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Our first two papers and their commentaries address areas of acupuncture practice that are quite contentious in the scientific community—stroke and myofascial trigger point pain.
Could acupuncture make a real difference to patients, or would resources be better used on other treatments?
Firstly, in acute stroke, Inoue et al (see page 155) report observations that electroacupuncture can sometimes lead to immediate improvement in the clinical status of patients, and then test for possible mechanisms using MRI (figure 1). The peer reviewers questioned these reports, and the authors vigorously defended their statement with references (in Chinese). We asked Zhang and colleagues, experts on acupuncture for stroke in China, to comment (see page 146): they say that sudden improvement in acute stroke with electroacupuncture has been reported, though rather rarely, and that resources would be better used in exploring acupuncture’s place in preventing long term sequelae.
Secondly, we address that ‘Cinderella’ of conventional musculoskeletal medicine, myofascial trigger point pain. Though the concept seems valuable clinically, the diagnosis is still fraught with inconsistencies and problems of definition, and evidence is still lacking on whether acupuncture and other physical treatments have specific effects or not. But now Ge et al (see page 150) have taken the understanding forward by defining some specific electrical properties of myofascial trigger points that were previously unknown—though Cummings’ commentary (see page 148) explaining more about the background to the study urges us to be cautious in interpreting the work.
A neat clinical trial from China by Tong et al (see page 169) shows that acupuncture joins acyclovir and corticosteroids in having little specific value in the acute treatment of facial palsy—which fortunately is often a self-limiting condition. It was interesting that recruitment to the study was difficult—in China! Optimists will point to the trend towards acupuncture, and argue for another, larger study though it may be more profitable to test acupuncture for residual defects of those patients who do not fully recover spontaneously.
This journal’s policy is to encourage reporting of feasibility studies because the lessons learned are important for others planning studies. Hughes and colleagues (see page 163) report such a study on acupuncture and reflexology for insomnia which has helped them to plan a full scale randomised controlled trial.
The group from Meiji University in Japan have reported several studies of low back pain in which they found significant effects of acupuncture in rather small samples. The latest careful report by Inoue et al (see page 174) does not give any clues as to what it is about their acupuncture needling that is so effective, but the results will contribute to the overall search for evidence on acupuncture and so are welcome.
Acupuncture is thriving in Brazil. Saad et al (see page 178) describe how acupuncture is already being offered as part of the pain service for inpatients, and describe how this differs from an outpatient service. Our Education and practice section continues with Straiton’s essay which combines knowledge about acupuncture mechanisms and theories of cortical development in the child to speculate on the important area of acupuncture responders and non-responders: it may all be due to the mother’s nurturing skills in the first 18 months of life. Cakmak (page 183) provides another thought-provoking review, this time of the possible role and mechanisms of electroacupuncture in an increasing the chance of cell survival in another increasingly recognised pathological event—heat-shock proteins and apoptosis.
The issue continues with letters on auricular electrostimulation, Sydenham’s chorea and peripheral neuropathy, then summarises recent research including some important studies on the psychological aspects of acupuncture treatment, and ends with the notices of meetings so that readers can plan next year’s learning on this fascinating topic of acupuncture.
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.
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