Acupuncture in Medicine | 2021
Electroacupuncture for lateral epicondylalgia
Abstract
I would like to comment on the conclusion of this paper with regard to the effects of electroacupuncture (EA) in lateral epicondylalgia. At first glance, the conclusion of this review implies that acupuncture may be effective, but EA is unlikely to be. As an invited author on this paper, I had the opportunity to comment on the interpretation of the review, but because data extraction was not my role, I did not take the time to carefully scrutinise the included papers in a way that might have informed the interpretation of the pooled data on EA. In other words, I am guilty of doing exactly what I have so often accused reviewers of acupuncture trials of doing in the past – I failed to read the ‘Methods’ sections of the included papers. I hope to address this by setting out the details of the EA treatments and their comparators here (see Table 1). All four trials used active comparators, including either intense manual acupuncture (MA) techniques or EA combined with massage.2–5 In meta-analysis, only one trial showed a clear superiority of the comparator over EA. The treatment used in this trial was a particularly intense manual needling technique using a needle of 0.60 mm diameter, which is moved vigorously (but not painfully) in the subcutaneous layer near the affected elbow. I have experienced this technique and the post-needling sensation was apparent for 2–3 days after each single brief treatment. Pooling these data does not allow us to draw conclusions on the efficacy of EA but does suggest that its effects are similar to most MA techniques. The statistical power is insufficient to comment on non-inferiority or equivalence at this stage. From a basic science perspective, it seems unlikely that EA would be less effective than MA since EA is essentially a combination of MA plus electrical stimulation. Most of these trials used co-interventions in both groups, which tends to reduce the difference in physiological terms and consequently the size of the effect measured. In clinical practice, I am an advocate of EA and frequently use it in Electroacupuncture for lateral epicondylalgia 990660 AIM Acupuncture in MedicineCummings