World Journal of Acupuncture-Moxibustion最新文献

Objective

Magnetic resonance imaging (MRI) studies have demonstrated anatomical and functional alterations of brain regions in patients with migraine, and the efficacy of acupuncture for migraine could regulate these abnormal alterations. However, its pathogenesis remains ambiguous, and inconsistent results have been reported. The purpose of this study was to explore abnormal structural and functional alterations in patients with migraine using voxel-based morphometry (VBM) analysis and a seed-based functional connectivity (FC) approach and to provide a basis for future research.

Methods

The study recruited 34 patients with migraine and 38 healthy controls who underwent structural and resting-state functional magnetic resonance imaging (fMRI). VBM was evaluated across the whole brain, and group differences in the gray matter (GM) were compared. The significantly altered GM volumes considered as the seeding area were further calculated for the FC of the whole brain. The correlation between structural or functional changes of the brain and clinical features was also evaluated.

Results

Patients with migraine manifested higher GM volumes in the left occipital lobe than healthy controls. Seed-based analyses demonstrated reduced FC between the left occipital lobe and right inferior frontal gyrus, extending to the anterior cingulate cortex (ACC) and right insula. Decreased FC in the left ACC was positively correlated with visual analog scale (VAS) and self-rating anxiety scale (SAS).

Conclusions

This study indicated that patients with migraine exhibited abnormal changes in brain regions, which could facilitate a better understanding of how brain structure and function impact the symptoms of migraine and provide the basis for elucidating the potential mechanisms of acupuncture for migraine.

Trial registration

Chinese Clinical Trial Registry, Chi CTR2000033995. Registered on 20 June 2020.

By reviewing the historical background and the current state of dry needling (DN), including the "Anti-DN Independence" movement by the acupuncture profession in the west, this paper emphasizes that DN is acupuncture, or more precisely, a "de-meridian" style of acupuncture. Clinical applications of DN and its modern studies have seen a tremendous growth spurt during the past two decades, which suggests that the meridian theory of traditional Chinese medicine (TCM) may not be the exclusive theory to guide acupuncture. Even certain high-quality DN trials may serve as good examples for acupuncture research, such as refining the stimulation targets in acupoints, recognizing the reflex properties of acupoints known as acu-reflex points (ARPs), or establishing standardized indicators of stimulus amount while objectively assessing the needling efficacy. Like any other therapies, DN has its shares of drawbacks or limitations, which reminds that while innovating classical acupuncture, it is still necessary to inherit the valuable experience of classic acupuncture and the rational core of meridian theory. This is crucial for enhancing the efficacy of clinical acupuncture intervention including DN to broaden the treatment scope and indications of acupuncture.

Endogenous opioid peptides (EOP) are the neurochemical basis of the anesthetic and analgesic effects of acupuncture, and the quantity of acupuncture stimulus can be controlled accurately by using electroacupuncture (EA). The present study explores the dose-effect relationship between EA with different parameters and the regulation of EOP system. In this paper, the intervention effects of EA on EOP system were specially discussed in terms of the single factor and the different combinations of the frequency, waveform and current intensity. This study shows that EOP system presents a frequency-response specificity. The low frequency of EA promotes the release of enkephalin, β-endorphin and endomorphin, the high one activates the dynorphin system selectively, and the intermediate frequency works on promoting the release of enkephalin and β-endorphin, as well as dynorphin. Sparse-dense wave of EA may induce the release of enkephalin, β-endorphin, endomorphin and dynorphin, presenting a synergistic effect. However, the waveform of EA should be selected flexibly in clinical practice. Sometimes the better therapeutic effect can also be obtained with the continuous wave of EA. EOP system is involved in mediating appropriate intensity of EA, while the acupuncture effect generated by an extra strong EA stimulation refers to a kind of stress response of non-opioid mechanism. The different combinations of EA parameters result in various effects. The combination of EA parameters should be optimized in accordance with different diseases, which is valuable for guiding clinical practice and the development of EA therapy.

