MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

This multicenter, randomized, sham-controlled trial was aimed at assessing the long-term efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Men with moderate to severe CP/CPPS were recruited, regardless of prior exposure to acupuncture. They received sessions of acupuncture or sham acupuncture over 8 weeks, with a 24-week follow-up after treatment. Real acupuncture treatment was used to create the typical de qi sensation, whereas the sham acupuncture treatment (the authors state they used the Streitberger needle, but the drawing looks more as though they used our device) does not generate this feeling.

The primary outcome was the proportion of responders, defined as participants who achieved a clinically important reduction of at least 6 points from baseline on the National Institutes of Health Chronic Prostatitis Symptom Index at weeks 8 and 32. Ascertainment of sustained efficacy required the between-group difference to be statistically significant at both time points.

A total of 440 men (220 in each group) were recruited. At week 8, the proportions of responders were:

  • 60.6% (95% CI, 53.7% to 67.1%) in the acupuncture group
  • 36.8% (CI, 30.4% to 43.7%) in the sham acupuncture group (adjusted difference, 21.6 percentage points [CI, 12.8 to 30.4 percentage points]; adjusted odds ratio, 2.6 [CI, 1.8 to 4.0]; P < 0.001).

At week 32, the proportions were:

  • 61.5% (CI, 54.5% to 68.1%) in the acupuncture group
  • 38.3% (CI, 31.7% to 45.4%) in the sham acupuncture group (adjusted difference, 21.1 percentage points [CI, 12.2 to 30.1 percentage points]; adjusted odds ratio, 2.6 [CI, 1.7 to 3.9]; P < 0.001).

Twenty (9.1%) and 14 (6.4%) adverse events were reported in the acupuncture and sham acupuncture groups, respectively. No serious adverse events were reported. No significant difference was found in changes in the International Index of Erectile Function 5 score at all assessment time points or in peak and average urinary flow rates at week 8.

The authors concluded that, compared with sham therapy, 20 sessions of acupuncture over 8 weeks resulted in greater improvement in symptoms of moderate to severe CP/CPPS, with durable effects 24 weeks after treatment.

Previous studies of acupuncture for CP/CPPS have been unconvincing. Our own systematic review of 2012 included 9 RCTs and all suggested that acupuncture is as effective as a range of control interventions. Their methodologic quality was variable; most were associated with major flaws. Only one RCT had a Jadad score of more than 3. We concluded that the evidence that acupuncture is effective for chronic prostatitis/chronic pelvic pain syndrome is encouraging but, because of several caveats, not conclusive. Therefore, more rigorous studies seem warranted.
This new study looks definitely more rigorous than the previous ones. But is it convincing? To answer this question, we need to consider a few points.

The study was sponsored by the China Academy of Chinese Medical Sciences and the National Administration of Traditional Chinese Medicine. The trialists originate from the following institutions:

  • 1Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (Y.S., B.L., Z.Q., J.Z., J.W., X.L., W.W., R.P., H.C., X.W., Z.L.).
  • 2Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (Y.L.).
  • 3ThedaCare Regional Medical Center – Appleton, Appleton, Wisconsin (K.Z.).
  • 4Hengyang Hospital Affiliated to Hunan University of Chinese Medicine, Hengyang, China (Z.Y.).
  • 5The First Hospital of Hunan University of Chinese Medicine, Changsha, China (W.Z.).
  • 6Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China (W.F.).
  • 7The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China (J.Y.).
  • 8West China Hospital of Sichuan University, Chengdu, China (N.L.).
  • 9China Academy of Chinese Medical Sciences, Beijing, China (L.H.).
  • 10Yantai Hospital of Traditional Chinese Medicine, Yantai, China (Z.Z.).
  • 11Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China (T.S.).
  • 12The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China (J.F.).
  • 13Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing, China (Y.D.).
  • 14Xi’an TCM Brain Disease Hospital, Xi’an, China (H.S.).
  • 15Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China (H.H.).
  • 16Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China (H.Z.).
  • 17Guizhou University of Traditional Chinese Medicine, Guiyang, China (Q.M.).

These facts, together with the previously discussed notion that clinical trials from China are notoriously unreliable, do not inspire confidence. Moreover, one might well wonder about the authors’ claim that patients were blinded. As pointed out above, the real and sham acupuncture were fundamentally different: the former did generate de qi, while the latter did not! A slightly pedantic point is my suspicion that the trial did not test the efficacy but the effectiveness of acupuncture, if I am not mistaken. Finally, one might wonder what the rationale of acupuncture as a treatment of CP/CPPS might be. As far as I can see, there is no plausible mechanism (other than placebo) to explain the effects.

So, is the evidence that emerged from the new study convincing?

No, in my view, it is not!

In fact, I am surprised that a journal as reputable as the Annals of Internal Medicine published it.

3 Responses to Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome? Another dubious study in a top journal

  • The difference between “real” acupuncture, i.e. practitioner-patient interaction involved in stimulatation and recognition of de qi sensation, compared with its absence in the sham acupuncture group, renders the the results meaningless.

