The objective of this study was to assess the efficacy and safety of electroacupuncture in 138 patients with earthquake-caused PTSD using Randomized Controlled Trials (RCTs). 138 cases enrolled were randomly assigned to an electro-acupuncture group and a paroxetine group. The electro-acupuncture group was treated by scalp electro-acupuncture on Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), and Fengchi (GB 20), and the paroxetine group was treated with simple oral administration of paroxetine. The efficacy and safety of the electro-acupuncture on treatment of 69 PTSD patients were evaluated using Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Treatment Emergent Symptom Scale (TESS) according to clinical data. The total scores of CAPS, HAMD, and HAMA in the two groups after treatment showed significant efficacy compared to those before treatment. The comparison of reduction in the scores of CAPS, HAMD, and HAMA between the two groups suggested that the efficacy in the treated group was better than that in the paroxetine group. The present study suggested that the electro-acupuncture and paroxetine groups have significant changes in test PTSD, but the electro-acupuncture 2 group was more significant.
Posttraumatic stress disorder (PTSD) develops in some people after they have been exposed to a traumatic event such as sexual abuse, a serious road traffic collision, a natural disaster, criminal victimization, or military combat. PTSD patients exhibit depressive symptoms, abnormality of the circulating levels of the stress hormones and neurotransmitter activity, and alteration of gene expression [
Based on the previous reports, the prevention and therapy methods of PTSD are mainly psychopharmacology, psychotherapeutic interventions, psychoeducation and support, and so forth. Psychopharmacology proved to be partially effective in reduction of symptoms of increased irritability and reexperiencing, but most often it had no effect on symptoms of avoidance. Along with new developments in neurophysiology of stress response antidepressants, anxiolytics, antiadrenergic agents, anticonvulsants, benzodiazepines, atypical antipsychotics, and novel agents came to be used for drug treatment, but the results were only partially satisfactory. Moreover, the limitations of conventional psychopharmacologic treatments were more expensive and were difficult to formal treatment for patients in low-income countries [
Natural disasters, like earthquakes, floods, fires, SARS, and so forth, not only cause losses of people’s lives and property, but also result in people’s psychological trauma. At 2:28 p.m. Beijing time, on May 12, 2008, an earthquake measuring 8.0 magnitude on the Richter scale, with its epicenter in Wenchuan county, hit a number of cities and counties in the southwest of China [
Acupuncture has been used for medicine with a continuous clinical history, such as emotional disorders, pain tissues, and postoperative nausea [
512 Wenchuan earthquake-caused PTSD patients in the disaster areas were collected and admitted in Traditional Chinese Medicine Hospital of Mianyang City, Traditional Chinese Medicine Hospital of Jiangyou City, and Psychiatric Hospital of Dujiangyan City from May 2008 to November 2008. Participants were initially screened by telephone, and full assessments were conducted only for participants who did not report any exclusion criteria during the telephone screening. All participants provided written informed consent approved by the Hospital Human Research Ethics Committee.
Justification of the selected outcomes and interventions was for the most part clearly stated. In reference to the standard for diagnosing PTSD in the
(1) Those who have suffered from depression or other mental disorders; (2) those who had the earthquake-caused severe damage with mentally retarded patients; (3) those who are taking anti-anxiety or antidepressant drugs; (4) those who are pregnant or lactating women.
138 patients were randomized into an electroacupuncture group and a medication (paroxetine) group. There was no significant difference statistically in baseline characteristics of two groups. The medication (paroxetine) group received paroxetine (Zhejiang Huahai pharmaceutical Co., LTD, Linhai, Zhejiang, China) with simple oral administration 20 mg every night, and the treatment cycle is six weeks for two consecutive treatments (12 weeks). In the treatment group, the Sishencong (Ex-HN 1), Baihui (GV 20), Shenting (GV 24), and Fengchi (GB 20) points were selected by the introduction of Nomenclature and Location of Acupuncture Points (GB/T12346–006). Sishencong is a group of four points which are located on vertex of head, each 1 cun away from Baihui (GV 20) at four directions (anterior, bilateral, and posterior, Figure
The locations of Baihui (GV 20), Sishencong (Ex-HN), Shenting (GV 24), and Fengchi (GB 20).
At one week before and after treatments, the safety of electro-acupuncture head points on treatment of the 512 Wenchuan earthquake-caused PTSD was evaluated by the measurement of body temperature, blood pressure, pulse, respiration, blood parameters, liver and kidney function, and so forth. The efficacy and side effects of treatment methods were also evaluated using Clinical-Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Treatment Emergent Symptom Scale (TESS) according to clinical data. The three-scale scores of CAPS, HAMD, and HAMA were analyzed and calculated the integral reduced rate at before treatment, after 6 weeks of treatment, and after 12 weeks of treatment. Moreover, results of CAPS were also recorded and calculated the integral reduced rate by followup at 3 and 6 months. Reduction rate is equal (
In the present study, the safety evaluation standards were divided into four levels, (1) those that no any adverse reaction was observed; (2) those that have a little adverse reactions, but the treatment may continue without any process; (3) those that moderate adverse reactions were observed, and the treatment may continue with some process or help; (4) those that adverse events caused the discontinuation of treatment.
