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Regarding clinical effectiveness of bee venom acupuncture for adhesive capsulitis
J Shoulder Elbow Surg (2013) 22, e19
www.elsevier.com/locate/ymse
LETTERS TO THE EDITOR Regarding clinical effectiveness of bee venom acupuncture for adhesive capsulitis To the Editor: I enjoyed reading the recent article by Koh et al2 in the journal. They stated that bee venom acupuncture (BVA) combined with physiotherapy is more effective than physiotherapy alone for patients with adhesive capsulitis in terms of pain reduction and disability lessening. However, I would like to express some comments regarding unclear injection sites, clinical considerations, and the significance of acupoints. The authors described that the BVA procedure required intramuscular injections of bee venom to 10 acupoints including LI15, LI16, TE14, GB21, and SI11, but the remaining 5 points were simply illustrated by the phrase ‘‘additionally 5 points around the shoulder’’ without an explanation of the acupoint locations and selection criteria. This unclear description does lead to difficulties regarding the reproducibility of the experiment. By pharmacokinetics, the bee venom (extracts of honey bee) injected intramuscularly acts through the blood circulation; thus, there is a potential risk of systemic allergic reaction.1 Practically, clinicians may tend to avoid using BVA that requires 10 injections at 10 shoulder areas in a single visit (lines 11-12, second column, third page); in turn, the practice is likely not risk free and not cost-effective. Although bee venom has antinociceptive and antiinflammatory properties, the study does not show confirmatory evidence that acupoints or acupuncture theory is involved in the patients’ recovery, because the authors did not test the effects of non-acupoint injection.2 In other
words, the experiment shows the bee venom injection providing add-on benefit to the physiotherapy for adhesive capsulitis, but the significance of acupoints for bee venom administration is not demonstrable. Regardless of my comments, Koh et al2 presented an appealing study that I would not hesitate to recommend to anyone who is interested in the field of alternative medicine. Yiu Ming Wong, PhD Health Science Unit (Physical Enhancement Center) Hong Kong Physically Handicapped & Able Bodied Association, Kowloon, Hong Kong
Disclaimer The author, his immediate family, and any research foundations with which he is affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References 1. Jung JW, Jeon EJ, Kim JW, Choi JC, Shin JW, Kim JY, et al. A fatal case of intravascular coagulation after bee sting acupuncture. Allergy Asthma Immunol Res 2012;4:107-9. http://dx.doi.org/10.4168/aair. 2012.4.2.107 2. Koh PS, Seo BK, Cho NS, Park HS, Park DS, Baek YH. Clinical effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a randomized controlled trial. J Shoulder Elbow Surg 2013. http://dx.doi.org/10.1016/j.jse.2012.10. 045 [Epub ahead of press].
1058-2746/$ - see front matter Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2013.04.001
www.elsevier.com/locate/ymse
LETTERS TO THE EDITOR Regarding clinical effectiveness of bee venom acupuncture for adhesive capsulitis To the Editor: I enjoyed reading the recent article by Koh et al2 in the journal. They stated that bee venom acupuncture (BVA) combined with physiotherapy is more effective than physiotherapy alone for patients with adhesive capsulitis in terms of pain reduction and disability lessening. However, I would like to express some comments regarding unclear injection sites, clinical considerations, and the significance of acupoints. The authors described that the BVA procedure required intramuscular injections of bee venom to 10 acupoints including LI15, LI16, TE14, GB21, and SI11, but the remaining 5 points were simply illustrated by the phrase ‘‘additionally 5 points around the shoulder’’ without an explanation of the acupoint locations and selection criteria. This unclear description does lead to difficulties regarding the reproducibility of the experiment. By pharmacokinetics, the bee venom (extracts of honey bee) injected intramuscularly acts through the blood circulation; thus, there is a potential risk of systemic allergic reaction.1 Practically, clinicians may tend to avoid using BVA that requires 10 injections at 10 shoulder areas in a single visit (lines 11-12, second column, third page); in turn, the practice is likely not risk free and not cost-effective. Although bee venom has antinociceptive and antiinflammatory properties, the study does not show confirmatory evidence that acupoints or acupuncture theory is involved in the patients’ recovery, because the authors did not test the effects of non-acupoint injection.2 In other
words, the experiment shows the bee venom injection providing add-on benefit to the physiotherapy for adhesive capsulitis, but the significance of acupoints for bee venom administration is not demonstrable. Regardless of my comments, Koh et al2 presented an appealing study that I would not hesitate to recommend to anyone who is interested in the field of alternative medicine. Yiu Ming Wong, PhD Health Science Unit (Physical Enhancement Center) Hong Kong Physically Handicapped & Able Bodied Association, Kowloon, Hong Kong
Disclaimer The author, his immediate family, and any research foundations with which he is affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References 1. Jung JW, Jeon EJ, Kim JW, Choi JC, Shin JW, Kim JY, et al. A fatal case of intravascular coagulation after bee sting acupuncture. Allergy Asthma Immunol Res 2012;4:107-9. http://dx.doi.org/10.4168/aair. 2012.4.2.107 2. Koh PS, Seo BK, Cho NS, Park HS, Park DS, Baek YH. Clinical effectiveness of bee venom acupuncture and physiotherapy in the treatment of adhesive capsulitis: a randomized controlled trial. J Shoulder Elbow Surg 2013. http://dx.doi.org/10.1016/j.jse.2012.10. 045 [Epub ahead of press].
1058-2746/$ - see front matter Ó 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2013.04.001