Inspired by Kwon et al 2024.[1]
EA – electroacupuncture
MA – manual acupuncture (referred to as AC in the paper)
CHHF – cold hypersensitivity in the hands and feet
VAS – visual analogue scale
WHOQOL-BREF – World Health Organisation quality of life brief scale
QoL – quality of life
ANOVA – analysis of variance– key to acronyms
This paper reports a multicentre trial from South Korea. Three universities were involved in the project, which recruited from November 2019 to September 2020. The study participants were women (n=72) aged between 19 and 59 who experienced cold hands and feet, which made them uncomfortable in their daily activities.
In order to be included in the trial they needed to show a temperature differential between the hand and arm of at least 0.3oC or between the foot and thigh of at least 2oC after 10 minutes at a room temperature of 24oC. A non-contact thermometer was used to measure temperature at set points on the limbs. Actually, they used acupuncture points, which is an interesting and convenient use of such points for descriptive terms. The points were LU4, PC8, ST32, and LR3. Only the left side was used for this initial screening prior to inclusion, but subsequently temperature difference was measured bilaterally.
The women included were randomised 1:1:1 to three parallel groups: EA, MA, or no treatment control. The points used in the acupuncture groups were TE5, LI4, SP6, and LR3. In the MA group, 0.20x30mm needles were simply inserted and left in place for 15 minutes. In the EA group, pairs of points in each limb were stimulated at 2Hz for 15 minutes at the highest intensity tolerated without pain. The treatments were applied twice a week for 5 weeks.
The time points used in the trial were baseline (T0), that was after randomisation and before treatment, immediately following the 5 weeks of treatment (T1), and after a further 4 weeks of follow-up (T2).
The primary outcome was VAS for CHHF symptoms (0 to 10 – no cold to the most severe cold imaginable). Other outcomes included skin temperature measurements as performed to determine inclusion in the study, with the average difference taken for the upper limbs and lower limbs separately. The WHOQOL-BREF was also used. This is a brief QoL assessment covering 4 domains – physical, psychological, social, and environmental.
Unfortunately, there was a baseline (T0) difference in the hand VAS, but fortunately this was not the case for the foot VAS. Both sets of VAS scores improved and there was a significant difference between groups at T1 and T2. There was a trend in favour of the EA group although the trial was too small to compare these groups directly.
Temperature differences were only significant in the feet at T2 (one-way ANOVA), but there were no differences in the between group comparisons over time (repeated measures ANOVA) in terms of changes in temperature difference.
The WHOQOL-BREF was significantly different between groups (repeated measures ANOVA) in only one domain, and that was the environmental domain. I assume this result occurred by chance as I cannot conceive of any reason why acupuncture would alter satisfaction with your environment without altering the domains of physical or psychological health. The social domain could conceivably change a little through acupuncture, I guess, if you took a particular liking to your acupuncturists.
I only found one other paper on PubMed including the terms cold hypersensitivity [ti] AND acup* [tiab]. It was an experimental trial published 10 years ago studying the effects of EA on oxaliplatin-induced neuropathic cold hypersensitivity in rats.[2]
It is a nice, neat study, also from South Korea, demonstrating differences between 2Hz and 100Hz EA and significant effects of 2Hz EA at a regional non-acupuncture point, although EA at ST36 was better. The group also demonstrated that the effects were mediated by endorphin release rather than by noradrenalin.
References
1 Kwon N-Y, Yu J-S, Kim D-I, et al. Effectiveness of electroacupuncture and acupuncture in alleviating cold hypersensitivity in the hands and feet: A randomized controlled trial. PloS One. 2024;19:e0313789. doi: 10.1371/journal.pone.0313789
2 Moon HJ, Lim B-S, Lee D-I, et al. Effects of electroacupuncture on oxaliplatin-induced neuropathic cold hypersensitivity in rats. J Physiol Sci. 2014;64:151–6. doi: 10.1007/s12576-013-0297-0
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