Efetividade da acupuntura auricular associada ao treinamento muscular pélvico para controle da incontinência urinária pós-prostatectomia radical: ensaio clínico randomizado / Effectiveness of auricular acupuncture associated with pelvic muscle training to control urinary incontinence after radical prostatectomy: randomized clinical trial

A prostatectomia radical pode causar efeitos urinários indesejáveis como incontinência urinária, noctúria, urgência miccional, frequência e esvaziamento incompleto da bexiga. Disfunções miccionais acarretam sentimentos e vivência de exclusão social e, consequente diminuição na qualidade de vida. Para casos de incontinência urinária pós-prostatectomia radical é indicada a realização do treinamento muscular do soalho pélvico como primeira escolha para auxiliar no mecanismo de fechamento uretral. Dentre as práticas integrativas e complementares que têm contribuições na área da saúde, pode-se citar a acupuntura auricular. Esta baseia-se na estimulação de acupontos no pavilhão auricular para aliviar sinais e sintomas de diversas condições, dentre elas, os sintomas do trato urinário inferior. O objetivo deste estudo foi avaliar a efetividade da acupuntura auricular associada ao treinamento muscular do soalho pélvico na incontinência urinária pós-prostatectomia radical. Trata-se de um ensaio clínico randomizado baseado nas recomendações do Consolidated Standards of Reporting Trials e Standards for Reporting Interventions in Clinical Trials of Acupuncture. Os dados foram coletados entre abril de 2019 e abril de 2020. A amostra foi constituída por 60 homens com incontinência urinária após retirada do cateter vesical de demora, alocados em dois grupos: controle (n=30) que recebeu orientações sobre treinamento muscular do soalho pélvico; e intervenção (n=30) que recebeu acupuntura auricular associada às orientações sobre treinamento muscular do soalho pélvico. As orientações sobre treinamento muscular ocorreram durante oito sessões presenciais semanais associadas à entrega de um livreto que auxiliava a continuidade dos exercícios em domicílio. Para o grupo intervenção, a acupuntura auricular também foi ofertada em oito sessões semanais. A avaliação ocorreu em dois momentos: antes de qualquer tratamento (pré-teste) e após oito semanas de acompanhamento (9ª sessão ­ pós-teste). Foram utilizados os instrumentos questionário sociodemográfico e clínico, daily pad used, pad test de uma hora, escala de incontinência urinária pós-prostatectomia radical, International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e King's Health Questionnaire (KHQ). O modelo longitudinal, com o uso das equações de estimações generalizadas e teste de diferença de proporções, foi empregado na análise estatística. O nível de significância adotado foi de 0,05. Resultados: a gravidade da incontinência urinária diminuiu entre o pré-teste e pós-teste no grupo intervenção e, também, no grupo controle sem diferenças estatísticas na evolução entre os dois grupos. Em relação ao impacto da incontinência na qualidade de vida, identificou-se diferença estatisticamente significativa entre os grupos no pós-teste ao nível do domínio "medidas de gravidade" (p=0,013), o que indicou menor impacto da IU para este domínio apenas no grupo intervenção. Na análise da frequência dos itens deste domínio, detectou-se diferença estatisticamente significativa entre os grupos no pós-teste para o item "troca suas roupas íntimas quando elas estão molhadas" (p=0,018). Evidenciou-se também que o grupo intervenção teve, respectivamente, 20,8% (p=0,007) e 25,3% (p=0,002) menos chance de apresentar noctúria e urgência miccional. Verificou-se também redução estatisticamente significativa no impacto da incontinência na qualidade de vida nos domínios "emoções" (p<0,001) e "sono e disposição" (p=0,008) no grupo intervenção. Conclusão: a AA não mostrou-se efetiva para potencializar a ação do treinamento muscular na redução da gravidade da incontinência urinária. Por outro lado, quanto ao impacto da incontinência urinária na qualidade vida, a associação da acupuntura auricular ao treinamento mostrou-se mais efetiva, principalmente pela diferença estatisticamente significativa entre os grupos no pós-teste para o domínio "medidas de gravidade", bem como pela redução da chance dos sintomas de noctúria e urgência miccional. Frente a esses achados, recomenda-se a associação das terapias como um cuidado efetivo aos homens com incontinência urinária pós-prostatectomia radical. Registro Brasileiro de Ensaios Clínicos: RBR-3jm5y2.

