RM Clemmons, DVM, PhD, CVA, CVFT
University of Florida
http://dog2doc.com/IVAS2011/
J Pain Symptom Manage. 2009 Apr;37(4):709-14. Epub 2008 Sep 11.
Acupuncture: what does the most reliable evidence tell us?
Many trials of acupuncture and numerous systematic reviews have recently
become available. Their conclusions are far from uniform. In an attempt to find
the most reliable type of evidence, this article provides an overview of Cochrane
reviews of acupuncture. Such reviews were studied, their details extracted, and
they were categorized as: reviews with a negative conclusion (no evidence that
acupuncture is effective); reviews that were inconclusive; and reviews with a
positive or tentatively positive conclusion. Thirty-two reviews were found,
covering a wide range of conditions. Twenty-five of them failed to demonstrate
the effectiveness of acupuncture. Five reviews arrived at positive or tentatively
positive conclusions and two were inconclusive. The conditions that are most
solidly backed up by evidence are chemotherapy-induced nausea/vomiting,
postoperative nausea/vomiting, and idiopathic headache. It is concluded that
Cochrane reviews of acupuncture do not suggest that this treatment is effective
for a wide range of conditions.
16080
412/year
 Human 12095
 Animal 3007

Scientific
(clinical trials, metaanalysis, randomized control trials)
 Human
 Animal
2605
52
67/year
Acupuncture Cites on PubMed
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
Total
Number of Cites

Year









Dog
218
Cat
235
Horse
66
Cow
38
Pig
35
Bird
12
Chicken
3
Rodent 1875
Human 12095

Total
1027
 Human 611
 Animal 130

Scientific (Clinical trials, metaanalysis, random control trials)
 Human 207
 English 113
 Chinese 89
 Animal
2

Saarto EE, Hielm-Björkman AK, Hette K, Kuusela EK, Brandão CV, Luna SP. Effect of a single
acupuncture treatment on surgical wound healing in dogs: a randomized, single
blinded, controlled pilot study. Acta Vet Scand. 2010 Oct 15;52:57.

METHODS: 29 dogs were submitted to soft tissue and/or orthopaedic surgeries. Five dogs had two
surgical wounds each, so there were totally 34 wounds in the study. All owners received instructions for
post operative care as well as antibiotic and pain treatment. The dogs were randomly assigned to
treatment or control groups. Treated dogs received one dry needle acupuncture treatment right after
surgery and the control group received no such treatment. A veterinary surgeon that was blinded to the
treatment, evaluated the wounds at three and seven days after surgery in regard to oedema (scale 0-3),
scabs (yes/no), exudate (yes/no), hematoma (yes/no), dermatitis (yes/no), and aspect of the wound
(dry/humid).

RESULTS: There was no significant difference between the treatment and control groups in the variables
evaluated three and seven days after surgery. However, oedema reduced significantly in the group
treated with acupuncture at seven days compared to three days after surgery, possibly due the fact that
there was more oedema in the treatment group at day three (although this difference was not significant
between groups).

CONCLUSIONS: The use of a single acupuncture treatment right after surgery in
dogs did not appear to have any beneficial effects in surgical wound healing.

Joaquim JG, Luna SP, Brondani JT, Torelli SR, Rahal SC, de Paula Freitas F. Comparison of
decompressive surgery, electroacupuncture, and decompressive surgery followed
by electroacupuncture for the treatment of dogs with intervertebral disk disease
with long-standing severe neurologic deficits. J Am Vet Med Assoc. 2010 Jun
1;236(11):1225-9.

DESIGN: Retrospective case series and prospective clinical trial. ANIMALS: 40 dogs between 3 and
6 years old and weighing between 10 and 20 kg (22 and 44 lb) with long-standing (> 48 hours)
clinical signs of severe neurologic disease attributable to thoracolumbar IVDD.

