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Intense acupuncture may improve Bell's palsy

By Kerry Grens

New York (Reuters Health) - Patients with facial paralysis saw greater improvements in function after a more intensive form of acupuncture in a new study from China that compared the treatment to standard acupuncture.

Researchers found that wiggling the acupuncture needles to produce a sensation called "de qi" led to a patient's having a better chance of recovering full facial function in six months than if the needles were just inserted and left alone.

De qi "should be considered to be included in clinical guidelines for acupuncture treatment," said Dr. Wei Wang at Key Laboratory of Neurological Diseases of Chinese Ministry of Education in Wuhan, Hubei.

The study did not measure how well people would have recovered without receiving acupuncture, so it's impossible to say whether the therapy worked any better than conventional, Western approaches or no therapy at all.

De qi is combination of feelings - including achiness, coolness, warmth, and tingling - which is considered by traditional Chinese medicine to ensure the best therapeutic benefit, said Wang, one of the authors of the study.

But "this long held belief has never been confirmed," he told Reuters Health.

To see whether de qi makes a difference to the effectiveness of acupuncture therapy, he and his colleagues asked 317 adults with Bell's palsy to undergo five half-hour acupuncture treatments for four weeks.

Bell's is usually a temporary facial paralysis that typically affects one side and lasts a few months.

It often results from a viral infection that inflames facial nerves, and the steroid prednisone is a common treatment. Over the counter analgesics, vitamins and physical therapy are also sometimes used to treat the condition.

About 40,000 Americans get Bell's palsy each year, according to the National Institute of Neurological Disorders and Stroke.

Wang said his group focused on this condition because recovery of the facial nerves affected by Bell's does not seem to be as susceptible to the placebo effect as other nerve conditions, such as pain.

Half of the participants were randomly assigned to receive treatments that would elicit de qi, in which the acupuncturist twisted the needles and moved them up and down several times during the session.

The other participants had the needles inserted and left alone.

All of the patients also received prednisone.

Neurologists, who didn't know which treatment each participant had received, determined the patients' facial function score on a scale of 200, with higher numbers corresponding to better movement.

In both groups, patients had started with facial function scores around 130 to 135. After six months of treatment, participants in the de qi group had somewhat greater facial function, such as in raising the eyebrows, blinking and baring teeth.

The de qi group scored an average of 195, while the other acupuncture group scored 186.

Wang said it's difficult to interpret just what these numbers mean in terms of muscle performance - say, whether a person can smile fully or not - but that a difference of nine points would be noticeable to the patients.

In addition, the team found that 94 percent of participants who received de qi acupuncture completely recovered their facial function by the end of six months, while 77 percent did in the other acupuncture group.

It's not clear how acupuncture - and de qi in particular - might improve the recovery from Bell's palsy.

Dr. Jian Kong, an assistant professor at Harvard Medical School and Massachusetts General Hospital, said one explanation could be that needles in the face increase blood flow to the area "so we can provide more nutrition to the nerves and help the inflammation to diminish quickly so people can recover."

Kong, who was not part of this study, agreed with the researchers that de qi is important to consider in acupuncture research, and that it is often overlooked.

One reason it's not always included in studies is that "there are many schools of acupuncture," with some placing greater emphasis on de qi than others, Kong told Reuters Health.

De qi is also complex, subjective and difficult to quantify. He said some people even consider the sensations of the acupuncturist to be more important in eliciting de qi than the sensations of the patient.

"Most clinical trials don't measure de qi sensation so we don't know how this sensation is associated with clinical outcomes," Kong said.

Wang said that this lack of standardization in acupuncture research might be why studies have yielded a mixed bag of results - sometimes showing a benefit and other times not.

"The effect of acupuncture may be seriously compromised" by not stimulating de qi, he said.

Kong said he and others have been developing standard de qi scales to offer some uniformity across studies.

"Hopefully we can figure out how this sensation is connected with the clinical outcome," Kong said.

SOURCE: http://bit.ly/XekkvV Canadian Medical Association Journal, online February 25, 2013.

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