However, the inferior quality and publication bias present in these studies may lead to a false-positive estimation. Meta-analysis based on these published trials should be treated in an exploratory nature only. In a review on the safety and effectivenes of various interventions for the treatment of neck pain, Binder stated that compared with sham treatment, inactive treatment, or waiting list control, acupuncture may be more effective than some types of sham treatment not further defined or inactive treatment not further defined at improving pain relief at the end of treatment or in the short-term less than 3 months , but not in the intermediate-term not defined or in the long-term not defined in people with chronic mechanical disorders.
The author also noted that acupuncture may be more effective than sham TENS at improving pain at 1 week after treatment, and at 6 months, in people with chronic neck pain. Needle acupuncture may be more effective than no acupuncture at improving a composite outcome of neck pain and disability not further defined at 3 months in people with chronic neck pain very low-quality evidence. Furthermore, compared with sham treatment, inactive treatment, or waiting list control, needle acupuncture may be more effective than no acupuncture at improving quality of life measured by SF at 3 months in people with chronic neck pain very low-quality evidence.
There is no evidence of benefit of acupuncture for dyspnea palliation in cancer patients. Ben-Aharon and associates conducted a systematic review of RCTs assessing all pharmacological and non-pharmacological interventions for dyspnea palliation in cancer patients. Two reviewers independently appraised the quality of trials and extracted data. The administration of subcutaneous morphine resulted in a significant reduction in dyspnea visual analog scale VAS compared with placebo. No difference was observed in dyspnea VAS score 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, without additional adverse effects. Oxygen was not superior to air for alleviating dyspnea, except for patients with hypoxemia. Nursing-led interventions improved breathlessness. Acupuncture was not beneficial. The authors concluded that their review supports the use of opioids for dyspnea relief in cancer patients.
The use of supplemental oxygen to alleviate dyspnea can be recommended only in patients with hypoxemia. Nursing-led non-pharmacological interventions seem valuable. Only a few studies addressing this question were performed. Thus, the investigators concluded, further studies evaluating interventions for alleviating dyspnea are warranted.
A systematic evidence review by Bausewein et al reached similar conclusions about the lack of adequate evidence to support the use of acupuncture for cancer-associated dyspnea. There is a lack of reliable evidence for acpuncture treatment of Parkinson's disease. Lam and co-workers evaluated the safety and effectiveness of acupuncture therapy monotherapy or adjuvant therapy , compared with placebo, conventional interventions, or no treatment in treating patients with idiopathic Parkinson's disease IPD.
All RCTs of any duration comparing monotherapy and adjuvant acupuncture therapy with placebo or no intervention were included. Data were abstracted independently by 2 investigators onto standardized forms, and disagreements were resolved by discussion. A total of 10 trials were included, each using a different set of acupoints and manipulation of needles.
None of them reported the concealment of allocation. Only 2 studies mentioned the number of dropouts; 2 used a non-blind method while others did not mention their blinding methods. Nine studies claimed a statistically significant positive effect from acupuncture as compared with their control; only 1 indicated that there were no statistically significant differences for all variables measured.
Only 2 studies described details about adverse events. The authors concluded that there is evidence indicating the potential effectiveness of acupuncture for treating IPD. However, results were limited by the methodological flaws, unknowns in concealment of allocation, number of dropouts, and blinding methods in the studies. They stated that large, well-designed, placebo-controlled RCTs with rigorous methods of randomization and adequately concealed allocation, as well as intention-to-treat data analysis are needed to ascertain the clinical value of acupuncture in the treatment of IPD.
There is insufficient evidence for the use of acupuncture in polycystic ovary syndrome. Stener-Victorin and colleagues described the etiology and pathogenesis of polycystic ovary syndrome PCOS and evaluated the use of acupuncture to prevent and reduce symptoms related with PCOS.
This syndrome is the most common female endocrine disorder and it is strongly associated with hyper-androgenism, ovulatory dysfunction and obesity. It increases the risk for metabolic disturbances such as hyper-insulinemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood 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. Thus, non-pharmacological treatment strategies need to be evaluated. Acupuncture may affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system.
Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggested that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation. In a randomized controlled trial, Stener-Victorin and associates examined the effect of low-frequency electroacupuncture EA and physical exercise on sympathetic nerve activity in women with PCOS. Direct recordings of multi-unit efferent post-ganglionic muscle sympathetic nerve activity MSNA in a muscle fascicle of the peroneal nerve before and following 16 wks of treatment were carried out.
Biometric, hemodynamic, endocrine, and metabolic parameters were measured. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine, and metabolic variables.
For the first time, these researchers showed that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. There is insufficient evidence of the effectiveness of acupuncture for toxic neuropathy. Zhou et al noted that thalidomide and bortezomib are effective in the treatment of multiple myeloma. Unfortunately, their use can cause sensory neuropathy that frequently limits dose and duration of treatment.
Although the relationship between peripheral neuropathy and therapeutic dose is controversial, many researchers have demonstrated a positive correlation between neuropathy and cumulative dose, dose intensity, and length of therapy. Peripheral neuropathic pain is the most troublesome symptom of neuropathy. Spontaneous pain, allodynia, hyperalgesia, and hyperpathia are often associated with decreased physical activity, increased fatigue, mood, and sleep problems.
Symptoms are often difficult to manage, and available treatment options rarely provide total relief. Moreover, 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 diabetic and human immunodeficiency virus-related neuropathy. However, the effectiveness of acupuncture in treating toxic neuropathy has not been assessed.
Although its putative mechanisms remain elusive, acupuncture has strong potential as an adjunctive therapy in thalidomide- or bortezomib-induced painful neuropathy, and a better understanding might guide its use in the management of chemotherapy-induced neuropathic pain.
The authors concluded that well-designed clinical trials with adequate sample size and power are warranted. There is no reliable evidence for the use of acupuncture as a treatment for erectile dysfunction. Lee and colleagues evaluated the current evidence for the use of acupuncture to treat erectile dysfunction ED.
Systematic searches were conducted in 15 electronic databases, with no language restrictions. Hand-searches included conference proceedings and our files. All clinical studies of acupuncture as a treatment for ED were considered for inclusion, and their methodological quality was assessed using the Jadad score. Of the 4 studies included, 1 randomized controlled trial RCT showed beneficial effects of acupuncture compared with sham acupuncture in terms of response rate, while another RCT found no effects of acupuncture.
The remaining 2 studies were uncontrolled clinical trials. Most investigations had methodological flaws e. The authors concluded that the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED. They stated that further research is needed to investigate if there are specific benefits of acupuncture for men with ED. A Cochrane review found insufficient evidence of the effectiveness of acupuncture in Bell's palsy.
Chen et al examined the effectiveness of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. Chinese journals in which the researchers thought they might find RCTs relevant to their study were hand-searched. These investigators reviewed the bibliographies of the randomized trials and contacted the authors and known experts in the field to identify additional published or unpublished data. They included all RCTs involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions.
Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently. All disagreements were resolved by discussion between the review authors. The literature search and hand-searching identified 49 potentially relevant articles. Of these, 6 RCTs were included involving participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs.
Of the 6 included trials, 5 used acupuncture while the other 1 used acupuncture combined with drugs. No trial reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials.
Poor quality caused by flaws in study design or reporting including uncertain method of randomization, allocation concealment and blinding and clinical differences between trials prevented reliable conclusions about the effectiveness of acupuncture.
The authors concluded that the quality of the included trials was inadequate to allow any conclusion about the effectiveness of acupuncture. They stated that more research with high quality trials is needed. There is insufficient evidence of the effectiveness of acupuncture for respiratory symptoms. Gibson and colleagues noted that anecdotal evidence from both clinicians and patients suggests there may be some beneficial effect of acupuncture in the treatment of respiratory symptoms, such as bronchospasm, breathlessness and hyper-ventilation syndromes.
Some respiratory clinicians are introducing acupuncture as a treatment modality for the management of respiratory symptoms, despite the 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 issues that are evident within this literature. In addition, they highlighted reasons for the lack of objective evidence to support acupuncture for respiratory conditions and the difficulties faced by acupuncture researchers when designing randomized, placebo-controlled trials.
The authors concluded that presently, there is insufficient evidence to support a recommendation on the use of acupuncture in respiratory disorders. There is insufficient evidence of the effectiveness of acupuncture for treatment of uterine fibroids.
