Superficial Needle Insertion Research Articles

Prospective comparison of acupuncture with sham acupuncture to determine impact on sedation and analgesia in mechanically ventilated critically ill patients (PASSION study): protocol for a randomised controlled trial

IntroductionSedation and analgesia are recommended to be employed in the intensive care unit (ICU) to enhance patient comfort and safety, facilitate mechanical ventilation and reduce oxygen demands. However, the increasing...

Effects of Traditional Chinese Acupuncture Compared with Sham Acupuncture on the Explosive Force Production by the Forearm Muscles in Female: A Randomized Controlled Trial.

Background Acupuncture can effectively enhance musculoskeletal rehabilitation, with effects such as reduced pain intensity and muscle tension and decreased disability. Objective The purpose of this study was to determine the efficacy of traditional Chinese acupuncture (TCA) compared with sham acupuncture (SA) in explosive force production by the forearm muscles in females. Methods A total of 32 subjects were included and randomly assigned to two groups: TCA group (n = 16): stimulated specific acupoints including Quchi (LI11), Shousanli (LI10), Hegu (LI4), Xiaohai (SI8), Tianjing (SJ10), and Waiguan (SJ5) for 15 minutes; SA group (n = 16): using superficial needle insertion at nonacupoints without stimulation. The subjects warmed up for the 3-time isokinetic test with an angular velocity of 30°/s and then performed a set of 15 full flexion (Flex) and extension (Ext) with an angular velocity of 180°/s using the CON-TREX isokinetic test training system recorded as the pretest. After acupuncture for 15 min, perform a set of the same isokinetic movement isokinetic records as the posttest. The average max torque, average work, average power, average peak power, average max speed, and total work were collected to evaluate the forearm explosive force changes. Use two-way repeated measures ANOVA to compare the difference before and after acupuncture between two groups. Results The results showed that acupuncture conditions (sham acupuncture as well as true acupuncture) and the intervention times (not acupuncture or acupuncture for 15 min) have a significant interaction effect on forearm explosive force and joint stiffness (P < 0.05). The simple main effect showed that the selected parameters of the TCA group increased significantly after acupuncture (P < 0.05), while the SA group did not (P > 0.05). We speculate that the activation of muscle may be related to the selected acupuncture points. Conclusion Acupuncture can produce excitation in motor nerves and muscles, and nerve stimulation increases the recruitment of motor units, thus improving the muscle explosive force.

Assessment of needle penetration depth and relationship with its analgesic effect

Abstract Background and Aims The field of invasive physical therapy offers a wide spectrum of effective methods for the treatment of myofascial pain. All these methods share the fact that they begin with the insertion of a solid needle. Thereafter, they diverge either because of the variable use of repeated insertions or because of the application of an electric current with different intensity and duration parameters. The so-called “needle effect” is described as an anesthetic effect which is achieved by probing with the needle the point where pain pressure sensitivity is found, using an appropriate orientation and depth in order to elicit this effect. At present, there continues to be controversy regarding whether the needle effect is a true clinical effect or placebo. Material and Methods This study is a controlled clinical trial with double blinding formed by three randomized groups: sham needling, needling at the level of the subcutaneous tissue (superficial) and needling at the level of the muscle tissue (deep). The intervention consisted in the insertion of the needle at the specified depth according to each group and maintained during 60 seconds. Each group comprised of 17 volunteer inline hockey players of both sexes from the Club Reus Deportiu sports club in the junior and senior categories (between 18 and 36 years of age). Algometry and joint range of motion were determined for the dominant lower limb before and after the intervention. A Student's t-test was performed for paired comparisons and an ANOVA for multiple comparisons. Results The same degree of algometry and joint range variation was obtained before and after the intervention in the three groups under study. No significant differences regarding algometry or joint range were obtained between the group of superficial needle insertion compared to the deep dry needling group, nor for any of these groups compared to the sham group. Conclusion No improvement was found in the pain pressure sensitivity in a latent Myofascial Trigger Point (MTrP) of the gastrocnemius muscle nor were there improvements in dorsal and plantar ankle flexion immediately after treatment for any of the needle depths studied. The mere insertion of an acupuncture needle in a MTrP in young athletes does not provide any therapeutic benefit within the study parameters. Therefore, it seems reasonable that repeated insertions or specific techniques should be used to achieve a beneficial effect.