PROCEDURES: Thoracolumbar medullar injury was classified on the basis of neurologic signs by
use of a scale ranging from 1 (least severe) to 5 (most severe). The DSX dogs (n = 10) were
retrospectively selected from those that underwent DSX for the treatment of thoracolumbar
IVDD. In addition, 19 dogs received EAP alone and 11 dogs underwent DSX followed by EAP (DSX
+ EAP). Outcome was considered a clinical success when a dog initially classified as grade 4 or 5
was classified as grade 1 or 2 within 6 months after the end of treatment.

RESULTS: The proportion of dogs with clinical success was significantly higher for dogs that
underwent EAP (15/19) than for dogs that underwent DSX (4/10); the proportion of dogs with
clinical success for dogs that underwent DSX + EAP was intermediate (8/11).

CONCLUSIONS AND CLINICAL RELEVANCE: EAP was more effective than DSX
for recovery of ambulation and improvement in neurologic deficits in dogs with
long-standing severe deficits attributable to thoracolumbar IVDD.

GI
6
 A meta-analysis of five RCTs showed favorable effects of
moxibustion on the response rate compared to conventional
drug therapy .

Heart
13
 Acupuncture may become an additional therapeutic strategy
to improve the exercise tolerance of patients with CHF.

Blood Pressure
6
 The present study showed that radial artery blood flow
volume decreased immediately during acupuncture at the LR3 acupoint, but was increased at 180 seconds after
acupuncture.


Brain
Hearing
11
1
 Acupuncture and moxibustion therapy of
excitation-focus transfer presents superior
therapeutic effect on sudden deafness as compared
with the routine western therapy.


Reproduction
Cancer
15
13

Pain
72
 These data suggest that the presence and intensity of
de qi has no effect on the pain relief obtained for
patients with OA.
 For this pathology (neck pain), the number of needles, 5
or 11, seems not to be an important variable in
determining the therapeutic effect .
 Significant improvements (p < 0.01) in painful symptoms
and electromyographic activities of masseter muscles in
maximal habitual occlusion after laser applications in
TMJ.

Arthritis
15

Asthma
2
 Acupuncture as an adjunct therapy to conventional medical
care does not seem to affect pulmonary function in asthmatic
patients. However, 12 sessions of acupuncture treatment
during 4 weeks showed a favorable effect on the quality of
life in adult asthmatic patients.

Stroke
14
 Our meta-analyses of data from rigorous randomized shamcontrolled trials did not show a positive effect of acupuncture
as a treatment for functional recovery after stroke.
 Randomized clinical trials demonstrate that acupuncture may
be effective in the treatment of post-stroke rehabilitation.

Stem Cells
 Our results indicate that acupuncture for SCI can
mobilize human CD133(+)34(-) cells.

Depression
9
 Subjects in the experimental group (elderly in
nursing home) showed a statistically significant
improvement in depressive mood status.
 Acupuncture therapy is safe and effective in
treating major depressive disorder (MDD) and poststroke depression (PSD).

Nausea
9
 Acupuncture (P6 or traditional) showed no
significant benefit to women in pregnancy.
 Study demonstrates that electroacustimulation
(PC6) offers added protection against symptoms of
postoperative nausea and vomiting.


Obesity
Analgesia
5
53

Analgesia
 TCA was not superior to sham acupuncture.
However, acupuncturists' styles had significant
effects on pain reduction and satisfaction,
suggesting that the analgesic benefits of
acupuncture can be partially mediated through
placebo effects related to the acupuncturist's
behavior.
 Significant reductions in pain, dysfunction, and
xerostomia were observed in patients receiving
acupuncture versus usual care for neck surgery.

Hauer K, Wendt I, Schwenk M, Rohr C, Oster P, Greten J. Stimulation
of acupoint ST-34 acutely improves gait performance in
geriatric patients during rehabilitation: A randomized
controlled trial. Arch Phys Med Rehabil. 2011 Jan;92(1):7-14.