Zhang et al evaluated the benefits and harms of acupuncture in women with uterine fibroids. All RCTs comparing acupuncture management with placebo acupuncture, no management, Chinese medication, Western medication or other managements of uterine fibroids were considered for inclusion.
Acupuncture management included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation e. Acupuncture management without needling was excluded. Two review authors assessed trial risk of bias according to their a priori criteria. No trials were included in this version of the review, therefore no data was collected. No randomized double-blind controlled trials met the inclusion criteria.
The authors concluded that the effectiveness of acupuncture for the management of uterine fibroids remains uncertain. They stated that more evidence is needed to establish the safety and effectiveness of acupuncture for uterine fibroids. There is a continued need for well-designed RCTs with long-term follow-up. In a randomized, patient-assessor blinded, sham-acupuncture, controlled trial, Shin et al assessed the safety and effectiveness of acupuncture for ocular symptoms, tear film stability and tear secretion in dry eye patients.
A total of 42 subjects with defined moderate to severe dry eye underwent acupuncture treatment 3 times a week for 3 weeks. In addition, adverse events were recorded. No adverse events were reported during this trial. The authors concluded that both types of acupuncture improved signs and symptoms in dry-eye patients after a 4-week treatment.
However, verum acupuncture did not result in better outcomes than sham acupuncture. Lee and colleagues evaluated the effectiveness of acupuncture as a treatment option for treating the condition of dry eye. These investigators searched the literature using 14 databases from their inceptions to December 3, , without language restrictions. They included RCTs comparing acupuncture with conventional treatment. Their risk of bias was assessed using Cochrane criteria. A total of 6 RCTs met all the inclusion criteria.
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 usage, 2 RCTs reported superior effects of acupuncture plus artificial tears, while 1 RCT failed to do so.
The authors concluded that these findings provide limited evidence for the effectiveness of acupuncture for treating 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, cross-over trial, Lam et al evaluated the safety and adjunctive effect of acupuncture added to refractive correction for anisometropic amblyopia in younger children. 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. After 15 weeks of treatment, the BCVA had improved by a mean of 2. The mean difference in BCVA between groups was 0. BCVA of less than or equal to 0. After the regimens were crossed-over at 30 weeks, group 1 had a mean of 1. The proportions of responders, resolution, and participants achieving a BCVA of less than or equal to 0. After completion of acupuncture, only 1 participant had greater than 1 line of VA decrease to 60 weeks.
Acupuncture was well-tolerated by all children, and no severe adverse effect was encountered. The authors concluded that acupuncture is a potentially useful complementary treatment modality that may provide sustainable adjunctive effect to refractive correction for anisometropic amblyopia in young children.
They stated that acupuncture has good potential to become a complimentary therapeutic modality for amblyopia, and further large-scale studies seem warranted. In a Cochrane review, Cheuk et al examined the effectiveness of acupuncture for people with autism spectrum disorders ASD in improving core autistic features, as well as communication, cognition, overall functioning and quality of life, and established if it has any adverse effects.
They also searched AMED February 26, and Dissertation Abstracts International March 3, , but these were no longer available to the authors or editorial base at the date of the most recent search. They included studies comparing an acupuncture group with at least one control group that used no treatment, placebo or sham acupuncture treatment in people with ASD.
They excluded trials that compared different forms of acupuncture or compared acupuncture with another treatment. Two review authors independently extracted trial data and assessed the risk of bias in the trials. They used relative risk RR for dichotomous data and mean difference MD for continuous data.
The authors included 10 trials that involved children with ASD. The age range was 3 to 18 years and the treatment duration ranged from 4 weeks to 9 months. The studies were carried out in Hong Kong, mainland China and Egypt.
Two trials compared needle acupuncture with sham acupuncture and found no difference in the primary outcome of core autistic features RFRLRS total score: MD 0. Six trials compared needle acupuncture plus conventional treatment with conventional treatment alone. The trials used different primary outcome measures and most could not demonstrate effectiveness of acupuncture in improving core autistic features in general, though 1 trial reported patients in the acupuncture group were more likely to have improvement on the Autism Behavior Checklist RR 1.
