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Tuckey C1, Kohut SH2, Edgar DW1,3,4,5
1The University of Notre Dame, School of Physiotherapy, Freemantle, Australia, 2AUT University, Clinical Sciences, Auckland, New Zealand, 3Burn Injury Research Node, The University of Notre Dame, Freemantle, Australia, 4Institute of Health Research, The University of Notre Dame, Freemantle, Australia, 5Fiona Wood Foundation, Murdoch, Australia
Background: Prolonged healing responses can cause the formation of abnormal scars, including hypertrophic scars (HTS). These are often red, itchy, painful, and raised due to excessive deposition of disorganized collagen, taking years to mature. Incidence of HTS is as frequent as 32-72% following burn injury and up to 60% post-surgery. They are associated with significant discomfort and dysfunction, including restricted mobility, disfigurement and distress. Current conservative treatments offered by physiotherapists include pressure garments, silicone gel, laser and massage. These demonstrate positive effects on scar thickness and pliability, however have limited ability to influence pain and/or itch. Percutaneous collagen induction (PCI) has shown promising results in human and animal models. Acupuncture is used by physiotherapists trained in acupuncture and acupuncturists to improve scar quality, pain and pruritus. Acupuncture is a gentler needling therapy than PCI, with reduced side effects such as pain, bruising, bleeding and swelling, making it more tolerable to the patient. Unlike pressure garments and silicone, acupuncture can be applied during all phases of wound healing. Therefore, it could moderate abnormal healing processes in acute healing as well as stimulating a fresh healing response in mature scars. Furthermore, treatments such as acupuncture target neurogenic inflammation of the scar, thus reducing mechanical and chemical sensitivity of sensory receptors in the scar. Reduced inflammation may in turn decrease activity of fibroblast cells and thus reduce the amount of collagen being laid down, thereby reducing scar thickness and enhancing pliability.
Purpose: If acupuncture can promote normalisation of scarring and accelerate maturation it has the potential to impact the quality of scar tissue and the sufferer's quality of life. Case reports and trials have been published, however no systematic reviews evaluating treatment efficacy of acupuncture for scars exist. This review appraised the current level of evidence for the use of acupuncture as a treatment modality to influence the symptoms of pain and/or itch of symptomatic, hypertrophic scars in human subjects.
Methods: A comprehensive electronic search investigating the use of acupuncture for scars was performed. Databases included Ebsco Health (including Cinahl, Medline and SportDiscus), AMED, Scopus and Google Scholar. Reference lists and grey literature databases were also searched. Study quality was assessed using the Oregon CONSORT STRICTA instrument (OCSI) for clinical trials and the Joanna Briggs Institute (JBI) checklist for case reports.
Results: Four case studies, one retrospective cohort study, one cohort study and three clinical trials were located. Two case studies rated as high quality and two as low quality. Studies rated as low to moderate quality (26-50%) on the OCSI checklist due to lack of detailed reporting, use of non-validated outcome measures and heterogeneity of participant cohorts. All reported positive outcomes for the use of acupuncture for scar symptoms, however treatment frequency, duration, number of treatments and acupuncture points used varied.
Conclusion(s): The findings demonstrate a paucity of relevant research. From the available literature, a low level of evidence for the treatment of scars by acupuncture was found.
Implications: Further well designed, controlled trials investigating acupuncture´s role in hypertrophic scar treatment are required.
Keywords: Acupuncture, Scars, Hypertrophic
Funding acknowledgements: This work has not been funded by an external agency.
Purpose: If acupuncture can promote normalisation of scarring and accelerate maturation it has the potential to impact the quality of scar tissue and the sufferer's quality of life. Case reports and trials have been published, however no systematic reviews evaluating treatment efficacy of acupuncture for scars exist. This review appraised the current level of evidence for the use of acupuncture as a treatment modality to influence the symptoms of pain and/or itch of symptomatic, hypertrophic scars in human subjects.
Methods: A comprehensive electronic search investigating the use of acupuncture for scars was performed. Databases included Ebsco Health (including Cinahl, Medline and SportDiscus), AMED, Scopus and Google Scholar. Reference lists and grey literature databases were also searched. Study quality was assessed using the Oregon CONSORT STRICTA instrument (OCSI) for clinical trials and the Joanna Briggs Institute (JBI) checklist for case reports.
Results: Four case studies, one retrospective cohort study, one cohort study and three clinical trials were located. Two case studies rated as high quality and two as low quality. Studies rated as low to moderate quality (26-50%) on the OCSI checklist due to lack of detailed reporting, use of non-validated outcome measures and heterogeneity of participant cohorts. All reported positive outcomes for the use of acupuncture for scar symptoms, however treatment frequency, duration, number of treatments and acupuncture points used varied.
Conclusion(s): The findings demonstrate a paucity of relevant research. From the available literature, a low level of evidence for the treatment of scars by acupuncture was found.
Implications: Further well designed, controlled trials investigating acupuncture´s role in hypertrophic scar treatment are required.
Keywords: Acupuncture, Scars, Hypertrophic
Funding acknowledgements: This work has not been funded by an external agency.
Topic: Musculoskeletal; Disability & rehabilitation; Service delivery/emerging roles
Ethics approval required: Yes
Institution: The University of Notre Dame, Australia
Ethics committee: Human Research Ethics Committee
Ethics number: 017029F
All authors, affiliations and abstracts have been published as submitted.
