Weiming Wang, Yan Liu, Ruimin Jiao, Sixing Liu, Jie Zhao and Zhishun Liu.

    Acupuncture in Medicine, July 2020, doi: 10.1177/0964528420947739

    Abstract

    Background: Plantar heel pain syndrome (PHPS), also known as plantar fasciitis, affects millions of people worldwide.  Electroacupuncture (EA) and manual acupuncture (MA) are the two acupuncture modalities frequently used for PHPS in the clinical setting. However, which modality is more effective has yet to be determined.

    Objective: To examine whether EA is more effective than MA with regards to pain relief for patients with PHPS.

    Methods: Participants were randomly assigned (1:1) to receive 12 treatment sessions of EA or MA over 4 weeks with 24 weeks of follow-up. The primary outcome was the proportion of treatment responders, defined as patients with at least a 50% reduction from baseline in the worst pain intensity experienced during the first steps in the morning after a 4-week treatment, measured using a visual analogue scale (VAS, 0–100; higher scores signify worse pain). Analysis was by intention-to-treat.

    Results: Ninety-two patients with a clinical diagnosis of PHPS were enrolled from 29 July 2018 through 28 June 2019.  Of the patients, 78 (85%) completed the treatment and follow-up. The primary outcome occurred in 54.8% (23/42) of the EA group compared to 50.0% (21/42) of the MA group after the 4-week treatment (difference –4.76, 95% confidence interval, –26.10 to 16.57, P = 0.662). There were no significant between-group differences for any secondary outcomes after 4 weeks of treatment and at 16 weeks and 28 weeks of follow-up. There were no serious treatment-related adverse events in either group.

    Conclusion: Among patients with PHPS, EA did not have a better effect with respect to relieving pain intensity than MA at week 4, although both EA and MA appeared to have positive temporal effects, with decreased heel pain and improved plantar function.

    Trial registration number: ChiCTR1800016531 (Chinese Clinical Trial Registry).

    Commentary

    This team, in Beijing, conducted a rigorous RCT comparing EA with MA for PHPS.  They concluded that the benefits were the same in both groups, in terms of pain, function, global assessment and PPT.  They also noted that outcomes were similar in groups having prior duration of less than, or more than, 12 months.

    The MA approach was to needle two Ashi points, plus KI3, BL60 and 57, with manipulation to obtain deqi and retention 30 min.  EA was the same, plus electrostimulation across the two Ashi points using 2Hz continuous, to a comfortable intensity.  Some might criticise this approach, on the grounds that 2 Hz is less effective than 100Hz, and that continuous stimulation at the same frequency may lead to accommodation and so is less effective (dense-dispersed input is commonly used to obviate this).  While acknowledging various limitations of the study, they do not mention this one.

    They defined ‘responders’ as those who got 50% or more reduction in first-step pain and the proportion of responders in the EA and MA groups after four were 54.8% and 50% respectively.  At 6-month follow-up the figures treatments were 72.5% and 73.7%.  A range of secondary OCMs showed similar patterns (e.g. daily worst pain VAS showed reductions of 31.3% and 32.1% at 4w; 39.5% and 35.2 at 28w.

    Of course, without a no-treatment control group, it is not possible to say these reductions are due to the intervention.  Fortunately, the same team have another study in the pipeline that addresses this issue; I look forward to seeing it:

    Wang W, et al. Efficacy of acupuncture versus sham acupuncture or waitlist control for patients with chronic plantar fasciitis: study protocol for a two-centre randomised controlled trial. BMJ Open 2020;10:e036773. doi:10.1136/ bmjopen-2020-036773 [Free open access]