There was no evidence that acupuncture was effective for the secondary outcome of communication and linguistic ability, though there seemed to be some benefit for the secondary outcomes of cognitive function and global functioning. Two trials compared acupressure plus conventional treatment with conventional treatment alone and did not report on the primary outcome. Individual study results suggested there may be some benefit from acupressure for certain aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning.
Four trials reported some adverse effects, though there was little quantitative information, and at times both intervention and control groups experienced them. Adverse effects included bleeding, crying due to fear or pain, irritability, sleep disturbance and increased hyperactivity.
None of the trials reported on quality of life. There are a number of problems with the evidence base: the trials were few in number 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; they reported inconsistent and imprecise results, and, due to carrying out large numbers of analyses, they were at risk of false positivity. The authors concluded that current evidence does not support the use of acupuncture for treatment of ASD.
There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults. They stated that further high quality trials of larger size and longer follow-up are needed. In a Cochrane review, Wei et al evaluated the safety and effectiveness of acupuncture in slowing the progression of myopia in children and adolescents. There were no date or language restrictions in the electronic searches for trials.
These researchers included RCTs that included any type of acupuncture treatment for myopia in children and adolescents. Two authors independently evaluated the search results according to the inclusion and exclusion criteria. Two authors extracted and assessed data independently. They contacted the study investigator for missing data. The authors included 2 RCTs conducted in Taiwan with a total of participants.
They did not perform a meta-analysis as the trials were assessing different outcomes. Neither trial met the pre-defined primary outcome criteria of myopia progression defined as 1 diopter mean change. Only 1 trial reported the changes of axial length without non-significant difference among groups and both trials reported that several children experienced mild pain during acupuncture stimulation. Two trials were included in this review but no conclusions can be drawn for the benefit of co-acupressure for slowing progress of myopia in children.
The authors concluded that further evidence in the form of RCTs are needed before any recommendations can be made for the use of acupuncture treatment in clinical use. These trials should compare acupuncture to placebo and have large sample sizes.
Other types of acupuncture such as auricular acupuncture should be explored further as well as compliance with treatment for at least 6 months or longer. Axial length elongation of the eye should be investigated for at least 1 year. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting.
These investigators addressed these important clinical issues using an evidence-based systematic review process led by a representative inter-professional panel of experts. The evidence supported the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD. Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit.
There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli music , relaxation, hand-held fans, counseling programs or psychotherapy. There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in non-hypoxemic patients with advanced COPD.
Williams et al stated that acne is a chronic inflammatory disease of the pilo-sebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonization with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear.
Other factors such as diet have been implicated, but not proven. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne.
Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually 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. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.
Moreover, the authors stated that complementary and alternative medicine including acupuncture can not be recommended for the treatment of acne because it is not supported by good evidence. Yan et al noted that burning mouth syndrome BMS is a common chronic pain condition that lacks a satisfactory treatment approach.
These researchers examined the effects of acupuncture or acupoint injection on the management of BMS and evaluated the evidence supporting the use of acupuncture therapy for BMS in clinical practice. Articles were screened, and the quality of the included trials was assessed independently by 2 reviewers. After screening, 9 studies with 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.
The authors concluded that in light of the positive outcomes reported, the use of acupuncture therapy for BMS patients warrants further research. Bo and colleagues evaluated the reports' qualities which are about RCTs of acupuncture treatment on diabetic peripheral neuropathy DPN. A total of 8 databases including The Cochrane Library to Sept.
Hand-search for further references was conducted. Language was limited to Chinese and English. No article gave the description of the mechanism of allocation concealment, no experiment applied the method of blinding. Only 1 article 1. No article mentioned the number of cases lost or eliminated. During 1 exp eriment, acupuncture syncope led to temporal interruption of the therapy.
Two articles 2. None of articles reported the base of calculation of sample size, or has any analysis about the metaphase of an experiment or an explanation of its interruption. One 1. The authors concluded that the quality of the reports on RCTs of acupuncture for diabetic peripheral neuropathy is moderate to low.
In a meta-analysis, Wang et al evaluated the effectiveness of acupuncture in facial spasm. The research team categorized results from each of the reviewed studies in 2 ways: the number of participants who showed a positive response to therapy total effectiveness rate , and the number of participants who made a full recovery clinical cure rate.