DESIGN: Multiple-blinded, randomized, controlled intervention trial.
SETTING: Geriatric ward rehabilitation.
PARTICIPANTS: 60 geriatric patients during rehabilitation.
INTERVENTIONS: Both groups received a 1-time acupoint stimulation
according to randomization. Stimulation of a verum acupoint (verum
treatment) according to principles of traditional Chinese medicine was
compared with a technically identical needle application on a
nonacupoint (control treatment) in the control group.

CONCLUSIONS: Study results showed that a 1-time



administration of a specific acupoint stimulation regimen
statistically significantly improved gait performance
during geriatric ward rehabilitation.

Landgren K, Kvorning N, Hallström I. Acupuncture reduces crying
in infants with infantile colic: a randomised, controlled,
blind clinical study. Acupunct Med. 2010 Dec;28(4):174-9. Epub
2010 Oct 18.

OBJECTIVE: To investigate whether acupuncture reduces the duration
and intensity of crying in infants with colic. Patients and methods 90
otherwise healthy infants, 2-8 weeks old, with infantile colic were
randomised in this controlled blind study. 81 completed a structured
programme consisting of six visits during 3 weeks to an acupuncture
clinic in Sweden. Parents blinded to the allocation of their children
met a blinded nurse. The infant was subsequently given to another
nurse in a separate room, who handled all infants similarly except that
infants allocated to receive acupuncture were given minimal,
standardised acupuncture for 2 s in LI4.

CONCLUSIONS: Minimal acupuncture shortened the
duration and reduced the intensity of crying in infants with
colic.

Kong JC, Lee MS, Shin BC, Song YS, Ernst E. Acupuncture for
functional recovery after stroke: a systematic review of
sham-controlled randomized clinical trials. CMAJ. 2010 Nov
9;182(16):1723-9. Epub 2010 Sep 27.



BACKGROUND: Acupuncture is frequently advocated as an adjunct treatment
during stroke rehabilitation. The aim of this review was to assess its
effectiveness in this setting.
METHODS: We searched 25 databases and 12 major Korean traditional
medicine journals from their inception to October 2009. We included
randomized controlled trials, with no language restrictions, that compared
the effects of acupuncture (with or without electrical stimulation) with sham
acupuncture. We assessed the methodologic quality of the trials using the
Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence
Database) scale.
CONCLUSIONS: Our meta-analyses of data from rigorous
randomized sham-controlled trials did not show a positive
effect of acupuncture as a treatment for functional
recovery after stroke.

Beer TM, Benavides M, Emmons SL, Hayes M, Liu G, Garzotto M, Donovan D, Katovic N,
Reeder C, Eilers K. Acupuncture for hot flashes in patients with prostate
cancer. Urology. 2010 Nov;76(5):1182-8. Epub 2010 May 21.



OBJECTIVES: To determine the effect of acupuncture on hot flash frequency and intensity,
quality of life, and sleep quality in patients undergoing hormonal therapy for prostate
cancer. Hot flashes are a common adverse effect of hormonal therapy for prostate cancer.
METHODS: Men who had a hot flash score > 4 who were receiving androgen deprivation
therapy for prostate cancer underwent acupuncture with electrostimulation biweekly for 4
weeks, then weekly for 6 weeks, using a predefined treatment plan. The primary endpoint
was a 50% reduction in the hot flash score after 4 weeks of therapy, calculated from the
patients' daily hot flash diaries. The hot flash-related quality of life and sleep quality and
biomarkers potentially related to hot flashes, including serotonin, calcitonin gene-related
peptide, and urinary 5-hydroxyindoleacetic acid, were examined.
CONCLUSIONS: Multiple placebo-controlled trials have demonstrated a
25% response rate to placebo treatment for hot flashes. Of the 22
patients, 41% had responded by week 4 and 55% overall in the present
pilot study, providing evidence of a potentially meaningful benefit.

Hübscher M, Vogt L, Ziebart T, Banzer W. Immediate effects of acupuncture on
strength performance: a randomized, controlled crossover trial. Eur J
Appl Physiol. 2010 Sep;110(2):353-8. Epub 2010 May 25.