The Construction of Sham Dry Needles and Their Validity

Appropriate control interventions are necessary to show the treatment effect of dry needling. Different control procedures, such as dry needling of the contralateral side, and sham treatments, such as random and superficial needle insertion, have been utilized in trials. However, those methods might elicit a physiological response and are subsequently not ideal for use as a control. This descriptive study illustrates the construction of low-cost sham dry needles and evaluates their validity. Forty-two healthy asymptomatic subjects received either sham or real dry needling intervention to their right gluteal muscles and reported if they felt that the needle pierced the skin. They also graded the severity and qualified (sharp or dull) the pain associated with the intervention. The results showed that most of the subjects in both groups believed the needle penetrated the skin. The quantity of pain associated with the treatment was similar in both groups, but the quality assigned was different. The authors conclude that sham dry needling can be accomplished and used as a valid control treatment in dry needling research using these low-cost sham needles.

Differences between therapeutic effects of deep and superficial acupuncture needle insertion for shoulder stiffness: A pilot randomized controlled clinical trial

Differences between therapeutic effects of deep and superficial acupuncture needle insertion for shoulder stiffness: A pilot randomized controlled clinical trial

Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial.

Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence. To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome. A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups. Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity. The primary outcome was live birth. Secondary outcomes included adverse events. Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene (P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, -0.6%; 95% CI, -5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%). Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women. clinicaltrials.gov Identifier: NCT01573858.

Acupuncture for joint symptoms related to aromatase inhibitor therapy in postmenopausal women with early-stage breast cancer: a narrative review.

Aromatase inhibitor-induced musculoskeletal syndrome (AIMSS) leads to discontinuation of aromatase inhibitor therapy in a significant proportion of patients with breast cancer. Acupuncture is popular among cancer patients and has previously been shown to improve symptoms in a range of musculoskeletal complaints. To determine the effectiveness and safety of acupuncture for the management of AIMSS in postmenopausal women with early-stage breast cancer. A literature search was carried out for randomised controlled trials (RCTs) on acupuncture for AIMSS in postmenopausal women with early-stage breast cancer. Characteristics of trials and outcomes were extracted from the retrieved articles, which were also assessed for risk of bias and quality of reporting. Four RCTs were retrieved of sample size 32-67 (totalling 190 participants). Compliance with treatment was high and rates of adverse events were low. Of the three two-arm RCTs, two found no difference between acupuncture and sham acupuncture and one found that acupuncture was statistically superior to sham acupuncture. The fourth RCT, which incorporated three arms, found acupuncture and sham acupuncture to be statistically superior to usual care but there was no difference between true and sham acupuncture. Three trials that used non-penetrating sham as the control found no effect of acupuncture over sham, but the one trial that used superficial needle insertion found acupuncture to be superior. Acupuncture is safe and results in improvement in AIMSS symptoms, but similar benefits are also elicited by non-penetrating sham acupuncture. Future research should seek to establish the durability of improvements.

Relaxation for perimenopausal and postmenopausal symptoms.

