treatment.

Rheumatoid arthritis

Lu and colleagues (2021) noted that rheumatoid arthritis (RA) patients are increasingly using a new type of acupuncture and related techniques (ACNRT) to manage their disease and improve their quality of life; however, the effectiveness of using ACNRT in combination with Western medicine (WM) for this purpose is still unknown. These investigators searched for RCTs of ACNRT and WM treatments for RA from January 1, 2000 to January 31, 2021 using PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as 3 databases. Chinese data: China National Knowledge Infrastructure, Data Library, and Wanfang Airiti. Primary endpoints were inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF). Secondary outcomes were clinical features, including VAS pain score; disease activity score (DAS-28); swollen joint count (SJC); tender joint count (TJC); morning stiffness (MS); and the results of a health assessment questionnaire (HAQ). The 3 types of ACNRT used in the focal trials were acupuncture, moxibustion, and electroacupuncture. Two qualified investigators extracted data from the results of these studies and independently examined the risk of bias. Statistical analyzes were performed using Comprehensive Meta-Analysis V3 software. A total of 12 RCTs with 874 patients met the inclusion criteria. Compared with patients receiving WM treatment alone, those receiving integrated ACNRT/WM treatment had greater reductions in CRP (weighted mean difference [WMD]: -6.299; 95% CI: -9.082 to -3.517), ESR ( WMD: -6.563, 95% CI: -8.604 to -4.522), VAS (WMD: -1.089, 95% CI: -1.575 to -0.602), DAS-28 (WMD: -0.633, 95% CI: -1.006 to -0.259), SJC (WMD: -1.921, 95% CI: -3.635 to -0.207), TJC (WMD: -1.491, 95% CI: -2.941 to -0.042). The authors concluded that this RA meta-analysis provided credible evidence in favor of ACNRT plus WM; however, high-quality, long-term, repeatable, multicentre RCTs with larger sample sizes are needed.

sexual dysfunction

Abdi and colleagues (2021) noted that sexual dysfunction can negatively affect quality of life and interpersonal relationships. Until now, much attention has been paid to TCM with better curative effects and fewer adverse effects. Recent studies have suggested the promising effect of acupuncture on sexual function. In a systematic review, these investigators examined the safety and efficacy of acupuncture in the treatment of male and female sexual dysfunction. They searched PubMed, Cochrane Central of Controlled Trials (CENTRAL), Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Scopus, and Google Scholar up to 2021; language and date limitations did not apply. The methodological quality of the studies was assessed using the Mixed Methods Assessment Tool (MMAT). Of the 160 articles initially evaluated, 13 articles were included. The results showed that acupuncture improved sexual dysfunction in the domains of desire, libido, erectile dysfunction, and impotence. Most of the studies did not report serious side effects of acupuncture and only 3 studies reported minor AEs. The authors concluded that the available evidence indicated that acupuncture has positive effects in improving sexual dysfunction without serious side effects. Furthermore, these investigators stated that although acupuncture has gained increasing popularity for the treatment of sexual dysfunction, evidence of high methodological quality regarding its effectiveness is lacking.

Teding Dianci Pu Lamp (TDP) as a complement to acupuncture

The Teding Diancibo Pu (TDP) lamp is a specific electromagnetic lamp that produces far infrared (below visible light) emissions (2-50 um range). “Teding Diancibo Pu” loosely translated means specific electromagnetic spectrum. The lamp is used in various hospitals in China and Japan to increase microcirculation, loosen fascia and muscles, and speed up the body's natural healing processes. The TDP lamp is different from other far infrared heating devices. Contains a heated mineral plate made with a proprietary formula of 33 trace elements, which stimulates the body to heal itself naturally.

In a randomized, controlled, single-blind, phase III clinical trial, Zhang and Yuan (2020) compared the effectiveness of 12.5% ​​honey mouth rinse and 0.2% chlorhexidine solution in reducing the rate of colonization Oropharyngeal bacteria in patients with mechanical ventilation. This study included 60 patients newly admitted to inpatient and trauma intensive care units (ICUs) from the 2 teaching hospitals in the city of Sanandaj affiliated with the Kurdistan University of Medical Sciences. Subjects were selected by convenience sampling and distributed into 2 groups of 30 patients using randomized blocks. In each group, the mouthwash was applied twice a day for 4 consecutive days. Mouth and throat swab samples were collected from all patients three times daily (pre-intervention, 2 days and 4 days post-intervention) and then the samples were transferred to eosin blood agar culture plates. methylene blue (EMB) and examined for bacterial growth and colonization after 24 to 48 hours. The findings showed that oropharyngeal colonization was not significantly different between the 2 groups, before the intervention, 2 days and 4 days after the intervention (p > 0.05). The 12.5% ​​honey mouthwash led to the inhibition of Staphylococcus aureus and Pseudomonas aeruginosa on the 4th day of intervention in all samples. The authors concluded that none of the solutions studied contributed to the reduction of bacterial colonization of the oropharynx. It appears that the growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa by 12.5% ​​honey mouthrinse in mechanically ventilated patients needs further investigation. Teding Dianci Pu therapy was one of the keywords of this study.

