Ng, D.K., Chow, P.Y., Ming, S.P., Hong, S.H., Lau, S., Tse, D., Kwong, W.K., Wong, M.F., Wong, W.H., Fu, Y.M., Kwok, K.L., Li, H. & Ho, J.C. (2004). A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis. Pediatrics, 114, 1242-7.

METHODS: 85 children with persistent allergic rhinitis were recruited from the pediatric outpatient clinic. They were randomized to receive either active acupuncture or sham acupuncture. Main outcome measures included daily rhinitis scores, symptom-free days, visual analog scale scores for immediate effects of acupuncture, daily relief medication scores, blood eosinophil counts, serum IgE levels, nasal eosinophil counts, patients' and parents' preferences for treatment modalities, and adverse effects. Acupuncture was performed twice per week for both groups. RESULTS: There were significantly lower daily rhinitis scores and more symptom-free days for the group receiving active acupuncture, during both the treatment and follow-up periods. The visual analog scale scores for immediate improvement after acupuncture were also significantly better for the active acupuncture group. Numbness, headache, and dizziness were found in both the active and sham acupuncture groups, with no difference in incidence, and the effects were self-limiting.

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Arthritis

Kwon, Y., Pittler, M. & Ernst, E. (2006). Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. Rheumatology, 45, 1331-7.

To evaluate the evidence for the effectiveness of acupuncture for peripheral joint osteoarthritis. Ten studies demonstrated greater pain reduction in the acupuncture groups.

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Witt CJena SBrinkhaus BLiecker BWegscheider KWillich S. (2006). Acupuncture in patients with osteoarthritis of the knee or hip: a randomized, controlled trial with an additional non-randomized arm. Arthritis and Rheumatology, 54, 3485-93.

METHODS: In a randomized, controlled trial, patients with chronic pain due to osteoarthritis of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months. 357 were randomized to the acupuncture group and 355 to the control group. RESULTS: At 3 months, the WOMAC had improved more in the acupuncture group than the control group. Similarly, quality of life improvements were more pronounced in the acupuncture group versus the control group.

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Back Pain

Hope-Allan, N., Adams, J., Sibbritt, D. & Tracy, S. (2004). The use of acupuncture in maternity care: a pilot study evaluating the acupuncture service in an Australian hospital antenatal clinic. Complementary Therapy and Nurses Midwifery, 10, 229-32.

METHOD: 52 women were given a questionnaire, and 71% were completed and returned. Of the 37 women who attended the acupuncture clinic, 49% had previously used at least one form of complementary medicine/therapy. The most common reason for treatment was physiological symptoms including back pain, symphysis pubis dysfunction and sciatica. RESULTS: All 37 women stated that acupuncture improved their well-being and this finding was statistically significant. These findings are offered as a means of identifying potential issues for future investigation in this under-researched area.

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Ratcliffe J, Thomas KJ, MacPherson H, Brazier J. (2006) A randomized controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ, 23, 626

To evaluate the cost effectiveness of acupuncture in the management of persistent non-specific low back pain, ten individualised acupuncture treatments were given over three months or usual care only. A short course of traditional acupuncture for persistent non-specific low back pain in primary care conferred a modest health benefit for minor extra cost as compared with usual care.

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Breast Cancer

Nedstrand, E., Wyon, Y., Hammar, M. & Wijma, K. (2006). Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. Journal of Psychosomatic Obstetric and Gynecology, 27, 193-9.

METHOD: Thirty-eight breast cancer-treated postmenopausal women with vasomotor symptoms were included in the study. They were randomized to either treatment with electro-acupuncture or applied relaxation over a 12-week study period with six months follow-up. Vasomotor symptoms were registered daily. Estimation of general well-being was made using the Symptom Checklist, and mood using the Mood Scale. These were applied during treatment and at follow-up. RESULTS: Hot flushes were reduced by more than 50%. Climacteric symptoms significantly decreased during treatment and remained so six months after treatment in both groups. Psychological well-being significantly improved during therapy and at follow-up visits in both groups. Mood improved significantly in the electro-acupuncture treated group.

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Cerebral Palsy

Liu, Z., Pan, P. & Ma, M. (2007). Effects of acupuncture on quality of life in children with spastic cerebral palsy. Zhongguo Zhong Xi Yi Jie He Za Zhi, 27, 214-6.

METHODS: One hundred Spastic Cerebral Palsy children, 2 to 7 years old, were randomly assigned to two groups equally. The control group was treated with rehabilitation training using Bobath and Vojta physical training methods and the acupuncture group treated also with the same training but with acupuncture conducted additionally. The therapeutic course was 3-12 months arranged according to the state of illness. RESULTS: The total effective rate, development quotient (DQ), improvement rate of brain hypogenesis and atrophy showed by skull CT, and recovery rate of cerebral emission computed tomography (ECT) were all higher in the acupuncture group than those in the control group.

Wu, X., Bai, G., Wen, J. & Yang, J. (2005). Evaluation on the therapeutic effects of digital acupoint pressure for obstetric spastic cerebral palsy. Journal of Traditional Chinese Medicine, 25, 247-51.

METHOD: spastic cerebral palsy were treated with digital acupoint pressure therapy. Ten indexes including intelligence, language, salivation, hand-grasping, thumb-adduction, turnover, sitting, standing, walking, and scissors-gait were divided into the 4 grades of normal, mild abnormal, moderate abnormal, and severe abnormal (dysfunction), The ranges were recorded and evaluated before and after the treatment on shoulder-abduction, elbow-extension, wrist-extension, forearm-backward-rotation, hip-abduction, straight-leg-lifting, knee-extension, and ankle-dorsiflexion. RESULTS: There were significant differences before and after the treatment in the 18 items under observation except for intelligence, with obvious improvement shown after the treatment (P<0.01), the effective rate being 92.5%.

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Colitis

Tkahashi T (2006) Acupuncture for functional gastrointestinal disorders. Journal of Gastroenterology, 41, 408-17.

Acupuncture may be effective in patients with functional GI disorders because it has been shown to alter secretion, GI motility, and visceral pain.

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Delivery

Neri, I., Airola, G., Contu, G., Allais, G., Facchinetti, E. & Benedetto, C. (2004). Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study. Journal of Maternal Fetal Neonatal Medicine, 15, 247-52.

METHOD: 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: At delivery, the proportion of cephalic version was lower in the observation group than in the active-treatment group. Thus, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group.

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Oomman,S., Liu, D. & Cummings, M. (2005). Acupuncture for acute postoperative pain relief in a patient with pregnancy-induced thrombocytopenia--anxiety case report. Acupuncture Medicine, 23, 83-5.

A 39 year old woman, scheduled for elective caesarean section in her second pregnancy, developed thrombocytopenia. Therefore, at the time of surgery, spinal anaesthesia and non-steroidal analgesic drugs were avoided and she was given a standard general anaesthetic procedure including fentanyl 100 microg and morphine 10 mg. In the early postoperative period she received tramadol 100 mg and a further 10 mg of morphine. These drugs did not control her pain, but caused side effects--in particular nausea and retching. Acupuncture to LI4 and PC6 pain on the right side produced dramatic pain relief within minutes.

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Wang, S., Gaal, D., Maranets, I., Caldwell-Andrews, A. & Kain, Z. (2005). Acupressure and preoperative parental anxiety: a pilot study. Anesthetic Analg, 101, 666-9.

METHOD: Sixty-one parents received acupressure either at the Yin Yang point (midpoint between the two eyebrows) or at a sham point. Anxiety (as measured by the Stait-Trait Anxiety Inventory), arterial blood pressure, and heart rate were assessed before and after the intervention and a Bispectral Index monitor was used to continuously monitor hypnotic sedation levels. RESULTS: Repeated measures analysis of variance showed that parents in the acupressure group reported significantly less anxiety at 20 min post-intervention as compared with parents in the sham group. Bispectral Index values, heart rate, and arterial blood pressure, however, did not differ between the two study groups .

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Dementia

Yang, M., Wu, S., Lin, J. & Lin, L. (2007). The efficacy of acupressure for decreasing agitated behavior in dementia: a pilot study. Journal of Clinical Nursing, 16, 308-15.

METHODS: Participants were recruited from a nursing home caring specifically for patients with dementia. All the subjects were assigned to an experimental protocol and had a six-week acupressure treatment program. Baseline data were collected in the first week. Individual treatment sessions began at the second week of the study and lasted 15 minutes, twice a day, five days a week for four weeks. After a treatment-free period of one week, all the subjects served as controls undergoing a four-week control protocol consisting of companionship and conversation. RESULTS: Comparison between the control and experimental phases indicated significant differences between the two groups on all outcome measures (Cohen-Mansfield Agitation Inventory, daily agitation records about physical attack, verbal and non-verbal attack and non-physical attack) with better results found during the acupressure phase.

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Depression

Mukaino, Y., White, A., & Ernst, E. (2005). The effectiveness of acupuncture for depression—a systematic review of randomised controlled trials. Acupuncture Medicine, 23, 70-76.

METHOD: Randomized control trials were in included in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted for meta-analysis. RESULTS: Seven randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication. There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs.

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Fibromyalgia

Martin DP, Sletten CD, Williams BA, Berger IH (2006) Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clinic proceedings, Mayo Clinic, 81, 749-57

Fibromyalgia patients receiving true acupuncture compared with a control group of patients who received simulated acupuncture. Total fibromyalgia symptoms were significantly improved in the acupuncture group compared with the control group during the study period. Fatigue and anxiety were the most significantly improved symptoms during the following-up period.

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Headaches

Melchart D, Weidenhammer W, Streng A, Hoppe A, Pfaffenrath V, Linde K. (2006) Acupuncture for chronic headaches--an epidemiological study. Headache, 46, 632-41

In this epidemiological study, headache patients reported clinically relevant improvements after receiving acupuncture. Randomized trials performed parallel to this study confirm the relevant overall effect, however, the effect may largely be due to potent unspecific needling and placebo effects.

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Immune

Arranz, L., Guayerbas, N., Sibonni, L. & De la Fuente, M. (2007). Effect of acupuncture treatment on the immune function impairment found in anxious women. American Journal of Chinese Medicine, 35, 35-51.

Emotional disturbances lead to immune system impairment. The question for this study was whether acupuncture control and restore the immune response. The acupuncture protocol consisted of manual needle stimulation of 19 acupoints, with each session lasting 30 min. The most favorable effects of acupuncture on the immune functions appeared 72 hours after the single session and persisted one month after the end of the complete treatment. Impaired immune functions in anxious women (chemotaxis, phagocytosis, lymphoproliferation and NK activity) were significantly improved by acupuncture.

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Labor

Chang, S.B., Park, Y.W., Cho, J.S., Lee, M.K., Lee, B.C. & Lee, S.J. (2004). Differences of cesarean section rates according to San-Yin-Jiao(SP6) acupressure for women in labor. Taehan Kanho Hakhoe Chi, 34,324-32.

METHOD: 209 women were assigned to one of three groups SP6 acupressure, SP6 touch, and control group. For 30 minutes, the SP6 acupressure group received SP6 acupressure,and the SP6 touch group received SP6 touch for the duration of each uterine contraction. The Control group was encouraged to deep breathe and relax for the duration of each uterine contraction for 30 minutes. RESULTS: The rates of cesarean section were 13%, 30%, and 22% for the SP6 acupressure group, SP6 touch group, and control group respectively. Cesarean section rates were significantly different between the SP6 acupressure and non-SP6 acupressure group.

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Chao, S. A., Chao, A., Wang, T., Chang, Y., Peng, H., Chang, S. Chao, A., Chang, C., Lai, C. & Wong, A. (2006). Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain, 127, 214-20.

METHOD: Healthy full-term parturients in the active phase of first-stage labor were randomly assigned to either TENS on four acupuncture points (n=52) or the TENS placebo (n=53). A visual analogue scale (VAS) was used to assess pain before and 30 and 60 min after treatment. The primary outcome was the rate of VAS score decrease in each group. A questionnaire was given at 24h post-partum to evaluate the satisfaction of the pain relieving method and the willingness to have the same treatment again. Mode of delivery and neonatal outcomes were measured as secondary variables. RESULTS: The TENS group experienced greater VAS score reduction than the TENS placebo group. Willingness to use the same analgesic method for a future childbirth was also significantly different.

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Chung, U., Hung, L., Kuo, S. & Huang, C. (2003). Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor. Journal of Nurses Research, 11, 251-60.

METHOD: 127 parturient women were randomly assigned to three groups. Each group received only one of the following treatments, LI4 and BL67 acupressure, light skin stroking, or no treatment/conversation only. Data collected from the VAS and external fetal monitoring strips were used for analysis. RESULTS: there was a significant difference in decreased labor pain during the active phase of the first stage of labor among the three groups. There was no significant difference in effectiveness of uterine contractions during the first stage of labor among the three groups. Results of the study confirmed the effect of LI4 and BL67 acupressure in lessening labor pain during the active phase of the first stage of labor. There were no verified effects on uterine contractions.

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Lee, M., Chang, S. & Kang, D. (2004). Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. Journal of Alternative Complementary Medicine, 10, 959-65.

METHOD: Seventy-five women in labor were randomly assigned to either the SP6 acupressure or SP6 touch control group. The participants were matched according to parity, cervical dilation, labor stage, rupture of amniotic membrane, and husband's presence during labor. There were no additional oxytocin augmentation or administration of analgesics during the study period. Labor pain was measured four times using a structured questionnaire, a subjective labor pain scale before intervention, immediately after the intervention, and 30 and 60 minutes after the intervention. Length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilatation, and full cervical dilatation to the delivery. RESULTS: There were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention; 30 minutes after the intervention; and 60 minutes after the intervention. The total labor time was significantly shorter in the SP6 acupressure intervention group than in the control group.

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Mechanisms

Li, G., Jack, C. & Yang, E. (2007). An fMRI study of somatosensory-implicated acupuncture points in stable somatosensory stroke patients. Journal of magnetic Resonance Imaging, 24, 1018-24.

METHOD: fMRI was performed with two different paradigms including tactile stimuli and electrical stimulation. RESULTS: Tactile stimulation in both patients and controls produced significant activation in primary and secondary sensory and motor cortical areas and the cerebellum. Greater activation was present in patients than controls in the somatosensory cortex with both the tactile task and the acupuncture point (acupoint) stimulation. Activation was greater during the tactile than the acupuncture stimulation in both the patients and the normal controls.

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Li, K., Shan, B., Xu, J., Liu, H., Wang, W., Zhi, L., Li, K., Yan, B. & Tang, X. (2006). Changes in fMRI in the human brain related to different durations of manual acupuncture needling.

METHOD: Different durations of needle insertion have been evaluated using functional magnetic resonance imaging. RESULTS: The stimulation of manual acupuncture with different durations induced different effects on the central nervous system. The longer duration manual acupuncture had the most effect.

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Moffet HH (2006) How might acupuncture work? A systematic review of physiologic rationales from clinical trials. BMC Complementary and alternative medicine, 7, 25

The dominant explanation for how acupuncture might work involves neurochemical responses and is not reported to be dependent on treatment objective, specific points, means or methods of stimulation.

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Migraine

Streng, A., Linde, K., Hoppe, A., Pfaffenrath, V., Hammes, M., Wagenpfeil, S., Weidenhammer, W. & Melchart, D. (2006). Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache, 46, 1492-502.

METHODS: One hundred fourteen migraine patients were randomized to treatment over 12 weeks either to acupuncture (8 to 15 sessions) or metroprolol (100 to 200 mg daily). The main outcome measure was the difference in the number of migraine days between baseline and the weeks 9 to 12 after randomization (derived from a headache diary). RESULTS: The proportion of responders (reduction of migraine attacks by > or =50%) was 61% for acupuncture and 49% for metoprolol. Both physicians and patients reported fewer adverse effects in the acupuncture group.

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Neck Pain

Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T. (2007) Acupuncture for neck disorders. Spine,15, 236-43

Neck Pain is one of the 3 most frequently reported complaints of the musculoskeletal system. 10 trials that examined acupuncture treatments for chronic neck pain suggested moderate evidence that acupuncture was more effective than inactive, sham treatments. There was limited evidence that acupuncture was more effective than massage at short-term follow-up.

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Neurological Disorders

Lee, H., Park, H., Park, J., Kim, M., hong, M., Yang, J., Choi, S. & Lee, H. (2007). Acupuncture application for neurological disorders. Neurological Research, 29, 49-54.

METHOD: In a review designed to summarize and to evaluate the available evidence of acupuncture for neurological disorders. RESULTS: no firm conclusion could be drawn on the use of acupuncture for epilepsy, Alzheimer's disease, Parkinson's disease, ataxic disorders, multiple sclerosis, amyotrophic lateral sclerosis and spinal cord injury

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Schröder S, Liepert J, Remppis A, Greten JH. (2007) Acupuncture treatment improves nerve conduction in peripheral neuropathy. European Journal of Neurology, 14, 276-81

Peripheral neuropathy patients diagnosed by nerve condition studies (NCS) received acupuncture therapy. Seventy six percent in the acupuncture group improved symptomatically and objectively as measured by NCS.

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Pain

Hong, Y. R. (2005). The effects of hand-acupuncture therapy on intermittent abdominal pain in children. Taehan Kanho Hakhoe Chi, 35, 487-493.

METHOD: Forty children were assigned to the experimental or control group. The experimental group received Hand-Acupuncture therapy on the meridian point for 20 minutes, while the control group rested on the bed. RESULTS: In the experimental group, pain intensity and medication requirement were significantly lower than that of the control group.

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Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich SN, Melchart D. (2007). The Impact of Patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain, 128, 264-71.

Patients received either 12 sessions of acupuncture or minimal (sham) acupuncture (superficial needling of non-acupuncture points) over an 8 week period. Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment. A significant association was shown between better improvement and higher outcome expectations.

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Physiology

Ifrim-Chen, F. & Ifrim, M. (2005). Acupoints [corrected] and meridians: a histochemical study. Italian Journal of Anatomy and Embryology, 110, 51-7.

METHOD: samples of 356 specimens (287 from 48 adult and 2 newborn cadavers and the remaining 69 from living patients) were taken at three different levels: (1) beneath acupoints; (2) between meridians; (3) at a distance from meridians. Seven different stainings were performed to show the distribution of collagen fibers, reticular fibers, mucopolysaccharides (MPS), connective tissue, nerve threads, and blood vessels in specimens obtained from different areas. RESULTS: Some structural and biochemical discrepancies associated with acupoints and meridians included: (1) collagen fibers; (2) nerve endings.

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Postoperative Nausea

Ezzo, J., Streitberger, K. & Schneider, A. (2006). Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. Journal of Alternative and Complementary Medicine, 12, 489-95.

Reviews were found on postoperative sickness, chemotherapy-induced nausea and vomiting, and pregnancy-related nausea and vomiting. Results for postoperative nausea and vomiting show the most consistent results with showing the superiority of stimulation over sham and for both nausea and vomiting. Stimulation seemed to be superior to antiemetic medication for nausea and equivalent for vomiting. Results for chemotherapy-induced nausea and vomiting showed that electroacupuncture, but not manual acupuncture, was beneficial for first-day vomiting. Acupressure was effective for first-day nausea but not vomiting. Results for pregnancy-related nausea and vomiting were mixed.

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Streitberger K, Ezzo J, Schneider A. (2006) Acupuncture for nausea and vomiting: an update of clinical and experimental studies. Autonomic Neuroscience: basic and clinical, 30, 107-17

For postoperative nausea and vomiting, results from 26 trials showed acupuncture-point stimulation was effective for both nausea and vomiting. For chemotherapy-induced nausea and vomiting, results of 11 trials differed according to modality, with acupressure appearing effective for first-day nausea, electroacupuncture appearing effective for first-day vomiting, and noninvasive electrostimulation appearing no more effective than placebo for any outcome. Experimental studies showed effects of P6-stimulation on gastric myoelectrical activity, vagal modulation and cerebellar vestibular activities in functional magnetic resonance imaging.

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Stress

Karst, M., Winterhalter, M., Munte, S., Francki, B., Hondronikos, A., Eckardt, A., Hoy, L., Buhck, H., Bernateck, M. & Fink, M. (2007). Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesthesia Analog, 104, 295-300.

patients having dental extractions were randomized to auricular acupuncture, placebo acupuncture, and intranasal midazolam and compared with a no-treatment group. The auricular acupuncture group and the midazolam group were significantly less anxious at 30 minutes after the treatment as compared with patients in the placebo acupuncture group. In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed.

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TMJ Pain

Smith P, Mosscrop D, Davies S, Sloan P, Al-Ani Z (2007) The efficacy of acupuncture in the treatment of temporomandibular joint myfascial pain: a randomised controlled trial. Journal of Dentistry, 35, 259-67

To compare the effect of real acupuncture and sham acupuncture in the treatment of temporomandibulat joint myofascial pain, Group 1 received real acupuncture treatment whilst Group 2 received sham acupuncture. Real acupuncture had a greater influence on clinical outcome measure of TMJ MP than those of sham acupuncture.