Journals watch: Acupuncture, basal cell carcinoma and cardiovascular fitness

A round-up of the latest research papers by Dr Alison Glenesk.

A study indicated that acupuncture is effective in treating chronic pain (Photograph: Dr P Marazzi/SPL)

Acupuncture for chronic pain

Arch Intern Med 2012; 172: 1444-53

The aim of this individual patient meta-analysis was to determine the effect size of acupuncture for four chronic conditions: neck/back pain, osteoarthritis, chronic headache and shoulder pain.

Individual data meta-analyses of 17,992 patients were conducted using data from 29 RCTs. Patients received acupuncture, sham acupuncture or no acupuncture.

After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across all pain conditions.

Patients having acupuncture had less pain, with scores that were 0.23, 0.16 and 0.15 SD lower than sham controls for back and neck pain, osteoarthritis and chronic headache, respectively. The scores compared with non-acupuncture controls were 0.55, 0.57 and 0.42.

The researchers concluded that acupuncture was effective for the treatment of chronic pain. Significant differences between true and sham acupuncture indicate that it is more effective than placebo, but the difference is small, indicating that insertion of needles is only one component of its effectiveness.

Treatment of superficial basal cell carcinoma

Br Assoc Dermatol 2012; 167: 733-56

It seems that more people are being diagnosed with basal cell carcinoma (BCC) at an earlier age, presumably owing to sun exposure. Newer, more cosmetically acceptable treatments are becoming important.

This review aimed to determine recurrence and tumour-free survival probabilities in primary superficial BCC treated with photodynamic therapy (PDT) or imiquimod.

A total of 36 studies were analysed. From 28 studies, the percentage of patients who were tumour-free at 12 weeks was 86% for imiquimod and 79% for PDT. Results for tumour-free survival at one year, derived from 23 studies, were 87% for imiquimod and 84% for PDT.

It seems that these treatments were similar in efficacy, although the authors suggest that head-to-head comparison is required. Interestingly, surgery and 5-fluorouracil treatment, which seem more familiar, appeared in very few studies.

Cardiovascular fitness and risk of developing depression

Br J Psychiatry 2012; 201: 352-9

In this study, male army conscripts born between 1950 and 1987, who were enlisting for mandatory national service (n = 1,117,292), were assessed physically and psychologically at the age of 18. They were then followed up for three to 40 years.

The aim was to assess whether cardiovascular fitness, as measured by bicycle ergometer at conscription, was associated with the risk of developing a serious affective disorder.

In fully adjusted models, low cardiac fitness was found to be associated with the development of serious depression in later life (HR 1.96).

No such association was found for bipolar disorder.

The authors conclude that this strengthens the theory of a cardiovascular contribution to the development of depression, but I am not convinced that it is as simple as cause and effect.

Energy used in computer games

Arch Paediat Adolesc Med 2012; 166: 1005-9

Computer games are viewed with disapproval by many people, mainly owing to their sedentary nature.

The goal of this comparison study involving 18 schoolchildren was to evaluate physiological response and energy expenditure while playing active video games using Kinect for the Xbox 360, compared with measurements for playing a traditional video game.

The active computer games studied here were Dance Central and Kinect Sports Boxing.

Heart rate, oxygen uptake and energy expenditure were considerably higher in the active games. Mean energy expenditure was 1.5, 3 and 4.4kcal/min for the sedentary, dance and boxing games, respectively. This equates to increased energy expenditure of 263% over baseline for the most energetic game.

The conclusion is that playing active video games is a potential means of increasing energy expenditure in children.

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

  • Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Review your patients who have chronic pain. Have they tried a course of acupuncture?
  • Revise current treatments for basal cell carcinoma and their efficacy.
  • Ask your depressed patients about their physical activity level and try to promote physical activity in this group.

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