The present study investigated the immediate efficacy of acupuncture compared to sham
acupuncture and placebo laser acupuncture on strength performance. A total of 33
recreational athletes (25.2 +/- 2.8 years; 13 women) were randomized to receive
acupuncture, sham acupuncture (needling at non-acupuncture points) and placebo laser
acupuncture (deactivated laser device) in a double-blind crossover fashion with 1 week
between trials. Assessment included bipedal drop jumps for maximum rebound height and
quadriceps maximum isometric voluntary force (MIVF). Furthermore, surface
electromyography (EMG) was used to measure the EMG activity of the rectus femoris
muscle during a 30-s sustained MIVF of the knee extensors. Mean power frequency (MPF)
analysis was applied to characterize muscular endurance. Measurements were performed at
baseline and immediately after treatment by a blinded investigator. Repeated measures
ANOVA and post hoc paired-sample t test with Bonferroni-Holm correction were used for
statistical analysis.

CONCLUSIONS: Study shows that a single acupuncture treatment was
efficacious for improving isometric quadriceps strength in recreational
athletes.

Wu MX, Li XH, Lin MN, Jia XR, Mu R, Wan WR, Chen RH, Chen LH, Lin WQ, Huang CY, Zhang
XR, Hong KD, Li L, Liu XX. Clinical study on the treatment of knee
osteoarthritis of Shen-Sui insufficiency syndrome type by
electroacupuncture. Chin J Integr Med. 2010 Aug;16(4):291-7. Epub 2010 Aug 10.



OBJECTIVE: To study the clinical effificacy of electroacupuncture (EA) on treating knee
osteoarthritis (KOA) of Shen ()-Sui () insuffificiency (SSI) syndrome type.
METHODS: A total of 245 patients (279 knees) of KOA-SSI were randomly assigned to two
groups by lottery: 141 knees in the treatment group and 138 knees in the control group. The
treatment group was managed with EA at the dominant points of Neixiyan (Ex-LE4) and
Waixiyan (Ex-LE5) as well as the conjugate points of Xuanzhong (GB39) and Taixi (KI3) for 30
min, once a day, with 15 days as one course; 2 courses were applied with a 5-day interval in
between. The control group was treated with intra-articular injection of 2 mL hyaluronic acid
into the affected joint every 7 days for 5 times in total. The clinical effects on the patients in
different stages were observed, and their symptom scores of knee and contents of
cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha
(TNF-alpha), prostaglandin E(2alpha) (PGE(2alpha)) and matrix metalloproteinases-3 (MMP3), in the knee joint fluid were measured before and after treatment.
CONCLUSIONS: EA could effectively alleviate the clinical symptoms in KOA
patients of stage III, showing an effect superior to that of hyaluronic acid. EA
also shows action in suppressing the secretion of IL-1, IL-6, TNF-alpha,
PGE(2alpha) and MMP-3 in the knee fluid.

Pontarollo F, Rapacioli G, Bellavite P. Increase of electrodermal activity of heart
meridian during physical exercise: the significance of electrical values
in acupuncture and diagnostic importance. Complement Ther Clin Pract. 2010
Aug;16(3):149-53. Epub 2010 Feb 2.

Electric field measurements of skin potential and electrical currents are physiological
indicators of electrodermal activity (EDA) and have been associated with a variety of
sensory, cognitive and emotional stimuli. The aim of this study was to investigate the EDA at
some hand acupoints before, during and after a physical exercise. EDA of eight points
located at the corner of fingernails of hands was measured in 10 healthy young volunteers
before, during and after a 14-min acute exercise in a bicycle ergometer. In pre-exercise
resting state the parameters were stable and similar between the 8 different tested points.

CONCLUSIONS: During exercise a significant increase of current (from 1000-2000
to 4000-8000 nA) was observed, with the maximal values related to the point
located on the ulnar side of the little finger, at the base of the nail,
corresponding to the Shao chong (HT9) of heart meridian.

Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt
H, Ring J, Darsow U. Influence of acupuncture on type I hypersensitivity itch
and the wheal and flare response in adults with atopic eczema - a
blinded, randomized, placebo-controlled, crossover trial. Allergy. 2010
Jul;65(7):903-10. Epub 2009 Dec 11.



BACKGROUND: Itch is a major symptom of allergic skin disease. Acupuncture has been
shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We
investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a
double-blind, randomized, placebo-controlled, crossover trial.
METHODS: An allergen stimulus (house dust mite or grass pollen skin prick) was applied to
30 patients with atopic eczema before (direct effect) and after (preventive effect) two
experimental approaches or control observation: acupuncture at points Quchi and Xuehai
[verum acupuncture (VA), dominant side], 'placebo-point' acupuncture (PA, dominant side),
no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min,
wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus
site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered.
CONCLUSIONS: Acupuncture at the correct points showed a significant
reduction in type I hypersensitivity itch in patients with atopic eczema.

Sherman KJ, Cherkin DC, Ichikawa L, Avins AL, Delaney K, Barlow WE, Khalsa PS, Deyo RA.
Treatment expectations and preferences as predictors of outcome of
acupuncture for chronic back pain. Spine (Phila Pa 1976). 2010 Jul 1;35(15):1471-7.





STUDY DESIGN: Preplanned secondary analysis of data from participants receiving
acupuncture in a randomized clinical trial.
OBJECTIVE: To determine whether patients' expectations of and preferences for
acupuncture predict short and long-term treatment outcomes for persons with chronic back
pain.
SUMMARY OF BACKGROUND DATA: Although accumulating evidence suggests that
patient expectations and treatment preferences may predict treatment outcomes, few
studies have examined this relationship for acupuncture.
METHODS: Four hundred seventy-seven acupuncture-naïve participants with chronic low
back pain who were randomized to 1 of 3 acupuncture or simulated acupuncture treatments
were the focus of this analysis. Ten treatments were provided during a 7-week period, and
participants were masked to treatment assignment. Before randomization, participants
provided expectations regarding treatment success, impressions, and knowledge about
acupuncture and treatment preferences. Outcomes of interest were functional status
(Roland score) and symptom bothersomeness at 8 and 52 weeks postrandomization,
obtained by telephone interviewers masked to treatment assignment.
CONCLUSIONS: Pretreatment expectations and preferences for acupuncture
were not found predictive of treatment outcomes for patients with chronic
back pain.

Wong CL, Lai KY, Tse HM. Effects of SP6 acupressure on pain and menstrual
distress in young women with dysmenorrhea. Complement Ther Clin Pract.
2010 May;16(2):64-9. Epub 2009 Nov 14.



OBJECTIVES: This study aims to evaluate the effects of Sanyinjiao (SP6) acupressure in
reducing the pain level and menstrual distress resulting from dysmenorrhea.
METHODS: Forty participants with dysmenorrhea were assigned to either the acupressure
group (n = 19) or the control group (n = 21). The acupressure group received 20 min of SP6
acupressure during the initial intervention session and was taught to perform the technique
for them to do twice a day from the first to third days of their menstrual cycle, 3 months
subsequent to the first session. In contrast, the control group was only told to rest.
Outcomes were measured through (1) the Pain Visual Analogue Scale (PVAS), (2) the ShortForm McGill Pain Questionnaire (SF-MPQ), and (3) the Short-Form Menstrual Distress
Questionnaire (SF-MDQ).
CONCLUSIONS: SP6 acupressure has an immediate pain-relieving effect for
dysmenorrhea. Moreover, acupressure applied to the SP6 acupoint for 3
consecutive months was effective in relieving both the pain and menstrual
distress level resulting from dysmenorrhea.

