Objectives: Acupuncture is a form of Traditional Chinese Medicine that has been used to treat a broad range of medical conditions, including dermatologic disorders. This systematic review aims to synthesize the evidence on the use of acupuncture as a primary treatment modality for dermatologic conditions.

Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register was performed. Studies were limited to clinical trials, controlled studies, case reports, comparative studies, and systematic reviews published in the English language. Studies involving moxibustion, electroacupuncture, or blood-letting were excluded.

Results: Twenty-four studies met inclusion criteria. Among these, 16 were randomized controlled trials, 6 were prospective observational studies, and 2 were case reports. Acupuncture was used to treat atopic dermatitis, urticaria, pruritus, acne, chloasma, neurodermatitis, dermatitis herpetiformis, hyperhidrosis, human papillomavirus wart, breast inflammation, and facial elasticity. In 17 of 24 studies, acupuncture showed statistically significant improvements in outcome measurements compared with placebo acupuncture, alternative treatment options, and no intervention.

Conclusions: Acupuncture improves outcome measures in the treatment of dermatitis, chloasma, pruritus, urticaria, hyperhidrosis, and facial elasticity. Future studies should ideally be double-blinded and standardize the control intervention.

Comments: Acupuncture has many applications for skin diseases and skin anti-ageing. Facial cosmetic acupuncture is used to temporarily reduce wrinkles and improve skin elasticity. Acupuncture is also used for relieving skin rashes such as atopic dermatitis and acne. However these days it is not always practical for patients to come 1 to 2 times a week for acupuncture, which is often the ideal treatment plan to improve the condition. This is why  I will recommend a herbal formulation that will work on multiple internal factors between acupuncture treatments.

SOURCE: Ma, Chelsea, and Raja K. Sivamani. “Acupuncture as a Treatment Modality in Dermatology: A Systematic Review.” The Journal of Alternative and Complementary Medicine 21.9 (2015): 520-529.

In Vitro Fertilisation  and Acupuncture

Statistically you have a 25% chance of falling pregnant and staying pregnant with first cycle of IVF. It’s no wonder that women and couples turn to acupuncture to try to increase chances of conception and full-term pregnancy. Women and men can receive acupuncture prior to IVF. On the day of embryonic transfer the women may have acupuncture within an hour after the procedure. A woman may continue having acupuncture through the first trimester and until the risk of miscarriage is very low.

Outcome measures:

This meta-anlaysis of several studies from six countries has a varied treatment scope. This study chose to look at six outcomes.

Clinical pregnancy, biochemical pregnancy, on-going pregnancy, live birth, implantation rate, and miscarriage.

Using the random-effects model, pooling of the effect estimates from all of the 17 trials showed no significant difference in the clinical pregnancy outcome between the acupuncture and the control groups
(RR= 1.09, 95% confidence interval (CI) 0.94–1.26, p = 0.25). No significant differences in the biochemical pregnancy, ongoing pregnancy, implantation rate, live birth, or miscarriage outcomes were found between the acupuncture and the control groups
(biochemical pregnancy: RR = 1.01, 95% CI 0.84–1.20, p = 0.95;
ongoing pregnancy: RR = 1.20, 95% CI 0.93–1.56, p = 0.16; implantation rate: RR = 1.22, 95% CI 0.93–1.62, p = 0.16;
live birth: RR = 1.42, 95% CI 0.92–2.20, p = 0.11;
miscarriage outcomes: RR = 0.94, 95% CI 0.67–1.33, p = 0.74).

Conclusions: No significant benefits of acupuncture are found to improve the outcomes of IVF or ICSI.

More information about treatment

In this meta-analysis acupuncture was viewed as any form of acupuncture used in clinical practice. This included auricular acupuncture, laser acupuncture, electro-acupuncture and traditional acupuncture. This study chose not to conduct an analysis of outcomes for each type of acupuncture instead focusing on the IVF outcomes.

However most of the case studies report using traditional acupuncture. Some case studies had control groups with sham acupuncture or alternative treatment , for example lying down for an hour was used in one study’s control group.

Comments on study

This meta-analysis also referred to previous smaller meta-anlaysis pointing out that there were contradictory findings. For example one meta-analysis had reported acupuncture significantly improved the pregnancy rate, whilst another meta-analysis reported no significant improvement for clinical pregnancy.

This meta-analysis concludes that across all the outcomes measured in the selected seventeen trials acupuncture does not produce any significant improvement against placebo or sham.

The study recommends future large TCM theory based randomised trials are needed.

This meta-analysis highlights the challenges facing evidence based acupuncture. How do you design and complete trails that will result in conclusive evidence?

References

ingender.com (stats on IVF pregnancy)

Long-Term Effect of Acupuncture for Treatment of Tinnitus” A Randomized , Patient and Assessor Blind, Sham-Acupuncture-Controlled, Pilot Trial. The Journal of Alternative and Complementary Medicine , Vol 18, No 5, 2012 pp.429-439. Fan Qu, PhD,1  Jue Zhou, PhD,2  and Ru-Xiang Ren, MD –

Source: Long-Term Effect of Acupuncture for Treatment of Tinnitus” A Randomized , Patient and Assessor Blind, Sham-Acupuncture-Controlled, Pilot Trial. The Journal of Alternative and Complementary Medicine , Vol 18, No 7, 2012 pp.693-699

Medical Condition

Tinnitus is a perception of noise within the person’s ears. Some patients describe it as  “beeping” or “hissing” noises, others a buzzing sound ‘like  swarm of bees”.  The severity and type of noise varies amongst sufferers. With this constant internal noise a suffers hearing can be impaired. We are yet to understand the patho-physiology of this condition and this lack of understanding is demonstrated in the fact that there is currently no drug on the market that provide a long-term relief for Tinnitus.

