We appreciate the comment from Dr Lin, Dr Chen, and Dr Xu on our study 'A randomized controlled study on acupuncture for peri-operative pain after open radical prostatectomy' [1]. Their insights are valuable, and we address their points as follows: Lin et al. suggest incorporating qualitative research methods to capture the complexity of postoperative pain. While qualitative findings can enrich understanding, our study focused on quantitative measures to ensure objectivity and reproducibility. Pain perception is subjective, and standardised scales such as the Numeric Rating Scale (NRS-11) are crucial for clinical comparability. However, we used the EuroQol-five Dimensions-five Levels (EQ-5D-5L) score as a qualitative parameter, which demonstrated good general health status at discharge, with no significant differences between groups. Due to the specific exclusion criteria, concerns were raised regarding the generalisability of our results. However, our criteria aimed to maintain a controlled environment, minimise confounding variables and ensure participant safety. Future studies could consider broader inclusion criteria while using robust methods to control for variability. Our choice of acupuncture points was based on traditional measures and scientific rationale [2, 3]. We selected P-6 (Neiguan), Ear Shenmen, and SP-6 (Sanyinjiao) based on their documented efficacy in treating pain. Although the neurophysiological mechanisms need to be further explored, the existing literature supports the efficacy of these points. Our study serves as a base for future research in which additional or alternative points could be investigated, possibly incorporating advanced imaging and biomarker analysis to elucidate the underlying mechanisms. The commentary notes that although acupuncture reduced the perception of pain, its impact on other recovery parameters, including medication consumption and timing of defecation was less pronounced. Our results primarily emphasise pain reduction, a key determinant of overall recovery. Despite a solid postoperative analgesic regimen, no differences in cumulative drug doses were observed among the groups. In our study, superficial press-tack needles were used for blinding purposes. The stimulus of the press-tack needles is relatively weak; thus, classical needle acupuncture may have a stronger effect on pain reduction and an additional impact on secondary endpoints. However, the effortless application of the press tacks, combined with a relatively simple acupuncture approach, with only three points far from the surgical site, can potentially train auxiliary personnel, facilitating integration into a multimodal pain management strategy in a postoperative setting [4]. Moreover, the patients experienced a generally low level of pain, which might have contributed to a comparable quality of life and recovery outcomes, thereby minimising the observable differences between the groups. We agree with Lin et al. that our study opens an exciting avenue for non-pharmacological pain management in urology. Our study demonstrated that acupuncture can significantly reduce postoperative pain after 'open radical prostatectomy'. We encourage future studies to expand patient diversity, include qualitative results, deepen the neurophysiological basis of acupuncture, and focus on the implementation of the concept in routine care, taking into account safety, patient preference, and cost-effectiveness. This work has not been presented anywhere else. The authors have no ethical conflicts to disclose. All authors have no conflicts of interest to declare. None. All authors consent to the publication of the article.
Objectives Chemotherapy-induced peripheral neuropathy (CIPN) can produce severe neurological deficits and neuropathic pain and is a potential reason for terminating or suspending chemotherapy treatments. Specific and effective curative treatments are lacking. Methods A pilot study was conducted to evaluate the therapeutic effect of acupuncture on CIPN as measured by changes in nerve conduction studies (NCS) in six patients treated with acupuncture for 10 weeks in addition to best medical care and five control patients who received the best medical care but no specific treatment for CIPN. Results In five of the six patients treated with acupuncture, NCS improved after treatment. In the control group, three of five patients did not show any difference in NCS, one patient improved and one showed impaired NCS. Conclusion The data suggest that acupuncture has a positive effect on CIPN. The encouraging results of this pilot study justify a randomised controlled trial of acupuncture in CIPN on the basis of NCS.
BACKGROUND Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus and can lead to serious complications. Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness. AIM To investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN. METHODS The acupuncture in DPN (ACUDPN) study was a two-armed, randomized, controlled, parallel group, open, multicenter clinical trial. Patients were randomized in a 1:1 ratio into two groups: The acupuncture group received 12 acupuncture treatments over 8 wk, and the control group was on a waiting list during the first 16 wk, before it received the same treatment as the other group. Both groups received routine care. Outcome parameters were evaluated after 8, 16 and 24 wk and included neurological scores, such as an 11-point numeric rating scale (NRS) 11 for hypesthesia, neuropathic pain symptom inventory (NPSI), neuropathy deficit score (NDS), neuropathy symptom score (NSS); nerve conduction studies (NCS) were assessed with a handheld point-of-care device. RESULTS Sixty-two participants were included. The NRS for numbness showed a difference of 2.3 (P < 0.001) in favor of the acupuncture group, the effect persisted until week 16 with a difference of 2.2 (P < 0.001) between groups and 1.8 points at week 24 compared to baseline. The NPSI was improved in the acupuncture group by 12.6 points (P < 0.001) at week 8, the NSS score at week 8 with a difference of 1.3 (P < 0.001); the NDS and the TNSc score improved for the acupuncture group in week 8, with a difference of 2.0 points (P < 0.001) compared to the control group. Effects were persistent in week 16 with a difference of 1.8 points (P < 0.05). The NCS showed no meaningful changes. In both groups only minor side effects were reported. CONCLUSION Study results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reduction in neurological deficits. No serious adverse events were recorded and the adherence to treatment was high. Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirm the results.