Radical prostatectomy can cause undesirable urinary effects such as urinary incontinence, nocturia, urinary urgency, frequency and incomplete emptying of the bladder. Voiding dysfunctions cause feelings and experience of social exclusion and, consequently, decrease in quality of life. For cases of urinary incontinence after radical prostatectomy, muscle training of the pelvic floor is indicated as the first choice to assist in the urethral closure mechanism. Among the integrative and complementary practices that have contributions in the health area, we can mention auricular acupuncture. This is based on the stimulation of acupoints in the ear to relieve signs and symptoms of several conditions, including lower urinary tract symptoms. The aim of this study was to evaluate the effectiveness of auricular acupuncture associated with pelvic floor muscle training in urinary incontinence after radical prostatectomy. This is a randomized clinical trial based on the recommendations of the Consolidated Standards of Reporting Trials and Standards for Reporting Interventions in Clinical Trials of Acupuncture. Data were collected between April 2019 and April 2020. The sample consisted of 60 men with urinary incontinence after removal of the indwelling bladder catheter, allocated into two groups: control (n = 30) who received guidance on floor muscle training pelvic; and intervention (n = 30) that received auricular acupuncture associated with guidelines on muscle training of the pelvic floor. The guidelines on muscle training took place during eight weekly face-to-face sessions associated with the delivery of a booklet that helped to continue the exercises at home. For the intervention group, auricular acupuncture was also offered in eight weekly sessions. The evaluation took place in two moments: before any treatment (pre-test) and after eight weeks of follow-up (9th session - post-test). The socio-demographic and clinical questionnaire, daily pad used, one-hour pad test, urinary incontinence scale after radical prostatectomy, International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and King's Health Questionnaire (KHQ) were used. The longitudinal model, using generalized estimation equations and proportional difference test, was used in the statistical analysis. The level of significance adopted was 0.05. Results: the severity of urinary incontinence decreased between the pre-test and post-test in the intervention group and also in the control group without statistical differences in the evolution between the two groups. Regarding the impact of incontinence on quality of life, a statistically significant difference was identified between the groups in the post-test at the level of the "severity measures" domain (p = 0.013), which indicated a lower impact of UI for this domain only in the intervention group. In the analysis of the frequency of the items in this domain, a statistically significant difference was detected between the groups in the post-test for the item "change your underwear when they are wet" (p = 0.018). It was also evident that the intervention group had, respectively, 20.8% (p = 0.007) and 25.3% (p = 0.002) less chance of presenting nocturia and urinary urgency. There was also a statistically significant reduction in the impact of incontinence on quality of life in the domains "emotions" (p <0.001) and "sleep and mood" (p = 0.008) in the intervention group. Conclusion: AA was not effective in potentiating the action of muscle training in reducing the severity of urinary incontinence. On the other hand, regarding the impact of urinary incontinence on quality of life, the association of ear acupuncture with training proved to be more effective, mainly due to the statistically significant difference between the groups in the post-test for the "severity measures" domain, as well as by reducing the chance of nocturia symptoms and urinary urgency. In view of these findings, the association of therapies as an effective care for men with urinary incontinence after radical prostatectomy is recommended. Brazilian Registry of Clinical Trials: RBR-3jm5y2.

