LIBYAN JOURNAL OF MEDICINE

2023, VOL. 18, 2251640

https://doi.org/10.1080/19932820.2023.2251640

REVIEW ARTICLE

Acupuncture in the treatment of post-stroke hiccup: A systematic Review and

meta-analysis
Jiaqi Wang*, Bangqi Wu*, Yibing Li*, Xuhui Wang, Zhaojun Lu and Wenqing Wang
Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center
for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China

ABSTRACT ARTICLE HISTORY

Aim: Central hiccups following a stroke are a frequent complication, exerting adverse effects Received 11 June 2023
on both the stroke condition and the patient’s daily life. Existing treatments exhibit limited Accepted 21 August 2023
efficacy and pronounced side effects. Acupuncture has been explored as a supplementary
KEYWORDS
intervention in clinical practice. This study aims to investigate the clinical effectiveness of
Traditional acupuncture;
acupuncture for post-stroke hiccups. stroke; hiccup; meta-analysis;
Methods: To identify published clinical randomized controlled trials addressing post-stroke systematic review
hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane
Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and
China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and
the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager
5.4 software, three authors independently reviewed literature, extracted data, and evaluated
study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4.
Results: A total of 18 trials were encompassed in the analysis. In comparison to standard
treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR:
1.27, 95% CI: 1.21–1.33; P < 0.00001). Notably, Hiccup Symptom Score displayed
a considerable decrease (WMD: −1.28, 95% CI: −1.64 to −0.93; P < 0.00001), concurrent with
a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323–9.617; P <
0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16–
1.25; P = 0.13), and there was a significant reduction in SAS (WMD: −7.23, 95% CI: −8.47 -
−5.99; P < 0.00001).
Conclusions: Our investigation suggests that acupuncture could prove effective in post-
stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the
included studies, conducting higher-quality randomized controlled trials to validate their
efficacy is imperative.

1. Introduction
of the hiccup reflex center [6]. While the precise anatomi­
Hiccup presents a common yet complex challenge sub­ cal locus of this center remains elusive, the Hiccup Reflex
sequent to a stroke. In a study conducted by Park et al., 51 arc has been elucidated. This arc encompasses the affer­
patients diagnosed with Wallenberg Syndrome resulting ent, central, and efferent nerves; stimulation of any seg­
from brainstem infarction were examined, revealing that ment thereof triggers hiccups [7]. Common medical
7 patients (13.7%) encountered hiccup episodes [1]. practice leans towards initiating treatment with drugs
Epidemiological investigations underscore cerebrovascu­ like Baclofen or Gabapentin, followed by the use of dopa­
lar disease as a foremost cause of mortality, with stroke mine blockers such as Metoclopramide, Chlorpromazine,
accounting for at least one in five deaths and about a third and Haloperidol [8]. However, such drug interventions
of all cerebrovascular disease-related fatalities [2]. The often result in evident adverse reactions, frequently caus­
emergence of diverse complications following a stroke ing dizziness or excessive sedation, counterproductive to
frequently contributes to elevated rates of mortality and the rehabilitation of stroke patients [9]. Consequently,
disability [3]. The onset of hiccups can lead to instances of attention has turned to complementary and alternative
choking, fostering Aspiration pneumonia, or inadequate treatments. Acupuncture is embraced across many
intake of nutrition, significantly impacting the patients’ nations as an effective approach to address post-stroke
quality of life. This phenomenon affects both the acute- hiccups. Acupuncture can enhance cerebral blood circu­
stage treatment and subsequent rehabilitation [4,5]. The lation, aid in restoring brain tissue excitability, heighten
underlying pathogenesis of hiccups lies in the stimulation the sensitivity of diverse afferent nerve impulses, thereby

CONTACT Bangqi Wu [email protected] Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese
Medicine, 88 Changling Road, Tianjin, China
*
Jiaqi Wang, Bangqi Wu and Yibing Li are Co-first authors.
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/),
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article
has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
2 J. WANG ET AL.

