Evidence on acupuncture therapies is underused in clinical practice and health policy

Lu, Liming; Zhang, Yuqing; Tang, Xiaorong; Ge, Shuqi; Wen, Hao; Zeng, Jingchun; Wang, Lai; Zhao, Zhen; Rada, Gabriel; Ávila, Camila; Vergara, Camilo; Tang, Yuyuan; Zhang, Peiming; Chen, Rouhao; Dong, Yu; Wei, Xiaojing; Luo, Wen; Wang, Lin; Guyatt, Gordon; Tang, Chunzhi; Xu, Nenggui

doi:10.1136/bmj-2021-067475

Cited by 74 publications

(84 citation statements)

References 28 publications

(81 reference statements)

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“…The main time is 30 min (31.71%) (Feng et al, 2013 ; Tian et al, 2015 ; Han et al, 2017 ; Jiang et al, 2017 ; Lin et al, 2017 ; Liu et al, 2017 ; He et al, 2018 ; Yang et al, 2019 ; Gao et al, 2020 ; Wang Z. et al, 2020 ; Wang H. L. et al, 2021 ; Bu et al, 2022 ; Chen et al, 2022 ), 20 min (21.95%) (Wang et al, 2004 ; Li and Lai, 2007 ; Lin and Wang, 2008 ; Shao et al, 2008 ; Wei et al, 2011 ; Zhu et al, 2012 , 2013 ; Zhang et al, 2017 ; Su et al, 2019 ), 30 S (21.95%) (Zhao et al, 2011 ; Zhang et al, 2014 ; Li et al, 2015 , 2016 ; Ye et al, 2017b ; Du et al, 2018 ; Yang et al, 2018b ; Pan et al, 2021 ; Xu and Zhang, 2022 ) and 10 min (17.07%) (Niu et al, 2009 ; Zhu et al, 2018 ; Wang L. et al, 2020 ; Yang et al, 2020 ; Zheng et al, 2020 ; Cao et al, 2021 ). All literatures indicated the duration of the entire treatment course, namely 14 days (42.86%) (Li et al, 2015 , 2016 ; Wang et al, 2015 ; Ye et al, 2017b ; Du et al, 2018 ; Yang et al, 2018b , 2019 , 2020 ; Zhu et al, 2018 ; Gao et al, 2020 ; Guo et al, 2020 ; Ma et al, 2020 ; Wang L. et al, 2020 ; Wang Z. et al, 2020 ; Zheng et al, 2020 ; Cao et al, 2021 ; Pan et al, 2021 ; Lu et al, 2022 ), 15 days (11.90%) (Wang et al, 2004 ; Li and Lai,…”

Section: Resultsmentioning

confidence: 99%

“…Acupuncture is the most widely used traditional and complementary medicine, it was used in 113 countries worldwide, and was commonly performed to treat disorders of the motor, nervous, digestive, endocrine, and reproductive systems (Zhang et al, 2022 ). Recent studies have found that acupuncture showed very clear efficacy in the treatment of VD (Lu et al, 2022 ). With the deepening of animal studies, a large amount of evidences showed that acupuncture can effectively treat cognitive dysfunction in animals through multiple targets or pathways (Ye et al, 2017a ).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of acupuncture in animal models of vascular dementia: A systematic review and network meta-analysis

Shi

Zhang

et al. 2022

Front. Aging Neurosci.

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Background and purposeAcupuncture is widely used in clinical practice for the treatment of vascular diseases. However, the protocol, efficacy, and mechanism of acupuncture in animal models of vascular dementia are still controversial. Based on the above problems, we initiated this comprehensive study.MethodsTo analyze the literatures included in this study, 4 databases were searched and the SYRCLE's Risk of bias tool was employed. To perform the subgroup analysis of different acupuncture methods and the Review Manager 5.3 was applied. Meanwhile, the pairwise and network meta-analysis were conducted using Addis 1.16.8. The outcomes included escape latency, number of crossings, time spent in the target quadrant, and swimming speed.ResultsForty-two studies with a total of 1,486 animals were included in this meta-analysis. According to the results from subgroup analysis, GV20 + ST36 (Baihui + bilateral Zusanli) combined with 14-day manual acupuncture can obtain best improvement of the rats cognitive function among all acupuncture regimens (MD: −23.41; 95%CI: −26.66, −20.15; I2 = 0%; P < 0.001). The heterogeneity of other acupuncture treatments was significantly higher than that of GV20 + ST36, because the treatment courses were not uniform. Pair-wise and network comparisons are highly consistent. The major results of the network meta-analysis were as follows, In comparison to the impaired group, the acupuncture group showed significantly reduced escape latency (MD: −25.87; 95%CI: −30.75, −21.12), increased number of original platform crossings (MD: 2.63; 95%CI: 1.94, 3.34) and time spent in the target quadrant (MD: 7.88; 95%CI: 4.25, 11.44). The overall results of the network meta-analysis are as follows: the normal and sham-operated groups performed the best, followed by medicine and acupuncture, while no effect was found in the impaired group treated with non-acupoint and palliative.ConclusionsAcupuncture significantly improves cognitive function in rats with vascular dementia. Compared to other acupuncture plans, (GV20 + ST36, MA) and 14 -day manual acupuncture can be used to obtain better results. The main mechanism of acupuncture in the treatment of vascular dementia is reduced oxidative stress, neuronal inflammation, and apoptosis, as well as the increased synaptic plasticity and neurotransmitters.Systematic review registrationhttps://inplasy.com/inplasy-2021-11-0036/, identifier: INPLASY2021110036.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of acupuncture in animal models of vascular dementia: A systematic review and network meta-analysis

Shi

Zhang

et al. 2022

Front. Aging Neurosci.