Outcome measures:

The subjective outcome was the score of Tinnitus Handicap Inventory (THI) and Visual

Analogue Scale (VAS) from baseline to 3 months after.

Pure Tone Average (PTA) and Speech Discrimination

(SD) from baseline to 3 months after were assessed as objective outcomes.

Results: A significant interaction between time and group in VAS ( p = 0.017) was evident, but not in THI, PTA, and SD scores. THI showed significant improvement at the end of treatment and 3 months after, compared to baseline, in real acupuncture ( p = 0.004). In SD, a significant long-term effect of real acupuncture was observed until 3 months after ( p = 0.011). However, the effect of real acupuncture in PTA was not maintained until 3 months after the end of treatment. No significant difference in the sham-acupuncture treatment group was evident. No statistical difference in any outcome was observed between real and sham acupuncture. Only in the mean percent change of VAS, real acupuncture showed statistical significance, compared with sham-acupuncture

from baseline to 3 months after ( p = 0.019).

Conclusions: Through evaluation of subjective (THI and VAS) and objective outcomes (PTA and SD), this study demonstrates the long-term effect of real acupuncture.

More information about treatment

All Real-acupuncture points were inserted to depth of 2mm, stimulated and retained for ten minutes. Points used in real acupuncture group were:

In prone position

GV-14, 15 ,20

GB 12,20,21

Then in supine position

SJ-21,22

SI -19

GB-7

GV-20

Extra Point HN3

Bl-2 (bi-laterally)

LI-20.

The Sham-Acupuncture  group used points not at specific documented meridian points. This included inserting points around the ear but not at any meridian point. Inserting points a few CMs from ST36, SJ-5. No specific stimulation technique was used . needles inserted to depth of 3mm and retained for ten minutes.

Other treatments applied for both groups were infrared light projected to area around ear to promote blood circulation during acupuncture.

Comments on study

Comparing Sham-acupuncture to real-acupuncture challenges a lot of acupuncturists because it can often the results have  no-significant statistical difference. This study is a good example of this contradiction to real-acupuncture. However when you look at each measurement  it gets more complicated. In the case of this study the Tinnitus Health Inventory (THI) scores are reported, a subjective self-reporting questionnaire of patients health, to have significantly improved for real-acupuncture at end of the treatment and this was maintained  3 month follow-up. But the sham group did not replicate these positive results. THI looks at patients emotional, psychological and physiological responses to their condition. All other measurements are more specific and there was no significant statistical difference between these. You can read more about measurements in the paper itself.

Regarding acupuncture in general it seems that for some conditions acupuncture works very well and is completely safe. However there are still  fundamental unanswered questions about this medicine.

We really don’t know how acupuncture works and why.

Why is it that sometimes real acupuncture  is superior to sham-acupuncture and sometimes it is not?

There is no high quality studies that have tested whether treatment variables such as: needling technique, needle retention time, needle type, needle depth, needles quantity, and needling style]  provides any significant difference in patient outcomes.

How do we account for the placebo effect in clinical trials as a factor in sham and real acupuncture?

We may never be able to answer these questions, but  does this matter if we have evidence based acupuncture that proves it works or doesn’t?

A systematic review of Acupuncture for the management of Chronic Headaches

Study: Conducted by Department of Anethesiology, Duke University Medical centre.

Treatment

This was  a review of efficacy of acupuncture to treat chronic headaches. The review involved looking at clinical trials that used true acupuncture over a course  ranging from 6 to 12 weeks and one more treatment sessions a week. The majority of the selected trials used sham acupuncture in the control group. A few trials compared true acupuncture with other treatments including physiotherapy, massage and relaxation and commonly used medication.

Medical Condition

Chronic headaches including migraines and tension-type headaches.

Participants

Thirty one trials consisting of 3916 patients met the inclusion criteria. The review only chose trials where participants were randomised for acupuncture or control receiving sham acupuncture , medication or other non pharmacological treatments.

17 trials were for treatment of migraine

10 trials were for treatment of tension type headaches

4 trials were for mixed headaches

Outcomes Measured

Headache intensity and frequency of headache, and health related QoL questionnaires were the primary information to determine efficacy of acupuncture treatments. These measurements were reviewed in a defined follow-up early period of close to 8 weeks and no more than 3 months and also  a late follow-up period of  close to  6 months but longer than 3 months. The treatment response rate was based on a  minimum improvement of 33% in headache frequency or headache index.

Results

Cochrane Quality and Risk Rating (if available)

The quality of the selected studies was not rated. However quality was independently assessed  by two independent reviewers who based their assessment on a criteria for selecting quality of controlled trials. See paper for more details.

Comments

The paper did not discuss point locations or provide any analysis of commonality of points used across the selected trials.

References

Sun and Gan (2008) Acupuncture of the management of Chronic Headache: A systematic Review. Journal of Anesthesia and Analgesia. 2008, Vol 107 (6) International Anesthesia Research Society