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Background: Shoulder-hand syndrome (SHS) is a common complication after stroke, and SHS-induced pain significantly hampers patients' overall recovery. As an alternative therapy for pain relief, acupuncture has certain advantages in alleviating pain caused by SHS after stroke. However, choosing the best treatment plan from a variety of acupuncture options is still a serious challenge in clinical practice. Therefore, we conducted this Bayesian network meta-analysis to comprehensively compare the effectiveness of various acupuncture treatment methods. Methods: We systematically searched for randomized controlled trials (RCTs) of acupuncture treatment in patients with post-stroke SHS published in PubMed, Embase, Cochrane, and Web of Science until 9 March 2023. We used the Cochrane bias risk assessment tool to assess the bias risk in the included original studies. Results: A total of 50 RCTs involving 3,999 subjects were included, comprising 19 types of effective acupuncture interventions. Compared to single rehabilitation training, the top three interventions for VAS improvement were floating needle [VAS = -2.54 (95% CI: -4.37 to -0.69)], rehabilitation + catgut embedding [VAS = -2.51 (95% CI: -4.33 to -0.68)], and other multi-needle acupuncture combinations [VAS = -2.32 (95% CI: -3.68 to -0.94)]. The top three interventions for improving the Fugl-Meyer score were eye acupuncture [Meyer = 15.73 (95% CI: 3.4627.95)], other multi-needle acupuncture combinations [Meyer = 12.22 (95% CI: 5.1919.34)], and traditional western medicine + acupuncture + traditional Chinese medicine [Meyer = 11.96 (95% CI: -0.59 to 24.63)]. Conclusion: Multiple acupuncture methods are significantly effective in improving pain and upper limb motor function in post-stroke SHS, with relatively few adverse events; thus, acupuncture can be promoted. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42023410957. [ABSTRACT FROM AUTHOR]

Xiaonan Meng,1,2,* Jie Sun,3,* Qi Liu,4,* Yueping Huang,5 Xianwen Qiu,6 David Jung Seto,7,8 Ying Li,3 Liping Wang,2 Chunying Li,2 Sen Gao,9 Haikuo Yu,10 Jiping Zhao,1 Baixiao Zhao1 1Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 2Department of Acupuncture and Moxibustion, Beijing Huguosi TCM Hospital, Affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Department of Integrated Chinese and Western Medicine Rehabilitation, Beijing Xiaotangshan Hospital, Beijing, People’s Republic of China; 4Department of General Internal Medicine, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 5School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 6Department of Acupuncture and Moxibustion, Beijing Shichahai Community Healthcare Center, Beijing, People’s Republic of China; 7Division of Integrative Medicine, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; 8Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 9Department of Rehabilitation, Beijing Huguosi TCM Hospital, affiliated with Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 10Rehabilitation Department, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiping Zhao; Baixiao Zhao, Email zjp7883@sina.com; baixiao100@vip.sina.comBackground: Post-stroke shoulder-hand syndrome (PS-SHS), a common neurological comorbidity after stroke episodes, poses a grave threat on patients’ functional recovery. Preliminary trials have demonstrated that the acupuncture and moxibustion treatment, including a dermal acupuncture tapping method known as plum blossom needling (PBN) can improve pain and motor dysfunctions in patients with PS-SHS. However, there are few reports describing simultaneous moxibustion treatment in combination with PBN. Hence, a novel plum blossom needle device with mild moxibustion (PBNMM) was developed to evaluate its potential efficacy and safety in patients with stage 1 PS-SHS.Materials and Methods: This multicenter, sham-controlled, randomized controlled trial (RCT) will recruit 102 eligible patients with stage 1 PS-SHS from three clinical centers, randomly allocated in a ratio of 1:1:1 to the PBNMM group, PBNMM with no moxa smoke (PBNMM-NMS) group and sham control group. Patients in each group will receive a 30-minute treatment once per day for 4 weeks, with 5 consecutive sessions per week, for a total of 20 sessions. The primary outcome measure will be defined as the decreased scores from baseline in the visual analog scale (VAS) assessment at week 4. Secondary outcome measures will include scores on the Fugl-Meyer Assessment of the Upper Extremity Scale (FMA-UE), the Modified Barthel Index (MBI), and the somatosensory evoked potential (SEP) records. All outcomes will be evaluated at baseline and weeks 4, 5, 6 and 10, and the intention-to-treat analysis will be applied.Conclusion: This study aims to provide robust evidence for the efficacy and safety of the PBNMM for PS-SHS treatment, as well as the specific impact of moxibustion smoke itself in dealing with PS-SHS.Clinical Trial Registration: Chinese Clinical Trial Registry No. ChiCTR2200062441. Registered on 7 August 2022.Keywords: plum blossom needling, mild moxibustion, novel device, post-stroke shoulder-hand syndrome, protocol, randomized controlled trial

