Pinaverium Reduces Symptoms of Irritable Bowel Syndrome in a Multicenter, Randomized, Controlled Trial.

BACKGROUND & AIMS: Pinaverium bromide (pinaverium) is an antispasmodic commonly used to treat irritable bowel syndrome (IBS), but there has been no convincing evidence for its effectiveness and safety. We evaluated these in a prospective, double-blind, placebo-controlled trial. METHODS: Patients with IBS, based on Rome III criteria, were assigned randomly to groups given pinaverium (50 mg, 3 times/day; n = 218) or placebo (3 times/day; n = 209) at 4 hospitals in China, from August 2012 through December 2013. The primary end points were reductions in abdominal pain and Bristol stool score. Secondary end points were reductions in pain and stool frequencies and abdominal discomfort and its frequency. We also evaluated changes in IBS global symptom scores and the number of adverse effects. RESULTS: Based on an intention-to-treat analysis, a significantly larger proportion of patients receiving pinaverium met either of the primary end points (50.0% met an end point at week 2, and 77.5% met an end point at week 4), compared with placebo (P < .001). Pinaverium reduced at least 1 secondary end point in significantly more patients receiving pinaverium (76.1% had a reduction at week 2, and 91.7% had a reduction at week 4) than placebo (P < .001). Based on symptom scores, significantly higher percentages of patients receiving pinaverium believed that their IBS symptoms improved (60%) than in the placebo group (34%; P < .001); 29% of patients in the pinaverium group believed that their IBS symptoms stayed the same (29%) and 11% said they worsened. Pinaverium was not associated with severe adverse effects; common side effects included nausea (3.7%), dizziness (3.2%), increased blood pressure (2.3%), and abdominal discomfort (2.3%). CONCLUSIONS: Based on a controlled trial, pinaverium reduces symptoms of IBS. It can be considered a first-line treatment for IBS. TRIAL REGISTRATION: NCT01641224 (www.ClinicalTrials.gov).

Discussion on Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis: a randomized controlled trial published in Arthritis & Rheumatology. / 对Arthritis & Rheumatology"å¼ºåŒ–é’ˆåˆºå¯¹æ¯”å‡é’ˆæ²»ç–—è†éª¨å ³èŠ‚ç‚Žéšæœºå¯¹ç §è¯•éªŒ"一文的讨论.

Professor LIU Cunzhi's team from Beijing University of Chinese Medicine published Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis: a randomized controlled trial in Arthritis & Rheumatology on November 10th, 2021, which demonstrates that three-session per week acupuncture is safe and effective for knee osteoarthritis patients. Experts from home and abroad discussed in depth the study design, acupuncture protocol, and interpretation of the results of the trial, emphasizing the importance of pretrial implementation, acupuncture dosage, reasonable setting of control group and assessing the efficacy of acupuncture, and pointed out that the mechanism of acupuncture for knee osteoarthritis still needs further study, and how to promote acupuncture for knee osteoarthritis according to the clinical practice abroad while ensuring the efficacy of acupuncture is worthwhile to explore.

A Retrospective Look at 50 Years of Acupuncture in the United States.

This article describes several key events concerning the introduction of acupuncture to the United States, considers the mainstream acceptance of acupuncture and the development of the acupuncture "infrastructure" for the past 50 years, and speculates on acupuncture's future trajectory. In the author's opinion, "the two factors which will contribute the most to the continuing development of acupuncture are acupuncture consumers and scientific research."

[Acupuncture randomized controlled trials: comparing China-based vs. Western-based studies].

With the worldwide spread of acupuncture as a therapeutic modality and the rapid development of acupuncture clinical research, the number of acupuncture randomized controlled trial (RCT) studies is steadily increasing in China and around the world. However, the results of these studies seem to come from two different worlds indeed. Chinese RCT studies overwhelmingly demonstrate positive outcomes from acupuncture, whereas Western-based studies generally conclude that there is no discernible difference between acupuncture and a placebo. Why should there be such different outcomes when the same scientific method is being used? This paper analyzes factors that may be contributing to the different outcomes between China-based and Western-based RCT studies by considering and comparing starting points, purpose, study design, investigators, acupuncture treatment regimen, methodological quality, results, conclusions, and deficiencies in acupuncture RCT. Based on these comparisons, this paper examines the value of acupuncture RCT in general, and the methodological confusion which seems to have propagated from study to study. We propose the following suggestions to remediate the acupuncture clinical research paradigm: First, acupuncture clinical researches should be carried out step-by-step according to universal, agreed-upon research protocols. Second, norms for reporting outcome metrics need to be standardized for each stage of a study.

