On the 18th December another Cochrane Review popped up on my daily PubMed search: Acupuncture for symptomatic gastroparesis. Cochrane reviews are substantial pieces of work, with numerous peer and editorial review stages built in to the process. The rigorous approach to assessing bias and the adoption of the GRADE system to summarise findings often results in conclusions expressing great caution and uncertainty even if, as in this case, most of the data favours acupuncture over conventional treatments.
As I have alluded to before in this blog, the inability to control for patient expectation (of receiving acupuncture) without performing an active intervention, leaves RCT design stuck between high risk of bias from lack of blinding and very small effects of needling over gentle needling (sham). In this review, most of the trials compared acupuncture with drugs, so the results were always destined to be downgraded to the lowest level of certainty (GRADE), principally because of the high risk of bias attributed to a lack of blinding.
Results and conclusions aside, this review had a nice surprise for me up its sleeve, and I found this in the background section under the subtitle: Description of the intervention. In my recent blog I focussed on the stark difference between acupuncture reviews in the subsection titled: How the intervention might work. So when this review popped up on the 18th I went straight to the ‘how it might work’ text, and in doing so my eye ran over the immediately preceding text. I was very impressed, so my next stop was the author details… surely I must know the team!
They come from Korea, and the second author was responsible for this translation…
Now go and have a read of the background of the review. Here is a direct link for you: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009676.pub2/full#CD009676-sec1-0002
A brief but impressive summary of the situation and challenges of clinical acupuncture research, and more importantly from my perspective is where it appears; ie within the most prestigious reviews library in medicine.
For those of you not tempted to read directly from the Cochrane library, gastroparesis is a state of abnormally reduced gastric motility without physical obstruction of the bowel. Laboratory data clearly shows that stimulation of the soma (via acupuncture) can influence bowel motility through neural reflexes,[2,3] and possibly other mechanisms. So provided that the nervous system is sufficiently intact following surgery or chronic disease, it seems reasonable to evaluate the technique in clinical circumstances.
The present review makes some useful suggestion for the way forward: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009676.pub2/full#CD009676-sec1-0007
- Kim KH, Lee MS, Choi T-Y, et al. Acupuncture for symptomatic gastroparesis. Cochrane database Syst Rev 2018;12:CD009676. doi:10.1002/14651858.CD009676.pub2
- Sato A, Sato Y, Shimada F, et al. Changes in gastric motility produced by nociceptive stimulation of the skin in rats. Brain Res 1975;87:151–9. doi:10.1016/0006-8993(75)90411-4
- Noguchi E. Acupuncture regulates gut motility and secretion via nerve reflexes. Auton Neurosci 2010;156:15–8. doi:10.1016/j.autneu.2010.06.010