enhancing neural function. Concurrently, acupuncture (2) The treatment group underwent standard forms
can gradually ameliorate blood supply to the hypothala­ of acupuncture or a combination with other
mus, while also bidirectionally regulating gastrointestinal treatments, irrespective of acupoint selection,
peristalsis, thereby mitigating hiccups [10]. The utility of treatment frequency, or duration. The control
acupuncture in post-stroke hiccup management remains group utilized Metoclopramide. Both groups
a topic of debate, possibly attributed to varying efficacy could receive equivalent fundamental treatment.
criteria and the scarcity of high-quality randomized con­ (3) Studies were confined to randomized controlled
trolled trials. Consequently, a comprehensive and trials (RCTs), and eligible articles were restricted
unbiased assessment of acupuncture’s efficacy in addres­ to either Chinese or English language.
sing post-stroke hiccups is imperative.
This study exclusively concentrates on prevalent
acupuncture modalities, encompassing traditional 2.2.2. Exclusion criteria
acupuncture, body acupuncture, and hand acupunc­ (1) Excluded were reviews, theoretical discussions,
ture. In accordance with the stipulated inclusion and case reports, animal experiments, crossover
exclusion criteria, relevant randomized controlled trials, and non-RCTs.
trials were meticulously screened within the database. (2) Other acupuncture forms, such as ear acupunc­
The aim was to evaluate the efficacy and safety of ture and acupoint injection, were excluded.
acupuncture in managing post-stroke hiccups, (3) Studies with incomplete data or duplicate pub­
thereby furnishing an evidence-based foundation for lications were excluded.
clinical application.

2. Methods 2.3. Outcome measurements

PRISMA (Preferred Reporting Item for Systematic 2.3.1. The primary outcome was the efficiency rate
Review and Meta-Analysis) statement guidelines Cured: Cessation after one treatment course, with no
align with the approach adopted in this systematic further episodes. Effective: Occasional brief episodes
review and meta-analysis [11]. We have registered this after one treatment course. Ineffective: Continuation
systematic review on PROSPERO: CRD42022337482. of sporadic episodes. Total effective rate = (cured +
effective)/total cases × 100% [12].
2.1. Search strategy
2.3.2. Hiccup symptom score
We executed searches across PubMed, the Cochrane Scoring: 0 points for no hiccup per day, 3 points for < 5
Library, EMBASE, Web of Science, China National times/hour without affecting eating, 6 points for 6–10
Knowledge Infrastructure (CNKI), Chinese Biological times/hour or < 5 times/hour affecting eating, 9 points
Medical (CBM), Wanfang Database, China Science for > 10 times/hour or < 10 times/min preventing eat­
and Technology Journal (VIP), as well as other data­ ing or accompanying gastroesophageal reflux [13].
bases for retrieval purposes. The search encom­
passed data creation until 1 February 2022. 2.3.3. Life quality score
Moreover, the Chinese Clinical Trial Registry and Assessed by the quality of life score [14]: Total score of
Clinicaltrials databases were explored from their 60, with < 20 indicating very poor; 21–30 indicating
inception to 1 February 2022. We also meticulously poor; 31–40 indicating fair; 41–50 indicating good;
investigated the references cited within the 51–60 indicating very good.
included studies. Chinese search terms comprised
acupuncture, electroacupuncture, cerebrovascular (1) Adverse reaction
accidents, cerebrovascular apoplexy, CVA, stroke, (2) SAS (Self-Rating Anxiety Scale)
hiccup, and spasm of the diaphragm. The English
search strategies may have been slightly adjusted to Used to assess psychological status in post-stroke
conform to individual database requirements. To complications [15]. Standard cutoff: 50, categorized
manage references, we employed NoteExpress as mild (50–59), moderate (60–69), and severe (>70).
3.5.0 software.
2.4. Study selection and data extraction
2.2. Eligibility criteria
All papers were managed using NoteExpress 3.5.0
2.2.1. Inclusion criteria software. Three authors (Jiaqi Wang, Bangqi Wu,
(1) Patients diagnosed with post-stroke hiccup. and Yibing Li) independently screened and extracted
Diagnosis relied on patients’ symptoms, includ­ data. Discrepancies were resolved by cross-checking
ing characteristic sound recognition [5]. the extracted data. Pertinent information, including
 LIBYAN JOURNAL OF MEDICINE 3

