Inspired by Cao et al 2025.[1]
ARC – acute renal colic
RCT – randomised controlled trial
IF – impact factor
IM – intramuscular
UTI – urinary tract infection
VAS – visual analogue score (usually 10cm horizontal line with no pain or worst pain at each end)
NRS – numerical rating scale (11-point digital verbal scale from 0 to 10)
NSAID – non-steroidal anti-inflammatory drug– key to acronyms
This is now the third RCT (n=84) of acupuncture in ARC that I have highlighted on this blog. The first was in 2021,[2] and the second in 2022.[3] All 3 were similar in size (n≈80) with 2 parallel arms. There was another trial (a prospective cohort trial this time) that I highlighted in 2023,[4] but this involved acupressure. All four can now be found in the blog category ARC.
To the best of my knowledge, these are the only such RCTs in the English language. There are, of course, quite a few Chinese language papers (at least 13), and I have highlighted a review of these on a previous blog.[5]
This latest paper is published in QJM (IF 7.3), which is the official journal of the Association of Physicians of Great Britain and Ireland. It was set up in 1907 by none other than Sir William Osler, and originally was called the Quarterly Journal of Medicine.
The 3 RCTs of acupuncture are all slightly different. The first was a double dummy comparison of acupuncture versus IM lornoxicam. The second used acupuncture or sham alongside IM diclofenac. The third one (the current trial) used acupuncture against a superficial off-point sham prior to the use of any pharmacological analgesia.
The first trial used points in the legs (SP9 and SP6) against a non-penetrating sham in the same points (my favourite design and preferred points). The second and third (current) trials used a set of 2 extra points on the back of each hand (yaotongdian). Both used superficial off-point shams, but they were a little different. I prefer the current trial’s sham, which used the yellow (0.6×0.15mm) Seirin Pyonex needles on the inside of the upper arm and forearm.
The big difference with the current trial was that the population was drawn from patients suspected to have ARC, but in whom the diagnosis had not been confirmed by imaging. In the previous studies, the diagnosis of ARC had been confirmed prior to inclusion. I guess this is how they justified withholding pharmacological analgesia. In the end all but 3 patients had the diagnosis confirmed. Of the 3 that did not have ARC, 2 were diagnosed with UTIs, and one was classified as abdominal pain of unknown origin (and presumably was subject to further investigation).
The trajectory of pain relief on VAS (previous trials) or NRS (current trial) was very similar in the acupuncture groups of all 3 trials. From a baseline of 7 to 8, the score had dropped to 4 or below at 5 minutes. In the control groups that received IM NSAID, it took 20 to 40 minutes for the VAS to fall to 4. In the current trial, the NRS in the control group was still over 5 at 30 minutes, and 60% of this group went on to receive an analgesic injection compared with one third of the acupuncture group.
As I have said before, my preference for treatment would be to use the leg points rather than the points in on the back of the hand. There are various reasons for this that I will discuss at the webinar on Wednesday.
References
1 Cao Y, Qu Z, Zhang S, et al. Early acupuncture intervention for pain relief in emergency department patients with suspected acute renal colic caused by urinary calculi: A randomized clinical trial. QJM. 2025;hcaf011. doi: 10.1093/qjmed/hcaf011
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
3 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
4 Chen C, Zhang Z, Lin M, et al. Acupressure versus parecoxib sodium in acute renal colic: A prospective cohort study. Front Med. 2022;9:968433. doi: 10.3389/fmed.2022.968433
5 Chen H-T, Kuo C-F, Hsu C-C, et al. Clinical efficacy of acupuncture for pain relief from renal colic: A meta-analysis and trial sequence analysis. Front Med. 2022;9:1100014. doi: 10.3389/fmed.2022.1100014
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