Consideration in Randomized Placebo-Controlled Trial on Neck Pain to Avoid the Placebo Effect in Analgesic Action.

Background: In neck pain treatment, many therapies are focused on etiology, while it is well-known that placebo analgesia is also present in these therapies. The specific efficacy for etiology may be underestimated by ignoring their actual placebo effect. In this study, a logistic regression analysis is used to explore the risk factors causing different placebo responses in patients with neck pain among two RCTs. The probability of the placebo effect is predicted based on these risk factors. Methods: Trial A and Trial B were similarly designed, randomized, double-/single-blind, placebo-controlled trials in patients treating neck pain with Qishe pill or Shi-style manipulation. Both studies set a placebo pill twice a day or traction for every other day as control. For further analyses on the placebo effect in neck pain management, logistic regression was used to assess subgroup-placebo interactions. The odds ratio assessed a significant influence on the placebo effect. Results: In this pooled analysis, the total number of patients recruited for these two studies was 284, of which 162 patients received placebo treatment (placebo drug or traction for every other day). No statistically significant differences are found at baseline between the participants with placebo effect and non-placebo effect in the gender, age, and disease duration except in VAS and NDI at the initial time. There are numerically more patients with placebo effect in the shorter disease duration subgroup (< 4 months [76%]), higher initial VAS subgroup (>60 mm [90%]), and worse initial NDI subgroup (>24 [72%]) compared with the gender and age subgroup. An ROC curve is established to assess the model-data fit, which shows an area under the curve of 0.755 and a 95% confidence interval of 0.677-0.830. Participants who show placebo effect after 2 weeks have significantly lower VAS scores after 4 weeks, while there is no significant difference in NDI improvement between the two groups after 4 weeks. Conclusion: Neck pain patients with shorter disease duration are more likely to overscore their pain severity, because of their less experience in pain perception, tolerance, and analgesia expectation.

[Design and application of a new type of fascia stretching cup].

In order to comprehensively stretch human fascia, adjust the biomechanical balance of fascia system and promote the recovery of physiological function of fascia, a new type of fascia stretching cup is designed. This design is composed of two or more silica gel cups and elastic stretching belts between cups. The bottom surface of the silica gel cup has an annular exhaust groove, which can increase the adsorption capacity of the cup to the skin. In the meanwhile, a removable magnet is placed in the groove at the top of each silica gel cup to assist analgesia. This design is suitable for the prevention and treatment of acute and chronic tendon and bone diseases with imbalance of meridians and tendons.

[Cumulative analgesic effects of EA stimulation of sanyinjiao (SP 6) in primary dysmenorrhea patients: a multicenter randomized controlled clinical trial].

OBJECTIVE: To compare the cumulative analgesic effect of electroacupuncture (EA) stimulation of Sanyinjiao (SP 6), Xuanzhong (GB 39) and non-acupoint for primary dysmenorrhea patients. METHODS: A total of 200 patients with primary dysmenorrhea were randomly assigned to Sanyinjiao (SP 6, a dysmenorrheal-relieving related acupoint) group, Xuanzhong (GB 39, an unrelated acupoint) group, non-acupoint group and control group, with 50 cases in each group. The participants were administered with EA (2 Hz/100 Hz, 0.5-1.6 mA) at SP 6, GB 39 and non-acupoint for 30 min, once daily for 3 consecutive days. The intensity of the pain was ranked from 0 (no pain) to 100 (intolerable) using visual analogue scale (VAS) and RSS (Cox retrospective symptom scale) severity rating scores (RSS-COX 2) before and after three interventions. RESULTS: In comparison with the control group, VAS and RSS-COX 2 scores were significantly lower in the SP 36, GB 39 and non-acupoint groups (P < 0.001, P < 0.05), suggesting an alleviation of the pain severity after EA treatment. No significant differences were found among the three treatment groups in both VAS and RSS-COX 2 scores (P > 0.05). CONCLUSION: EA stimulation of SP 6, GB 39 and non-acupoint has a good cumulative analgesic effect in patients with primary dysmenorrhea.

[Doctor HUANG Shi-ping's acupuncture with golden needles].