first author, study type, country, publication year, [14,15,18–24,26,30,31], one study indicated improve­
age, sample size, treatment and control interven­ ments in the Life Quality Score [18], one study referred
tions, treatment duration, and outcomes, were to the enhancement of SAS [24], and two studies noted
recorded using Excel. Disagreements were resolved adverse events [14,24]. Tables 1 and 2 outline the fea­
through consultation with the fourth author (Xuhui tures of the included studies.
Wang).

2.5. Bias risk assessment 3.3. Bias risk assessment

Three authors (Jiaqi Wang, Bangqi Wu, and Yibing Li) All 18 studies were randomized controlled trials. In accor­
independently evaluated study quality using dance with the Cochrane tool, every study referencing
Cochrane Handbook 5.1.0 software. Bias risk was randomization did so, excluding one study [19]. Seven
assessed for random sequence generation, allocation studies did not specify the mechanism of randomization
concealment, participant and researcher blinding, [12,13,15,18,27–29]. The random number table approach
outcome assessor blinding, incomplete outcome or computer-generated random number method was
data, and selective outcome reporting. Bias risk was employed in 10 studies to generate random sequences
categorized as ‘low,’ ‘high,’ or ‘unclear.’ Issues were [14,17,20–26,30]. Allocation concealment was not dis­
addressed through discussions or consultation with cussed in any study. Regarding outcome completeness,
the fourth author (Xuhui Wang). bias risk in all trials was rated as low. Other biases were
marked as uncertain due to insufficient data. Overall, the
included studies exhibited low-quality standards.
2.6. Data analysis Figure 2 and Figure 3 provide a summary of the quality
assessment of eligible studies.
Dichotomous outcomes were assessed using com­
bined risk ratios (RR) with a 95% confidence interval
(CI), while continuous outcomes were represented by
the mean difference (MD) and 95% CI. Statistical het­ 3.4. Results of meta-analysis
erogeneity was evaluated via forest plots and the I2 3.4.1. Effective rate
statistic. Sensitivity analysis was conducted to identify Sixteen studies compared the effective rate at treat­
sources of heterogeneity [16]. Funnel plots and ment completion [12–15,17–21,23–26,26–30], with 16
Egger’s tests were utilized to assess publication bias. trials involving 1206 participants. As no significant
Statistical analyses were performed using RevMan 5.2 heterogeneity was detected between the studies (I2
and Stata 16.0.2. = 9%, P = 0.35, P > 0.1), the fixed-effects model was
applied for analysis. The results demonstrated
3. Results a significantly higher effective rate in the treatment
groups compared to the control groups (RR: 1.27, 95%
3.1. Study selection CI: 1.21–1.33; P < 0.00001), with a notable group dif­
Following the devised search strategy, a total of 1125 ference indicated by P < 0.00001. (Figure 4).
papers were retrieved from database inception until
1 February 2022. After removing duplicate entries, 547 3.4.2. Hiccup symptom score
records remained. Upon reviewing titles and abstracts, Twelve studies reported hiccup symptom scores in the
427 records were subsequently excluded. acupuncture and control groups [14,15,18–26,30]. The
Out of the remaining 120 articles, 102 were heterogeneity test revealed strong heterogeneity I2 =
excluded from analysis due to the following reasons 97%, P < 0.00001, prompting the selection of the ran­
upon full-text review: 94 studies utilized differing dom-effects model for meta-analysis (Figure 4, WMD:
medications as control groups, three studies featured −1.28, 95% CI: −1.64, −0.93; P < 0.00001). The interven­
multiple control groups, four studies had inadequate tion group exhibited significantly lower hiccup symp­
data, and one study contained inaccurate data. tom scores compared to the control group (P < 0.00001).
Ultimately, 18 studies were included in this meta- Given the pronounced heterogeneity (I2 = 97%),
analysis [12–15,17–30]. (Figure 1) meta-regression analysis was further conducted,
including age and treatment duration. The meta-
regression indicated no significant association
3.2. Study characteristics
between treatment effect and treatment duration
All studies reported no significant differences in general (Coef. = 0.006, Std. Err. = 0.028, P = 0.823 (95% CI −
information between intervention groups. Sixteen stu­ 0.048, 0.060). Similarly, age showed no significant
dies reported the effective rate [12–15,17–21,23,24,26– association with treatment effect (Coef. = 0.099, Std.
30], 12 studies presented the Hiccup Symptom Score Err. = 0.284, P = 0.727 (95% CI − 0.458, 0.657).
4 J. WANG ET AL.