The research team reviewed a total of 13 studies involving 1, participants with facial spasm. Researchers in China had conducted all studies, and most studies were poor in methodological quality. All studies reported that acupuncture was superior to other treatments, including carbamazepine, mecobalamin, and massage, and the meta-analysis on these low-quality studies yielded similar results.
The authors concluded that present trials evaluating the effectiveness of acupuncture in treatment of facial spasm are mostly poor in methodological quality. These studies showed that acupuncture was superior to other treatments for facial spasm; however, in its meta-analysis, the research team could not draw an affirmative conclusion as to the benefits of acupuncture due to the poor methodological quality and localized population of the included trials.
The authors concluded that the field needs large international, well-conducted RCTs. In a Cochrane review, He and colleagues evaluated the safety and effectiveness of acupuncture for children with mumps. They also hand-searched a number of journals from first issue to current issue. These researchers included RCTs comparing acupuncture with placebo acupuncture, no management, Chinese medication, Western medication or other treatments for mumps.
Acupuncture included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation body, electro, scalp, fire, hand, fine needle, moxibustion. Two review authors independently extracted data and assessed the quality of included studies. Only 1 study with participants met the inclusion criteria. There were a total of participants in the acupuncture group, of which recovered, with their temperature returning back to normal and no swelling or pain of the parotid gland; the condition of 14 participants improved, with a drop in temperature and alleviation of swelling or pain of the parotid gland.
There were participants in the Western medicine group, of which 56 recovered and the condition of 63 improved. The acupuncture group had a higher recovery rate than the control group. The relative RR of recovery was 1. However, the acupuncture group had a longer time to cure than the control group. The mean was 4. There was a potential risk of bias in the study because of low methodological quality. The authors concluded that they could not reach any confident conclusions about the safety and effectiveness of acupuncture based on 1 study.
They stated that more high-quality research is needed. Zhang et al systematically examined published reviews and meta-analyses in order to determine if and when acupuncture is an effective treatment for stroke and stroke-related disorders. These investigators 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 to treat stroke or stroke-related conditions were included.
Two authors independently assessed the compliance of studies with eligibility criteria, and extracted data from included studies. The quality of systematic reviews was assessed according to the Overview Quality Assessment Questionnaire.
A total of 24 systematic reviews were included, of which 4 Acupuncture was analyzed as an acute stroke intervention in 3 reviews In contrast, reviews in which the outcome was improvement in global neurological deficit scores or performance on the video-fluoroscopic swallowing study test or water-swallowing test often 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 for treating post-stroke neurological impairment and dysfunction such as dysphagia, although these reported benefits should 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 ameliorate 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 the development of more precise tools to assess these improvements after stroke. Zeng and associates evaluated the effectiveness of acupuncture for cancer-related fatigue CRF. Randomized controlled trials of acupuncture for the treatment of CRF were considered for inclusion.
A total of 7 RCTs were included for meta-analysis, involving a total of subjects. The authors concluded that there were 4 sets of comparison for the effectiveness of acupuncture for CRF; statistical pooling of the reduction in CRF from baseline to follow-up showed in favor of acupuncture. However, 3 sets of comparison for the pooled estimates of effect sizes had no statistical significance.
Although one set of comparison acupuncture plus education interventions versus usual care had statistically significant differences, it is unclear whether this pooled positive outcome is attributable to the effects of acupuncture or to the education intervention.
In addition, the duration of follow-up in these included trials was up to 10 weeks, and some RCTs had methodological flaws. They stated that further rigorously designed RCTs adhering to acceptable standards of trial methodology are needed to determine the effectiveness of acupuncture and its long-term effects on CRF. Cao and colleagues evaluated the safety and effectiveness of acupuncture for patients with vascular mild cognitive impairment VMCI.
A total of 7 electronic databases were searched for RCTs that investigated the effects of acupuncture compared with no treatment, placebo or conventional therapies on cognitive function or other clinical outcomes in patients with VMCI. The quality of the trials selected was evaluated according to the "risk of bias" assessment provided by the Cochrane Handbook for Systematic Reviews of Interventions.
