Inspired by Tu et al 2022.[1]
ARC – acute renal colic
key to acronyms
BUCM – Beijing University of Chinese Medicine
IF – impact factor
MA – manual acupuncture
IM – intramuscular (injection – a route for administering drugs)
NSAID – non-steroidal anti-inflammatory drug
aka – also known as
de qi – typical needling sensation perceived by the patient plus a change in the resistance to needle manipulation perceived by the acupuncturist
VAS – visual analogue scale (score)
This is another efficacy trial of acupuncture in ARC from China, but this time from a well-known research team from BUCM, and published in JAMA Network Open (IF 13.37).[1]
It is a similar size (n=80) to a previous 2-arm double dummy study I highlighted at the end of last year: Acupuncture for ARC 2021.[2] This time acupuncture (MA) was compared with a superficial off-point sham as adjunctive interventions alongside the use of an IM injection of an NSAID (diclofenac 50mg). So, to be clear, in this trial everyone got an injection of diclofenac after randomisation, and then they either got real MA or sham MA as an additional treatment.
EX-UE-7 aka Yaotongdian
2 extra points on the dorsum of each hand
The points used in the real MA group were 2 extra points (EX-UE-7 aka Yaotongdian) on the dorsum of each hand (4 points in total per patient). They are in palpable depressions in the proximal interosseus spaces between the second and third and the fourth and fifth metacarpals. These points were needled using 40×0.30mm needles to a depth of 8-10mm and the needles manipulated to achieve de qi sensations. In the sham group, one of 8 different sets of 2 non-points each were randomly allocated and needled 1-4mm in depth without stimulating de qi. These non-points were located 3mm away from real acupuncture points that were considered to have no specific role in the treatment of ARC.
The primary outcome was the response rate at 10 minutes after needle manipulation. A responder was defined as a patient whose pain score on VAS reduced by at least 50%. VAS pain was measured at baseline and then at 0, 5, 10, 15, 20, 30, 45, and 60 minutes after needle manipulation. VAS was measured in the standard way by presenting patients with a 10cm line with ‘no pain’ written at one end and ‘worst pain possible’ at the other.
The response rate at 10 minutes was 77.5% in the real MA group and 10% in the superficial sham group (p<0.001). The VAS scores were significantly different between the groups in favour of the real MA intervention at all time points up to 60 minutes.
It took 30 minutes from injection of diclofenac plus sham MA for the VAS to drop below 4 (ie a satisfactory level for post-op pain). This was achieved in the real MA group in just 5 minutes.
There is no reference to the Lanzhou paper in this one from Beijing, so I guess the two groups were not aware of each other’s research activity, and it seems likely that the Beijing paper had already been submitted for publication before the Lanzhou paper was published.
The speed of response to MA was similar in both studies, but the final mean VAS score was lower in the more recent paper suggesting that the combination of NSAID plus real acupuncture may have a small advantage.
…the speed of onset of pain relief seems so much faster than NSAIDs, surely it would catch on!
The MA interventions were quite different, as were the sham techniques. We saw needling in leg points (SP9 and SP6) with 0.16mm diameter needles in Lanzhou compared with needling into interossei in the hand with 0.30mm diameter needles in Beijing. I imagine there was quite a difference in the strength of sensation between these approaches. Personally, I would go for larger diameter needles in the leg points as an initial approach. This would be so easy to teach, and the speed of onset of pain relief seems so much faster than NSAIDs, surely it would catch on!
References
1 Tu J-F, Cao Y, Wang L-Q, et al. Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial. JAMA Netw Open 2022;5:e2225735. doi:10.1001/jamanetworkopen.2022.25735
2 Zhang X, Liu X, Ye Q, et al. Acupuncture versus Lornoxicam in the Treatment of Acute Renal Colic: A Randomized Controlled Trial. J Pain Res 2021;14:3637–48. doi:10.2147/JPR.S339006
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