Figure 1. PRISMA flow diagram.

Table 1. Characteristics of included studies(1).

Number of Intervention Relevant Study
Study Intervention patients (T/C) period outcomes type
T C
Chen Shuang 2017 A+BT M 90(45/45) Lasted for 7 days ①② RCT
Chi Xiangfeng 2019 A M 54(27/27) Lasted for 7 days ①②③ RCT
Cui Meijuan 2021 A M 90(45/45) Lasted for 7 days ①②③ RCT
Guo Hongyan 2020 A M 46(23/23) Lasted for 5 days ① RCT
Guo Zhengang 2018 A M 68(34/34) Lasted for 7 days ①② RCT
Liu Chaoyang 2009 A M 62(31/31) Unknown ① RCT
Liu Limei 2012 A+EA M 60(30/30) Lasted for 3 days ① RCT
Liu Yonggang 2021 A M 90(45/45) Lasted for 5 days ① RCT
Su Changming 2007 A M 80(40/40) Lasted for 5 days ① RCT
Wang Jinhua 2019 A M 100(50/50) Lasted for 7 days ② RCT
Wang Liang 2020 A M+BT 60(30/30) Lasted for 7 days ①② RCT
Wang Zhenguo 2019 A+AS M 60(30/30) Lasted for 7 days ①②④ RCT
Yang Jie 2015 A M 98(49/49) Lasted for 7 days ①② RCT
Yang Lanlan 2019 A M 92(46/46) Lasted for 7 days ①② RCT
Yang Qingtang 2017 A M 96(48/48) Lasted for 7 days ①②④⑤ RCT
Zhang Honglei 2020 A+EA M 98(49/49) Lasted for 7 days ① RCT
Zhang Jun 2021 A M 76(38/38) Lasted for 4 weeks ①② RCT
Zheng Desong 2016 A M 96(48/48) Lasted for 7 days ② RCT
Abbreviation: T: treatment group; C: control group
A: acupuncture M: Metoclopramide EA: ear acupuncture
BT: Breath training AS: acupoint sticking
①the Effective Rate ②Hiccup Symptom Score ③Life Quality Score
④Adverse Reaction ⑤SAS(Self-Rating Anxiety Scale)
RCT: randomized controlled trial
 LIBYAN JOURNAL OF MEDICINE 5

Table 2. Characteristics of included studies(2).

