Background: Cervical cancer is a malignant neoplasm arising from the uterine cervix and may be associated with severe pain and complex complications in advanced stages. Pain management in advanced cervical cancer remains challenging, particularly in patients with fistula formation and those undergoing surgical intervention. Objective: This case report describes the role of acupuncture as an adjunctive therapy for pain and perioperative symptom management in a patient with advanced cervical cancer complicated by a rectovaginal fistula. Case: A 66-year-old woman with stage IVA squamous cell carcinoma of the cervix complicated by a rectovaginal fistula was treated at Cipto Mangunkusumo General Hospital, a tertiary referral hospital in Jakarta, Indonesia. Intervention: The patient received 11 acupuncture sessions consisting of manual body acupuncture at LI4, PC6, ST36, ST37, SP6, SP9, SP10, GB34, LR3, and KI3; auricular Battlefield Acupuncture (BFA); bilateral stomach and sacral auricular points; and auricular press needles applied to Shenmen and bilateral thalamus points. During hospitalization, the patient underwent laparotomy for stoma creation and nephrostomy. Perioperative auricular acupuncture was administered using the National Acupuncture Detoxification Association (NADA) protocol. Results: Pain intensity progressively decreased during the course of acupuncture treatment, with VAS scores improving from 7 to 0 after the 11th session. The patient demonstrated favorable perioperative and postoperative outcomes, with stable pain control and no significant postoperative symptoms. Conclusions: This case suggests that acupuncture—including body acupuncture, BFA, and perioperative auricular acupuncture using the NADA protocol—may serve as a beneficial adjunctive therapy for pain and symptom management in patients with advanced cervical cancer undergoing surgical intervention. Further controlled studies are warranted to evaluate its efficacy in similar clinical settings.
Introduction: In 2020 Medicare initiated reimbursement for acupuncture for treatment of chronic low back pain (cLBP), with coverage limited to services provided by physicians and certain clinicians under their supervision. Independent licensed acupuncturists are ineligible for payment. The restrictive terms of coverage may compromise adequate and equitable patient access to acupuncture under Medicare. The purpose of the study was to quantify utilization and treatment intensity of acupuncture for cLBP under Medicare by state. Methods: We employed a cross-sectional design to examine 2020–2023 Medicare claims. We measured Utilization as acupuncture recipients per 100,000 Part B beneficiaries and Treatment Intensity as acupuncture visits per 100,000 Part B beneficiaries. To model utilization and treatment intensity across US states, we estimated Empirical Bayes adjusted rates for each state using Poisson regression models with state-level covariates. Quintiles of rates for utilization and treatment intensity were mapped by state to illustrate geographic variation. Results: Among all states the mean rate of utilization was 235.4 recipients per 100,000 Part B beneficiaries. The mean rate of treatment intensity was 1,721.9 services per 100,000. Utilization appeared relatively higher in West coast, Northeastern, and northern prairie states and states with large urban areas. Conclusions: Utilization and treatment patterns related to acupuncture for Medicare Part B beneficiaries vary widely by state. The marked geographic variation in patient utilization and treatment intensity suggests that access is not equitable. The variation is likely related to both the availability of acupuncture services under Medicare and patient preference.
Background: Korean Medicine Clinical Practice Guidelines (KM-CPGs) increasingly include acupuncture recommendations, yet cross-disease patterns of acupuncture point selection remain insufficiently characterized. Methods: We extracted acupuncture point recommendations from 45 KM-CPGs published up to December 26, 2024. Point names were standardized according to World Health Organization standard locations, and frequency distributions were visualized using heat maps and body maps. Eigenvector centrality-based network analysis was used to examine point co-recommendation structures across four disease categories. Results: ST36, LI4, SP6, LR3, and GV20 were the most frequently recommended points. Disease-category-specific profiles included GB34, BL23, SI3, and EX-B2 for musculoskeletal/injury conditions; GV20, HT7, PC6, and EX-HN1 for mental/behavioral disorders; LI4, GB20, and EX-HN5 for nervous system disorders; and SP6, BL23, CV4, and KI3 for genitourinary/pregnancy-related conditions. These findings indicate the combined use of regional and distal point strategies. Conclusions: Data mining and network analysis revealed both shared and disease-category-specific acupuncture point profiles in KM-CPGs, providing a reference map for future validation against real-world clinical practice data.
Objective: To describe symptomatic and functional changes observed during acupuncture treatment in a patient with suspected CSF1R-related leukoencephalopathy. Case: A 43-year-old woman with progressive neurological impairment began weekly acupuncture at our institution on November 8, 2024. The report focuses on an initial 8-month treatment period. Direct clinical observation by the second author began in January 2025. Concurrent treatment included weekly physiotherapy and chiropractic treatment; no disease-specific long-term pharmacologic treatment was reported by the patient’s husband. Results: During the early treatment period, the patient exhibited marked lower-limb stiffness and heightened physical reactivity to touch and needling. Even light stimulation could elicit pronounced stiffening of the lower limbs, and needle insertion was difficult because of marked tissue resistance. As treatment continued, these reactions became less pronounced: the limbs appeared more relaxed, passive movement and needle insertion became easier, and excessive responses to touch were less frequently observed. During subsequent periods of regular acupuncture, this relatively improved state was generally maintained, with less bodily stiffness, easier needling, a more upright sitting posture, and calmer, more responsive behavior. When acupuncture was interrupted, these features tended to become less apparent, while greater stiffness and heightened physical reactivity tended to recur. These observations were clinical and temporal in nature and were not based on standardized quantitative outcome measures. Conclusion: During the initial 8-month treatment period, repeated symptomatic and functional improvements were observed during periods of regular acupuncture. Recurrence of greater stiffness and reactivity after treatment interruptions further suggested a temporal relationship between regular acupuncture and symptom control. Although long-term follow-up showed continued progression of the underlying neurological disease, these observations suggest a potential adjunctive role for acupuncture in symptomatic and functional management of progressive leukoencephalopathy and warrant further investigation using standardized outcome measures.
Background: Hypertensive encephalopathy (HE) in pediatric patients is a life-threatening condition requiring prompt and controlled blood pressure reduction to prevent neurological complications. Case Illustration: We report a 7-year-old child with chronic kidney disease on continuous ambulatory peritoneal dialysis who presented with HE complicated by seizures and persistent hypertension despite intravenous nicardipine and multiple oral antihypertensive agents. Adjunctive manual scalp acupuncture was initiated using GV20 (Baihui) , EX-HN1 (Sishencong) , and additional ashi points. Results: Following treatment, the patient demonstrated a progressive reduction in blood pressure over seven sessions, accompanied by resolution of seizures, improvement in sleep, and reduction of associated symptoms such as neck pain. This improvement enabled gradual de-escalation of intravenous nicardipine and transition to oral therapy. No recurrent neurological events were observed during hospitalization or follow-up. Discussion: The observed clinical response suggests that scalp acupuncture may have a potential adjunctive role in pediatric HE. Plausible mechanisms include autonomic modulation, attenuation of sympathetic activity, improvement of cerebral blood flow and vascular reactivity, modulation of nitric oxide-related pathways, and neuroprotective or anti-inflammatory effects. Conclusions: The application of scalp acupuncture for pediatric HE may be a promising therapeutic adjuvant in controlling blood pressure. Nevertheless, causality cannot be established from a single case, particularly given concurrent antihypertensive therapy and dialysis-based volume management. Further studies are needed to evaluate its efficacy and safety in this setting.
