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This latest issue of Acupuncture in Medicine opens with a systematic review by Kim et al., examining the impact of acupuncture on patients recovering from surgical resection of colorectal cancer, which adds to an ever-increasing literature on peri-operative acupuncture. The positive effects of acupuncture on post-operative nausea and vomiting are already well established,1 and we have recently published a number of clinical trials examining its effects on other aspects of surgical recovery, including pain2 ,3 and gastric motility,4 and considered whether it might be used more widely in clinical practice.5 Kim et al., found that acupuncture treatment positively impacted (objective) functional indices including the time to first flatus (reduced by 7 h) and time to first defecation (reduced by 18 h) relative to sham acupuncture. However, in view of substantial heterogeneity and low to moderate quality of the evidence, they also highlighted a need for further high quality trials to more precisely define the role of acupuncture in this patient group, and stressed the need to evaluate its impact on quality of life and other patient-orientated outcome measures.
My editor's choice article for this issue is the recent clinical trial of acupuncture for fibromyalgia by Vas et al., which was widely publicised at the time of online first publication and currently holds the highest Altmetric score of all articles published in the journal to date. In this trial, 164 fibromyalgia sufferers (diagnosed using the criteria of the American College of Rheumatology) were randomised to receive nine weekly sessions of individually tailored acupuncture or a non-penetrating sham acupuncture intervention as an adjunct to standard analgesic and anti-depressant medication. Verum acupuncture was associated with a greater reduction in perceived pain intensity, number of tender points and levels of fatigue, anxiety and depression, as well as improvements in pressure pain threshold, functional capacity and quality of life, measured using a (validated) “fibromyalgia impact questionnaire (FIQ)”, at 10 weeks. Encouragingly, these effects were sustained at 6-month and 12-month follow-up.
This definitive, high quality clinical trial is followed by a number of more exploratory quantitative and qualitative studies including a pilot randomised controlled trial of manual acupuncture±electroacupuncture as an adjunct to standard care for symptomatic lumbar spinal stenosis by Kim et al. While the trial was underpowered to show any significant effect on the nominated primary outcome measure (Owestry disability index), the authors showed that the methodology was feasible and we look forward to their full-scale trial in due course. Cruz et al., investigate the impact of an acupuncture-related technique (ultrasound-guided percutaneous needle electrolysis) on heart rate variability and demonstrate evidence of a strong parasympathetic effect. Consequently, they suggest that practitioners should monitor their patients carefully for clinically significant vasovagal responses during this procedure. Next, Ellen Crumley presents the findings of her qualitative research into the practice styles of physician acupuncturists from around the world. I am sure that readers will be fascinated to learn how their contemporaries manage to incorporate medical acupuncture into their clinical practice and explore potential barriers that physicians might encounter.
Finally, there follow three basic science papers in animal models of osteoarthritis, myofascial pain and insulin resistance, respectively. The latter is nicely complemented by a comprehensive review article in the Education and Practice section by Crumley and Peplow, which provides a contemporary update on the literature on acupuncture treatment of insulin resistance with respect to both clinical and animal studies. Although this field is still evolving, the prospect of using acupuncture to treat insulin resistant states (including polycystic ovarian syndrome, obesity and diabetes mellitus) is extremely exciting, and we eagerly await further contributions from various research groups working in this area.
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