[Trajectory of the internationalization of acupuncture at different times: thoughts on post-internationalization of acupuncture].

The process of acupuncture internationalization includes two basic stages: pre-internationalization period and post-internationalization period. The former is mainly characterized by unidirectional export led by China, while other countries and regions are mainly learning and absorbing. The latter is manifested by the localization transformation and development of acupuncture in foreign countries, which brings severe challenges to traditional Chinese acupuncture. It is helpful to grasp the international trend of acupuncture development by actively understanding the trajectory of acupuncture internationalization. To effectively cope with the challenges brought by the post-internationalization period, modern acupuncture is needed to be developed proactively. Only by establishing a modern acupuncture system compatible with modern science, can China continue to lead the international acupuncture academic development.

[Discussion on Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial published in JAMA Internal Medicine].

Professor LIANG Fan-rong's team from Chengdu University of TCM published Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial in JAMA Internal Medicine on July 29, 2019, which demonstrates that acupuncture as an adjunctive therapy is safety and effective for mild and moderate chronic stable angina. Sixteen experts at home and abroad conducted serious discussions on the research design, evaluation methods, principles and mechanisms, clinical significance and enlightenment of future acupuncture research, and provided practical suggestions for acupuncture and moxibustion to go global and gain international recognition.

Two Evidence-Based Acupuncture Models.

Modern clinical trials have produced controversial data interpretation which refutes conventional standard teachings and practices. Acupuncture scholars and practitioners have been stimulated to scrutinize these trials and analyze conventional practices. This paper presents two acupuncture models which address these issues. One rationalizes the clinical trial results with newer understanding of acupuncture points and techniques, while the other reconciles these results with rediscovered techniques of palpating points and performing needling. These two models indicate that acupuncture is in transition from classical model to evidence-based models.

[Localization of Chinese acupuncture-moxibustion in the United States: the openness of modern acupuncture-moxibustion system].

The internationalization of Chinese acupuncture-moxibustion is inevitably accompanied by the localization of acupuncture-moxibustion. The localization of acupuncture-moxibustion will inevitably promote the diversified development of acupuncture-moxibustion technique and theory, which fully demonstrates the openness of modern acupuncture-moxibustion. In this study, the characteristics of localization of Chinese acupuncture-moxibustion in the United States are explored and studied from the following aspects: legal adjustment, technical adjustment, educational adjustment, service adjustment and theoretical adjustment.

Estimated Number of Acupuncture Practitioners in Mainland China in 2018: Multiperspectives.

Background and Objective: Acupuncture and Oriental medicine are widespread, practiced in >183 countries and regions. As such, it has played an important role in the world health care system. However, there are no official statistics available on the number of acupuncture practitioners in China. The aim of this study is to calculate the number ranges of acupuncture practitioners in China in 2018. Materials and Methods: In total, 33.708 million was used as the total number of patient visits for acupuncture in 2018 in China. This number was calculated using the data released by the National Administration of Traditional Chinese Medicine (China), in which the average daily workload of all acupuncture practitioners in China was 134,832 patient visits. Acupuncture practitioners in China are part of Chinese Medicine doctors (CMDs) at the physician level, called "acupuncture doctors." This number 134,832 was divided by the workload of a single doctor of acupuncture, which was 19.4 or 7.0 patient visits per day. These numbers were from a survey by the authors. There are also the numbers 16.0 or 9.4 patient visits per day; these numbers were calculated from the salary level of acupuncture practitioners at 10,000 Yuan per month (providing the doctor's net income was 30% or 50% in his/her gross income). From these 2 sources, the authors then obtained 2 sets of ranges of acupuncture practitioners in China in 2018. There were 9,927 CMDs in 49 big hospitals, of which 619 were acupuncture practitioners; the ratio of acupuncture practitioners to the whole of all CMDs was 6.23%. Using this ratio multiplied by the whole number of CMDs in 2018, then the number of acupuncture practitioners in China in 2018 could be obtained as well. Results: Calculating based on the workload, the range of acupuncture practitioners in China in 2018 was from 6,950 to 19,262. Calculating based on the salary level, the range was 10,618 to 17,697. Calculating based on the ratio of the number of acupuncture practitioners to the whole population of CMDs, the number was 28,360. Conclusions: The reasonable range of acupuncture practitioners in China in 2018 was 10,618 to 17,697, with a median of 14,157. Considering that some acupuncture practitioners are also engaged in teaching, research, and management, the mentioned number is enlarged by 30% to produce 18,404, which would be reasonable. It was also concluded that the density of acupuncture practitioners was 1.31 per 100,000 residents.