    Blindingly obvious unblinded bias all round.

    One of the listed institutions credited for the study was: ThedaCAre Regional Medical Center, Appleton, Wisconsin (K.Z.)

    https://directory.thedacare.org/provider/kehua-zhou-md

    https://scholar.google.com/citations?user=Rcmuq1cAAAAJ&hl=en

    Kehua Zhou has good Chinese connections.

    It is fair to say that this study on one of Xi Jinping’s declared Chinese jewels is of entirely Chinese provenance.

    Kehua Zhou has published in Frontiers of medicine:
    https://www.springer.com/journal/11684

    Traditional Chinese medicine: potential approaches from modern dynamical complexity theories

    Yan Ma, Kehua Zhou, Jing Fan, Shuchen Sun

    https://scholar.google.com/citations?view_op=view_citation&hl=en&user=Rcmuq1cAAAAJ&citation_for_view=Rcmuq1cAAAAJ:BqipwSGYUEgC

    “Despite the widespread use of traditional Chinese medicine (TCM) in clinical settings, proving its effectiveness via scientific trials is still a challenge. TCM views the human body as a complex dynamical system, and focuses on the balance of the human body, both internally and with its external environment. Such fundamental concepts require investigations using system-level quantification approaches, which are beyond conventional reductionism. Only methods that quantify dynamical complexity can bring new insights into the evaluation of TCM. In a previous article, we briefly introduced the potential value of Multiscale Entropy (MSE) analysis in TCM. This article aims to explain the existing challenges in TCM quantification, to introduce the consistency of dynamical complexity theories and TCM theories, and to inspire future system-level research on health and disease.”

    Damned reductionism! No need for Quantum Mechanics.

    Multiscale Entropy will explain it all.

  • One wonders what point was penetrated in this study?

    An omnipotent point that is often referred as appropriate for a case of prostatisis is the Ren-1 or Conception Vessel. Also called The HuyYin or Yin Meeting Place, if I am not mistaken. This point regulates damp and damp heat.
    The Ren-1 points is not only known to be useful for problems of the prostate but also many other ailments such as Cold Penis – a condition usually but not always associated with a lack of sexual desire (according to the source).

    It also works for:

    > Amenorrhoea and irregular menses
    > Heat in the chest arising from yin deficiency.
    > Pain in the skin of the body, especially of the abdomen and perineum
    > Impotence, infertility and sterility
    > Frigidity (possibly)

    Needling the Ren-1 is also said to calm the mind and therefore used for mania but can also be used in less extreme conditions.

    Its utility further includes the following problems:

    > Inability to urinate or defecate
    > Hernia
    > Anal and vaginal problems
    > Pain in the urethra, the penis, anus, labia, vulva or vagina
    > Pruritis vulvae – intense itching of the vulvae
    > Swelling in the vulva and vagina
    > Anal itching
    > Constant erections
    > Swollen testes
    > Chronic piles

    In addition to addressing irregularities associated with the Yin, this prodigious point regulates Yang to control the following:

    > Prolapse of anus, vagina or uterus
    > Enuresis and other involuntary urination
    > Involuntary seminal emissions
    > Sweating of the genitals

    Perhaps most remarkable of all its awesome advantages, the Ren-1 point is also known for its potential to rescue the victims of drowning and reviving those in coma!
    As the scholar I refer to in the link below, knowledgeably warns, at least in those countries where personal invasion is treated seriously you are advised to obtain the drowning persons consent prior to removing their intimate clothing articles to correctly locate and access this pluripotent point, which is located in the perineum between the anal orifice and the scrotal base or vaginal orifice,whichever applies to the case.
    He also wisely suggests that should a male subject insist on lying supine during your attentions to this anatomical area, you must ask the customer to hold his genitals out of the way while you employ your acuminate instrument.

    As to the desirable depth of drilling, views apparently differ widely. Some sources advise a depth of only a centimeter or two while others use at least one inch of the needle. A successful case of repeatedly penetrating the perineum to all of three inches has reportedly been recorded as very successful.
    As a surgeon, I would fail my obligation not to observe and make a point[sic] of the following:
    A depth of one inch is very much more than skin deep and may well reach the prostate, at least in lean individuals. A depth of three inches perpendicular to the perineal skin will most certainly transfix thee prostate and may reach other delicate organs e.g. the seminal vesicles and bladder. To avoid septic complications, a thorough sterile preparation should be advised for such an invasive procedure. Remarkably, sterile precautions seem rare in the practice of acupucture and I have yet to find manuals or guides to the application of acupuncture, that emphasise prevention of infectious complications.
    Of course, proper aseptic technique would be difficult on the beach when smartly penetrating the HuiYin to revive an unconcious victim of drowning. A swab of alcohol and clean gloves would be a minimal requirement in similar invasive procedures within the so called “western” variety of healthcare that most of the world prefers.

    Main source:
    Warning!
    It is not advisable to read the following while eating or drinking.

    https://www.acupuncture-points.org/conception-vessel-1.html

    Conclusion:
    Absolute bollocks!

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