Clinical experiments were designed by Research Department of Hong Kong and Hang Seng School of Commerce, and data was analyzed using SPSS 16.0 software package.
Participant characteristics for the 5.12 Wenchuan earthquake-caused SCI patients were shown in Table
Participant characteristics of the two groups.
Characteristic | Paroxetine | Electroacupuncture |
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Sex number (%) men | 28 (43.7) | 26 (40) | 0.778 |
Sex number (%) women | 36 (56.3) | 39 (60) | |
Age, mean (SD) | 50.3 ± 12.3 | 48.3 ± 13.3 | 0.562 |
Figure
Flow chart of the study sample.
As shown in Table
Comparison of scores in CAPS, HAMA, and HAMD before and after treatment.
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HAMD | Paroxetine ( |
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HAMA | Paroxetine ( |
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Note: afor the intergroup comparison; bfor the intragroup comparison.
As shown in Table
Comparison of reduction rate in CAPS, HAMA, and HAMD before and after treatment.
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CAPS | Control ( |
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HAMD | Control ( |
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HAMA | Control ( |
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Note: athe intergroup comparison; bthe intragroup comparison.
As shown in the clinical results of TESS, 185 adverse events on behavior, autonomic nerve, cardiovascular system, and so forth, were observed in the paroxetine group. The side effects on behavior were mainly as following: excitement or agitation (4 patients, 2.16%), depression (3 patients, 1.62%), activity increased (2 patients, 1.08%), activity declined (6 patients, 3.24%), insomnia (28 patients, 15.1%), and fatigue (7 patients, 3.78%). The side effects autonomic nerve mainly included xerophthalmia (36 patients, 3.78%), stuffy nose (1 patients, 0.54%), blurred vision (3 patients, 1.62%), constipation (17 patients, 9.19%), saliva increase (8 patients, 4.32%), sweat (11 patients, 5.95%), nausea and vomiting (11 patients, 5.95%), and diarrhea (6 patients, 3.24%). The side effects on cardiovascular system were mainly dizziness (5 patients, 2.70%), tachycardia (3 patients, 2.62%), and skin allergy symptom (1 patients, 0.54%). The side effects of appetite loss/anorexia (21 patients, 11.4%) and headache (11 patients, 5.95%) were observed. A systematic review of prospective studies of acupuncture safety found the most common adverse events were needle pain, hematoma, faint during acupuncture treatment, and bleeding. In the electro-acupuncture group, the most frequent side effects reported by the patients were minor needle pain (24 patients, 39.3%), minor superficial bleeding (27 patients, 44.3%), and minor hematoma (9 patients, 14.8%) which were experienced during acupuncture. Only one case of moderate pain (1.64%) was reported in 61 adverse events. Moreover, results from the body temperature, blood parameters, pulse, and respiration of all patients, as well as liver and kidney function showed that no significant changes are observed in the electro-acupuncture treatment. However, the leukocyte count of one patient in the control group decreased significantly, which is related to the side effects of paroxetine. The patient stopped taking paroxetine and was given appropriate treatment. After two weeks, the leukocytes reached normal level. These findings suggested that the efficacy and safety of electro-acupuncture method on PTSD treatment are relatively better than those of the paroxetine method.
In the view of Western medicine, PTSD is primarily caused by a combination of rauma mental troubles and mental disorders in disaster, as well as interference with the normal emotions and work of the neurosis. PTSD can continue for years, and its symptoms can affect every life domain physiologically, psychologically, occupationally, and socially [
Acupuncture is accepted as an effective treatment for many symptoms and disorders, including neuropsychiatric disorders. The number of patients choosing acupuncture as an alternative treatment is increasingly parallel to growing scientific evidence supporting the efficacy of acupuncture [
In Traditional Chinese Medicine, the symptom of PTSD belongs to scope of “emotional diseases” or “Depression,” if diseases occur in the head, Baihui (GV 20), Sishencong (Ex-HN 1), Shenting (GV 24), and Fengchi (GB 20), and so forth, which are closer to the precentral gyrus [
In the present study, our results suggested that the scores of CAPS, HAMA, and HAMD in the two groups show no significant differences before and after treatment (
The efficacy and safety of electro-acupuncture at selected acupoints have been investigated to treatment 512 Wenchuan earthquake-caused PTSD patients using Randomized Controlled Trials (RCTs). The present study suggested that both electro-acupuncture and medication therapy may improve the symptoms of PTSD patients; the former is better than the latter in efficacy. Although acupuncture was shown to be of value as a therapeutic intervention for PTSD patients, further definitive research about simultaneous clinical and biological effects is needed to support the use of electro-acupuncture for PTSD treatment.
This work was financially supported by The Administration of Traditional Chinese Medicine of Sichuan Province, China (no. 2008-43).