Acupuncture Shows Effectiveness for Anxiety in Patients With Parkinson Disease

After 2 months of treatment, findings showed more improvement in anxiety and mental status with acupuncture in patients with Parkinson Disease than those on sham acupuncture.

In a recent randomized, double-blinded, clinical trial (ChiCTR2100047253), results demonstrated significant reductions in anxiety in patients with Parkinson Disease (PD) treated with acupuncture.1 These findings suggest that acupuncture, with clinical monitoring, may reduce symptoms of anxiety for this patient population.

After 8 weeks of treatment, the Hamilton Anxiety Scale (HAM-A) score showed the variation of 0.22 (95% CI, –0.63 to 1.07; P = .62) between the real acupuncture (RA) and sham acupuncture (SA) groups. At the same time point, the real acupuncture group had a significant 7.03-point greater (95% CI, 6.18 to 7.88; P < .001) reduction in HAM-A score in comparison with the sham acupuncture group.

Lead investigator Jing-qi Fan, PhD, Guangzhou University of Chinese Medicine, Guangdong, China, and colleagues wrote, “The clinical improvement in the anxiety of the participants in the RA group was better than the SA group. It can be preliminarily concluded that although there is a certain placebo effect in the short term, acupuncture is clinically effective on anxiety in patients with PD. The placebo effect of acupuncture in the present study disappeared over time; its therapeutic effect was maintained long-term.”1

The study recruited 70 eligible patients including 34 women (48.5%) and 36 men (51.4%) between June 20, 2021, and February 26, 2022, from a Parkinson clinic in China. The patients were randomized (1:1) for acupuncture or sham acupuncture for 8 weeks. Sixty-four patients (91%) completed treatment as well as follow-up on April 15, 2022, with only 4 mild adverse events occurring during the study period. The HAM-A score was the primary outcome, with secondary outcomes such as the Unified Parkinson Disease Rating Scale (UPDRS), 39-item Parkinson Disease Questionnaire (PDQ-39), and serum levels of the adrenocorticotropic hormone (ACTH) and cortisol (CORT) scores.

Results from the secondary outcomes showed no statistical significance in the variance in enhancement of UPDRS I and PDQ-39-EW at the end of treatment between both groups (UPDRS I: 0.03 [95% CI, −0.06 to 0.67]; P = .92; PDQ-39-EW: −0.25 [95% CI, –1.22 to 0.72]; P = .62). The RA group reported a significant reduction in UPDRS score of −3.40 points (95% CI, 2.36 to 4.45; P < .001) at follow up in comparison with the SA group. Additionally, the RA group had a significant reduction in PDQ-39 score of 9.59 points (95% CI, 2.70 to 16.49; P = .02) in comparison with the SA group. Then, after the treatment period, there was a statistically significant change (2.16;95% CI, 0.90 to 3.45; P < .001) observed of ACTH between the RA and SA groups.

“The improvement of the overall condition and QOL of the participants in the RA group was better than that of those in the SA group at follow-up,” the investigators wrote. “This may be because reduction of anxiety symptoms leads to reduction of motor symptoms. Improvement of anxiety may also improve the QOL as a whole by promoting the recovery of social roles, and reducing the limitations caused by PD. Thus, it can be preliminarily concluded that acupuncture can improve the overall condition and QOL of patients with PD by alleviating anxiety symptoms.”1

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Both the RA (65.6%) and the SA groups (62.5%) reached the minimal clinically significant difference (MCID) which is a principal for interpreting clinical outcomes.2 Notably after the follow-up, 86.8% patients in the RA group and 6.4% patients in the SA group reached MCID. “There are 2 main reasons for this,” Fan et al wrote. “First, all the participants of this study are Chinese. Acupuncture, as a traditional Chinese therapy, is highly recognized in China. Thus, participants would generally believe that they have received an effective treatment. Second, as anxiety is a subjective symptom, it is easy to produce a placebo effect during its treatment by using a highly recognized treatment.”

Strengths of the study were the double blinded design for patients and acupuncture operators along with the masking effect of the sham needle devices being consistent with the real acupuncture needles. Additionally, the data provided a basis mechanism on acupuncture for patients with anxiety and PD. “To our knowledge, this is the first randomized clinical trial of the effectiveness of an acupuncture treatment regimen targeted for anxiety in patients with PD,” Fan et al noted.1

Limitations included some bias in using HAM-A score of at least 14 as the standard for evaluating anxiety in PD as some items of scale were experienced by PD patients with anxiety and without anxiety. Also, the placebo effect may have been caused by cultural factors as only Chinese participants were included in this study. Hence, future studies should consider the economic benefits and patient acceptance for the evaluation of acupuncture.

“This study found acupuncture to be an effective treatment for anxiety in patients with PD. These findings suggest that acupuncture may enhance the wellbeing of patients who have Parkinson disease and anxiety,” Fan et al noted.1

REFERENCES
1. Fan JQ, Lu WJ, Tan WQ, et al. Effectiveness of Acupuncture for Anxiety Among Patients With Parkinson Disease: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(9):e2232133. Published 2022 Sep 1. doi:10.1001/jamanetworkopen.2022.32133
2. McGlothlin AE, Lewis RJ. Minimal clinically important difference: defining what really matters to patients. JAMA. 2014;312(13):1342-1343. doi:10.1001/jama.2014.13128
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