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This issue of Acupuncture in Medicine opens with a large systematic review and meta-analysis of acupuncture for lumbar disc herniation. Readers who treat patients with acute/subacute/chronic back pain anywhere across the wide spectrum of aetiology may feel encouraged by the positive findings of this review (despite the methodological limitations of some of the included trials), given its clinically relevant focus on comparative effectiveness relative to a range of other active treatments. Some of the comparators that acupuncture was shown by the authors to out-perform, for example, non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, will be ubiquitous and widely available, whilst others, such as huoxue zhitong decoction, will only be familiar to Chinese herbalists. Nevertheless, the large pooled effect size of acupuncture compared with diclofenac (standardised mean difference −1.36) on low back pain scores is particularly encouraging, especially in light of the decision of the National Institute for Health and Care Excellence to roll back their prior endorsement of acupuncture in their latest guideline on the management of low back pain in adults1 and growing concerns regarding the safety profile of certain NSAIDs.2
This is followed by an interesting secondary analysis of a recent randomised clinical trial (RCT) of scalp acupuncture in subacute haemorrhagic stroke published in the general clinical journal Medicine.3 While the original trial failed to show a difference between verum scalp acupuncture plus standard care and standard care alone in the primary outcome of neurological deficit score, this secondary analysis (which must of course be interpreted with caution) indicates more subtle effects on gait among patients undergoing 3D spatiotemporal analysis, which is worthy of further investigation in future trials. Next, Bao et al present the findings of a large survey of breast cancer survivors, in which they explore characteristics that may predict and/or influence patient willingness to undergo acupuncture treatment for pain symptoms related to their disease or treatment. This is followed by an interesting study by Schwehr et al examining the proportion of American patients receiving what is generally considered to represent a full course of acupuncture (ie, an adequate neurophysiological dose). Based on their data, extracted from the 2012 National Health Interview Survey, they also make some pertinent recommendations regarding insurance coverage for acupuncture, which is currently limited in the USA.
Next comes our usual representation of basic science articles, reflective of a growing number of submissions from preclinical acupuncture research laboratories from all over the world. Our clinician readership may be interested to know that basic science papers are now by far the most common type of article submitted to the journal but also have the greatest rejection rate, such that only the highest quality investigations make it into print. Thus, our clinical to preclinical content ratio remains close to 50:50 despite the imbalance at the time of submission. In response to ongoing feedback from our readers, I will do my best to ensure this continues, while attempting to attract ever more high quality clinical trials and review articles (a task that is likely to become easier as our impact factor continues to grow). The current issue contains diverse preclinical papers featuring rodent models of cerebral palsy, diet-induced obesity and fibromyalgia.
Our April issue closes with a narrative review by Hullender Rubin et al on acupuncture alongside in vitro fertilisation, an area of personal interest and something I have written on critically.4 This remains topical given the ongoing slew of publications on acupuncture and infertility, including the recent negative factorial RCT of acupuncture/clomiphene published in JAMA.5 It is therefore timely to review factors that may influence treatment success and how they may inform future trial design.
Contributors DJC wrote the manuscript and approved the final version accepted for publication.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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