Taking Doctor HUANG Shi-ping as the representative, the school of Huang's golden needle is based on Chinese martial art. Golden needles are adopted as main tool. Attaching great importance on the combination of acupuncture and moxibustioin, it is also characterized with penetrating needling with long needles. Through the development of three generations, it once outshone other schools in the field of acupuncture, and became famous all over the world. It made great contribution to the development of the course of acupuncture. However, with the development of the history, the form of acupuncture education as well as apparatus were all undergone an unified reform. Therefore, Doctor HUANG Shi-ping's acupuncture school be lost gradually.

Immediate analgesia effect of single point acupuncture in primary dysmenorrhea: a randomized controlled trial.

BACKGROUND: Acupuncture is often used for primary dysmenorrhea. OBJECTIVE: To assess the efficacy of a single point of acupuncture in the management of primary dysmenorrhea compared with sham acupuncture and no acupuncture. METHODOLOGY: Patients with primary dysmenorrhea were randomly assigned to acupoint group (n=50), unrelated acupoint group (n=50), nonacupoint group (n=46), or no acupuncture group (n=48). Acupuncture and sham acupuncture were administered once-daily for 3 days with electro-acupuncture at Sanyinjiao (SP6) that was specifically designed to treat primary dysmenorrhea, or an unrelated acupoint (Xuanzhong, GB39), or nonacupoint location. The primary outcome was pain intensity as measured by a 100-mm visual analog scale (VAS) at baseline; 5, 10, 30, and 60 minutes following the start of the first intervention. Cox retrospective symptom scale (RSS), verbal rating scale (VRS), pain total time, and proportion of participants using analgesics were also recorded during three menstrual cycles. RESULTS: The primary comparison of VAS scores demonstrated that patients receiving acupuncture (-15.56 mm, 95% CI -22.16 to -8.95, P<0.001), unrelated acupoint (-18.14 mm, 95% CI -24.81 to -11.47, P<0.001), and nonacupoint (-10.96 mm, 95% CI -17.62 to -4.30, P=0.001) treatment presented significant improvements compared with no acupuncture group. There were no significant differences among the four groups with respect to secondary outcomes. CONCLUSION: Acupuncture was better than no acupuncture for relieving the pain of dysmenorrhea following a single point of acupuncture, but no differences were detected between acupoint acupuncture and unrelated acupoint acupuncture, acupoint acupuncture and nonacupoint acupuncture.

Systematic review of clinical trials of acupuncture-related therapies for primary dysmenorrhea.

BACKGROUND: Acupuncture-related therapies might be an effective intervention for primary dysmenorrhea. OBJECTIVE: To evaluate the effects of acupuncture-related therapies for treating primary dysmenorrhea. SEARCH STRATEGY: A specified literature search was performed of the Cochrane Library, MEDLINE, EMBASE, CNKI, and CBM databases. SELECTION CRITERIA: All clinical controlled trials pertaining to acupuncture-related therapies for primary dysmenorrhea were included, and the quality of the trials was assessed. DATA COLLECTION AND ANALYSIS: Two independent reviewers were responsible for data extraction and assessment. The original data of each trial were analyzed with software (Revman 4.2), but a meta-analysis could not be carried out because of the heterogeneity of the trials. MAIN RESULTS: Thirty randomized controlled trails (RCTs) and two controlled clinical trials (CCTs) were identified. Most of the trials were of low methodologic quality (six trials were Grade B and 26 trials were Grade C). Data analysis indicated that there were conflicting results regarding whether acupuncture-related therapies were more effective than control treatments. However, there was a small, methodologic sound trial of acupuncture which suggested that acupuncture was more effective than control groups (placebo acupuncture: WMD=-0.57 and 95% CI=-0.76-0.38; standard control: WMD=-.19 and 95% CI=-0.37-0.01; visitation control: WMD=-1.04 and 95% CI=-1.28-0.80). CONCLUSIONS: Because of low methodologic quality and small sample size, there is no convincing evidence for acupuncture in the treatment of primary dysmenorrhea. There is an urgent need for randomized, blinded, placebo-controlled trials to assess the effects of acupuncture.

[Clinical study on the indications of 33 acupoints].

Multi-central randomized controlled method was used to scientifically verify indications of 33 acupoints and provide definite clinical basis for the indications of single acupoint. Of the 52 studies, 40 studies showed that the therapeutic effect in acupuncture observation groups were better than the control group; 11 studies showed similar therapeutic effect of the two groups, and 1 study showed the acupuncture observation group was worse than the control group. Therefore, results indicate that in a certain observation cycle, acupuncture at single acupoint have different effects on diseases.