Lai Fun Ho, Yuanqi Guo, Jessica Yuet-Ling Ching, Kam Leung Chan, Ping Him Tsang, Man Hin Wong, Min Chen, Liyi Chen, Bacon Fung-Leung Ng and Zhi Xiu Lin
Acupuncture in Medicine; July 2020, doi: 10.1177/0964528420946048
Objective: To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP).
Methods: This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention to treat analysis.
Results: Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients (P < 0.001). There were no study-related adverse events.
Conclusion: EAWN therapy could be an effective treatment for PHP in middle-aged and older adults.
Trial registration number: ChiCTR1800014906 (Chinese Clinical Trials Registry)
This study from Hong Kong presents a rigorous RCT showing significant benefits from EA plus warm needling (EAWN) compared with staying on a waiting list.
The treatment involved needling Ashi and KI5, with manipulation to elicit deqi, then retention for 30 min, during which there was stimulation with “dense-disperse waves at 2Hz” and warming the needles by moxa sticks affixed to the needle-handles. This was repeated six times over four weeks.
At week 4 the VAS first-step pain scores had reduced by 44% (cf no change in the control group) and this improved to about 58% by follow-up at week 8. Similar improvements were seen in FFI and GRC (Global Rating of Change). The MID (minimum clinically important difference) was achieved at week 4 by 70% in the treatment group and 5% in the control group.
It is useful to have this study, clearly showing the lack of change in the waiting list group, and the trajectory of change following treatment. As in the Wang study, the effect size is clinically significant, though not huge.
I am left wondering why one would bother with warming the needles, which must be quite a fiddle, with the EA connected. Wouldn’t it be simpler to increase the effect by applying EA to more points? Perhaps it would be good to do a study comparing the use of EA alone, to needle warming alone, to the combination and, of course, to waiting list or placebo.