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An obituary in this issue recalls the contribution to acupuncture made by Bruce Pomeranz, one of the 1970s’ pioneers who linked the newly discovered opioid peptides (then called ‘endorphins’) to acupuncture for pain relief. This marked the start of the modern scientific approach to acupuncture, and plausibility. By coincidence, it just so happens that only one of our six original papers is on the subject of pain relief.
It may be that we are witnessing a similar breakthrough, in the linking of obesity and plasma nesfatin-1 that is described in the study by Guo and colleagues. Evidence is growing on the effectiveness of acupuncture for obesity, both compared with sham acupuncture, and compared with no acupuncture (diet alone) as in this study. There is increasing interest in the hormone nesfatin-1 as a possible appetite suppressant. The study showed that obesity was associated with lower nesfatin-1 levels (see figure 1), and that these levels were raised by acupuncture. Like many other trials in this area, the follow-up period is too short—45 days in this case—for the evidence to be clinically relevant to a chronic condition. But the results were interesting, with weight loss of 7% in the acupuncture group compared with 4.3% in the controls.
The second RCT is on acupuncture for depression, and Wang and colleagues expand the evidence for the effectiveness of acupuncture by testing it on inpatients, and in combination with standard antidepressant drug treatment. The trial may have somewhat limited application in routine care because it used 30 treatments with a special technique which involved turning patients halfway through their treatment. But as Macpherson points out in his editorial, the addition of this new evidence to his own recent study in chronic depression in primary care might shift the balance in favour of acupuncture when the Cochrane review is updated.
Another new slant on acupuncture is the setting described by Stuyt et al, where drug users have a kind of ‘global detox’ in a no-smoking environment. The authors offered auricular acupuncture, with interesting results in different groups of patient. Acupuncture is used for smoking cessation in many different settings, which hinders the pooling of evidence: one possible future direction for research is discussed in a linked editorial.
Birkeflet and colleagues tested the reliability of TCM diagnosis in women with infertility, the novelty here being that the practitioners were provided with standardised information—so that only the interpretation was tested. Sadly, TCM clinical diagnosis seems unreliable. I say ‘sadly’, because anyone with experience of TCM diagnosis knows it should be able to provide more subtle shades of diagnosis than purely Western methods. But of course, the use of diagnosis to select points for some supposed ‘energetic’ function is still highly implausible.
Now back to the main subject, pain. One priority for this journal is to publish rigorous pilot studies. These are not designed to provide evidence of effectiveness, of course, but to provide information on how to design a robust and successful main study. For acupuncture for diabetic neuropathic pain, there is already a considerable amount of evidence—but it is insufficiently rigorous to be conclusive. Jeon and colleagues have described their useful experience, and we wish them well with the main study.
Chia describes a learning experience: his patient improved only when the needle was placed deeper and stimulated electrically. Since she had not responded to the first treatment, her subsequent response seems unlikely to have been simply expectation but, more probably, neuromodulation—a term which indicates where Pomeranz’ ‘endorphins’ have led us, over the years.
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