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This third issue of Acupuncture in Medicine for 2016 opens with two RCTs. The first, which is also this month's editor's choice, is a trial of contralateral MA for chronic shoulder pain. Compared to other regional musculoskeletal complaints, such as neck and back pain, the evidence base in this area remains inconclusive; the most recent Cochrane review identified “little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function” and highlighted the need for further well designed clinical trials.1 The new trial by Zhang et al is particularly interesting as the protocol deliberately excluded local needling and thereby effectively evaluated only segmental and general effects of acupuncture, such as modulation of descending pain inhibition/facilitation, endorphin release and deactivation of the limbic system. Compared to wait list controls, subjects receiving 4 weeks of contralateral acupuncture not only reported reduced VAS scores from 2 weeks onwards, but also demonstrated evidence of improved function and quality of life. Their findings are similar to those of Vas et al2 who found that needling at a single distant point (ST38) improved shoulder function and pain scores and reduced analgesic use when used as an adjunct to physiotherapy. Whether adding in local needling, which has been included in most other trials of acupuncture for shoulder pain, offers further benefit remains unknown, as no direct comparison of different needling styles has additionally been made. However, growing evidence suggests that needling at sites that are anatomically distant from the origin of pain can achieve clinically relevant analgesia.
The second clinical trial by Segura-Orti et al compared dry needling of myofascial trigger points in the upper trapezius with the strain-counterstrain technique in patients with neck pain and found no significant differences between the two treatment approaches. Both trials featured in this issue were prospectively registered in publically accessible registries, as required by the recent changes to our editorial policy,3 and were reported according to the internationally endorsed CONSORT (Consolidation Standards of Reporting Trials) guidelines. In my role as Editor-in-Chief of Acupuncture in Medicine, I am screening a greater number of submissions than ever before, and it is refreshing to observe a clear trend towards higher quality of reporting of both clinical trials and basic science studies. However, there is likely to be room yet for improvement, as highlighted by Ma et al in this issue. Following a review of the ‘Instructions to Authors’ of 63 Chinese journals of Traditional Chinese Medicine as well as a survey of their respective editors, it was apparent that the vast majority of journals do not promote these same high standards of reporting and research ethics. As the greatest number of submissions to Acupuncture in Medicine now comes from China, it is essential to stress the fact that guidelines such as CONSORT and its extension papers, including STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture), should be universal.
Elsewhere in this issue you will find a plethora of basic science reports providing some diverse and novel mechanistic insights into the role of acupuncture for a wide range of conditions. Highlights include rat studies examining the effect of needling at HT7 on cerebral glucose metabolism in Alzheimer's disease (the inspiration for our latest cover), the impact of EA at LR3 on cardiac remodelling in hypertension, and the role of the spinal dynorphin/κ-opioid system in labour pain and its modulation by EA. Much like the clinical trial of contralateral acupuncture opening this issue, these papers emphasise the powerful effects that needling at a distant site can have on pain and function.
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