Hip and Trending Holistic Medicine

Stimulated by Jung et al 2020.[1] Image from Slashme on Wikipedia . I wonder if the person or committee that came up with the acronym MACE had ever seen this image of the fruit of Myristica fragrans (nutmeg) split open to show the seed with the surrounding aril (also known as mace). I cannot help thinking it looks a bit like a ventricle. It is somewhat ironic that last week I rather dismissed a paper on acupuncture in hypertension and the fMRI activation findings associated with certain points,[2] and just a few days later we publish this huge retrospective cohort study on acupuncture and MACE in hypertension. MACE – Major Adverse Cardiovascular Events HT – Hypertension I don’t recall seeing the acronym MACE before, but I guess it is part of the terminology used within these huge healthcare databases. It will be higher up the tree of terms from those conditions we are more familiar with as clinicians: myocardial infarction (MI), stroke and death! I have highlighted most...

Stimulated by Yu et al 2020,[1] and Zhang et al 2020.[2] Image from Federico Beccari on Unsplash . The key paper I am highlighting this week comes from the same imaging centre in Boston that gave us Rewiring the brain with acupuncture .[1] It was another paper that I nearly missed, but a subsequent paper in Acupuncture in Medicine led me to take a closer look. The paper from Acupuncture in Medicine is considerably less sophisticated,[2] and raises more questions than it answers, but it allows us to make some contrasts in terms of methods. In this paper 31 patients with essential hypertension were randomised to receive one of two acupuncture protocols daily for 5 days per week in two consecutive weeks. Resting state fMRI was performed before and after the first session and then again at the end of the treatment course. The group that was intended to receive the proper treatment (Group A) had LR3 and KI3 needled bilaterally with a technique that would have been close to both th...

Stimulated by Qin et al 2020,[1] and Pei et al 2020.[2] Image modified from Figure 1 of Qin et al 2020.[1] The first paper I am highlighting this week is an adverse event report attributed to acupuncture. It is quite unusual for two reasons. First, as the title states, the case presented with a shoulder dysfunction that turned out to be an atraumatic anterior dislocation. Second, following manual relocation of the humeral head, the x ray film image suggested persistent inferior subluxation, which subsequent MRI demonstrated to be a collection in the subdeltoid bursa. This collection proved to be an abscess that grew methicillin sensitive Staph aureus. Further questioning of the patient revealed a formerly undeclared history of acupuncture for cervical spondylosis around one month prior to presentation. As is usually with case reports that are written by the specialist team who deal with the adverse event, there is insufficient detail of the acupuncture to draw clear conclusions...

Stimulated by Lin et al 2020.[1] Image from HVAC photoshoot 2012.[2] This paper caught my eye for two reasons. First because the title implied the results might be useful for clinical practice, and second because it was an acupuncture trial published in the journal Pain , a journal that does not publish acupuncture trials very often. It is not a huge trial (n=60), and technically it is not a positive trial, but it did show some differences between groups. Some will be surprised that they managed to show any difference between groups when both received electroacupuncture (EA) to local points for their OAK (OsteoArthritis of the Knee). That is what is quite unique about this paper, because there was a big difference between groups in terms of the frequency and total number of treatments applied. EA was applied for 30 minutes to LR9–GB33 and two other points based on the location of pain, and the related meridian points. The extra points Xiyan were used, but I was pleased to see t...

Stimulated by Arriaga-Pizano et al 2020.[1] Image by  Cesar Marquez  on  Unsplash . This paper was published online on 20 th May, and it took me a while before I had a closer look and discovered that it is really quite unique. It was a subsequent paper published a week later, a systematic review of acupuncture in low back pain (LBP),[2] that led me to considering devoting a blog to the topic. …it packs quite a lot into a single paper Having looked a bit closer at Arriaga-Pizano et al , I am quite excited to tell you why this is such a unique paper. It is relatively small (n=36 plus n=24) and focuses or rather healthy males (athletes), but it includes lots of different aspects: electroacupuncture (EA) vs sham; EA vs diclofenac; treatment of induced LBP; treatment of chronic LBP; release of catecholamines after EA; and assessment of the potential anti-inflammatory effect of those catecholamines released by EA. So, it packs quite a lot into a single paper. We do...

