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Background: Abdominal organ injuries are a rarely reported complication when deep acupuncture needling is applied to the abdomen. In order to ascertain the allowable needle insertion range (ANIR) of the abdomen region, we selected acupoint CV12, which is commonly used for treating gastric disease, and ANIR was measured with an ultrasound device. Method: Eighty-five healthy volunteers were recruited, of which 83 cases of ultrasound images were obtained. To investigate the prediction factor of ANIR, we also measured several anthropometric factors. Results: The average ANIR was 25.3 ± 10.2; generally, the ANIRs of females were thicker than those of males; and the liver was observed in 62.7% subjects' ultrasound images. The non-observed group showed thicker ANIR and higher BMI than the liver-observed group. Conclusion: There are reliable variables that make it possible to predict the ANIR. It is advised to refer to anthropometric factors in needling acupoint CV12 to avoid complications with the acupuncture treatment. However, individual differences are not negligible when applying deep needling. Thus, if the risk is not judged before or during the procedure, practitioners could consider the patient's ANIR on CV12 when applying acupuncture by examining the individual anatomical structures using ultrasound and considering internal organ positions to prevent adverse events due to acupuncture. [ABSTRACT FROM AUTHOR]

Objective: Electroacupuncture (EA) is used in the treatment of various diseases through the use of electrical stimulation. Reports of adverse events (AEs) associated with acupuncture are relatively consistent, but the safety of EA has been less well reported. In this systematic review, we provide a summary of the types of AEs related to EA in clinical practice. Methods: Twelve electronic databases, including those in English (PubMed, Ovid-EMBASE, CENTRAL), Korean (KMbase, KISS, NDSL, KISTI, OASIS), Chinese (CNKI, Wanfang, Weipu) and Japanese (J-STAGE), were systematically searched for single case studies and case series through April 2018. There were no language restrictions. We included clinical studies in which EA was used as a key intervention and in which AEs that may have been causally related to EA were reported. Results: Thirty-seven studies, including 27 single case studies and 10 case series, were evaluated. The most frequently reported AEs were pallor (eight cases), skin pigmentation (eight cases), vertigo (seven cases), chest tightness (six cases), vomiting (six cases) and unconsciousness (five cases). Thirty-one cases (62%) achieved full recovery and three cases (6%) achieved partial recovery. There were also three cases of death (6%). Conclusion: AEs related to EA included acupuncture-related AEs and serious AEs induced by electrical stimulation. Currently, specific stimulation conditions associated with EA-specific AEs are not identifiable due to inappropriate reporting. However, skin pigmentation, syncope or spasm, implantable cardioverter-defibrillator shock, cardiac emergencies, electrical burns, and potential internal organ injury are potential EA-specific AEs regarding which physicians should be cautious in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Ninety percent of patients with advanced cancer have moderate to severe pain, and up to 70% of patients with cancer pain do not receive adequate pain relief. This randomized controlled clinical trial was designed to determine the feasibility and evaluate the effects and safety of intradermal acupuncture (IA) in patients who were being administered analgesics for cancer pain. Methods: Advanced cancer patients experiencing pain were randomly assigned to IA or sham IA treatment for 3 weeks (15 patients for each group), wherein the CV12, bilateral ST25, LI4, LR3, PC06, and Ashi points were selected and stimulated. Follow-up evaluations were conducted 3 weeks after the end of treatments. The grade and dosage of analgesics for cancer pain, pain intensity, quality of life, and safety were assessed. Results: Twenty-seven patients (90%) completed 6-week trial, and no serious adverse events were associated with either IA or sham IA procedures except the transient side effect such as fatigue. Nine patients in the IA group (64.3%) and 5 in the sham IA group (38.5%) responded to the 3-week intervention. These patients were mostly in the nonopioid and the weak opioid levels of the World Health Organization analgesic ladder. Self-reported pain declined by −1.54 ± 1.45 and −1.15 ± 1.57 in the IA and sham IA groups, respectively, with improved quality of life reported. Conclusions: IA treatment appears feasible and safe for advanced cancer patients. It might reduce analgesic usage in the early World Health Organization analgesic ladder stage cancer patient, though it could not show significant outcome differences due to design limitation of sham IA. [ABSTRACT FROM AUTHOR]

