Stimulated by recent letters in Acupuncture in Medicine.[1–4]
In the last week or so we have published several letters online, and they are all quite different and interesting, so I thought I would devote this week’s blog to a brief mention of each of them, as well as a couple of other papers out today on PubMed.
Minerva is the Roman goddess of poetry, medicine, wisdom, strategic warfare, commerce weaving and the crafts. Her Greek equivalent is Athena, who sprang forth from the head of her father Zeus (Jupiter) in full armour when his head was split open by Hephaestus in an attempt to treat Zeus’s cephalalgia. The latter was produced by Athena’s mother Metis who was hammering away on the inside of his head producing the amour for her daughter.
Anyway, Minerva is the section of the BMJ that I always used to read, made up of a selection of recent news and research findings.
The first letter is from Phyllis, a BMAS member and physiotherapist from South Africa. She has long been involved in treatment of chronic pain and has written a book detailing all the varied and different approaches she uses. She is particularly fond of electrical stimulation and describes a case where she successfully used several stimulation techniques, including electroacupuncture (EA), to help rehabilitate a patient following a gunshot wound to the head. The case involved use of NI-PRF (non-interventional pulsed radiofrequency), a relatively unknown technique that I remember Phyllis mentioning to me at a meeting some years ago. I was pleased to see that she had presented some controlled data on this technique at a conference in Zurich last year.
The second letter is a case report of successful treatment of blepharoptosis with acupuncture from Malaysia. I had not come across the term written in this way before… we had always simply used the word ptosis, but since this is from a Greek word meaning ‘to fall’, it does seem more appropriate to add the blepharon- at the start for context. The Minerva title seems all the more appropriate now!
The third letter is something quite different – a bibliometric analysis of research trends in our very own Acupuncture in Medicine. There are some lovely diagrams showing mapping of keywords used and the organisations involved in the publications analysed, but the fact that we are publishing more research from China, and a greater number of mechanistic studies in laboratory animals was not a big surprise to me, nor will it have been to our editor-in-chief David Carr.
The fourth letter describes quite an astonishing case of paralytic ileus that appeared to be improved using EA after most conventional treatment had failed. The EA treatment was very similar to that used in the huge study (n=1075) on chronic severe functional constipation that I highlighted in a previous blog. Thirty minutes of EA was applied to abdominal and leg points 3 times a day for 4 days, after which the patient passed 300ml of stool. The CT images in the report are quite striking, showing a saggital view with lots of gas in a distended abdomen before the EA treatment and much less after the treatment.
The other papers that caught my eye today are both about fibromyalgia (FM).[6,7] The first is a fairly large (n=301) clinical trial of TENS demonstrating a significant and just clinically relevant benefit for 4 weeks of real TENS over placebo TENS, and a slightly larger effect over no TENS. There was also a positive effect on fatigue.
This first paper had caught my eye because of the last author – a big name in academic physiotherapy and pain, Kathleen Sluka. I then looked at the second paper because it had an intriguing title ‘Heritability of the fibromyalgia phenotype varies by age’, and I wanted to see the results…
What would you guess?
This was a genome wide study of 26 749 individuals undergoing elective surgery at the University of Michigan. They estimated SNP-based (single nucleotide protein) heritability of the FM score by age and sex categories. Basically, how similar is the genome in patients with FM based on their age and sex. It sounds simple but 26k of full genomes is a lot of data points!
They found that there was a much stronger genetic component in younger individuals (those less than 50 years of age) compared with those over 60. There was a three-fold difference in heritability. This may be explained by increasing numbers of individuals with ‘secondary FM’ in the older group, and if you are wondering what exactly that is, there is a very nice open access editorial by Bennet and Friend in the Journal of Rheumatology on the very subject.
1 Berger P. A rehabilitation approach to a patient with traumatic brain injury. Acupunct Med 2019;:964528419884947. doi:10.1177/0964528419884947
2 Kim YJ. Acupuncture management of blepharoptosis: a case report. Acupunct Med Published Online First: 14 November 2019. doi:10.1177/0964528419883283
3 Lee I-S, Chae Y. A bibliometric analysis of acupuncture research trends in Acupuncture in Medicine. Acupunct Med Published Online First: 14 November 2019. doi:10.1177/0964528419884327
4 Zhao F, Zeng J, Xian S, et al. Acupuncture improves paralytic ileus secondary to sepsis: a case report. Acupunct Med Published Online First: 13 November 2019. doi:10.1177/0964528419883279
5 Berger P. A randomized controlled, single-blind trial to investigate if an electrical current – Non-Interventional Pulsed Radio Frequency (NI PRF) – could improve neuropathic pain and symptoms in patients with diabetic peripheral neuropathy. J Pain Reli 2018;07:80–1. doi:10.4172/2167-0846-C1-021
6 Dailey DL, Vance CG, Rakel BA, et al. A Randomized Controlled Trial of TENS for Movement-Evoked Pain in Women with Fibromyalgia. Arthritis Rheumatol (Hoboken, NJ) Published Online First: 18 November 2019. doi:10.1002/art.41170
7 Dutta D, Brummett CM, Moser SE, et al. Heritability of the fibromyalgia phenotype varies by age. Arthritis Rheumatol 2019;:art.41171. doi:10.1002/art.41171
8 Bennett RM, Friend R. Secondary Fibromyalgia. J Rheumatol 2019;46:127–9. doi:10.3899/jrheum.180611