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This issue of Acupuncture in Medicine has an unusually strong emphasis on women’s and children’s health courtesy of a cluster of interesting new studies. First up is our editor’s choice article, which is a systematic review (SR) of acupuncture as an adjunct to in vitro fertilisation (IVF) specifically among women with polycystic ovarian syndrome (PCOS). The use of acupuncture and related techniques alongside IVF per se remains controversial. As highlighted by my recent editorial on this topic,1 the latest SRs have been negative at face value; however subgroup analyses show statistically and clinically significant pooled effects of treatment: (1) when excluding trials using sham controls, which are often associated with pregnancy rates in the sham groups that are even greater than those observed in the verum acupuncture and untreated groups; (2) when examining trials with low baseline pregnancy rates (<32%); and (3) when considering studies in which the timing of acupuncture treatment incorportated the period of controlled ovarian stimulation, as opposed to only embryo transfer±luteal phase support. The latter is particularly pertinent for patients with PCOS, who have a higher risk of ovarian hyperstimulation syndrome (OHSS) during hormonal stimulation of the polycystic ovary. In their SR, Jo & Lee found that acupuncture may reduce the incidence of OHSS as well as increase clinical pregnancy rate when applied to this patient population. Like many previous SRs and randomised controlled trials (RCTs), they were underpowered to show differences in live birth rate with only 430 participants across the four included studies. However, their findings indicate that this is an area worthy of further investigation and adds to the list of reproductive and metabolic features of PCOS that acupuncture may influence, including menstrual regularity and insulin resistance.2
Next up is an RCT of acupuncture for infantile colic that received a lot of attention in the press, both positive and negative, when published ahead-of-print earlier this year. It should be clearly noted that this trial was negative with respect to its primary outcome. However, it is nonetheless a worthwhile contribution to the field given certain methodological strengths (despite the inherent limitations acknowledged by the authors). Considering that the other major trials in this area have had contradictory results,3 4 the exploratory aspects of this new RCT by Landgren et al should at least help guide further research, pending a long overdue SR on this topic. It is also interesting to see that acupuncture for colic seems to be increasingly practiced in Sweden regardless of the uncertainly over its effectiveness, given recruitment suffered as acupuncture treatment became widely available outwith the trial.
Next, Vixner et al present a new secondary analysis of their recent RCT evaluating manual acupuncture and electroacupuncture (EA) for labour pain,5 in which they examined for factors potentially associated with the response to acupuncture. While no significant treatment interactions were identified, they did find certain variables impacted the experience of labour pain, which may aid patient selection by maternity units offering intrapartum acupuncture. Continuing on a women’s health theme, Yang et al examine patterns of acupuncture use in a large cohort of Australian females, demonstrating an association with chronic medical conditions, and Ma et al show that EA stimulates endogenous oestrogen production and differentially regulates the expression of sex steroid receptors in a rat model of menopause induced by surgical removal of the ovaries. Consequently, EA may help mitigate menopausal symptoms as well as prevent osteoporosis.6
Elsewhere in this issue you will find a longitudinal epidemiological study examining temporal trends in acupuncture use in the USA, highlighting its increasing utilisation, and a mechanistic study examining the impact of EA on the polarisation of macrophages and wider inflammatory response following spinal cord injury in rats. In addition, Zhu et al follow-up on their recent preclinical study of EA for constipation7 with a complementary experiment in a rat model of diarrhoea induced by the administration of Folium Sennae. This pair of studies demonstrates nicely the potential for bidirectional regulation of gastrointestinal function by acupuncture stimulation under differential baseline conditions. Furthermore, they implicate serotonin and tryptophan hydroxylase in the mechanism of action underlying the effects of acupuncture on both constipation and diarrhoea, with potential clinical relevance for patients with various subtypes of irritable bowel syndrome.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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