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Should we elicit de qi with our needles? De qi is satisfying because it seems to indicate that the nerve has been stimulated successfully. But if we should, then every needle, every patient, every condition? It is frustrating that this has not yet been resolved by our researchers (and I hold my own head in shame here too). We publish a paper by Peter White and colleagues (see page 120) which throws some light on the question—though the acupuncture was not effective, so we cannot say whether any pain relief was associated with de qi or not, or whether individual patients who did experience de qi might have experienced more pain relief even if there was no group difference. So a detailed commentary by Johnson and Benham (see page 111) is welcome for considering this paper in detail and for going well beyond it to summarise the current state of the literature and some of their own evidence. We join them in their hope that this result will ‘galvanise neurophysiological investigators to explore the phenomenon further’.
It is reassuring when objective physiological measures show changes after acupuncture: polysomnography may not be widely available, but those who have access to the equipment might be stimulated by the work of Freire and colleagues (see page 115) in patients with sleep apnoea, indicating that this might be a promising area for more studies.
An ah shi point probably means different things to different people, but Son and colleagues (see page 126) interpreted the lesions of facial acne as ah shi points and tested the effect of needling them in a controlled trial, again with objective measures such as counts and photography. The results were disappointing.
Two useful observational studies follow: in the first, van den Berg and colleagues (see page 130) carefully assessed the quality of life in patients whose musculoskeletal problems were treated with acupuncture. The study is limited by small sample size and mixed conditions, but worthy of publication because of the attention to detail in the analysis and the presentation of results, where changes in the eight dimensions are shown in a commendably clear graphic (figure 1). The second observational study, by Tufan and colleagues (see page 136), seems to break new ground: acupuncture for palliation of symptoms in patients with chronic hepatitis, where the outcomes of good acceptability and significant benefit clearly justify larger studies.
Our laboratory study by Nakajiama and colleagues (see page 140) proposes and tests an interesting question: whether acupuncture needles could provide a means of getting electrical stimulation close to the relevant sites for treatment of non-united fractures? Our reviewers strongly emphasised the need to ensure total sterility before trying this technique clinically.
The last two papers concern research methodology: Takakura and colleagues (see page 144) have emphasised a new concept in another paper that tests their new placebo needle, designed to blind both the practitioner and the patient. They investigate the confidence of the acupuncturists in making their judgements as to whether the needle they just used was real or placebo. High confidence would presumably increase the risk of unblinding, by casual body language, for example. But the situation is not simple, because seven out of 10 needles judged with total confidence were actually judged incorrectly! This adds yet another twist to the difficulties in interpreting sham-controlled trials. The work on database searches by Lui and colleagues (see page 149) might appear a little dry but actually carries an important message: literature reviews only give half the picture if they do not search the Eastern databases as well as the Western ones.
In a case report, Rosted (see page 154) reminds us that when we see a patient with headache, we should examine the jaws!
Finally, it gives me great pleasure to report that Acupuncture in Medicine has now been accepted for indexing in Science Citation Index (SCI) Expanded and Current Contents/Clinical Medicine. All papers from 2008 onwards will be included and we shall have our first impact factor published in June 2011. We can now hope to attract an even wider range of authors and papers, since many universities insist that their staff only publish in SCI journals. Tell your friends!
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