Since the time of publication of the Women's Health Initiative (WHI) study, menopausal symptom management has become more complex because of increased awareness of the risks associated with hormone replacement therapy (HRT). Currently, a wide range of management options is available. Some women take prescription drugs, and others use self care strategies, including lifestyle modifications, over-the-counter preparations and complementary and alternative therapies, such as herbal preparations, exercise programmes and relaxation techniques. Relaxation techniques consist of a group of behavioural interventions. They are considered relatively harmless, but their effectiveness in treating vasomotor symptoms and sleep disturbances remains debatable. To determine the effectiveness of relaxation techniques as treatment for vasomotor symptoms and associated sleep disturbances in perimenopausal and postmenopausal women. Searches of the following electronic bibliographic databases were performed in February 2014 to identify randomised controlled trials (RCTs): the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO, Social Science Citation Index and CINAHL. Handsearches of trial registers, relevant journals and published conference abstracts were also performed. RCTs were included if they compared any type of relaxation intervention with no treatment or other treatments (except hormones) for vasomotor symptoms in symptomatic perimenopausal/postmenopausal women. Two review authors selected studies, assessed quality and extracted data. Included studies were combined, if appropriate, by using a random-effects model to calculate pooled mean differences and 95% confidence intervals. Four studies were eligible for inclusion (281 participants): Two studies compared relaxation with electroacupuncture or superficial needling, one study compared relaxation with paced respiration or placebo control (α-wave electroencephalographic biofeedback) and one study compared relaxation with no treatment.No evidence was found of a difference between relaxation and acupuncture or superficial needle insertion in the number of hot flushes per 24 hours (mean difference (MD) 0.05, 95% confidence interval (CI) -1.33 to 1.43, two studies, 72 participants, I(2) = 0%; very low-quality evidence). Nor did any evidence suggest a difference between the two interventions in hot flush severity, measured using the Kupperman Index (MD -1.32, 95% CI -5.06 to 2.43, two studies, 72 participants, I(2) = 0%; very low-quality evidence).The other two studies found no clear evidence of a difference in hot flush frequency between relaxation and paced respiration, placebo or no treatment. The data for these comparisons were unsuitable for analysis.None of these studies reported night sweats, sleep disturbances associated with night sweats or adverse effects as an outcome.The main limitations of identified evidence were lack of data, imprecision and failure to report study methods in adequate detail. Evidence is insufficient to show the effectiveness of relaxation techniques as treatment for menopausal vasomotor symptoms, or to determine whether this treatment is more effective than no treatment, placebo, acupuncture, superficial needle insertion or paced respiration.

An Experimental Study on the Self-Report of Acupuncture Needle Sensation during Deep Needling with Bi-Directional Rotation

Traditionally, acupuncturists manipulate needles to enhance sensations referred to as de qi or 'acupuncture needle sensation'. Acupuncture needle sensations are complex and quantifying the experience has been difficult. The aim of this crossover study was to measure self-reported needle sensation during deep and bi-directional rotated needling in 15 healthy volunteers. Each participant received an experimental intervention consisting of superficial needling followed by deep needling and then deep needling with bi-directional rotation. The control intervention consisted of superficial needling, followed by mock deep needling and then mock bi-directional rotation of the needle. The intensity of overall needle sensation was measured using a visual analogue scale (VAS). The subjective acupuncture sensation scale was used to capture component sensations. VAS scores were higher during 'deep' needle penetration when compared to superficial needling with mock deep insertion (p=0.0002). VAS scores were also higher during deep needling with bi-directional rotation compared to superficial needling with mock bi-directional rotation (p<0.0001). There were higher scores for total component sensation scores and for the sensation of throbbing during the deep needling with bi-directional rotation (p=0.001) when compared to superficial needling with mock bi-directional rotation. Tentative evidence that bi-directional needle rotation generated stabbing, tingling, heaviness, soreness and aching was also found. Bi-directional rotation of a needle inserted into deep soft tissue produced higher acupuncture needle sensation intensities when compared to superficial needle insertion with mock deep penetration and bi-directional rotation.

Randomized, Blinded, Sham-Controlled Trial of Acupuncture for the Management of Aromatase Inhibitor–Associated Joint Symptoms in Women With Early-Stage Breast Cancer

PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience joint symptoms that can lead to discontinuation of effective therapy. We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC. METHODS We conducted a randomized, controlled, blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs. TA included full body/auricular acupuncture and joint-specific point prescriptions, whereas SA involved superficial needle insertion at nonacupoint locations. Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks. Results Of 51 women enrolled, 43 women were randomly assigned and 38 were evaluable. Baseline characteristics were comparable between the two groups. Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks, which was lower for TA compared with SA (3.0 v 5.5; P < .001). We also found differences between TA and SA in pain severity (2.6 v 4.5; P = .003) and pain-related interference (2.5 v 4.5; P = .002) at 6 weeks. Similar findings were seen for the WOMAC and M-SACRAH scores. The acupuncture intervention was well-tolerated. CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness, which was not seen with SA. Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect.