Objective

The body of research on acupuncture as a treatment strategy for fibromyalgia (FM) is steadily growing. This evidence map identifies, describes, and summarizes the current status of studies conducted to evaluate the efficacy of acupuncture for FM, identify research gaps, and provide information that could guide the design of future studies.

Methods

Seven electronic databases–Cochrane Library, PubMed, Embase, China Biomedical Literature Database, VIP, Wanfang Database, and Chinese National Knowledge Infrastructure–were searched for relevant articles on acupuncture for FM. The search period was from the dates of inception of the databases to December 19, 2022. Original clinical studies and systematic reviews on the use of acupuncture-related modalities for the treatment of FM were included. The basic information, quality assessments, and evidence maps of the included studies are presented as charts and bubble plots. The quality assessment tools used for evaluating the different types of studies included in the present study were Cochrane Collaboration's tool, Canadian Institute of Health Economics quality appraisal tool, and A MeaSurement Tool to Assess systematic Reviews 2.

Results

Fifty studies were included in this study. Of these, 39 (78.00%) were randomized controlled trials (RCTs), 6 (12.0%) were case series, and 5 (10.0%) were systematic reviews. The included studies focused on manual acupuncture and conventional treatment in the treatment and control groups, respectively. The outcomes analyzed in the RCTs included pain (94.9%), sleep quality (46.2%), depression (46.2%), physical function (46.2%), stiffness (35.9%), well-being (35.9%), work status (35.9%), anxiety (33.3%), fatigue (33.3%), quality of life (17.9%), and overall effective rate (10.3%). The methodological quality of most of the studies was low or critically low regardless of the study design. In most studies, the therapeutic effect of acupuncture was significantly superior to that of the comparator.

Conclusion

This evidence map suggests that acupuncture-related modalities may be promising options for FM management. However, various studies on this topic have a high risk of bias or are of low quality. Further evidence-based research should be conducted to rigorously examine the efficacy of acupuncture for FM and promote generalizability of the findings.

In recent years, the importance of real-world research based on real-world data has been widely recognized in many countries and regions around the world. Oriented by real-world data, real-world research is conducted to obtain real-world evidence, which becomes a hot spot in clinical study. In such circumstances, how to use the diagnosis and treatment data of clinical practice to evaluate the effect and safety of acupuncture becomes future direction of acupuncture research. This paper analyzed the current situation of the real-world research in the field of acupuncture and put forward the influencing factors and the countermeasures to provide the references for the real-world research of acupuncture.

Objective

To find the hotspots of acupuncture research in the last decade and predict future trends.

Methods

The Web of Science Core Collection was used to retrieve articles published on the topic of acupuncture from January 1, 2012, to August 31, 2022. CiteSpace 6.1.R3, VOSviewer 1.6.18, SCImago Graphics and other tools were used to visualize and analyze the number of publications, countries, authors, journals, institutions, keywords, and cited articles.

Result

A total of 10,942 articles published from January 2012 to August 2022 were analysed. A total of 97 countries and regions have conducted acupuncture research, with the highest number of research conducted in China. Furthermore, 8,056 institutions were involved in acupuncture research. In addition, 1,823 journals have published articles related to acupuncture research, with the highest number published by the journal Evid-Based Compl Alt (1,096 articles). The hotspots of acupuncture research are acupuncture analgesia (low back pain, knee osteoarthritis, headache, shoulder pain, neck pain, cancer pain, migraine), acupuncture anti-inflammatory (allergic rhinitis [AR], inflammatory pain), female-related diseases (polycystic ovary syndrome and breast cancer), cerebrovascular diseases (stroke and hemiplegia), rehabilitation treatment (postoperative nausea and vomiting, postoperative pain, and trauma pain in veterans), resting functional magnetic resonance imaging (fMRI), nervous system diseases (nerve regeneration and neuroprotection), depression, insomnia, Alzheimer's disease (AD), evidence-based researches, etc.

Conclusion

From the analysis of acupuncture research hotspots, acupuncture research was mainly focused on acupuncture mechanisms, clinical efficacy, and acupuncture standards. The emerging trends for the future include the standardization of acupuncture research and the treatment of chronic diseases with a clinical basis and more efficacy through the use of acupuncture in internal medicine.