vascular dementia

In a systematic review protocol, Ye and colleagues (2017) provided the methods used to assess the safety and efficacy of acupuncture in the treatment of vascular dementia (VaD). The following 8 databases will be searched from inception to July 2017: Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. All RCTs in English or Chinese related to acupuncture for vascular dementia will be included. Outcomes will include changes in ADL and cognitive function. The incidence of AA will be evaluated for safety evaluation. Two reviewers will independently perform study inclusion, data extraction and quality assessment. Risk of bias assessment and data synthesis will be performed using the Review Manager software. The authors stated that this systematic review will provide an assessment of the current state of acupuncture treatment for VD. The conclusions drawn from this review may benefit LV patients, clinicians and policy makers. The process of carrying out this review will be divided into 4 parts:

1. ID,
2. inclusion in the study,
3. data extraction and
4. data synthesis.

This review has 2 main potential limitations:

1. various forms of acupuncture can cause considerable heterogeneity, and
2. the quality of the reports included may be poor, which will limit the ability to draw conclusions based on a high level of confidence.

The results of this systematic review will be disseminated through peer-reviewed publications or conference presentations.

dry needling

Many professional societies and organizations consider dry needling to be a type of acupuncture, both of which involve inserting solid, thread-like needles into parts of the body to treat various health conditions. However, there are differences between the two methods based on theory, the technique of how and where the needles are placed, and professional training.

"It is important to note that dry needling is not the same as acupuncture. It uses similar tools, but that is where the similarities end. Dry needling is performed by different professionals with different training" (Mayo Clinic, 2017).

Acupuncture has been around for over 2,000 years and is based on the philosophy of Traditional Chinese Medicine (TCM). Acupuncture follows the principles of energy flow as a guide to where the needles will be inserted at points along the meridian lines (energy transport channels). 15 to 30 minutes. This technique is performed by an acupuncturist duly trained and accredited to practice acupuncture in the United States. Accreditation requirements vary based on state and institutional regulations.

Dry needling (also known as manual intramuscular stimulation or intramuscular needling) is considered by many to be a relatively new treatment modality that is no longer based on TCM concepts and belongs to a subcategory of Western medical acupuncture (Hu et al, 2018). "Dry needling (DN) originally known as a hypodermic needle in an empty syringe, inserted into the body without injection," has now been expanded to include filiform needles used in acupuncture (McIntyre, 2016). Dry needling involves inserting needles directly into a myofascial trigger point in an attempt to inactivate it and therefore decrease associated pain. Physiotherapists often perform dry needling or trigger point to help patients with acute or chronic pain.

Dommerholt (2011) states that "Although various approaches to needling are commonly referred to as 'dry needling', it is important to realize that there are significant differences between schools of dry needling, their specific needling techniques, underlying philosophy or rationale, and the duration of the puncture". training programs "Each approach seems to address particular aspects of the big picture. Different dry needling techniques have been promoted to treat various forms of soft tissue dysfunction."

An increasing number of clinical trials have been conducted to explore the efficacy of dry needling in the treatment of pain; however, the conclusions were contradictory. The actual efficacy of dry needling remains controversial (Hu et al, 2018).

Several models of dry needling have been developed, including a radiculopathy model, a myofascial trigger point (MTrP) model, a neurological model, and a superficial dry needling model. Superficial dry needling involves inserting a needle as deep as 10 mm or into subcutaneous tissue and can be combined with needle manipulation in situ. Deep needle penetration involves the insertion of a needle through the skin, beyond the subcutaneous tissue, and into muscle or other connective tissue structures and may be combined with needle manipulation. Most dry needling studies involve deep needling PGM for pain relief; however, deep needle penetration has not consistently shown superior results compared to superficial needle insertion (Griswold et al, 2019).