This study employed a systematic review of randomized clinical trials to evaluate the efficacy and adverse effects of Chinese herbal medicine (CHM) for menopausal symptoms. Five electronic databases, including 2 English databases (MEDLINE and Cochrane Library) and 3 Chinese databases (VIP Database for Chinese Technical Periodicals, Chinese National Knowledge Infrastructure, and Chinese BioMedical Literature Database) were searched. Thirteen high-quality, randomized, clinical trials that scored 3 to 5 using the Jadad scale were included. Two thousand two hundred ninety-one participants were involved: 1294 received CHM therapies and 997 were in the control groups. Outcomes for menopausal symptoms were measured by quantitative questionnaires or participants' symptom diaries. According to the present evidence, CHM with an adequate Chinese diagnosis for menopausal symptoms is effective and has better results than that without adequate Chinese diagnosis. The evidence also shows that CHM is safe but has some slight adverse effects.
Acupuncture is commonly used in Traditional Chinese Medicine for treatment of diabetic peripheral neuropathy (DPN), but data from randomized controlled trials are rare.This randomized, placebo-controlled, partially double-blinded clinical trial randomly assigned adults with confirmed type 2 diabetes-induced DPN to receive 10 sessions of needle acupuncture, laser acupuncture, or placebo laser acupuncture for 10 consecutive weeks. Treatment was provided at bilateral acupoints Ex-LE-10 (Bafeng), Ex-LE-12 (Qiduan), and ST-34 (Lianqiu). Neurological assessments, including nerve conduction studies (NCS) of sural and tibial nerves, were performed at baseline and weeks 6 and 15. Primary outcome was delta of sural sensory nerve action potential (SNAP). Secondary outcomes included further NCS values, clinical scores, and patient-reported outcome measures (PROMs).Of 180 participants, 172 completed the study. Sural SNAP and sural and tibial nerve conduction velocities improved significantly after 10 treatments when comparing needle acupuncture to placebo. Needle acupuncture showed earlier onset of action than laser acupuncture. PROMs showed larger improvements following needle and laser acupuncture than placebo, reaching significant differences for hyperesthesia and cramps following needle acupuncture and for heat sensation following laser acupuncture.Classical needle acupuncture had significant effects on DPN. Improvement in NCS values presumably indicates structural neuroregeneration following acupuncture.背景: 针灸是中医常用的治疗糖尿病周围神经病变(DPN)的方法; 但来自随机对照试验的数据很少 方法: 这项随机、安慰剂对照、部分双盲的临床试验将确诊为2型糖尿病所致DPN的成人患者随机分为针刺组、激光针刺组或安慰剂激光针刺组; 连续10周。在双侧穴位Ex-LE-10(八风)、EX-LE-12(气端)和ST-34(梁丘)进行治疗。在基线、第6周和第15周进行神经学评估; 包括腓肠神经和胫神经的神经传导研究(NCS)。主要结果是腓肠感觉神经动作电位(SNAP)的增量。次要结果包括进一步的NCS值、临床评分和患者报告的结果测量(PROMs)。 结果: 在180名参与者中; 172人完成了研究。与安慰剂相比; 针灸治疗10次后; 腓肠神经SNAP、腓肠神经和胫神经传导速度均有明显改善。针刺起效早于激光针刺。与安慰剂相比; 针刺和激光针刺对PROMS有更大的改善; 针灸后的感觉过敏和痉挛具有显著差异; 激光针灸后的热感方面具有显著差异。 结论: 经典针刺治疗DPN疗效显著。NCS值的改善可能表明针灸后存在结构性神经再生。.
The meridian system is a systematic order of empirical knowledge functioning as a rational ground for a balanced treatment by combining meridians. In TCM theory, a continuous circulation of Qi through 12 meridians is postulated, described as the Chinese clock (CC). On this basis, combinations of meridians and acupoints had been described in historical writings. The most common is the interior/exterior system beside the neighbouring system, the opposite clock system, and three systems, developed out of the theory of the six stages. All of these represent symmetrical combinations, which were defined by the steps in the CC. We calculated the possible combinations that fit into the systematics of the historical descriptions, leading to 19 systems. Merging the data of the 19 systems, possible steps in the CC clock for balancing a meridian are 1, 2, 3, and 6. Step 4 is not possible. Step 5 is a combinatory possibility but has no widespread tradition except for activating the yin extraordinary vessels. These possibilities can be plotted on the CC as a powerful tool for daily practice. Only two meridians might be excluded as potentially balancing meridians, so it seems almost impossible to define noneffective acupuncture points as controls in clinical trials.
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