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This issue of Acupuncture in Medicine includes a relatively rare look at the technique of laser acupuncture (LA) courtesy of two original reports. Although the primary focus of the journal is on needle acupuncture, i.e. manual and electroacupuncture (EA), current editorial policy allows consideration of reports of related, non-penetrating techniques, such as LA, moxibustion and transcutaneous electrical acupuncture point stimulation (TEAS), that are of “significant clinical or academic interest” (www.aim.bmj.com/site/about/guidelines.xhtml). The comprehensive and detailed open access systematic review by Glazov et al. certainly satisfies these criteria, presenting a thorough evaluation of the efficacy of LA and non-acupuncture type low level laser therapy (LLLT) for lower back pain, one of the most prevalent symptoms encountered in clinical practice and a common indication for acupuncture and related techniques. Their meta-analysis identified three key factors associated with therapeutic benefit, specifically higher dose laser interventions (>3J/point), shorter durations of low back pain (<30 months) and, arguably most interesting for our readers, a non-acupuncture approach to LLLT. Regarding the latter observation, the authors noted that LA trials overall have tended to use low doses of laser, which was indeed the case in their most recent trial, which failed to demonstrate significant benefit of verum LA over sham.1 The second laser paper of this issue is a prospective cohort study by Hsieh et al. showing positive effects of LA in gastrointestinal cancer patients with oxaliplatin-induced peripheral neuropathy.
Four of the remaining articles in this issue follow a neuropsychiatric theme. Among them, the editor's choice article for this issue is another systematic review, by Deng and Wang, that evaluated the effectiveness of EA for treatment of the amnestic subtype of mild cognitive impairment (AMCI), which is a precursor to dementia. Although the quality of the available evidence is relatively poor, there appears to be a beneficial effect of EA on clinical outcomes when used as an alternative or adjunctive treatment to conventional therapy (nimodipine), which warrants further investigation through further, higher quality randomised controlled trials (RCTs). Secondly, Liu et al. present their pilot RCT of acupuncture for patients experiencing a first episode of acute ischaemic stroke and demonstrate the feasibility of their methodology, treatment protocol and primary outcome measure, namely change in the National Institutes of Health stroke scale (NIHSS) score over a four-week period. A recent systematic review of 17 other trials highlighted a significant risk of bias and a need to explore characteristics of the treatment including duration, acupuncture point selection and neurophysiological dose.2 A follow-up RCT recruiting the full sample size calculated by Liu et al. would be a welcome addition to the literature and might help clarify the role of acupuncture as an adjunct to stroke rehabilitation. Thirdly, Guo et al. present a non-randomised trial of EA with or without cognitive behavioural therapy for subsyndromal depression, a precursor to clinical depression, in undergraduate students, thereby extending the existing literature on EA for stress3 and pre-examination anxiety4 in this particular population. Finally, Yeo et al. provide novel insights into potential gender differences in treatment response to acupuncture within the central nervous system using functional magnetic resonance imaging, thus expanding the existing evidence base in support of differential effects of needling in men versus women.5
Elsewhere in this issue, you will find original articles detailing a novel acupuncture-related technique combining needling with vibrational stimulation (called vibro-acupuncture) and the effects of EA on skeletal muscle mass and glucose transporter 4 levels in rats undergoing resistance training. These are followed by clinical observations of the effects of EA on levels of oestradiol, luteinising hormone and follicle-stimulating hormone in subfertile women with diminished ovarian reserve, and the effects of manual acupuncture on trigger finger.