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“…In conclusion, our case shows that acupuncture eliminated the symptoms of weakness and numbness and pain in ICI-related GBS patient's limbs and improved their quality of life. Recent research shows that acupuncture has advantages in treating neurological disorders ( 49 ). Based on our experience, we believe that acupuncture may be an effective, economical, and safe complementary therapy for treating GBS.…”

Section: Discussionmentioning

confidence: 99%

Acupuncture Treatment of Guillain–Barré Syndrome After Using Immune Checkpoint Inhibitors: A Case Report

Liu

et al. 2022

Front. Neurol.

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Guillain–Barré syndrome(GBS) is an autoimmune-mediated peripheral neuropathy. Immune checkpoint inhibitors (ICIs) are the standard treatment for cancer and may lead to immune-related adverse events (irAEs) such as GBS. Corticosteroids, plasma exchange (PE), and intravenous immunoglobulin (IVIG) are currently accepted treatments for ICI-induced GBS. However, there are still adverse reactions, and the effect of relieving symptoms is not as good as expected. Safe and effective complementary replacement therapy to alleviate GBS symptoms and ameliorate the quality of life is urgently required. In this case, a 63-year-old man received ICI therapy and antitumor chemotherapy for lung malignancy. After two courses of treatment, the patient gradually developed limb weakness, numbness, and pain at the ends of the limbs, with cerebrospinal fluid (CSF) albuminocytological dissociation, and electromyography (EMG) suggested demyelinating changes and was diagnosed as GBS. Although the patient received high doses of intravenous gamma globulin and limb weakness symptoms were alleviated, there was still significant numbness and pain in the extremities. After four times of acupuncture treatments, the patient complained that the symptoms of limb numbness and fatigue were significantly alleviated without any discomfort. This case report may provide a new alternative and complementary therapy for immune checkpoint inhibitor-induced GBS, but more definitive and robust evidence is needed to support its efficacy.

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“…The adverse events related to acupuncture are usually mild, and most of them can be avoided through standardizing clinical practices [ 22 , 23 ]. With the rapidly growing research on the clinical application of acupuncture, the evidence of acupuncture's therapeutic effects on neurological disease has increased [ 24 ]. Clinical studies have proved the superior effects of acupuncture on ameliorating vertigo severity and improving the vertebrobasilar blood flow velocity in PCIV patients [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Blood Flow Velocity Modulation and Clinical Efficacy of Acupuncture for Posterior Circulation Infarction Vertigo: A Systematic Review and Meta-Analysis

Zhao

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. Vertigo is a cardinal symptom of posterior circulation infarction (POCI). Acupuncture is demonstrated to have a beneficial effect on posterior circulation infarction vertigo (PCIV). However, the mechanism of acupuncture therapy is not clarified. This study aims to assess the cerebral blood flow velocity modulation and clinical efficacy of acupuncture for PCIV patients. Methods. We conducted this systematic review for clinical randomized controlled trials (RCTs) regarding acupuncture on PCIV. The study duration was from September 2020 to September 2021. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP. The publication date was set from inception to August 31, 2020. Based on the inclusion and exclusion criteria, two researchers independently screened literature and extracted data including basic study information, intervention details, outcome details, and adverse events. Outcome measures included the blood flow velocities of vertebrobasilar arteries and the Clinical Effective Rate of posterior circulation infarction vertigo. Pooled data were presented as standardized mean differences (SMDs) and relative risks (RR), with 95% confidence intervals (CIs). The meta-analysis was conducted using Review Manager software version 5.3.0. Results. A total of 20 eligible RCTs (1541 participants) were included in this review, which compared acupuncture therapy (1 RCT) or acupuncture combined with pharmaceutical therapy (19 RCTs) to pharmaceutical therapy in patients with posterior circulation infarction vertigo. 7 studies assessed the blood flow velocities of the basilar artery examined by Transcranial Doppler (TCD), 8 studies assessed the bilateral vertebral arteries, and 13 studies evaluated the Clinical Effective Rate of posterior circulation infarction vertigo. Meta-analysis results showed that blood flow velocities of the basilar artery (SMD = 0.58, 95% CI = 0.40–0.76; P < 0.05 ), left vertebral artery (SMD = 0.48, 95% CI = 0.22–0.73; P < 0.05 ), and right vertebral artery (SMD = 0.44, 95% CI = 0.19–0.69; P < 0.05 ) were significantly higher in the acupuncture group compared with the control group. Clinical Effective Rate (RR = 1.22, 95% CI = 1.15–1.29; P = 0.792 ) was significantly better in the acupuncture group compared with the control group. Conclusions. This study shows that acupuncture therapy is useful in improving the blood flow velocity of vertebrobasilar arteries and Clinical Effective Rate in patients with posterior circulation infarction vertigo. However, double-blind, sham-controlled trials with large sample sizes are required to support our conclusions.

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Evidence on acupuncture therapies is underused in clinical practice and health policy

Abstract: Nenggui Xu and colleagues call for more effective evidence dissemination of and research into promising acupuncture therapies

Cited by 74 publications

References 28 publications

Efficacy of acupuncture in animal models of vascular dementia: A systematic review and network meta-analysis

Efficacy of acupuncture in animal models of vascular dementia: A systematic review and network meta-analysis

Acupuncture Treatment of Guillain–Barré Syndrome After Using Immune Checkpoint Inhibitors: A Case Report

Cerebral Blood Flow Velocity Modulation and Clinical Efficacy of Acupuncture for Posterior Circulation Infarction Vertigo: A Systematic Review and Meta-Analysis

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