Position statements from professional organizations (not a comprehensive list) on the practice of dry needling:

• The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) states that dry needling is considered acupuncture. "Dry Needling is a recently coined name for an acupuncture technique that involves inserting acupuncture needles directly into muscles and 'trigger points' to relieve musculoskeletal pain." "Some physical therapists and other health professionals have declared "dry needling" to be "new" and "not acupuncture" because the location of the points and the style of needling are based on anatomical structures and physiological functions rather than on the traditional theory of acupuncture of Chinese medicine.
• The American Academy of Medical Acupuncture (AAMA) states: "Dry needling, like acupuncture, involves the use of solid needles (as opposed to the use of hollow hypodermic needles used for injections) to treat the muscle pain by stimulating and breaking up muscle knots and bands Unlike trigger point injections used by physicians and licensed acupuncturists for the same purpose, anesthesia is not used in dry needling There is controversy over the definition of dry needling Physicians dry needling is considered a style of acupuncture or trigger point by licensed acupuncturists and licensed acupuncturists Acupuncture where insertion sites are determined by painful areas and tight muscles These sites may be treated alone or in combination with known acupuncture points Do not use meridians or other oriental medicine paradigms of acupuncture to determine ionic insertion sites. Regardless of theory, it is indisputable that dry needling is an invasive procedure. The length of the needle can vary up to 4 inches to reach the affected muscles. It is essential to understand that dry needling, in the hands of minimally educated professionals, can cause extreme damage. Any invasive procedure has associated and potentially serious medical risks and is safe only if performed by a properly educated, trained and experienced healthcare professional. The dry needling technique often involves needling muscle structures that may be deep and/or hidden under layers of other muscles and tissues and near sensitive structures and organs, including blood vessels, nerves, and organs such as the lungs. The patient may develop painful bruising after the procedure, and adverse sequelae may include bruising, pneumothorax, nerve damage, vascular injury, and infection. Angle the needle incorrectly and, for example, the lung could be punctured. Post-procedure pain relievers may be needed (over-the-counter medications are usually sufficient). In the worst case, vital organs can be punctured, resulting in complex medical situations or even death." .with the routine use of needles in their practice and who are duly licensed to perform these procedures, such as licensed physicians or licensed acupuncturists. In our experience and medical opinion, it is legally inadvisable to broaden the scope of physical therapists to include dry needling as part of their practice" (NCCAOM, 2016).
• The American Academy of Physical Medicine and Rehabilitation (AAPM&R, 2012) "recognizes dry needling as an invasive procedure using acupuncture needles that has associated medical risks. Therefore, the AAPMR maintains that this procedure should only be performed by professionals with standard training and familiar with the routine use of needles in their practice, such as licensed acupuncturists or licensed physicians."
• The American Association for Acupuncture and Oriental Medicine (AAAOM) "determined that dry needling and any of its alternative designations, including intramuscular manual therapy, trigger point needling, functional dry needling, intramuscular stimulation, or any other method using the which a needle is inserted to effect therapeutic change, is, by definition, the practice of acupuncture."
• The American Medical Association (AMA, 2016) recognizes dry needling as an invasive procedure and states that it should only be performed by professionals with standard training and familiar with the routine use of needles in their practice, such as licensed physicians and licensed acupuncturists.

Dry needling, while targeting a trigger point, differs from a trigger point injection in that there is no injection of medication or fluid.

Dry Needling and Myofascial Trigger Points

Trigger points were treated with dry needling. A myofascial trigger point is a discrete focal tenderness, 2 to 5 mm in diameter, located in distinct narrow bands or knots of skeletal muscle (AHFMR, 2002). When palpated, these hyperirritable areas cause pain in distant areas, or referred pain zones, which are specific to each trigger point. Trigger point injection, or direct wet needling, involves injecting fluid directly into the trigger point located in the taut muscle band. The primary goal of trigger point injection is rapid pain relief and elimination of muscle spasms to break the pain cycle. This facilitates physiotherapy aimed at reducing muscle contracture and increasing range of motion. Trigger point injection is rarely used alone, but is often part of a multidisciplinary approach aimed at treating trigger points and reducing all contributing factors (Scott and Guo, 2005; AHFMR, 2002; Sanders et al, 1999). Therefore, treatment may also include patient education, psychosocial support, oral medications, and physical therapy to improve the strength and flexibility of the affected musculoskeletal systems. A review by the Alberta Heritage Foundation for Medical Research (Scott and Guo, 2005) found that evidence for the effectiveness of trigger point injections when used as the sole treatment for patients with chronic head, neck, and shoulder pain and Whiplash syndrome was inconclusive regardless of sterile water injection, saline, or botulinum toxin. The review found that the combined use of dry needling and trigger point injection with procaine offers no clear clinical benefit in the treatment of chronic craniofacial pain, while the effectiveness of trigger point injection for the treatment of chronic craniofacial pain is unknown. cervicogenic headache. In contrast, the review found that lidocaine injection into trigger points may be helpful in treating joint pain caused by osteoarthritis (Scott and Guo, 2005). The review found no evidence that trigger point injection is more effective than other less invasive treatments, such as physiotherapy and ultrasound, in achieving pain relief, and there are some suggestions that the only advantage of injecting anesthetic into trigger points is trigger points is that it reduces the pain of the needling process (Scott and Guo, 2005). Typically, approximately 3 treatments are required to completely eliminate a trigger point (AHFMR, 2002). Multiple trigger points can be injected in 1 session, but rarely more than 5. Repeated injections into a given muscle are not recommended if 2-3 previous attempts have been unsuccessful (Alvarez and Rockwell, 2002; Sanders et al, 1999). Pain relief can last from the duration of anesthesia to many months, depending on the chronicity and severity of the trigger points and concomitant treatment of perpetuating factors. According to available guidelines, the use of trigger point injections should be short-term and part of a comprehensive rehabilitation program. Available guidelines indicate that, although there are several uncontrolled case studies using trigger point injections in more acute pain presentations, to date there is virtually no consistent evidence for their application in patients with chronic nonmalignant pain syndrome (Sanders et al. al, 1999; AHFMR, 2002).