Stimulated by Lin et al 2020,[1] Park et al 2020,[2] and Khan et al 2019.[3] Shifen Waterfalls, Shifen, Taiwan . Image by  Vernon Raineil Cenzon  on  Unsplash , modified by MC in Lightroom. What is the risk of mortality associated with acupuncture? Well, it depends on the context of course, and I am using this title to draw together a few recent papers that I want to highlight. The main paper demonstrating a reduced risk of mortality associated with acupuncture, and the others highlighting adverse effects with the potential of mortality. The first paper, published online on 20 th May in Acupuncture in Medicine , is another of the large retrospective observational studies from Taiwan. Lin et al found 17 121 subjects who had been hospitalised with hip fracture between 2000 and 2010. This number was reduced by exclusion of open and pathological fractures to 11 551. From this sample they identified 925 who had received at least one acupuncture treatment within ...

Image by  Paweł Czerwiński  on  Unsplash . The main paper this week was an obvious choice as it is a big clinical trial published in a mainstream general medicine journal. Currently the paper has not surfaced on PubMed, although it is published online. I was tipped off by an email from the journal editor as I had been one of the reviewers. Annals of Internal Medicine I am pleased to say that we published the pilot study in Acupuncture in Medicine ,[2] which lead up to this definitive multicentre clinical trial.[1] Note that we only published it in early February! I remember considering highlighting it at the time, but it didn’t make the cut. Well, it does now! PDS – postprandial distress syndrome The papers are on postprandial distress syndrome (PDS) the most common subclassification of functional dyspepsia (FD). The pilot study randomised 42 patients and the larger trial, just published, randomised 278. The populations both met the Rome IV criteria for P...

Stimulated by Li et al 2020,[1] and Kim et al 2020.[2] Image by Sharon Pittaway on Unsplash . I was looking around for a story, and I thought I ought to check through the Online First papers from Acupuncture in Medicine . I’m sure you frequently do the same. Another paper from Lisa’s team (see last week’s blog ) caught my eye. She had mentioned it on Women’s Health Day, but there was a lot of other data too, so I am again a bit late to get to this one. It was published just over a month ago, so that is some improvement from last week. I did see it when it came out, but it is an observational cohort study, and it didn’t tickle me intellectually until I saw this second, more recent paper with which to make a contrast. Does acupuncture have metabolic effects? They are both investigating the metabolic effects of acupuncture. One is a cohort of 80 women with polycystic ovarian syndrome and insulin resistance treated 3 times a week for 6 months, and the other is a sham controll...

Stimulated by Risal et al 2019.[1] Yes, I am late to this party! Well, in my defence, there is no mention of ‘acup’ anywhere in the text of this paper, so it did not pop up in my searches back in December 2019 when it was published. By the way, ‘acup’ is a really useful set of letters if you want to search for any word related to acupuncture or acupressure, and you don’t get any false positives… there do not seem to be any words with this combination of letters that are not associated with the subject. Last Wednesday was the BMAS Women’s Health Day. We have held this day every year since 2007, and it is led by Elisabet (Lisa) Stener-Victorin… a unique surname to search for in the literature as well by the way. Lisa has been a full professor at the Karolinska Institute in Stockholm for the last few years, having moved her lab from the University in Göteborg (Gothenburg in English). She is certainly one of the most prolific researchers within the acupuncture field in the West, and in...

Stimulated by Kim et al ,[1] and Lu et al .[2] No sooner than I have blogged about acupotomy for the first time (last week), than another novel related technique is reported. The first paper I am highlighting is a case report of the use of round acupuncture in carpal tunnel syndrome (CTS). The second paper is another trial of acupuncture in CIPN (chemotherapy–induced peripheral neuropathy). There is a link between the two I will relate concerning a case I have seen in clinic. Round acupuncture Round acupuncture utilises a needle that has similar dimensions to the acupotomy needle I described in the last blog. The difference is that the end is smooth and round, unlike the chisel shape of the acupotomy needle. In this case report, the needle dimensions were 0.80x80mm, so that is the same gauge as a green hypodermic needle. The patient had surgical release for bilateral CTS 9 years prior. Symptoms recurred after excessive use of her right wrist, and these did not respond to stero...

Stimulated by Jeong et al ,[1] and Huang et al .[2] Screengrab from Day 19 of ‘What’s the point’ . I am highlighting 2 papers. The first listed above, and most recent, raises some interesting points, but the second paper, from last year is much more interesting. I reviewed the latter for Pain Medicine, and then when it was published, I found that I could not access the full text. I wanted to highlight it on this blog at the time but was not able to access it until it was much later. So, in short, I am using this first paper from last week as an excuse to return to one I missed. Acupotomy Have you heard of acupotomy? Well, it is a rather surgical form of acupuncture that uses needles shaped like small chisels. The needles used in this study were 0.75mm in diameter and 80mm in length, and they were inserted after skin anaesthesia with Emla cream. For comparison, a 21G green hypodermic needle, typically used to take a blood sample, is just over 0.8mm in diameter. The insert...