RevMan V. A total of 12 trials with participants were included. Meta-analysis showed acupuncture in conjunction with other therapies could significantly improve Mini-Mental State Examination scores mean difference 1. No included trials mentioned any adverse events of the treatment. The authors concluded that the current clinical evidence is not of sufficient quality for wider application of acupuncture to be recommended for the treatment of VMCI; they stated that further large, rigorously designed trials are warranted.
Yang et al conducted a systematic review of RCTs to evaluate the effectiveness of acupuncture for diabetic gastroparesis DGP. Eligible RCTs designed to examine the effectiveness of acupuncture in improving dyspeptic symptoms and gastric emptying in DGP were selected for analysis. Risk of bias, study design and outcomes were extracted from trials. Relative risk RR was calculated for dichotomous data. Mean difference MD and standardized mean difference SMD were selected for continuous data to pool the overall effect.
These investigators searched studies, among which 14 RCTs were considered eligible. Overall, acupuncture treatment had a high response rate than controls RR, 1. There was no difference in solid gastric emptying between acupuncture and control. Acupuncture improved single dyspeptic symptom such as nausea and vomiting, loss of appetite and stomach fullness.
The majority of the RCTs reported positive effect of acupuncture in improving dyspeptic symptoms. The authors concluded that the results suggested that acupuncture might be effective to improve dyspeptic symptoms in DGP, while a definite conclusion about whether acupuncture was effective for DGP could not be drawn due to the low quality of trials and possibility of publication bias.
They stated that further large-scale, high-quality RCTs are needed to validate this claim and translate this result to clinical practice. In a prospective, blinding-validated, randomized controlled multi-center trial, Skjeie et al tested the hypothesis that acupuncture treatment has a clinically relevant effect for infantile colic.
Research assistants and parents were blinded. Intervention was 3 days of bilateral needling of the acupuncture point ST36, with no treatment as control. A total of patients were recruited; 23 patients were excluded, and 90 randomized; 79 diaries and 84 interviews were analyzed. Main outcome measures were difference in changes in crying time during the trial period between the intervention and control group. This was not considered clinically relevant, according to protocol. The authors concluded that this trial of acupuncture treatment for infantile colic showed no statistically significant or clinically relevant effect; they suggested that acupuncture for infantile colic should be restricted to clinical trials.
Zhang et al analyzed the effectiveness of acupoint application therapy for infantile diarrhea. The authors of the present paper did a literature retrieval using the China National Knowledge Infrastructure CNKI database, Chinese bio-medical database and Wanfang database covering the period of January 1, to June 30, , and made a systemic evaluation on the retrieved RCTs of acupoint application therapy for infantile diarrhea using Cochrane system evaluation method.
Trial quality was assessed using the Jadad score that evaluates the randomization process, blinding, and the description of withdrawals or drop-outs. The RevMan 5. A total of 16 papers 2, patients were included in the meta-analysis. Statistical difference indicates a better therapeutic effect of acupoint application group than the control group, providing evidence in favor of acupoint application therapy for infantile diarrhea.
Funnel chart displays that the researched object distribution is symmetric, being smaller in the bias. But the potential publication bias still possibly exists. The authors concluded that acupoint application therapy for infantile diarrhea has some advantages, which needs further confirmation due to lower quality of the collected literatures. They stated that larger sample, high quality RCTs are highly recommended. Zhu and colleagues examined the safety and effectiveness of acupuncture for pain in endometriosis.
Randomized single or double-blind controlled trials enrolling women of reproductive age with a laparoscopically confirmed diagnosis of endometriosis and comparing acupuncture body, scalp or auricular to either placebo or sham, no treatment, conventional therapies or Chinese herbal medicine were selected for analysis.
Three authors independently assessed risk of bias and extracted data; they contacted study authors for additional information. Meta-analyses were not performed as only 1 study was included. The primary outcome measure was decrease in pain from endometriosis. Secondary outcome measures included improvement in quality of life scores, pregnancy rate, adverse effects and rate of endometriosis recurrence.
A total of 24 studies were identified that involved acupuncture for endometriosis; however only 1 trial, enrolling 67 participants, met all the inclusion criteria. The single included trial defined pain scores and cure rates according to the Guideline for Clinical Research on New Chinese Medicine.