Yuichi Katsura,1,2 Satoshi Ohga,3 Kazuhiro Shimo,3 Takafumi Hattori,2 Tsukasa Yamada,1,2 Takako Matsubara2,3 1Department of Rehabilitation, Kishiwada Rehabilitation Hospital, Kishiwada-shi, Osaka, 596-0827, Japan; 2Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, 651-2180, Japan; 3Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, 651-2180, JapanCorrespondence: Yuichi Katsura, Department of Rehabilitation, Kishiwada Rehabilitation Hospital, 8-10, Kanmatsu-chou, Kishiwada-shi, Osaka, 596-0827, Japan, Tel +81-72-426-7777, Fax +81-72-426-7771, Email rm9xhj04@s.kobegakuin.ac.jpPurpose: The purpose of this study was to investigate the prevalence of post-stroke complex regional pain syndrome (CRPS) and to examine the characteristics of inactivity status of the upper limb in post-stroke CRPS patients. In addition, as a sub-analysis, the association between the upper limb inactivity status and pain intensity was investigated in post-stroke CRPS patients.Patients and Methods: This cross-sectional study included 102 patients with first-ever stroke between April 2019 and February 2020. Each patient was allocated into one of two groups based on the presence or absence of CRPS. Demographic data (age, sex, stroke etiology, lesion side, and number of days since stroke onset) were collected. The following evaluations were performed in all patients: Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log (MAL). The numerical rating scale (NRS) to determine pain intensity was assessed only in patients with post-stroke CRPS.Results: Nineteen and 83 patients were assigned to the post-stroke CRPS and control group, respectively. The prevalence of post-stroke CRPS was 18.6% (19/102). FMA, ARAT, and MAL scores were significantly lower in patients with post-stroke CRPS than those without it. FMA and ARAT scores were significantly correlated with NRS scores, but MAL was almost zero-scored in patients with post-stroke CRPS.Conclusion: The study results indicated that activity status of the affected upper limb was severely deteriorated, and more inactivity of the upper limb was associated with higher pain intensity in patients with post-stroke CRPS. Thus, our results suggest that post-stroke CRPS may be influenced by the degree of upper limb inactivity after stroke.Keywords: complex regional pain syndrome, post-stroke shoulder-hand syndrome, stroke, Fugl–Meyer Assessment, Action Research Arm Test, Motor Activity Log

Yun Chen,1 Yanming Zhang,2,3 Xuan Su4 1Guangdong Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Guangzhou University of Chinese Medicine, Foshan, People’s Republic of China; 2The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 3Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, People’s Republic of China; 4The Ninth People’s Hospital of Nanhai District, Foshan, People’s Republic of ChinaCorrespondence: Xuan Su, Email suxuan2022@126.com View the original paper by Dr Meng and colleagues

Objective: To compare the effects between penetration acupuncture at Baxie (EX-UE 9) combined with rehabilitation and simple rehabilitation for swelling hand in post-stroke shoulder-hand syndrome., Methods: Sixty patients were randomly assigned into an observation group and a control group,30 cases in each one. Penetration acupuncture at Baxie (EX-UE 9) combined with rehabilitation were used in the observation group,and the acupoints were the affected Baxie (EX-UE 9) and Wailaogong (EX-UE 8). Simple rehabilitation was used in the control group. All the treatment was given for 3 weeks,5 days a week with 2 days at the interval,once a day. The swelling degree and motor function of the affected hand were assessed before and after treatment in the two groups. Also,the effects were compared., Results: The swelling and motor function scores after treatment were improved compared with those before treatment in the two groups(all P <0.01),with better effects in the observation group(both P <0.01). The total effective rate was 93.3%(28/30) in the observation group,which was better than 73.3%(22/30) in the control group( P <0.01)., Conclusions: Penetration acupuncture at Baxie (EX-UE 9) combined with rehabilitation can effectively and timely alleviate the swelling hand and motor function of post-stroke shoulder-hand syndrome,which are better than simple rehabilitation.