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In this issue
  1. Adrian White, editor

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This journal does not shy away from reporting adverse events of acupuncture, as long as they contain learning points for safer practice. Some journals and some authors seem to use them negatively, to attack acupuncture. For instance, the editor noticed several Korean reports that failed to explore the full details of the acupuncture practice that led to the problem, so emphasising the hazard but not the learning. This issue's Image of Acupuncture provides an outstanding example of bad practice, from Korea: deep needling directly into the abdomen, compounded by failure to deal correctly with the stuck needle, which then broke. Park's editorial on this case adds a fascinating piece of history, and calls for productive dialogue between conventional and complementary medical professions in Korea—ultimately for patient benefit.

This issue's research summaries contain several more examples of adverse events, most of them (cardiac tamponade, inoculation tuberculosis) the result of bad practice rather than bad luck. But the journal also hopes to fulfil another necessary role—highlighting one case where the blame was attributed to acupuncture but the evidence was clearly inadequate.

Sticking for the moment with what practitioners do with the needle, we do not yet have a clear modern interpretation of the traditional concepts of manipulation (such as ‘draining’ or ‘reinforcing’). Different needle movements could stimulate various receptors—stretch and pressure receptors for example, at different tissue levels, resulting in differential sensory nerve stimulation. We need to know more, and as a valuable first step, Seo and colleagues (again from Korea) investigated manipulation as performed by eight experienced practitioners. Each individual was consistent, but there were marked differences between the practitioners, represented in figure 1.

Figure 1

Amplitude and frequency patterns of needle manipulation by three practitioners (Generalised additive mixed modelling). Source Seo Y et al. Acupunct Med doi:10.1136/acupmed-2014-010585

Another mystery is the mechanism of acupuncture's effect in preventing migraine (apart from inactivating trigger points, which are rarely the primary cause). It seems to be a general effect of needling not related to specific points, and now Cayir and colleagues suggest it could involve changes in activity of the matrix metalloproteinases—MMPs. Your editor was ignorant of MMPs so invited Castro and Tanus-Santos to write an editorial, which explains everything. What with last issue's evidence on acupuncture's effect on nesfatin-1, it sometimes seems that every physiological mechanism can be influenced by acupuncture. Often these will be clinically irrelevant, but that does not apply to Seo's study since the patients clearly improved.

Our other papers show some interesting trends. In a pilot study, Smith and colleagues show no adverse events on lymphoedema following breast surgery—though, conservatively, they did not needle points in lymphoedema areas. Meng et al found a large trend towards reduction in osteoporosis after a prolonged course of electroacupuncture (EA) in patients with spinal cord injury. The acupuncture was given alongside the best available conventional therapy.

Interesting observations include that of Skorupska and colleagues who used a thermal camera to visualise vasodilatation associated with needling a trigger point: it spread in the pattern of the referred pain—but this is only one case. Set and colleagues suggest that, for women with both depression and obesity, continuous auricular acupuncture might benefit both—but separately.

Lack of response to treatment, provided you have the correct treatment, is a good reason to check the diagnosis: da Encarnação did just that—and had a surprise.

And finally, back to treatment technology. Martini used wart cryotherapy apparatus for auriculotherapy in a patient with a severe bleeding disorder. And Zhang et al showed that needles with plastic handles buckle less readily than those with copper handles. Buckling leads to breaking—so a plastic handle might at least have saved the patient with the deep needle in the abdomen from the need for surgery.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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