Abstract Introduction BMI and body weight have been regarded as factors that determine an individual’s needling depth. But in previous research on GB21 (jianjing), we observed various cases in which subjects with the same BMI had a different safe needling depth. GB21 is high risk acupoint that can occur pneumothorax, So precise and safe treatment is required. The aim of this study was to investigate the correlation between needling depth and various anthropometric parameters, focusing on acupoint GB21. Methods Ultrasonographic images GB21 from 52 (24 male and 28 female) healthy volunteers were recorded during normal respiration. Subject‘s weight, height, neck circumference, shoulder width, chest circumference, and abdominal circumference were also measured. Results BMI was positively associated with maximal safe needling depth (r = 0.48, p < 0.001); however, NC, SW, and height showed highly significant correlations with maximal safe needling depth (NC, r = 0.75, p < 0.001; SW, r = 0.57, p < 0.001; height, r = 0.52, p < 0.001). CC and AC had lower correlations than BMI (CC, r = 0.41, p < 0.01; AC, r = 0.32, p < 0.05). Conclusion Although BMI has been traditionally used as an important index in determining needling depths, our study showed that anthropometric parameters have a higher correlation with maximal safe needling depth on a high-risk acupoint associated with organ damage. Thus, anthropometric parameters may be potentially useful as an initial screening tool to avoid adverse effects of Acupoint GB21. [ABSTRACT FROM AUTHOR]

Introduction This is a retrospective case series exploring the therapeutic benefits of acupuncture-related modalities in combination with standard care (integrative treatment) for people with degenerative disc disease (DDD) with axial low back pain. Methods The medical records of 24 patients with DDD were retrospectively reviewed and their demographic and clinical characteristics recorded. They were grouped into two according to the therapeutic intervention. The disability and pain intensity of the low back were measured using Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The rate of improvement was studied retrospectively to evaluate the feasibility of acupuncture-related modalities as part of combination therapy. Result Of the 24 patients who met the eligibility criteria, 11 (45.8%) received integrative treatment. There were significant reductions in the disability and pain intensity in 11 patients who received an integrative package care (P < 0.05). Additionally, clinically relevant changes in the mean differences and improvement rates of ODI and NRS were observed in both groups; however, the differences in ODI and NRS (11.09 and 2.18, respectively) and improvement rates (33.82% and 39.09%, respectively) were greater in integrative treated patients than in conventionally treated ones. Conclusions This study describes the use of acupuncture-related modalities and raises the possibilities of their use in combination therapy for the improvement of function and pain management in patients with DDD. In light of these promising results, future clinical trials with attention to appropriate patient selection, guidelines for integrative treatment, and optimal standards for outcome measurement are necessary to evaluate the effectiveness of integrative treatment. [ABSTRACT FROM AUTHOR]

Acupoint GB21 (Jianjing) is used for treating back and shoulder pain but is associated with a risk of pneumothorax. We aimed to determine the SND (safe needling depth) at GB21 according to posture and breathing in real time. Ultrasonographic images of GB21 during normal breathing, inspiration, and expiration in a SP (sitting position) were acquired for 52 healthy volunteers. Images were also acquired during normal respiration in the PP (prone position) with arms raised and lowered. The average SND was greater for men than for women (p<0.05). Analysis of variance revealed that the SND was greater for the PP than for the SP (p=0.01 and p<0.05, resp.). Although the SND tended to change according to posture, the average depth tended to deviate widely in some subjects. During breathing, the differences between inspiration and expiration were less than 1 mm in most subjects, but some showed differences more than 4.5 mm. The SND at GB21 was greater in overweight subjects and significantly greater in the PP and during maximal expiration. However, intragroup differences were greater than the intergroup differences. Therefore, it is dangerous to simply apply needling depth on a gender or BMI basis. The practitioner would adjust the SND by examining the individual anatomical structures. [ABSTRACT FROM AUTHOR]