Dysmenorrhea scores were lower in the acupuncture group mean difference The total effective rate "cured", "significantly effective" or "effective" for auricular acupuncture and Chinese herbal medicine was The improvement rate did not differ significantly between auricular acupuncture and Chinese herbal medicine for cases of mild-to-moderate dysmenorrhea, whereas auricular acupuncture did significantly reduce pain in cases of severe dysmenorrhea.
Data were not available for secondary outcomes measures. The authors concluded that the evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review. This review highlighted the necessity for developing future studies that are well-designed, double-blinded, RCTs that assess various types of acupuncture in comparison to conventional therapies.
Acupoint Point Injection Acupuncture point injection also known as acupoint injection therapy, biopuncture entails the injection of small amounts of saline or other substances e. However, there is insufficient evidence to support the effectiveness of this approach. In a Cochrane review, Green et al evaluated the effectiveness of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement in function, grip strength and adverse effects.
Identified keywords and authors were searched in an effort to retrieve as many trials as possible. Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomized and pseudo-randomized trials in all languages were included in the review provided they were testing acupuncture compared to 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 effect. For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analyzed and interpreted as relative risks.
Trial results were combined 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, uncertain allocation concealment and substantial loss to follow-up and clinical differences between trials, data from trials could not be combined in a meta-analysis. No significant differences were found in the longer term after 3 or 12 months. A RCT of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit Haker b.
A 4th RCT included trial published in Chinese demonstrated no difference between vitamin B12 injection plus acupuncture, and vitamin B12 injection alone Wang The authors concluded that there is insufficient evidence to either support or refute the use of acupuncture either needle or laser in the treatment of lateral elbow pain.
This review has demonstrated needle acupuncture to be of short-term benefit with respect to pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. They stated that further trials, utilizing appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.
In a prospective, observational, pilot study, Wang et al examined the effects of vitamin K acupuncture point injection on menstrual pain in young women aged 14 to 25 from different countries and cultural backgrounds who have had unmitigated severe primary dysmenorrhea for 6 months or more.
All subjects were treated with bilateral acupuncture point injection of vitamin K on the first or second day of menstrual pain. Pain intensity, total duration, and average intensity of menstrual distress, hours in bed, normal daily activity restrictions, and numbers of analgesic tablets taken to relieve pain were recorded before the treatment and for 4 subsequent menstrual cycles.
There were no adverse events. Some women experienced mild, self-limited pain at the injection site. The authors concluded that acupuncture point injection with vitamin K alleviated acute menstrual pain, and relief extended through the non-treatment follow-up cycles in this uncontrolled pilot study conducted in 2 countries. They stated that further investigation employing controlled experimental designs is warranted.
Liang et al reported the findings of 2 patients with amyotrophic lateral sclerosis ALS who were treated with 4 weeks of acupuncture injection point therapy using Enercel. These patients were administered 0. Patient 1 exhibited flaccid paralysis of all 4 extremities and impaired speech and swallowing. However, she did not continue to receive the Enercel acupoint injections, and she subsequently demonstrated a slow, progressive loss of neurological function during the ensuing 3 months, as shown on follow-up examinations.
Patient 2 had significantly impaired speech and mild motor loss in the upper extremities and the left leg. After 4 weeks of treatment, his voice had significantly improved to the point where his speech was understandable and his motor functions had returned to normal. He continued receiving Enercel acupoint injections during the 3-month follow-up period and his clinical improvements were maintained. Thus, these 2 patients with ALS showed clinical improvements after 4 weeks of Enercel acupoint injection therapy.
Follow-up data suggested that ongoing therapy may be necessary in order to maintain these positive effects. The authors concluded that the findings of this preliminary study merits further study and confirmation. In a Cochrane review, Paley et al evaluated effectiveness of acupuncture for relief of cancer-related pain in adults. Randomized controlled trials evaluating any type of invasive acupuncture for pain directly related to cancer in adults of 18 years or over were selected for analysis.
It was planned to pool data to provide an overall measure of effect and to calculate the number needed to treat to benefit, but this was not possible due to heterogeneity. Two review authors independently extracted data adding it to data extraction sheets. Quality scores were given to studies. Data sheets were compared and discussed with a third review author who acted as arbiter. A total of 3 RCTs participants were included.