Randomized, blinded, placebo-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer

571 Background: Aromatase inhibitors (AIs) have become the standard of care for the treatment of postmenopausal, hormone-sensitive breast cancer (BC). However, patients receiving AIs may experience joint symptoms which can lead to early discontinuation of this effective therapy. We examined whether acupuncture improves AI-induced arthralgias in women with early stage BC. Methods: This study is a randomized, single-blinded trial of true vs sham acupuncture twice weekly for 6 weeks in postmenopuasal women with early stage BC and self-reported musculoskeletal pain related to adjuvant AI therapy. The active intervention included full body/auricular acupuncture and a joint-specific point prescription, whereas the sham arm involved superficial needle insertion at nonacupoint locations. Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), and Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline, 3 and 6 weeks. Lower scores reflect improvement in symptoms. Results: Of 43 women enrolled, 38 were evaluable at 6 weeks. Baseline characteristics were comparable between the groups. Median age: 57 (37–77); White/Hispanic/Black/Asian: 15/21/1/1; median body mass index (kg/m2): 29 (18–45). True acupuncture was associated with about a 50% decrease in mean BPI-SF scores, whereas no change from baseline was observed for the sham acupuncture group (see table). Similar findings were seen for the WOMAC and M-SACRAH pain, stiffness, and function scores (P&lt;0.05). No adverse events were reported. Conclusions: Women with AI-induced arthralgias treated with acupuncture had significant improvement of joint pain and stiffness, which was not seen with sham acupuncture. Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect. [Table: see text] No significant financial relationships to disclose.

A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women

Objective To compare the effects of electro-acupuncture with oral estradiol and superficial needle insertion on hot flushes in postmenopausal women.Material and methods Forty-five postmenopausal women with vasomotor symptoms were randomized to electro-acupuncture, superficial needle insertion or oral estradiol treatment during 12 weeks, with 6 months' follow-up. The number and severity of flushes were registered daily and the Kupperman index and a general estimate of climacteric symptoms were completed before, during and after therapy.Results In the electro-acupuncture group, the mean number of flushes/24 h decreased from 7.3 to 3.5 (ANOVA, p < 0.001). Eleven of the 15 women had at least a 50% decrease in number of flushes (with a mean decrease of 82%). Superficial needle insertion decreased the number of flushes/24 h from 8.1 to 3.8 (p < 0.001). In seven out of 13 women, the number of flushes decreased by at least 50% (mean decrease 83%). In the estrogen group, the number of flushes decreased from 8.4 to 0.8 (p < 0.001). The decrease in number of flushes persisted during the 24-week follow-up period in all treatment groups. The Kupperman index and the general climacteric symptom score decreased, and remained unchanged 24 weeks after treatment in all groups (p < 0.001). Electro-acupuncture decreased the number of flushes/24 h significantly over time, but not to the same extent as the estrogen treatment. No significant difference in effect was found between electro-acupuncture and the superficial needle insertion.Conclusion We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women and cannot recommend superficial needle insertion as an inactive control treatment.

Effects of electro–acupuncture on psychological distress in postmenopausal women

Objectives: To evaluate effects of electro–acupuncture (EA) on general psychological distress and relate to experience of climacteric symptoms in 30 postmenopausal women. Design: A randomised single-blind controlled design was used to evaluate effects of EA and extremely superficial needle insertion, with the latter serving as a near-placebo control. Settings: The Linköping University Hospital in Sweden. Interventions: Fourteen treatments during 12 weeks with follow-ups at 3 and 6 months. Outcome measures: General psychological well-being, mood and experience of climacteric symptoms. Results: Mood Scale improved only in EA group and not until 12 weeks compared to baseline, from 110 to 129 ( P=0.01), and to 120 at 3-month follow-up ( P=0.04). Mood was significantly better than control at 8 ( P=0.05) and 12 weeks ( P=0.01). Visual analogue scale estimation of climacteric symptoms was decreased at 4 weeks in both groups, and lasted throughout the study period, in EA group from 5 to 2 ( P=0.04) and in control group from 5 to 3 ( P=0.02) at 6-month follow-up. Well-being was ameliorated from 4 weeks in EA and from 8 weeks in control group until end of study ( P=0.01, P=0.03). No significant differences on climacteric symptoms or well-being existed between the groups. Conclusions: This study does not show that EA is better than superficial needle insertion for the amelioration of general psychological distress and experience of climacteric symptoms in women with vasomotor symptoms after menopause. However, the more pronounced effect on mood suggests that EA might have additional effects compared with superficial needle insertion.

Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects

It has been postulated that sensory stimulation (acupuncture) affects the cardiovascular system via the autonomic nervous system. Previously, skin temperature, thermography, plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture. By using power spectral analysis, the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity. The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and/or parasympathetic nervous system in healthy subjects. Materials and Methods. Twelve healthy volunteers, six men and six women, mean age 34.4 (range 23–48) participated in three balanced, randomly distributed sessions. At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11. The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation. The introduction was followed by three test sessions. Session A. A short acupuncture needle, (Seirin no 3, ∅0.20×15 mm) was inserted perpendicular into the earpoint, Lu 1, in the left inferior hemi-conchae. Session B. An acupuncture needle (Hwato, ∅0.30×30 mm) was inserted perpendicular into the Hegu point (LI 4) in the middle of the right dorsal thenar muscle. Session C. An acupuncture needle (Hwato, ∅0.30×30 mm) was inserted perpendicular superficially into the skin overlying the Hegu point on the left hand. Results. Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min ( P<0.05) and during the post-stimulation period of 60 min ( P<0.05). No significant changes were observed in either the sympathetic activity, blood pressure or heart rate. Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period ( P<0.01) and during the post-stimulation period ( P<0.01 and P<0.001, respectively). A significant decrease in the heart rate frequency ( P<0.05) at the end of the post-stimulation period was also demonstrated. The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min ( P<0.01) while no changes were observed during the stimulation period. Conclusion. It is indicated that sensory stimulation (acupunctura) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation.

Effects of Acupuncture on Climacteric Vasomotor Symptoms, Quality of Life, and Urinary Excretion of Neuropeptides among Postmenopausal Women

A majority of postmenopausal women experience vasomotor symptoms, which have a significant impact on the women's quality of life. Estrogens are the treatment of choice but can for different reasons not be used by all women. There is therefore a great need for viable alternative treatments. The patophysiology behind hot flushes and sweatings is so far not fully understood. Several studies have concluded that low levels of estrogens after menopause will lead to instability in the thermoregulatory center in the hypothalamus probably due to low [s-endorphin levels. Since acupuncture is known to increase central [s-endorphin activity, we wanted to evaluate if this treatment could ameliorate vasomotor symptoms which, to our knowledge, has not been scientifically evaluated previously. We also aimed to reveal if the vasoactive neuropeptides Calcitonin Gene-related peptide (CGRP), neuropeptide Y (NPY), neurokinin A, and substance P were involved in the mechanisms behind these symptoms.Results: Electro-acupuncture decreased flushes by 50 %, and superficial needle insertion by 30 %. The difference in reduction between the groups was not significant. Along with the decrease of flushes we found a significant reduction of the 24h urinary excretion of the neuropeptide CGRP, which is one of the most potent vasodilators known. When we later compared electro-acupuncture (EA), superficial needle insertion (SNI) and estrogen treatment, we found a significant reduction of 24h flushes by almost 60 % after EA and SNI. However, about 20% were non-responders in both groups. The responders in the EA group reduced their flushes and sweatings by 82 % and in the SNI group the reduction was 68%. We found no significant difference in effect between the acupuncture groups. Estrogen was the most effective treatment with a 91% reduction of flushes (range 58-100 %). We found a higher excretion of CGRP/24h urine in postmenopausal women with vasomotor symptoms, than in women without symptoms. Furthermore we found a 73 % elevation of CGRP in plasma, along with a 34% increase ofNPY concentration, during flushes in postmenopausal women.Conclusion: The results indicate that acupuncture is as a viable alternative or complement to traditional pharmacological treatments in postmenopausal women with vasomotor symptoms. The vasoactive neuropeptide CGRP is most likely involved in the mechanisms of vasomotor symptoms, probably as an executor or mediator of the skin vasodilatation and sweating that occur during the hot flush.

Acupuncture Treatment in Epicondylalgia: A Comparative Study of Two Acupuncture Techniques

The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. Five acupuncture points were treated: LI 10, 11, 12, Lu 5, and SJ 5. After 10 treatments significant differences were observed between the groups favoring the classical acupuncture technique in relation to subjective and objective outcome. No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical "deep" acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3- and 12-month follow-up.