Intense acupuncture shows promise for Bell’s palsy rehabilitation

Intense or "de qi" acupuncture produces significantly better results when added to prednisone treatment than low-intensity acupuncture for patients with Bell's palsy, show findings from a randomized controlled trial.

"The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect," explain Wei Wang (Huazhong University of Science and Technology, Wuhan, China) and colleagues in the Canadian Medical Association Journal.

However, little scientific evidence exists confirming the benefit of achieving de qi, which involves manipulation of acupuncture needles to generate feelings of soreness, tingling, fullness, aching, cool, warmth, heaviness, and radiating sensation, and it is often neglected in practice.

Wang and colleagues therefore recruited 338 Chinese patients with Bell's palsy to take part in a randomized controlled trial comparing non-manipulative, weak-stimulation acupuncture (n=171; controls) with de qi, intense-stimulation acupuncture (n=167). All patients were given the corticosteroid prednisone (10-30 mg/day) as a basic therapy and had 20-30-minute sessions of acupuncture over 4 weeks. In total, 15 acupuncturists carried out the therapy, all of whom had at least 10 years professional experience and had been trained in standard acupuncture techniques by an expert.

When the patients were followed up at 6 months, those in the de qi group had a significant improvement in facial function compared with controls. Taking into account patients who dropped out of the study (n=22), 94.3% of the patients in the de qi group and 77.1% of those in the control group achieved a complete recovery at 6 months.

Comparing the difference of least squared means, scores for the facial disability index and World Health Organization quality of life questionnaire were also significantly higher in the de qi compared with the control group, by 9.8 and 29.9 points, respectively.

The researchers concede that their study had limitations, such as not having a sham acupuncture group, and a small percentage (17.1%) of patients not rating de qi. But they say that the complete recovery rate in the study control group was similar to that seen with corticosteroids alone (76.7%) in a recent Cochrane review and is consequently likely to be a good representation of sham acupuncture.

They also point out that conditions such as Bell's palsy are known to be less susceptible to psychosocial effects such as those seen with acupuncture and analgesia and therefore conclude that "de qi and its related techniques should be properly appreciated in acupuncture practice and research, and should be considered for inclusion in clinical guidelines for acupuncture."

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