One high-quality study investigated the effect of auricular acupuncture compared with auricular acupuncture at "placebo" points and with non-invasive vaccaria ear seeds attached at "placebo" points. Participants in 2 acupuncture groups were blinded but blinding wasn't possible in the ear seeds group because seeds were attached using tape.
This may have biased results in favor of acupuncture groups. Participants in the real acupuncture group had lower pain scores at 2-month follow-up than either the placebo or ear seeds group. There was high-risk of bias in 2 studies because of low methodological quality. One 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, point-injection and medication in participants with stomach cancer. Long-term pain relief was reported for both acupuncture and point-injection compared with medication during the last 10 days of treatment. Although both studies have positive results in favor of acupuncture, they should be viewed with caution due to methodological limitations, small sample sizes, poor reporting and inadequate analysis. 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 examined the possibility of Carthami-Semen CS, Safflower seed acupuncture point injection as a new promising treatment for chronic daily headache CDH. A total of 40 subjects with CDH were recruited and randomized to a CS acupuncture point injection group or a normal saline NS acupuncture point injection group. Secondary outcome measures were the changes in the number of headache-free days and health status as assessed with the Short Form 36 Health Survey SF HIT scores decreased by Headache-free days increased by There were significant increases in SF scores compared with baseline in both groups, but the mean improvement was greater in the CS acupuncture point injection group.
No serious adverse events were reported. The authors stated that these findings suggested that the CS acupuncture point injection could be a new safe and promising treatment for CDH. They stated that a larger and long-term follow-up trial is needed to determine more definitely the efficacy of CS acupuncture point injection and to elucidate how long the effect lasts. Zhang et al examined the effects of acupoint injection on cervical spondylosis.
The selected literatures were summarized and classified from 3 aspects of acupoints selection, medication selection and manipulations. The medications contain simple Chinese herbs e. Disposable syringes were used for injection equipment. The authors stated that while acupoint injection in treating cervical spondylosis is effective, however, mechanism studies are still deficient since most of the researches focused on clinical observation.
They concluded that manipulation of acupoint injection is not standardized; laws of clinical effect are unclear. Thus, they stated that "the above mentioned defects are still remained for further improvement". Bae et al conducted a meta-analysis of an array of appropriate studies to evaluate the pre-operative anxiolytic efficacy of acupuncture therapy.
In the meta-analysis, data were included from RCT studies in which groups receiving pre-operative acupuncture treatment were compared with control groups receiving a placebo for anxiety. The authors concluded that acupuncture therapy aiming at reducing pre-operative anxiety has a statistically significant effect relative to placebo or non-treatment conditions.
They stated that well-designed and rigorous studies that employ large sample sizes are needed to corroborate this finding. Ryu et al stated that to explore the pain mechanism, numerous animal models have been developed to simulate specific human pain conditions, including cancer-induced bone pain CIBP.
In this study, these researchers analyzed the current research methodology of acupuncture for the treatment of CIBP. This open consensus standard was developed, with no compensation to the authors, for the greater benefit of the legal system of the United States. By clearly and precisely referring to primary legal materials, we are able to communicate our legal reasoning to others, including pleading a case in the courts, advocating changes in legal policy in our legislatures or law reviews, or simply communicating the law to our fellow citizens so that we may be better informed.
We do not begrudge the Harvard Law Review Association one penny of the revenue from the sale of their spiral-bound book dressed in blue. However, we must not confuse the book with the system. There can be no proprietary claim over knowledge and facts, and there is no intellectual property right in the system and method of our legal machinery.
The infrastructure of our legal system is a public utility, and belongs to all of us. This is code about law. IBM made a fortune selling Genuine IBM personal computers, but this did not prevent others from making clones that were able to exercise the instructions in the underlying chipset.
When technology changed the nature of the computer industry, IBM did not spend its days trying to defend an outdated mode of operation and instead moved up the food chain. The company has grown and prospered because of the computing revolution and the Internet instead of trying to preserve an outdated position of economic power that could not last.
Likewise, I wish the Harvard Law Review Association and their three companion law reviews the best in continuing to sell their Genuine Blue spiral-bound book and any associated on-line services. However, that cannot mean prohibiting an open source developer from using common abbreviations, and it certainly does not imply any ownership or control over how, in our democracy, we communicate the law with our fellow citizens.
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