Know thy tool: the intricacies of acupuncture needles

Zhang, G 2017, Know thy tool: the intricacies of acupuncture needles, Doctor of Philosophy (PhD), Health and Biomedical Sciences, RMIT University.


Document type: Thesis
Collection: Theses

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Title Know thy tool: the intricacies of acupuncture needles
Author(s) Zhang, G
Year 2017
Abstract Background

Acupuncture therapy is a commonly used form of complementary and alternative medicine involving the insertion of fine needles into particular points/loci on the body to exert a therapeutic outcome. Over recent decades, the field of acupuncture research has significantly expanded and matured. However, to generate unequivocal results, a number of critical research questions must be addressed as a matter of priority.

Aims of this PhD thesis

This PhD thesis aimed to address three crucial questions related to the tool of acupuncture — the acupuncture needle in the following three study parts.

Part I: Electrolytic corrosion of the needle in electroacupuncture

Electroacupuncture is a frequently used method that combines needling and electrical stimulation in practice. One safety concern in relation to electroacupuncture is the possible electrolytic corrosion of the stainless-steel needle, leading to the potential cell apoptosis in electrically stimulated tissues. However, contradictory results reported from previous in vitro and in vivo studies left this question unresolved.

The research in Part I aimed to examine whether electrolytic corrosion of stainless steel acupuncture needles occurs after undergoing electroacupuncture to establish the safety profile of this therapy. A cross-disciplinary (Biomedical Science and Engineering) experimental study has been conducted. Under continuous monitoring of stimulation parameters, electroacupuncture treatments of 30 minutes mimicking clinical practice were delivered to two healthy participants. The electrical stimulated needles and used needles without electrical stimulation or unused needles were examined and compared meticulously to the micron level using a scanning electron microscope (SEM), to determine whether any needle surface changes occurred after the treatment.

Thirty-two (32) needle samples used in the electroacupuncture were collected and examined. As the main findings, the SEM images showed the surface finish, burr attachments and surface characteristics of the needle samples. No evidence of electrolytic corrosion was detected on any needle that underwent electrical stimulation.

Part II: Standardised placebo acupuncture device for clinical research

In the sham or placebo-controlled trials investigating the efficacy of acupuncture, many methods have been employed as controls, including pseudo stimulation, sham invasive acupuncture and placebo non-invasive acupuncture. Thus far, their appropriateness as placebo controls has not been concluded by clinical research. Existing literature suggested that three placebo acupuncture devices have been considered to be standardised and used in recent clinical research, namely the Streitberger, the Park and the Takakura devices. The research in Part II has aimed to evaluate whether the standardised placebo device (SPAD) meet the requirements of the best design, based on the criteria of maximising the blinding effects and minimising the clinical impact on outcomes.

A systematic review including 16 randomised controlled trials (RCTs) testing the SPADs on healthy participants and another systematic review including 40 SPAD controlled RCTs on patients had indicated that all these three devices had certain limitations with respect to blinding and/or physiological inertness. Further examination of the three standardised placebo acupuncture devices suggested that future improvement of acupuncture placebo control is critically needed. As an outcome, the Takakura device aiming for double blinding trials (both practitioner and acupuncture receivers) is of higher quality with fewer limitations. Taking it a step further, an improved placebo device was also proposed based on the Takakura device. In order to enhance the quality of acupuncture placebo-controlled trials, the methodology of these trials has been thoroughly discussed following these two systematic reviews.

Part III: Needle used in acupuncture animal experiments

A broad range of acupuncture animal experiments provide important insights into the roles of biomarkers and elucidate the potential mechanisms of action of acupuncture as an intervention. In these experiments, the ‘acupuncture-like’ stimulation on small-sized laboratory animals was delivered using the same acupuncture needles used for human. However, considering the significant size difference between the species, this practice has been questioned by researchers for potentially delivering excessive stimulus on the animals, thus compromising the results and their interpretations.

The research in Part III has aimed to investigate the current status of acupuncture needles used in animal experiments and the potential issues associated with such practice. A preliminary review of the recently published animal studies was conducted. The information related to the experimental animals and needles has been extracted and analysed.

A total of 1,936 laboratory studies of acupuncture on small rodents published between 2013 and 2016 were identified. The results showed that current acupuncture animal experiments used needles with diameters ranging from 0.10 mm to 0.50 mm, which are no different from those commonly used in clinical practice. These needles are considered over-sized for laboratory animals and hence generated higher magnitude of stimulation and might have caused excessive tissue injury rather than the expected positive acupuncture-like stimulus. Therefore, findings reported in acupuncture animal experiments might not have accurately reflected the real practice of acupuncture. To address this issue, a specifically designed needle device was then proposed.

General conclusions of this PhD project

Electroacupuncture has an excellent safety profile as it has a low risk of electrolytic corrosion of stainless steel acupuncture needle, particularly when the charge-balanced electric stimulator is used. The improvement of the Takakura device for placebo-controlled trials and the new needle device for animal experiments will be needed to further enhance the quality and relevance of findings from such studies.

By careful reviews of the above three intricate issues, this project called attention to ensure the precision, validity and reliability of the evidence in acupuncture research. As such, it shall contribute to the development of acupuncture as a form of evidence-based clinical care.
Degree Doctor of Philosophy (PhD)
Institution RMIT University
School, Department or Centre Health and Biomedical Sciences
Subjects Structural Engineering
Traditional Chinese Medicine and Treatments
Keyword(s) acupuncture
safety
electroacupuncture
placebo effect of acupuncture
evidence-based acupuncture
efficacy
acupuncture animal studies
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