Auriculotherapy for sleep bruxism in children: a series of cases

Sleep bruxism is defined as a behavior that causes masticatory muscle activities during sleep. Sleep bruxism in childhood leads to consequences, which may vary from teeth wear in deciduous dentition to temporomandibular disfunction symptoms. There's no data that demonstrates improvement of children with sleep bruxism during and after auricular acupuncture treatment. Objective: Therefore, this case report series aimed to evaluate the effect of auriculotherapy on children presenting sleep bruxism. Methods: Twelve patients were included in this study, in the mean age of 6,9. The diagnosis was evaluated by the question: "Does your kid grind their teeth while sleeping?". Treatment was performed by an acupuncture specialist in a standardized way. The therapy was given for three weeks and the effect was evaluated through a sleep diary, in which the parents noted whether or not their child grinded teeth while sleeping before (baseline) and during therapy (T1 to T3). Sleep bruxism was categorized as presence or absence of nocturnal teeth grinding and the frequency varied from 0 to 7 (baseline), 0 to 5 (T1), 0 to 7 (T2) and 0 to 4 (T3) between patients. The intensity of the reported sleep bruxism was compared according to the periods by pared T-test ( =0.05). Results: It was observed that the frequency of reports decreased significantly from baseline to T3. Conclusion: These results suggest that ear acupuncture may be an alternative therapy for sleep bruxism in childhood, once it demonstrated to reduce its frequency in this study, although patients may present different effects to therapy due to biological variability.

Introdução: Bruxismo do sono é definido como um comportamento que causa atividades musculares durante o sono. Na infância, leva a consequências que podem variar de desgaste dentário na dentição decídua a sintomas de disfunção temporomandibular. Não há estudos que demonstrem melhora de casos de crianças com bruxismo do sono durante e após tratamento com auriculoterapia. Objetivo: portanto, esta série de casos visou avaliar o efeito da auriculoterapia em crianças apresentando este quadro. Métodos: Doze pacientes foram inclusos neste estudo, com a media de idade de 6,9. O diagnóstico foi avaliado pela pergunta "Seu filho range os dentes quando dorme?". O tratamento foi executado por um especialista em acupuntura de forma padronizada. A terapia foi feita por três semanas e o efeito foi avaliado através de um diário do sono, no qual os pais anotavam se a criança rangeu os dentes enquanto dormia antes (baseline) e durante a terapia (T1 a T3). Bruxismo do sono foi categorizado como presença ou ausência de ranger de dentes e a frequência variou de 0 a 7 (baseline), 0 a 5 (T1), 0 a 7 (T2) e 0 a 4 (T3) entre os pacientes. A intensidade foi comparada de acordo com os períodos pelo teste-T pareado (=0,05). Resultados: Foi observado que a frequência de relatos diminuiu significativamente de baseline a T3. Conclusão: Estes resultados sugerem que auriculoterapia pode ser uma terapia alternativa para o bruxismo do sono na infância, uma vez que demonstrou reduzir sua frequência neste estudo, embora os pacientes possam apresentar efeitos diferentes devido à variabilidade biológica.

Auriculoterapia com agulhas para melhora da qualidade de vida em pacientes com câncer: revisão integrativa / Auriculotherapy with needles to improve the quality of life of cancer patients: an integrative literature review / La acupuntura auricular y la calidad de vida de pacientes con cáncer: revisión integradora

Objective: The study's goal has been to identify in the literature the use of auriculotherapy with needles as an intervention to improve cancer patients' life quality. Methods: It is an Integrative Literature Review of articles published in Portuguese, English, Spanish and/or German, available in full at the databases VHL, CAPES, CINHAL, PubMed, Web of Science and Scopus. The study was carried out in January 2017. The descriptors employed were cancer, neoplasms, auriculotherapy, ear acupuncture, and auricular acupuncture, and six studies were then selected. Results: The use of auricular therapy with needles as interventions in the clinical symptoms due to cancer and its treatment, as well as in the improvement of the domains affected in people's life quality have indicated satisfactory evidence. Conclusion: The evidences have identified an improvement in the quality of life of oncology patients that underwent auriculotherapy with needles, therefore, this intervention is a safe, effective and economical complementary therapy, which is very well accepted by the patients

