Bell’s palsy symptoms and associated disability improved significantly after 6 months of increased-intensity acupuncture, according to results of a randomized trial.
Active stimulation of the de qi sensation center — by lifting, thrusting, and twirling the needles after insertion — led to complete facial muscle recovery at 6 months in almost 90% of patients as compared with 71% of patients treated with acupuncture without active stimulation, reported Wei Wang, MD, PhD, of the Chinese Ministry of Education, and co-authors.
In addition, all functional and quality-of-life domains evaluated showed significantly greater improvement in the de qi group than in the control group, they wrote online inCMAJ.
Traditional theories of clinical acupuncture practice hold that a threshold stimulation level must be achieved to activate de qi, a compound sensation center that has a key role in attainment of optimal therapeutic effects with the therapy. De qi comprises the sensations of soreness, tingling, fullness, aching, cool, warmth, heaviness, and a radiating sensation at and around acupoints.
“For patients with [Bell’s] palsy treated with prednisone, the addition of strong-stimulation acupuncture, which can elicit a higher intensity of de qi, significantly improved the therapeutic effect,” the authors wrote. “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.”
Despite its long history, de qi has accumulated little confirmatory evidence from randomized clinical trials, the authors noted. The lack of evidence has led to neglect of de qi as an essential aspect of acupuncture practice.
To add to the evidence base for de qi, investigators at 11 centers in China performed a randomized trial involving patients with Bell’s palsy. The patient population was chosen because of the assumption that the process of facial nerve regeneration is not as susceptible to psychosocial effects of acupuncture as compared with pain and pain syndromes.
Acupuncturists who participated in the study had at least 10 years of clinical experience and had received training in all standard procedures, including stimulation of de qi.
Eligible patients had unexplained unilateral facial-nerve weakness, were evaluated within 7 days of symptom onset, and had had no prior treatment for the condition. Patients with recurrent facial paralysis were excluded.
All patients received prednisone and were randomized to de qi stimulation or to conventional acupuncture with no manipulation.
Treatment in both groups consisted of 20 sessions lasting 30 minutes each (five sessions per week for 4 weeks). Patients were interviewed by researchers blinded to treatment assignment after sessions one, five, 10, 15, and 20. Researchers asked patients to rate the intensity of each of eight sensations included in de qi, using a scale of 0 (not at all) to 10 (unbearable).
When the trial ended, they had complete data on 316 patients out of the 338 randomized.
By intention-to-treat analysis and per-protocol analysis, the de qi group had significantly more improvement compared with the control group for all outcomes: complete recovery, facial disability index (physical and social function), and quality of life (physical, psychological, social, and environmental domains).
The active therapy arm had a mean de qi score of 22.74 versus 14.85 for the control group (P<0.001).
The investigators found a significant positive association among patient ratings of de qi on the VAS and grade 1 (normal function) scores on the House-Brackmann scale at 6 months (OR 1.07, 95% CI 1.04 to 1.09).
They noted that they did not use sham acupuncture in the control group “because Chinese people generally trust in acupuncture, and informed consent for the use of sham acupuncture is very difficult to obtain from these patients.”
The researchers also cautioned that the association between the intensity of de qi and therapeutic effect must be interpreted with caution as 17.1% of patients did not rate de qi.