Urinary bladder cancer (UBC) is one of the most common cancers, with 1 out of every 26 men and 1 out of every 80 women worldwide developing the disease during their lifetime. Moreover, it is a disease that predominantly affects the elderly and is becoming a major health problem as the elderly population continues to rapidly increase. In spite of the rapid development of medical science, the 5-year survival rate has remained around 75% since the 1990s, and the FDA has approved no new drugs for UBC over the last 10 years. In addition, most patients experience frequent recurrence and poor quality of life after diagnosis. Therefore, in order to solve unmet needs by alternative methods, we present our clinical cases of UBC where we observed outstanding results including regression and recurrence prevention exclusively through Traditional Korean Medicine such as (1) herbal therapy, (2) acupuncture, (3) pharmacopuncture and needle-embedding therapy, (4) moxibustion, and (5) cupping therapy. From our experience, it appears that multimodal strategies for synergistic efficiency are more effective than single Korean Medicine treatment. We hope this will encourage investigation of the efficacy of Korean Medicine treatment in clinical trials for UBC patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the feasibility of a combined treatment of bee venom acupuncture (BVA) and non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of non-specific chronic neck pain (NCNP). Patients with NCNP for ≥3 months were randomly allocated to a BVA, NSAIDs, or combined group (1:1:1), receiving 6 sessions of BVA, loxoprofen (180 mg daily), or a combination, respectively, for 3 weeks. Recruitment, adherence, and completion rates were calculated to assess feasibility. Bothersomeness, pain, disability, quality of life, depressive status, treatment credibility, and adverse events were assessed. In total, 60 participants were enrolled, and 54 completed the trial. Recruitment, adherence, and completion rates were 100%, 95%, and 90%, respectively. Bothersomeness, pain, disability, and depressive symptoms significantly improved in all groups after treatment (p < 0.05). The combined group showed continuous improvement during the follow-up period (p < 0.05). Quality of life was significantly improved (p < 0.05), and treatment credibility was maintained in the BVA and combined groups. No serious adverse events were reported. Combined treatment of BVA and NSAIDs are feasible for the treatment of NCNP, showing high persistence of the effect, credibility, and safety. Additional trials with longer follow-up are needed to confirm this effect. [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain (CNP) is a common painful medical condition with a significant socioeconomic impact. In spite of widespread usage, the effectiveness and safety of combined treatments between conventional and complementary alternative medical treatment modalities has not been fully established in a rigorous randomized clinical trial (RCT). This pilot study will provide the clinical evidence to evaluate the feasibility and refine the protocol for a full-scale RCT on combined treatment of bee venom acupuncture (BVA) and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with CNP.Methods/design: This is a randomized, single-blind clinical trial with three parallel arms. Sixty patients between 18 and 65 years of age with non-specific, uncomplicated neck pain lasting for at least three months will be enrolled. Participants will be randomly allocated into the BVA, NSAIDs or combined treatment group. Assessors and statisticians will be blinded to the random allocation. All researchers will receive training to ensure their strict adherence to the study protocol. Patients from the BVA and combined treatment group will be treated with a bee venom increment protocol into predefined acupoints for six sessions over a three week period. BVA intervention is developed through a comprehensive discussion among interdisciplinary spine disorder experts, according to the guidelines of Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Patients from the NSAIDs and combined treatment groups will be prescribed loxoprofen (one tablet to be taken orally, three times a day for three weeks). Bothersomeness from CNP measured using a visual analogue scale (VAS) will be the primary outcome assessed at screening, visit two (baseline), four, six, eight (4th week assessment) and nine (8th week assessment) follow-up session. VAS for pain intensity, neck disability index (NDI), quality of life, depressive status and adverse experiences will also be analyzed.Discussion: Our study results will contribute to feasibility evaluation and to relevant RCT protocol development for a full-scale RCT on combined treatment of BVA and NSAIDs for CNP patients.Trial Registration: This study is registered with the United States (US) National Institutes of Health Clinical Trials Registry: NCT01922466. [ABSTRACT FROM AUTHOR]