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Welcome to the first issue of Acupuncture in Medicine of 2017, which begins with two interesting review articles. The first, which is also incidentally this month's editor's choice article, is a conventional systematic review and meta-analysis that comes courtesy of the integrative medical research group at Stanford University who, together with colleagues in China, set out to evaluate the potential role of acupuncture for the management of post-stroke hiccups. Although ultimately limited by the methodological quality of a relatively small number of included trials, their findings indicate that acupuncture may help induce the cessation of hiccups when used as an adjunct to pharmacological therapy including baclofen, sodium valproate, anisodamine hydrobromide and atropine. Though no definite conclusions could be drawn, their tentative findings are encouraging and contribute to an ever-growing literature on multi-modal treatment approaches to stroke rehabilitation, where acupuncture may induce a number of positive effects.1 ,2 The second review, by Clark et al. takes a rather different form, presenting a critical interpretive synthesis that effectively “brainstorms” the entire topic of acupuncture for plantar heel pain beyond simple assessment of effectiveness, which was previously addressed by the authors’ earlier (conventional) systematic review on the same subject, which appeared in the pages of this journal in 2012. This new paper offers numerous novel insights and highlights the diversity of acupuncture practice; its fascinating methodology can no doubt be extrapolated to many other domains of acupuncture.
These reviews are followed by two secondary analyses of published randomised controlled trials (RCTs). MacPherson et al. extend the follow-up period of their high quality RCT of acupuncture for irritable bowel syndrome, published in BMC Gastroenterology back in 2012, out to 24 months, in order to explore the longer-term (likely non-specific) effects of the acupuncture intervention and the associated interaction with the practitioner. Although no sustained effect of acupuncture was observed at the new two-year time point, their updated mathematical model further highlighted the beneficial effects seen at the original study's time points, commensurate with the findings of the authors’ original report. This is followed by another analysis by Yeung et al. examining potential factors that might predict the response to acupuncture amongst RCT participants with insomnia; the authors report that higher educational levels are associated with greater therapeutic benefit.Following these secondary analyses, we have two excellent surveys. Firstly, Mayor and Bovey present the findings of what is arguably the largest-ever international survey of acupuncture practitioners on the topic of electroacupuncture (EA) and reveal interesting patterns of EA use with respect to practitioner demographics, professional background and geographical distribution. Secondly, Lee et al. explore and confirm a potential relationship between the use of acupuncture and the phenomenon of “pain catastrophising” (the tendency to exaggerate and misinterpret the experience of pain) in breast cancer survivors. Elsewhere in this issue you will find a new basic science report in a rodent model of Alzheimer's disease exploring the contribution of peroxisome proliferator activated receptor γ, which sheds further light on the potential mechanisms of action underlying the effects of acupuncture in this condition, thus extending the findings of other recent preclinical studies on this topic.3 ,4 This is followed by two other rodent experiments highlighting the critical role of the medial preoptic area of the hypothalamus in mediating the beneficial effects of EA on reproductive function following ovariectomy, and the role of N-methyl-D-asparate (NMDA) receptors in mediating the effect of EA on pain in fibromyalgia, a condition for which verum acupuncture has recently been demonstrated to outperform sham.5 We end with a case series of myofascial trigger point dry needling in patients affected by both sleep bruxism and temporomandibular disorders.
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