Kietrys et al (2013) state that dry needling consists of inserting an acupuncture-like needle into a myofascial trigger point, with the aim of reducing pain and restoring range of motion in people with myofascial pain syndrome (MPS) . The authors explored the evidence on the effectiveness of dry needling in reducing pain in people with MPS in the upper trimester. An electronic bibliographic search was carried out using the keyword dry needling. Finally, twelve RCTs were selected. Methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). Findings from 3 studies comparing dry needling with sham or placebo provided evidence that dry needling can immediately decrease pain in patients with MPS in the upper quarter, with an overall effect favoring dry needling. Results from 2 studies comparing dry needling with sham or placebo provided evidence that dry needling may decrease pain after 4 weeks in patients with upper quarter MPS, although a wide confidence interval for the effect generally limits the impact of the effect. The results of the studies that compared dry needling with other treatments were very heterogeneous, probably due to the variation in the comparator treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. The authors concluded that, based on the best currently available evidence (grade A), they recommend dry needling, compared with placebo or placebo, for pain reduction immediately after treatment and at 4 weeks in patients with MPS in the upper trimester. However, due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation.

In a 2017 review of trigger point dry needling found in the Journal of Orthopedic & Sports Physical Therapy, the authors reviewed 13 randomized controlled trials that examined the effectiveness of dry needling in musculoskeletal pain. The authors found that, to date, most of the evidence is of very low to moderate quality. There are also risks of bias in the available research. Furthermore, there is very little evidence on the long-term benefits of dry needling, or to guide optimal doses and treatment techniques.

DryNeedling for the treatment of low back pain

The UpToDate reviews on "Subacute and chronic low back pain: pharmacological and non-pharmacological treatment" (Chou, 2020a) and "Treatment of acute low back pain" (Knight et al, 2020) do not mention dry needling as a therapeutic/management option .

Furthermore, a “Subacute and Chronic Low Back Pain: Non-Surgical Interventional Treatment” (Chou, 2020b) states that “Trigger Point or Local Injection: A systematic review found no clear difference between trigger point or local injections with a local anaesthetic, with or without a corticosteroid, and control interventions (saline or dry needle injections or ethyl chloride plus acupressure) for short-term pain relief (7 days to 2 months) in 3 trials of patients with subacute low back pain or chronic. All trials had methodological weaknesses and evaluated heterogeneous injection methods. One study evaluated an iliac crest injection, another evaluated iliolumbar ligament injections, and another evaluated trigger point injections. The limited benefit observed in low-quality and heterogeneous studies does not support its widespread use.”

Appendix

Necessary documents

Acupuncture must be provided in accordance with a written continuum of care. The purpose of the written plan of care is to assist in the determination of medical necessity and must include the following:

The written plan of care must be sufficient to determine the medical necessity of treatment, including:

1. The diagnosis together with the date of onset or exacerbation of the disorder/diagnosis;

   1. A reasonable estimate of when the objectives will be achieved;

   2. Specific, quantitative and objective goals in the long and short term;

   3. Acupuncture evaluation;

   4. The frequency and duration of treatment;mi

   5. The acupuncture protocol to be used in the treatment.

2. Signatures of the treating physician and/or acupuncturist of the patient.

   1. The care plan must be ongoing (i.e., updated as the condition of the limb changes) and treatment must demonstrate a reasonable expectation of improvement (as defined below):

      1. Acupuncture services are considered medically necessary only if there is a reasonable expectation that acupuncture will achieve measurable improvement in the condition of the limb in a reasonable and predictable period of time.

         (Video) How can acupuncture help manage pain? Ian Appleyard, British Acupuncture Council, explains

      2. The extremity should be reassessed regularly and there should be documentation of progress made towards acupuncture goals.

Treatment goals and subsequent documentation of treatment results must specifically demonstrate that acupuncture services are contributing to this improvement.

The above policy is based on the following references: