File Name: acupuncture and moxibustion .zip
Acupuncture and moxibustion have been accepted as treatment options for primary dysmenorrhea PD. So far, several systematic reviews SRs and meta-analyses MAs have reported on the efficacy and safety of acupuncture and moxibustion in treating PD. The aim of this study was to critically summarize the evidence from relevant SRs and MAs reporting on the efficacy and safety of acupuncture and moxibustion in treatment of PD. A total of 28 SRs and MAs, original studies, reporting on 26, female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality.
Metrics details. Acupuncture and moxibustion have widely been used to treat lateral elbow pain LEP. A comprehensive systematic review of randomized controlled trials RCTs including both English and Chinese databases was conducted to assess the efficacy of acupuncture and moxibustion in the treatment of LEP.
Revised STRICTA criteria were used to appraise the acupuncture procedures, the Cochrane risk of bias tool was used to assess the methodological quality of the studies. All studies had at least one domain rated as high risk or uncertain risk of bias in the Cochrane risk of bias tool. Results from three RCTs of moderate quality showed that acupuncture was more effective than sham acupuncture.
Results from 10 RCTs of mostly low quality showed that acupuncture or moxibustion was superior or equal to conventional treatment, such as local anesthetic injection, local steroid injection, non-steroidal anti- inflammatory drugs, or ultrasound.
There were six low quality RCTs that compared acupuncture and moxibustion combined with manual acupuncture alone, and all showed that acupuncture and moxibustion combined was superior to manual acupuncture alone. Moderate quality studies suggest that acupuncture is more effective than sham acupuncture.
Interpretations of findings regarding acupuncture vs. Future studies with improved methodological design are warranted to confirm the efficacy of acupuncture and moxibustion for LEP. Peer Review reports. It is a significant health burden because it affects work productivity and the quality of life of LEP sufferers. Currently there is no ideal treatment for LEP. The most common treatments for LEP are steroid injections, non-steroidal anti-inflammatory drugs NSAIDs or a regime of physiotherapy with various modalities [ 2 ].
Steroid injections have a short-term two to six weeks effect in improving symptoms [ 3 ], whereas NSAIDs have a smaller effect than steroid injections [ 4 ]. Evidence is lacking for the efficacy of physiotherapy [ 5 ]. Furthermore, there is no evidence regarding the efficacy in the long term use of current conservative treatment options, and the potential side effects such as skin atrophy and depigmentation [ 6 ] limit the use of steroid injections.
The need for a safe and effective treatment for LEP is therefore paramount. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions [ 7 ], including LEP. In traditional Chinese medicine TCM , acupuncture and moxibustion are two inseparable therapeutic methods; the former stimulates the acupoint with a needle whereas the latter with heat generated by burning of moxa Artemisia Vulgaris.
Acupuncture has been popularly used all over the world, but it is still not recognized as a standard treatment for LEP because the evidence supporting its efficacy is still limited. In the most recent review on the topic, Buchbinder et al. The authors concluded that needle acupuncture may be more effective than sham acupuncture in relieving pain after one treatment as well as after ten acupuncture sessions at two weeks, but there is no difference between needle acupuncture and sham acupuncture at the 3-or month follow-up.
They also found that needle acupuncture may be more effective at improving functional impairment at 2-week follow-up compared with sham acupuncture, and electro-acupuncture may be more effective than manual acupuncture in reducing pain. Nevertheless, they concluded the acupuncture intervention as "unknown effectiveness" in their report, due to the fact that the analyzed studies were of very small sample size and had flaws in the study design, including uncertain allocation concealment, substantial loss to follow up and lack of assessments for potential adverse effects.
Although a number of systematic reviews have been performed on acupuncture for LEP [ 4 , 8 — 10 ], these reviews did not include articles published in Chinese. Moreover, moxibustion, which also acts by stimulating the acupoints and is commonly used concurrently with acupuncture for LEP, was not included in previous reviews. Given the fact that many studies of acupuncture and moxibustion for LEP have been published in non-Western scientific literature and have not been reviewed, the literatures identified by previous reviews may not be comprehensive enough to cover all the current evidence of acupuncture and moxibustion for LEP.
In view of this, we conducted a comprehensive systematic review on randomized controlled trials of acupuncture and moxibustion for LEP that were published in both Chinese and Western language literatures. This review aimed to find out if acupuncture or moxibustion alone was more effective than sham acupuncture or other conventional treatments in the treatment of LEP.
We also wanted to know if acupuncture and moxibustion combined was more effective than acupuncture or moxibustion alone. Search was also made in ClinicalTrials. The following terms were used in our search strategies: moxibustion or acupuncture or electro-acupuncture or needle and lateral epicondylitis or, lateral epicondylalgia, or tennis elbow, or lateral epicondyle, or external humeral epicondylitis, or brachioradial bursitis, or lateral elbow pain, or lateral elbow.
Equivalent Chinese terms were used in searching the Chinese language databases. We imposed no language restrictions. Two authors MG and WFY searched the databases and assessed potentially relevant articles against the inclusion criteria independently. Any disagreement regarding the eligibility of a study was resolved by discussion.
We included only randomized controlled trials studying subjects with a primarily diagnosis of lateral epicondylitis or lateral elbow pain, in which acupuncture, moxibustion, or acupuncture and moxibustion combined was used for treatment.
Acupuncture is defined as needle acupuncture, including electro-acupuncture and auricular acupuncture that employed needle penetration. Other variants of acupuncture, such as acupressure, acupoint injection, laser acupuncture, auricular acupressure, and transcutaneous electrical nerve stimulation TENS were excluded.
Treatments that used acupotomy small needle-scalpel therapy were also excluded. Moxibustion is defined as burning of moxa either directly or indirectly over acupoints. In direct moxibustion, the moxa is placed directly over the skin.
In indirect moxibustion, the burning moxa is positioned over the acupoint, either held by an apparatus, or placed over a piece of herbal material, such as ginger or biscuit made from medicinal herbs. We also included studies of combining acupuncture and moxibustion treatment acupuncture and moxibustion combined, AMC which is usually done by placing a moxa block on the handle of the acupuncture needle or placing a moxa-cone on top of a thin piece of ginger-slice.
Studies using acupuncture or moxibustion in combination with other treatments, such as medication, massage, cupping, physiotherapy, traditional Chinese herbs, or injection were not included. For control interventions, we included studies that used other standard therapies, such as injection of Western drugs, physiotherapy, oral Western medication, sham acupuncture, or no treatment.
We also included studies that compared AMC with either acupuncture or moxibustion alone. However, we did not include studies that compared the same intervention with different combinations of acupoints, as acupoint specificity was not the focus of this review. Primary outcomes extracted included measures on pain and function.
Secondary outcomes extracted included measures on quality of life. The details of acupuncture procedure were extracted according to the revised STRICTA [ 11 ], which covered acupuncture rationale, needling details, treatment regime, other components of treatment, practitioner background, and control intervention.
The methodological quality of identified studies was assessed by two authors MG and WFY independently using the Cochrane risk of bias tool [ 13 ]. The Cochrane risk of bias assessment has 6 domains: random sequence generation, allocation concealment, blinding of participants and outcome assessors, complete collection and reporting of outcome data, free of selective outcome reporting, and adequate attention to other sources of bias. Given the difficulties in blinding the acupuncturist, we only assessed the blinding of participants and outcome assessors.
According to a recent report by Wu et al. Therefore a telephone inquiry to the first authors, and, if they were not available, to the second authors, was conducted to find out how many of them truly met acceptable standards for allocating participants to study groups. We used Review Manager Software 5. Publication bias would be assessed by drawing a funnel plot if there were ten studies or more included in the meta-analysis.
Meta-analysis would only be performed, if studies had no domain rated as having high risk of bias by the Cochrane risk of bias assessment and had sufficient similarities in clinical characteristics [ 13 ]. The search identified English and Chinese potentially relevant citations for review. After removal of duplicates, English and Chinese citations were left. One hundred ninety-six full-text articles were retrieved for further assessment.
Two studies were duplicated publications [ 15 , 16 ]. Finally, 19 studies 14 Chinese, four English, one Italian met the inclusion criteria and were included in this review.
All 19 included studies were full length journal reports. Of the 19 studies, 14 were published in Chinese and were conducted in China; four were published in English, three of which were conducted in Germany [ 15 — 17 ] and one was conducted in Canada [ 18 ].
The remaining study was conducted in Italy and published in Italian [ 19 ]. Together these studies involved a total of subjects, with being in the treatment arm and in the control arm. All included trials used a two-armed, parallel group design, except for the Shen et al. The sample size of the included studies ranged from 16 to subjects.
The terminology used for LEP varied between studies. Twelve studies [ 18 — 29 ] used the term lateral epicondylitis, whereas the term tennis elbow was used by four studies [ 30 — 33 ] to describe the condition. One study used both terms in its title, but in the text consistently used the term lateral epicondylitis [ 17 ]. One study used the term chronic epicondylitis [ 15 ] and the remaining study used the term chronic elbow pain [ 16 ].
We decided to use the term LEP, rather than epicodylitis as research has shown that the pathophysiology of tennis elbow is a breakdown of the tendon tendinosis rather than inflammation [ 34 ]. In this review the term LEP refers to pain at the lateral side of the elbow region, especially to pain which originates from the lateral epicondyle.
The duration of the LEP described in the included studies varied from seven days to five years. Follow-up periods varied from one day up to one year after the last treatment. One study [ 16 ] used non-invasive sham acupuncture at BL 13 on the back, in which subjects were stimulated with a pencil like probe and were shown an acupuncture needle.
The other two studies [ 15 , 17 ] inserted real acupuncture needles a few centimeters away from traditional acupoints, their interconnecting lines meridians and painful pressure points. Two studies [ 29 , 33 ] used scarring moxibustion, in which the moxa was burned indirectly on the skin, and the area was allowed to heat up to the extent of blister-formation, which would turn into fully formed scar tissue after a period of two to four weeks.
The remaining study [ 22 ] reported to allow the moxa-cones to heat up the local area until the skin became red and hot to touch, but not to a degree that would cause blister formation. For control treatments, Jin et al. Acupuncture alone was used in ten studies, of which nine [ 15 — 19 , 21 , 30 — 32 ] used manual stimulation and one study [ 20 ] employed electro-acupuncture. Moxibustion alone was used in three studies [ 22 , 29 , 33 ], and AMC was used in seven studies [ 20 , 23 — 28 ].
The most commonly used acupoints were local tender points Ashi points which were used by 14 studies. Only one study [ 16 ] employed an exclusively distal needling approach, in which the ipsilateral Yang Ling Quan GB 34 acupoint was used. The total number of treatment sessions ranged from one to The number of needles used per session ranged from one to 12 needles. The number of moxa-cones used in the moxibustion and AMC interventions ranged from two to seven cones per acupoint.
Although all the trials reported the methods of acupoint selection, only Fink et al. Only three studies [ 15 , 16 , 19 ] reported the background of the TCM practitioner. All studies had at least 1 domain rated as high risk of bias, except the study by Fink et al.
Adequate randomization sequence generation was described in only four studies [ 15 , 18 , 31 , 32 ]. Adequate allocation concealment was described in none of the studies. All studies addressed incomplete outcome data adequately and reported all outcome measures. Five studies [ 20 , 23 , 27 — 29 ] had not examined between-group imbalance at baseline.
Once production of your article has started, you can track the status of your article via Track Your Accepted Article. The focus of the journal includes, but is not confined to, clinical research, summaries of clinical experiences, experimental research and clinical reports on needling techniques, moxibustion techniques, acupuncture analgesia and acupuncture anesthesia. Article types considered for publication include reviews, academic discussion, education and academic lectures, research on historical documents, introduction to typical cases, meridian-collaterals and acupoints, proved acupoint or prescriptions of acupoints, and news reports. We also provide many author benefits, such as special discounts on Elsevier publications and much more. Please click here for more information on our author services. Please see our Guide for Authors for information on article submission. In partnership with the communities we serve; we redouble our deep commitment to inclusion and diversity within our editorial, author and reviewer networks.
The task of acupuncture-moxibustion treatment is to select a few meridian points, insert a needle, and give appropriate stimulus at the appropriate depth.
Metrics details. Acupuncture and moxibustion are more integrated in the Chinese healthcare system than in the national healthcare systems of other countries. Development of acupuncture and moxibustion in China is making progress in this field. For overseas researchers, this commentary offers perspectives on the current status of acupuncture and moxibustion in China and examines relevant opportunities and challenges in healthcare reforms.
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Once production of your article has started, you can track the status of your article via Track Your Accepted Article. The focus of the journal includes, but is not confined to, clinical research, summaries of clinical experiences, experimental research and clinical reports on needling techniques, moxibustion techniques, acupuncture analgesia and acupuncture anesthesia. Article types considered for publication include reviews, academic discussion, education and academic lectures, research on historical documents, introduction to typical cases, meridian-collaterals and acupoints, proved acupoint or prescriptions of acupoints, and news reports. We also provide many author benefits, such as special discounts on Elsevier publications and much more. Please click here for more information on our author services.
The therapeutic effects were observed after continuous treatment for 3 months. The total effective rate was Acupuncture plus ginger-partitioned moxibustion is better than Ibuprofen sustained release capsules in treating dysmenorrhea. This is a preview of subscription content, access via your institution. Rent this article via DeepDyve.
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