Convergence of Medicines: West Meets East in Newly-Discovered Organs and Functions.

Although the foundations and evolution of Chinese medicine and Western medicine are very different, an increasing amount of research has revealed that those Eastern medicine principles practiced over thousands of years are confirmed by new technologies applied to the basic science of the human body. Recent scientific discoveries present enticing opportunities to reconcile Chinese medicine theories with Western biomedicine. Is there a trend toward the convergence of Eastern and Western medicine? Four studies which exemplify the potential for convergence are described in this article. The studies present findings in regard to mesentery, interstitium, a gut-lung axis, and lung-centered hematopoiesis, and were published recently in leading journals such as Science, Nature, and Lancet.

Acupuncture price in forty-one metropolitan regions in the United States: An out-of-pocket cost analysis based on OkCopay.com.

Few studies have focused on the cost of acupuncture treatments although acupuncture has become popular in the United States (U.S.). The purpose of the current study was to examine the out-of-pocket costs incurred from acupuncture services based on an online website, OkCopay.com. We examined descriptive statistics (range, median and 20% intervals) for the cost of acupuncture "first-time visits" and "follow-up visits" in 41 metropolitan regions in the U.S. The acupuncture prices of 723 clinics throughout 39 metropolitan regions were included, except for Birmingham, Alabama and Detroit, Michigan as there was no online data available at the time of the study for these two regions. The cost range for a first-time acupuncture visit was $15-400; the highest median was $150 in Charleston, South Carolina, while the lowest was $45 in St. Louis, Missouri. The top 10 cities for the highest median were: Baltimore, Washington, D.C., New York, San Francisco, San Jose, Boston, Atlanta, Seattle, Portland and Indianapolis, with the median $120, while the median for all 723 clinics was $112. For the follow-up visits, the cost range was $15-300; the highest median was $108 in Charleston, South Carolina, and the lowest $40 in Miami, Florida. The 10 cities with highest median follow-up acupuncture visit costs were: New York, Baltimore, New Orleans, Washington, D.C., Philadelphia, San Francisco, San Jose, Seattle, Boston and Atlanta, with the median $85, while for all 723 clinics the median price was $80. The estimation of the average gross annual income of each acupuncturist from the regions studied was $95,760, while the total annual cost of patients seeking acupuncture services in the U.S. was about $3.5 billion in 2018.

Discussions on real-world acupuncture treatments for chronic low-back pain in older adults.

Chronic low-back pain (CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association (ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity; therefore, it should be effective for CLBP in older adults.

Acupuncture and the Opioid Epidemic in America.

The opioid epidemic has become a signifificant public health crisis in the United States of America. This crisis has elicited a response at high levels of governmental and health care organizations including the American College of Physicians, the Food and Drug Administration, the Joint Commission, the National Academies of Science, Engineering and Medicine, the National Association of Attorneys General, and the White House. In various ways, these organizations have recognized that acupuncture can play an important role in dealing with the opioid epidemic. This paper presents and analyzes the scientifific evidence supporting the effificacy of acupuncture in regard to opioid addiction.

Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial.

BACKGROUND: Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia. METHODS/DESIGN: The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment. DISCUSSION: Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.

To be, or not to be: The calculated politics of acupuncture in JAMA.

Ten acupuncture-related articles were published in The Journal of the American Medical Association (JAMA) between 1998 and 2017. Five studies showed positive results in terms of the effectiveness of acupuncture/Chinese medicine (CM); five studies showed negative results. This article summarizes the acupuncturerelated clinical trials published over the last 20 years in JAMA, and addresses what seems to be a fundamental ambivalence in Western medical journals regarding the scientific validity of acupuncture/CM. As yet there has been no consensus on the role of acupuncture in healthcare in Western countries. This is hardly surprising, considering the conflicting evidence found in published studies. Skepticism regarding acupuncture/CM is largely grounded in the fact that an accurate model for assessing the true clinical effects of acupuncture has yet to be created. This article discusses some of the pitfalls which result from applying Western-based scientific principles to CM, and suggests that in many cases, "negative" studies have been misinterpreted. The clinical experience of acupuncture practitioners is often in direct conflict with many of the negative conclusions published in journals. We are in need of an accurate model for sham and placebo treatments, and must analyze all published studies for design flaws and faulty conclusions.