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In this issue
  1. David John Carr1,2
  1. 1 Institute of Medical and Biomedical Education, St George's, University of London, London, UK
  2. 2 Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr David John Carr, NYU School of Medicine, 550 First Avenue, New York 10016, USA; dcarr{at}bmj.com

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This issue of Acupuncture in Medicine opens with the editor’s choice article, in which the myofascial trigger point (MTrP) takes centre stage. As our readership becomes ever more geographically and philosophically diverse, it is worth taking a moment to recap what we know about this fascinating phenomenon. As Western medical acupuncture continues to develop, in contemporary practitioners’ hands, MTrPs may be as common a target for the acupuncture needle as traditional acupuncture points, depending on the degree to which painful musculoskeletal conditions contribute to one’s clinical practice. Anyone who is accustomed to palpating skeletal muscle will be familiar with the cardinal features of the MTrP, which was first described by Janet Travell in 1942 as a discrete, hyperirritable spot in a taut band that reproduces the patient’s pain on palpation and may demonstrate a local twitch response on stimulation. While MTrPs are widely recognised by practitioners of physical medicine and contemporary acupuncture, their pathophysiology remains relatively poorly understood and yet is characterised by biochemical abnormalities (elevated levels of acetylcholine, serotonin and noradrenaline), acid-base disturbance (reduced pH), autonomic dysfunction and spontaneous electrical activity.1 The role of the autonomic nervous system is further investigated in the study by Abbaszadeh-Amirdehi et al, who measured the impact of MTrP needling on sympathetic markers including neuromuscular junction response and sympathetic skin response in 20 patients and 20 matched controls. They found that a single treatment reduced the sympathetic hyperactvitity that was observed at the MTrP site in the patient group. This adds to our understanding of the mechanisms underlying the beneficial effects of trigger point therapy, which also likely involves remote effects driven by changes in endogenous opioids.2 An analgesic effect was also demonstrated, reflected by increased pain pressure threshold in the patients (but not healthy volunteers) consistent with other recent papers supporting the efficacy and effectiveness of trigger point acupuncture.3 4While there arguably remains a degree of controversy in some acupuncture communities over the distinction between dry needling of MTrPs and traditional acupuncture,5 6 it certainly appears that this approach has merits. Indeed, given the well-publicised fact that MTrPs seem to show a close correlation with the so-called ah shi points of traditional acupuncture,6 needling at MTrPs might already empirically represent a key component of classical approaches to treating myofascial pain.

Elsewhere in this issue you will find articles focusing on quality and safety, which are always extremely welcome in the pages of this journal. Kwon et al measured concentrations of volatile organic compounds released during moxibustion and reassure us that the overall levels remained within safe limits, which is a welcome conclusion given the many potential risks of moxa smoke inhalation, including oxidative damage to DNA.7 Meanwhile, Zeng et al highlight deficiencies in reporting quality of randomised controlled trials of acupuncture for stroke rehabilitation, stressing the need for greater promotion of the CONSORT and STRICT guidelines. This is followed a survey of Australian cancer patients by Oh et al, who showed high levels of interest in acupuncture and go on to explore the factors contributing to this willingness to engage.

We also have the usual flurry of preclinical studies, which include papers examining effects of electroacupuncture on gastrointestinal function, oligodendrocyte differentiation and N-methyl-D-aspartate (NMDA) receptor expression in rodent models of stress, demyelination and Parkinson’s disease, respectively. Our final basic science article of the issue reports the positive effects of transcutaneous electrical acupuncture point stimulation (TEAS) on neuropathic pain, highlighting that penetration of the skin is not always needed. The latter is a nice segue into the final original article – a narrative review by Chae & Olausson that comprehensively covers more superficial forms of somatosensory stimulation.

References

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Footnotes

  • Competing interests None declared.

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

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