Cho SY, Jahng GH, Park SU, Jung WS, Moon SK, Park JM. fMRI study of effect on
brain activity according to stimulation method at LI11, ST36: painful
pressure and acupuncture stimulation of same acupoints. J Altern
Complement Med. 2010 Apr;16(4):489-95.




OBJECTIVES: The objective of this study was to assess differences in brain responses
between pressure and acupuncture stimulation at the same acupoint using functional
magnetic resonance imaging (fMRI).
SUBJECTS: A total of 10 healthy right-handed volunteers were studied.
DESIGN: fMRI was performed with two different paradigms; namely, pressure and
acupuncture stimulation at acupuncture points LI11 and ST36 on the left. fMRI data were
analyzed using SPM2.
CONCLUSIONS: Brain signal activation patterns according to the stimulation
methods and acupoints were observed to differ. Acupuncture stimulation
activated more regions than pressure at the same acupoint. In particular,
acupuncture stimulation activated the limbic system, such as the
parahippocampal gyrus and anterior cingulate cortex.

Hopton A, MacPherson H. Acupuncture for chronic pain: is acupuncture more
than an effective placebo? A systematic review of pooled data from
meta-analyses. Pain Pract. 2010 Mar-Apr;10(2):94-102. Epub 2010 Jan 8.



OBJECTIVES: There is controversy as to whether or not acupuncture is more effective than
placebo. To help clarify this debate, we synthesized the evidence gathered from systematic
reviews on the pooled data of high-quality randomized controlled trials comparing
acupuncture to sham acupuncture for chronic pain.
METHOD: Systematic reviews of acupuncture for the most commonly occurring forms of
chronic pain (back, knee, and head) published between 2003 and 2008 were sourced from
Ovid databases: Medline, Allied and Complementary Medicine database, Cochrane Library
and Web of Science during December 2008. Eight systematic reviews with meta-analyses of
pooled data were eligible for inclusion. Data were extracted for short- and longer-term
outcomes for the most commonly occurring forms of pain. Two independent reviewers
assessed methodological quality.
CONCLUSIONS: The accumulating evidence from recent reviews suggests that
acupuncture is more than a placebo for commonly occurring chronic pain
conditions. If this conclusion is correct, then we ask the question: is it now
time to shift research priorities away from asking placebo-related questions
and shift toward asking more practical questions about whether the overall
benefit is clinically meaningful and cost-effective?

Witt CM, Lüdtke R, Wegscheider K, Willich SN. E Physician characteristics and
variation in treatment outcomes: are better qualified and experienced
physicians more successful in treating patients with chronic pain with
acupuncture? J Pain. 2010 May;11(5):431-5.

The aim of this paper was to quantify the influence of the physician's training and
experience in the field of acupuncture on the outcome in patients with chronic pain. Patients
visiting their physician because of chronic low back pain, headache, pain due to
osteoarthritis of the knee or hip, or neck pain, were included in 4 multicenter, randomized,
controlled studies. All patients received routine care; patients in the acupuncture groups
received additional acupuncture treatment (on average 10 sessions). The data was pooled,
and the 3-month change from baseline of the SF-36 bodily pain subscale as the main
outcome defined. A total of 9,990 patients (mean age 49.6 +/- 13.6 years, 68% female)
treated by 2,781 physicians (mean age 46.3 +/- 7 years, 37% female) were analyzed. The
physicians had 7.3 +/- 5.2 (mean +/- sd) years of experience in acupuncture and their mean
duration of formal acupuncture training had been 287 +/- 321 hours. The outcome was
markedly improved in the acupuncture group.

CONCLUSIONS: We identified only 1 physician characteristic with a significant
influence on the outcome: Internists performed better and orthopedists worse
than the average physician. Neither the duration of training nor the duration
of experience had any impact on the extent of the acupuncture effect.

Science supports the use
of acupuncture for many
conditions that affect
man and animals.

We will have work to do
to provide better
evidence for where
acupuncture can be
applied best for the
treatment and
prevention of disease.