Deans' stroke musings: Efficacy and safety of acupuncture in post-stroke constipation: a systematic review and meta-analysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, October 11, 2023

Efficacy and safety of acupuncture in post-stroke constipation: a systematic review and meta-analysis

But is marijuana better?

Don't do the following, I'm not medically trained.

Marijuana use linked with decreased constipation

The latest here:

Efficacy and safety of acupuncture in post-stroke constipation: a systematic review and meta-analysis

Tianye Sun¹

Kaiyue Wang¹

Lili Li¹

Mingyuan Yan¹

Lin Zou¹

Mi Zhang¹

Songyi Yang¹

Jing Wu²

Jinmin Liu³^*

¹Beijing University of Chinese Medicine, Beijing, China
²Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
³Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China

Background and objective: Post-stroke constipation (PSC) is a common complication of strokes that seriously affects the recovery and quality of life of patients, and effective treatments are needed. Acupuncture is a viable treatment option, but current evidence is insufficient to support its efficacy and safety. This study aims to evaluate the efficacy and safety of acupuncture in the treatment of PSC.

Methods: A systematic search of eight databases was conducted to identify PSC-related randomized clinical trials from the inception of each database through May 2023. Methodological quality assessment was conducted by RoB 2.0, meta-analysis was conducted by RevMan 5.3 and Stata 15.1, and evidence quality was evaluated by GRADE. Moreover, reporting quality of acupuncture interventions was assessed using the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA).

Results: Thirty RCTs involving 2,220 patients were identified. We found that acupuncture was superior to conventional treatment (CT) in improving total responder rate [risk ratio (RR): 1.16, 95% confidence interval (CI): 1.09 to 1.25, p < 0.0001], decreasing constipation symptom scores [standardized mean difference (SMD): -0.65, 95% CI: −0.83 to −0.46, p < 0.00001], increasing serum P substance (SP) levels (SMD: 1.92, 95% CI: 0.47 to 3.36, p = 0.009), reducing the time to first bowel movement (BM) (SMD: -1.19, 95% CI: −2.13 to −0.25, p = 0.01), and lowing serum vasoactive intestinal peptide (VIP) levels (SMD: –2.11, 95% CI: −3.83 to −0.38, p = 0.02). Furthermore, acupuncture plus CT was superior regarding total responder rate (RR: 1.26, 95% CI: 1.17 to 1.35, p < 0.00001), serum SP levels (SMD: 2.00, 95% CI: 1.65–2.35, p < 0.00001), time to first BM (SMD: –2.08, 95% CI: −2.44 to −1.71, p < 0.00001), and serum VIP levels (SMD: –1.71, 95% CI: −2.24 to −1.18, p < 0.00001). However, regarding Bristol Stool Scale (BSS) score, acupuncture plus CT was superior to CT (SMD: -2.48, 95% CI: −3.22 to −1.73, p < 0.00001), while there was no statistically significant difference between acupuncture and CT (SMD: 0.28, 95% CI: −0.02 to 0.58, p = 0.07). Acupuncture causes fewer AEs than CT (RR: 0.13, 95% CI: 0.06 to 0.26, p < 0.00001), though there was no statistically significant difference between acupuncture plus CT vs. CT (RR: 1.30, 95% CI: 0.60 to 2.84, p = 0.51).

Conclusion: Acupuncture may be an effective and safe therapy for PSC. However, given the inferior quality of clinical data, additional well-designed RCTs are required to confirm these findings.

1. Introduction

Stroke is one of the top three global disease burdens (GBD 2019 Stroke Collaborators, 2021), and post-stroke constipation (PSC) is a common complication with a prevalence of 50–70% in stroke patients (Su et al., 2009; Liu Q. et al., 2018; Liu Z. et al., 2018). PSC seriously affects the treatment and rehabilitation of stroke (Harris and Chang, 2022), leading to decreased quality of life, prolonged hospitalization, and increased healthcare costs. PSC also induces or aggravates other complications like post-stroke depression and may lead to recurrent stroke and death (Sumida et al., 2019), placing a substantial burden on the national healthcare system.

The exact mechanism of PSC is unclear. Studies suggest a close relationship with autonomic dysfunction (Liu Q. et al., 2018; Liu Z. et al., 2018), multidrug usage (Su et al., 2009), dietary changes, and reduced activity (Lim et al., 2015). Recently, the brain-gut axis has received much attention as a bi-directional channel between the gastrointestinal tract and the autonomic nerves of the central nervous system that uses a variety of neurotransmitters, brain-gut peptides, and gut microbes (Carabotti et al., 2015; Camilleri, 2021; Xu et al., 2021), which are considered relevant to the development of PSC. Because of the lack of clinical and basic research related to PSC, current treatment strategies are mostly based on clinical practice guidelines for functional constipation (Chang et al., 2022, 2023), such as the use of laxatives, 5-hydroxytryptamine type 4 agonists, and enemas. However, relief is usually temporary, and side effects such as bloating, diarrhea, colon damage, melanosis coli, and cardiovascular adverse events cannot be ignored (Gilsenan et al., 2019; Chang et al., 2022, 2023). Safer and more effective alternative treatments are urgently needed.

Acupuncture is a complementary and alternative medicine of Chinese origin, of which the most common forms include manual acupuncture (MA), electroacupuncture (EA), moxibustion, and warm acupuncture (WA). Studies demonstrate that acupuncture is a relatively safe alternative to laxatives that effectively alleviates gastrointestinal and neurological symptoms in patients (Wang et al., 2015; Liu et al., 2016; Pei et al., 2020; Lu et al., 2022; Zheng et al., 2022). Moreover, electrophysiology studies have shown that acupuncture regulates autonomic nerves and gastrointestinal hormones by transmitting signals from somatic stimulation to the central nervous system via the upper spinal cord, thereby affecting gastrointestinal tract function (Takahashi, 2013).

Clearly, acupuncture may be an effective and safe complementary and alternative therapy to improve PSC. Previous meta-analyses (Yang et al., 2014; Tang et al., 2020) have investigated the therapeutic effects of acupuncture on PSC, but their conclusions require further validation because of deficiencies in outcome indicators, included literature, and controls for confounding factors. Therefore, to further confirm the efficacy and safety of the treatment, we conducted a comprehensive evaluation of the available clinical evidence on the latest randomized clinical trial (RCT) data of acupuncture for PSC