Objetivo: Identificar na literatura o uso da auriculoterapia com agulhas como intervenção para melhoria da qualidade de vida de pacientes com câncer. Método: Revisão integrativa de artigos publicados em português, inglês, espanhol e/ou alemão, disponíveis na íntegra nas bases de dados BVS, CAPES, CINHAL, PUBMED, WEB of SCIENCE e SCOPUS. A pesquisa ocorreu no período de janeiro de 2017. Foram utilizados os descritores câncer, neoplasia, auriculoterapia, acupuntura orelha e acupuntura auricular, sendo selecionados seis estudos. Resultados: O uso da auriculoterapia com agulhas como intervenções nos sintomas clínicos decorrentes do câncer e de seu tratamento bem como na melhoria dos domínios afetados na qualidade de vida apontou evidências satisfatórias. Conclusão: As evidências identificaram melhora na qualidade de vida de pacientes oncológicos que foram submetidos a auriculoterapia com agulhas e que esta intervenção é uma terapia complementar segura, eficaz e econômica, muito bem aceita pelos pacientes

Objetivo: Identificar la producción disponible relacionada al uso de la acupuntura auricular como intervención para la mejora de la calidad de vida de pacientes con cáncer. Método: Revisión integrativa de literatura con búsqueda en bases electrónicas y bibliotecas virtuales BVS, CAPES, CINHAL, PUBMED, WEB of SCIENCE y SCOPUS En el período de enero de 2017 con los descriptores cáncer, neoplasia, auriculoterapia, acupuntura o acupuntura auricular y acupuntura auricular, la acupuntura auricular y la acupuntura auricular. La revisión integrativa propuesta tuvo lugar en seis etapas distintas y complementarias. Resultados: Se identificaron seis artículos con evidencias satisfactorias de las intervenciones en los síntomas clínicos inherentes al cáncer y su tratamiento que demostraron impactos positivos de la auriculoterapia como intervención. Conclusión: Los estudios relacionados con el tema son escasos, apuntan una realidad científica poco explorada. Un número mayor de estudios clínicos debe ocurrir para fortalecer las evidencias de las intervenciones terapéuticas efectivas, subsidiar la práctica y asegurar asistencia cualificada

Review and prospect of clinical application of ear-acupuncture treating post-operative syndromes of breast cancer / 中国针灸

To analyze the application of ear-acupuncture for post-operative syndromes of breast cancer so as to provide method and evidence for the syndromes. The related clinical literature was retrieved from CNKI, WANFANG and VIP databases from the database establishment time to August 30, 2017. We found ear-acupuncture are mainly used in treating nausea and vomiting caused by radiation and chemotherapy (shenmen (TF), jiaogan (AH), wei (CO), pi (CO), etc), insomnia in the rehabilitation period (xin (CO), pizhixia (AT), shenmen (TF), etc), depression and anxiety (pizhixia (AT), shenmen (TF), pi (CO), wei (CO), xin (CO), gan (CO), etc), and joint pain (pain point), etc.

Preliminary Analysis of Auricular Points Based on Primitive Stress System / 上海针灸杂志

The one-to-one correspondence between auricular points and internal organs is due to the existence of primitive stress system inside human body. The primitive stress system consists of gap junction intercellular communication pathways which transport small molecules to support the development of embryo prior to the formation of cardiac vessels. When embryo is mature, this transportation function enters into a resting state and will only be triggered when cells receive nociceptive stimulations. After the injured cells are repaired or replaced, the relevant pathways will rest again. The discovery of the primitive stress system not only explains the phenomenon of the correspondence between auricular points and internal organs, opening a new way of exploring the phenomena of body acupoints, but also develops a novel field in the research of bioscience.

Clinical Study of Auricular Point Therapy for Chronic Fatigue Syndrome / 上海针灸杂志

Objective To investigate the clinical efficacy of auricular point therapy for chronic fatigue syndrome.Methods Eighty patients with chronic fatigue syndrome were randomly allocated to treatment and control groups, 40 cases each. The treatment group received ear acupuncture plus auricular plaster therapy and the control group, conventional acupuncture. The overall symptom was scored, the Fatigue Assessment Instrument (FAI) score was recorded and immunoglobulins (IgA, IgG and IgM) were measured in the two groups before treatment and after four courses.Results There were statistically significant pre-/post-treatment differences in the overall symptom score, the FAI score and immunoglobulins in the two groups (P<0.05). There were statistically significant post-treatment differences in the FAI score, and IgA and IgG between the treatment and control groups (P<0.05). Conclusion Auricular point therapy is an effective way to treat chronic fatigue syndrome.

