Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials

Moffet, Howard H.

doi:10.1016/j.jclinepi.2008.02.013

Cited by 20 publications

(15 citation statements)

References 82 publications

(104 reference statements)

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“…‘acu’ = needle; ‘puncture’ = penetration), and the vast majority of the ‘acupuncture’ trials are not claiming to move qi along meridians or channels. Furthermore, the vast majority of the so-called ‘acupuncture’ RCTs have used Western medical diagnoses (not traditional Chinese or Oriental medicine78,79 diagnoses such as bi syndrome, qi , blood stagnation, and kidney yang deficiency143,148) such as chronic neck pain,23,24,29,35,61,63–65,80,111–114 plantar fasciitis,48,49,54,56,126,127 knee osteoarthritis,50–52,81–90, and carpal tunnel syndrome 36,37,40,41,44,45,47. These same ‘acupuncture’ trials have investigated the efficacy of inserting thin filiform needles (without medicine) into ‘Ah-Shi points’ (Chinese for ‘auwh that’s where it hurts’ or ‘that’s it’; synonymous with trigger points57,58,154) and/or non-trigger point locations.…”

Section: Physical Therapists Should Not Ignore the Findings Of Westermentioning

confidence: 99%

Dry needling: a literature review with implications for clinical practice guidelines

Dunning¹,

Butts

Mourad³

et al. 2014

Physical Therapy Reviews

254

205

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Background:Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs).Objectives:To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions.Major findings:According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners.Conclusions:Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, ...

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Section: Physical Therapists Should Not Ignore the Findings Of Westermentioning

confidence: 99%

Dry needling: a literature review with implications for clinical practice guidelines

Dunning¹,

Butts

Mourad³

et al. 2014

Physical Therapy Reviews

254

205

View full text Add to dashboard Cite

show abstract

“…Melzack, Stillwell and Fox 61 originally suggested that acupuncture points correspond with trigger points (reactive points that when pressed trigger local and referred pain), claiming a 71% correspondence between the two, although more recent research suggests that correspondence is closer to 18-19% rather than the 71% originally suggested. 62 In a systematic review, Moffet 63 suggests that acupuncture can affect outcome but outcome is not necessarily point dependent or dependent on any particular stimulation technique. However, acupuncture points and meridian theory within TCM are based on a method of practice, effective in disease treatment for centuries.…”

Section: Do Acupuncture Points Have Additional Properties Compared Tomentioning

confidence: 99%

The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms

Brown¹,

Holmes²,

Jones³

2009

Physical Therapy Reviews

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Aims: This paper discusses the evidence for the analgesic efficacy of Acu-TENS, the application of transcutaneous electrical nerve stimulation to acupuncture points, and its possible mechanisms of action. Method: A brief review of recent clinical studies of Acu-TENS in isolation, in combination with other treatment and in comparison with electro-acupuncture, and laboratory studies using pain models is followed by a wider discussion of the evidence. This discussion is structured around questions relating to whether the site of TENS application influences analgesic response; the influence of parameters of Acu-TENS; whether Acu-TENS and acupuncture induce analgesia via similar mechanisms; and possible placebo effects. Results: While Acu-TENS does appear to induce analgesia, evidence for the use of particular TENS parameters and specific stimulation points is limited. The analgesic effects of Acu-TENS appear to be modulated at multiple levels within the central nervous system including recognised physiological, neuropharmacological and placebo mechanisms. Conclusion: Much future research is needed but it should be coordinated through collaboration between researchers and practitioners if the essential evidence base is to be systematically built. In addition to establishing the most effective Acu-TENS parameters and points of application, influences including psychological and cultural factors and beliefs, which may be pivotal to response, merit investigation.

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“…However, the efficacy assessment of this traditional intervention is mainly based on empirical knowledge rather than scientific evidence. Some researchers even concluded that conclusive evidence is lacking to show that acupuncture was more effective than placebo, sham acupuncture or standard care [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

sEMG based quantitative assessment of acupuncture on Bell’s palsy: an experimental study

Han

Xiong

Zhao

et al. 2015

Sci. China Inf. Sci.

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Acupuncture is a traditional Chinese therapeutic method, recognized by western medicine as an important complementary therapy. However, the efficacy assessment of this traditional intervention has been mainly empirical rather than scientific. In this paper, we propose a surface electromyography (sEMG) based approach for quantitative assessment of acupuncture on Bell's palsy. The assessment is made by comparing the muscle activities of healthy with diseased ones. A feature-vector of four individual sEMG features is introduced for more comprehensive representation of muscle activity. A clustering technique is then proposed to calculate quantitative differences between the muscle activities of the healthy and diseased sides. A regressive model is also proposed to predict the recovery trend of a patient based on the quantitative assessments during his/her clinical acupuncture history. As reported in the paper, a total of 20 selected Bell's palsy patients have participated in the extensive experiments that were conducted to verify the performance of the proposed method.

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Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials

Cited by 20 publications

References 82 publications

Dry needling: a literature review with implications for clinical practice guidelines

Dry needling: a literature review with implications for clinical practice guidelines

The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms

sEMG based quantitative assessment of acupuncture on Bell’s palsy: an experimental study

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