Background: Neck pain is a common musculoskeletal symptom that has negative effects on quality of life and work productivity. Acupuncture has been widely used for neck pain, and a number of randomized controlled trials (RCTs) and systematic reviews (SRs) have evaluated its effectiveness. However, previous studies have obtained inconsistent results regarding the effects of acupuncture for neck pain, and there is no SR for the comparative efficacy and safety of various types of acupuncture. Therefore, we herein conducted a SR and network meta-analysis to compare and rank different types of acupuncture with respect to their effectiveness in treating neck pain. Methods: We searched 9 electronic databases for relevant RCTs published from their inception to July 1, 2021. Pairwise meta-analyses and network meta-analysis were performed with R software using the frequentist framework. Change of pain intensity was assessed as the primary outcome, and change of pain-related disability and efficacy rate were assessed as secondary outcomes. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument were used to evaluate the quality of the included RCTs and the certainty of the evidence. Results: A total of 65 RCTs involving 5266 participants and 9 interventions were included. Three network meta-analyses were constructed for the following: pain intensity (42 RCTs, 3158 participants), pain-related disability (21 RCTs, 1581 participants), and efficacy rate (40 RCTs, 3512 participants). The results indicated that fire acupuncture, electroacupuncture, and warm acupuncture were more effective than manual acupuncture in terms of pain intensity reduction and efficacy rate, and that electroacupuncture decreased pain-related disability more effectively than manual acupuncture. Fire acupuncture ranked first among the 9 interventions. The overall q of evidence was very low according to the GRADE assessment. The reported adverse events were not serious. Conclusion: Fire acupuncture, warm acupuncture, acupoint catgut embedding, and electroacupuncture ranked higher than other interventions (usual care, sham acupuncture, no treatment) in reducing the pain and disability index scores and the efficacy rate. However, the included trials were evaluated as being of low quality; thus, we recommend additional well-designed RCTs with larger sample sizes to confirm these findings. Systematic review registration: PROSPERO, CRD42021235274.

Su-Ji Choi, YunSeok Choi, Yeon Sun Lee, Eun-Ji Noh, Dong-Il Kim. Korean J Acupunct 2021;38:43-61. https://doi.org/10.14406/acu.2021.004

Background: Overactive bladder (OAB) is a common disease in menopausal women that can negatively affect a patient’s quality of life and cause high stress levels. Despite several studies of the effects of electroacupuncture (EA) and manual acupuncture (MA) on OAB, to our knowledge, there has been no direct comparison between EA and MA for postmenopausal OAB in a single trial. The object of this study was to evaluate the effectiveness and safety of EA at two frequencies (2 and 16 Hz) and MA for OAB in postmenopausal women. Methods: In this multicenter, randomized, controlled, parallel clinical trial, 147 participants were allocated randomly to 16 Hz EA, 2 Hz EA or MA groups in a 1:1:1 ratio. All participants received EA or MA twice a week for 6 weeks at CV3, CV4, GV20 and bilateral KI3 and SP6. The EA groups also received electrical stimulation at 2 or 16 Hz at CV3/CV4 and KI3/SP6. A total of 140 participants completed 6 weeks of treatment with 16 Hz EA (n = 48), 2 Hz EA (n = 46) or MA (n = 46) and were followed-up after 4 weeks. The primary outcome measurement was the change in the number of micturitions per 24 hours (averaged over 3 days) from baseline to week 6. Secondary outcome measures included daytime and nocturnal micturitions per 24 h, total number of urinary urgency and urge urinary incontinence (UUI) episodes over 3 days, overactive bladder symptom score (OABSS) and King’s Health Questionnaire (KHQ) score. Results: The primary outcome did not significantly differ between groups ( p = 0.160). Of all secondary outcomes, there was a significant difference only in total urinary urgency, which was reduced in 2 Hz EA versus MA groups (−9.9 ± 10.37 vs −4.3 ± 7.21, p = 0.012). Otherwise, there were no significant differences between groups. There were no serious adverse events reported during the treatment period. When symptoms were re-evaluated at week 10 (4 weeks post-treatment), most scores were similar to week 6 but there remained no significant differences between groups. Conclusion: There were no significant differences between 2 Hz EA, 16 Hz EA and MA for the treatment of OAB-related symptoms in postmenopausal women, except for a tentative finding that 2 Hz EA may reduce the number of urinary urgency episodes compared to MA (secondary outcome without correction for multiple testing). Trial registration number: KCT0003912 (Clinical Research Information Service).

The objective of this study was to conduct a systematic review and network meta-analysis to evaluate and compare the effectiveness of various types of acupuncture for menopausal hot flashes (HF). Randomized controlled trials (RCTs) were retrieved from 8 electronic databases, and the risk of bias was evaluated for the included studies. Pairwise meta-analysis and network meta-analysis were performed using Review Manager and R software for indirect comparison and ranking, respectively. In total, 23 RCTs (2,302 patients) were eligible for systematic review, of which 10 were included in network meta-analysis. Network meta-analysis showed manual acupuncture (MA) had the highest probability of reducing HF frequency and severity, followed by sham acupuncture (SA), electroacupuncture, usual care, or no treatment; furthermore, warm acupuncture significantly improved menopause-specific quality of life compared with MA or electroacupuncture. Compared with hormone replacement therapy, acupuncture had less efficacy in reducing HF frequency but enhanced menopause-specific quality of life. There was no significant difference between MA and SA in mitigating HF. The existing evidence showed that MA could be used for alleviating menopausal HF. However, it is recommended that more high-quality RCTs should be performed.

Objectives: The aim of this study was to find out whether east asian herbal medicine (EAHM) treatment alone is effective in improving pregnancy-related indicators compared to conventional medicine in women with Diminished Ovarian Reserve (DOR).Methods: We searched eligible studies from PubMed, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure Database, CiNii, Korean Medical Database, Korean Studies Information Service System, Oriental Medicine Advanced Searching Integrated System, ScienceOn. GRADE pro was used to evaluate the current evidence of the study.Result: A total of 5 studies, 325 women with DOR were included. EAHM showed a significant effect on improvement of pregnancy rate (n=270, RR 2.13 [95% CI 1.44 to 3.15], Z=3.78, p=0.0002, I2=0%) and Anti-Mullerian Hormone (AMH) level (n=211, SMD 0.82 [95% CI 0.40 to 1.25], Z=3.80, p=0.0001) compared to conventional medicine. In ovulation rate (n=156, RR 0.86 [95% CI 0.70 to 1.06], Z=1.43, p=0.15, I2=0%), Antral Follicle Count (n=245, SMD 0.27 [95% CI -0.25 to 0.79], Z=1.01, p=0.31), and follicle stimulating hormone (n=245, SMD 0.29 [95% CI -0.13 to 0.70], Z=1.36, p=0.17) level, EAHM showed similar effects to conventional medicine. In this study, the most frequently used herbal medicines were Cuscutae Semen, Dipsaci Radix, and Angelicae Gigantis Radix.Conclusion: This meta-analysis showed that EAHM could improve pregnancy rates and AMH levels in women with DOR. However, more well-designed RCTs will have to be performed further in the future.