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      Bibliometric Analysis of Research Assessing the Use of Acupuncture for Pain Treatment Over the Past 20 Years

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          Abstract

          Objective

          A bibliometric approach using quantitative analytical methods was applied to explore the development of research investigating acupuncture for the treatment of pain. This study also evaluated the current status of acupuncture analgesia with a visualization analysis of journal articles.

          Methods

          Articles on acupuncture for pain control that were published from 2000 to 2019 were retrieved from the Web of Science database. Extracted records were analyzed in terms of year of publication, country, journal, research area, authors, and organizational affiliations. The VOSviewer program was used to visualize trends in research on acupuncture for pain control.

          Results

          Analyses of 4595 original and review articles revealed that the total number of publications has continually increased over the last 20 years. The country producing the most articles in this field was the United States, followed by China and South Korea. A network analysis based on the cooccurrence of keywords revealed the following three major types of studies: clinical studies, pain management studies, and mechanism studies.

          Conclusion

          The present study evaluated research on acupuncture for pain control using bibliometric methods and revealed current trends in acupuncture analgesia research, as well as potential future hot spots of research in this field.

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          Most cited references 22

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          Acupuncture for patients with migraine: a randomized controlled trial.

          Acupuncture is widely used to prevent migraine attacks, but the available evidence of its benefit is scarce. To investigate the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine. Three-group, randomized, controlled trial (April 2002-January 2003) involving 302 patients (88% women), mean (SD) age of 43 (11) years, with migraine headaches, based on International Headache Society criteria. Patients were treated at 18 outpatient centers in Germany. Acupuncture, sham acupuncture, or waiting list control. Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks. Patients completed headache diaries from 4 weeks before to 12 weeks after randomization and from week 21 to 24 after randomization. Difference in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after randomization. Between baseline and weeks 9 to 12, the mean (SD) number of days with headache of moderate or severe intensity decreased by 2.2 (2.7) days from a baseline of 5.2 (2.5) days in the acupuncture group compared with a decrease to 2.2 (2.7) days from a baseline of 5.0 (2.4) days in the sham acupuncture group, and by 0.8 (2.0) days from a baseline if 5.4 (3.0) days in the waiting list group. No difference was detected between the acupuncture and the sham acupuncture groups (0.0 days, 95% confidence interval, -0.7 to 0.7 days; P = .96) while there was a difference between the acupuncture group compared with the waiting list group (1.4 days; 95% confidence interval; 0.8-2.1 days; P<.001). The proportion of responders (reduction in headache days by at least 50%) was 51% in the acupuncture group, 53% in the sham acupuncture group, and 15% in the waiting list group. Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control.
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            Acupuncture analgesia: a review of its mechanisms of actions.

            The mechanism of acupuncture analgesia (AA) has been widely explored since the 1970s. Early studies investigated the relationship between acupuncture and endogenous opiates (beta-endorphin, enkephalin, endomorphin and dynorphin). Before the 1990s, most experts agreed on the concept that in normal animal models, lower frequency electroacupuncture (EA) stimulates the release of beta-endorphin, enkephalin and endomorphin, which in turn activates the mu- and delta-opioid receptors, and that higher frequency EA stimulates dynorphin which activates the kappa-opioid receptor. Besides endogenous opiates, our studies have focused on serotonin. The serotoninergic descending inhibitory pathway is suggested to be an important mechanism of acupuncture analgesic, collaborating with endogenous opiates. Many efforts have been made to clarify these mechanisms, but to date no satisfactory consensus has been reached. In the late 1990s, researchers began to focus on the different analgesic effects of EA between normal and hyperalgesic animal models. Published data from these studies imply that normal and hyperalgesic animals respond differently to EA. Results from experiments on the anti-hyperalgesia effect of EA have raised a new issue about the influences of EA on receptors to excitatory amino acid in the spinal cord level. Results from various studies have shown that these receptors play a role in the mechanism of AA. Recently, research on the autonomic nervous system (ANS) seem to indicate its connection with acupuncture. The inflammatory reflex (via the ANS) might be a crucial part of anti-hyperalgesia elicited by acupuncture, and this reflex, which regulates the immune system in the organism, can elucidate not only the mechanism of AA but also the mechanism of acupuncture applied to other inflammatory conditions. Innovation of functional image study enables us to analyze the responses of cortex on living human body to acupuncture. However, results of these experiments are still controversial. After 30 years of acupuncture research, there are still many puzzles left to be solved regarding the mechanism of AA.
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              Citation-based clustering of publications using CitNetExplorer and VOSviewer

              Clustering scientific publications in an important problem in bibliometric research. We demonstrate how two software tools, CitNetExplorer and VOSviewer, can be used to cluster publications and to analyze the resulting clustering solutions. CitNetExplorer is used to cluster a large set of publications in the field of astronomy and astrophysics. The publications are clustered based on direct citation relations. CitNetExplorer and VOSviewer are used together to analyze the resulting clustering solutions. Both tools use visualizations to support the analysis of the clustering solutions, with CitNetExplorer focusing on the analysis at the level of individual publications and VOSviewer focusing on the analysis at an aggregate level. The demonstration provided in this paper shows how a clustering of publications can be created and analyzed using freely available software tools. Using the approach presented in this paper, bibliometricians are able to carry out sophisticated cluster analyses without the need to have a deep knowledge of clustering techniques and without requiring advanced computer skills.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                11 February 2020
                2020
                : 13
                : 367-376
                Affiliations
                [1 ]Acupuncture & Meridian Science Research Center, College of Korean Medicine, Kyung Hee University , Seoul, Republic of Korea
                [2 ]Korean Medicine Convergence Research Center, Kyung Hee University , Seoul, Republic of Korea
                [3 ]Chinese Medicine Research Center, China Medical University , Taichung, Taiwan, R.O.C.
                Author notes
                Correspondence: Younbyoung Chae Acupuncture & Meridian Science Research Center, Kyung Hee University , 1 Hoegi-dong, Dongdaemun-gu, Seoul, Republic of Korea Email ybchae@khu.ac.kr
                Article
                235047
                10.2147/JPR.S235047
                7023857
                © 2020 Lee et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 5, References: 24, Pages: 10
                Categories
                Original Research

                Anesthesiology & Pain management

                network analysis, pain, bibliometric analysis, analgesia, acupuncture

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