Clinical Study of Acupuncture Intervention in Muscle, Bone and Joint Pain Caused by Aromatase Inhibitors in the Treatment of Breast Cancer / 上海针灸杂志

Objective To investigate the clinical efficacy of acupuncture intervention in muscle, bone and joint pain caused by aromatase inhibitors in the treatment of breast cancer. Method One hundred and forty breast cancer patients with aromatase inhibitors-caused muscle, bone and joint pain were randomly allocated to groups A, B, C and D, 35 cases each. group A received ear acupuncture plus the intravenous drip of zoledronic acid;group B, ear acupuncture alone;group C, the intravenous drip of zoledronic acid alone;group D, oral administration of calcium carbonate and vitamin D3 chewable tablets and alfacalcidol soft capsules. The Brief Pain Inventory score was observed in every group before and after treatment. Bone mineral densities of the lumbar vertebrae were compared between the groups before and after treatment. Result In groups a and B, there was a statistically significant difference in the pain interference score at three, six and twelve weeks of treatment and at six weeks after the end of treatment compared with before treatment (P0.05). Conclusion Ear acupuncture can significantly relieve muscle, bone and joint pain caused by aromatase inhibitors and the pain relief is not related to bone mineral density, but muscle, bone and joint pain recurs in the patients after the treatment is discontinued. Zoledronic acid can not relieve the pain. Ear acupuncture plus zoledronic acid is not more effective than ear acupunctura alone in relieving the pain.

Tratamiento de las bursitis en hombros con aurículoterapia y tuina / Treatment of bursitis in shoulders with auriculotherapy and tuina

Se realizó un estudio de dos grupos de 30 pacientes cada uno, el grupo 1 se trató con aurículoterapia solamente y en el grupo 2 combinamos la aurículoterapia con la tuina. Logramos que el 65 % evolucionara favorablemente y el resto (35 %) obtuvo alguna mejoría, lo que confirmó la eficacia del tratamiento. La edad que predominó fue entre los 45 y 54 años, para un 70 %, el dolor disminuyó su intensidad en el 98% y el ángulo de movimientos aumentó en todos los pacientes tratados. Los resultados indican que ambos tratamientos son inocuos, útiles, eficaces y económicos, pues con el tratamiento combinado (grupo 2) se obtuvo éxito terapéutico a partir de la cuarta sesión, mientras que con aurículoterapia sola se alcanzó a partir de la séptima sesión. No hubo reacciones adversas en ninguno de los dos métodos de tratamiento.

A study of two groups of 30 patients each of them was carried out, group 1 was treated with auriculotherapy only and in group 2 we combined auriculotherapy with tuina. We found that 65 % evolved favorably and the remaining (35 %) had some improvement, which confirmed the effectiveness of treatment. The prevailing age was among 45 and 54 years for 70 % pain reduced its intensity in 98 % and the movement angle increased in all patients treated. Results indicate that both treatments are innocuous, useful, effective and economic, because with combined treatment (group 2), a therapeutic success was obtained from fourth sessions, while with auricolotherapy alone it was in the seventh. These were no adverse reactions in any of the two treatment methods.

Jiangtang Mixture Combined with Ear Acupuncture for Type 2 Diabetic Insulin Resistance:A Clinical Observation of 40 Cases / 中医杂志

Objective To study the therapeutic effect and mechanism of Jiangtang Mixture combined with ear acupuncture for type 2 diabetic insulin resistance(IR).Methods Totally 120 cases of type 2 diabetic IR were randomly and equally divided into western medicine(Metformin) group,Chinese medicine (Jiangtang Mixture) group and Chinese medicine with ear acupuncture group.The treatment lasted for one month.The therapeutic effect,fasting plasma glucose(FPG),fasting insulin(FINS),postprandial 2 hours plasma glucose(P2hPG),hemoglobin A1c(HbA1c),blood fat,insulin Sensitivity index(ISI) and insulin resistance index(IRI) were observed before and after treatment.Results The total effective rate in Chinese medicine with ear acupuncture group was 92.5%,which was superior to those in Chinese medicine group (P