Age (years) (mean ± SD)
Study Year Country Study period T C
Chen Shuang 2017 China 2015.1–2016.12 64 63
Chi Xiangfeng 2019 China 2015. 10–2017.12 58.48±9.09 57.96±8.53
Cui Meijuan 2021 China 2018 .3–2020.3 55.59±3.67 55.55±3.64
Guo Hongyan 2020 China 2018.1–2019.6 64.5 64.5
Guo Zhengang 2018 China 2014.6–2017.6 56.3±5.36 56.2±5.35
Liu Chaoyang 2009 China 2005 .5–2008.3 62 64
Liu Limei 2012 China 2008.8–2011.2 61.5 58.5
Liu Yonggang 2021 China 2020.1–2020.12 71.0±8.1 71.2±8.4
Su Changming 2007 China 2002.5–2006.10 56.6±15.2 57.9±13.6
Wang Jinhua 2019 China 2015.3–2016.4 62.35±4.2 59.6±5.5
Wang Liang 2020 China 2017.4–2020.4 61.43±5.69 61.85±6.12
Wang Zhenguo 2019 China 2017.7–2018 .6 58.00±10.23 58.20±11.18
Yang Jie 2015 China 2012.12–2013.12 61.32±5.59 62.07±5.63
Yang Lanlan 2019 China 2016 .3–2017.10 60.25±3.25 60.35±3.14
Yang Qingtang 2017 China 2014.6—2016 .6 65.50±7.39 64.25±8.89
Zhang Honglei 2020 China 2016.2–2018.8 60.98±12.79 61.34±13.15
Zhang Jun 2021 China 2010.3–2021.3 60.5±0.3 60.4±0.4
Zheng Desong 2016 China 2014.7–2015.3 62±5 63±4
NOTE: Abbreviation: SD: standard deviation; T: treatment group; C: control group.

Figure 2. Diagram of the bias risk.

Note: Green: Low risk of bias; Yellow: Unclear risk of bias; Red: High risk of bias

Figure 3. Summarized bias risk.

6 J. WANG ET AL.

Figure 4. Outcome of meta-analysis.

3.4.3. Life quality score 3.4.5. SAS (Self-Rating Anxiety Scale)

One study reported improvement in quality of life Only one study reported SAS scores for the thera­
following treatment [18]. The fixed-effect model peutic and control groups after the entire treatment
demonstrated a significant difference in quality of [24]. The results from the fixed-effects model
life improvement between the acupuncture and con­ demonstrated a significant difference between
ventional drug groups (WMD: 8.470, 95% CI: 7.323 ~ groups (P < 0.00001), indicating that SAS scores in
9.617; P < 0.00001). the acupuncture group were lower than those in
the control group (WMD: −7.23, 95% CI: −8.47~
−5.99; P < 0.00001).
3.4.4. Adverse events rate
Two studies reported adverse events [14,24]. In the first
study [14], one case of skin rash occurred in the acupunc­
ture group, while the control group featured two
3.5. Bias test
instances of sleepiness, one of dizziness, and three of 3.5.1. Bias test of effective rate
nausea. The second study [24] included one case of A funnel plot analysis of the 16 studies indicated poten­
hematoma, one of bleeding, and two of pain in the tial publication bias (Egger test, P < 0.05), which neces­
acupuncture group, with the control group having five sitated bias correction using the trim and fill method
cases of nausea, tiredness, and sleepiness. The fixed- (Figure 5). After six iterations, 22 articles were hypothe­
effects model indicated a lower incidence of adverse sized, eliminating publication bias. The combined effect
events in the acupuncture group compared to the con­ of these 22 articles yielded RR = 3.278 (3.144–3.419).
trol group (RR: 0.45, 95% CI: 0.16 ~ 1.25; P = 0.13), A comparison of results before and after the trim and
although the difference was not statistically significant fill method showed minimal changes, indicating rela­
(P = 0.19). tively stable results. (Figure 6)
 LIBYAN JOURNAL OF MEDICINE 7

Bias test of the effective r ate

Funnel plot with pseudo 95% confidence limits

0
.05 .1
se(logRR)
.15 .2
.25

-.2 0 .2 .4 .6 .8
logRR

Bias test of hiccup symptom scor e

Funnel plot with pseudo 95% confidence limits
0
.2
se(WMD)
.4 .6
.8

-3 -2 -1 0
WMD

Figure 5. Bias test of the effective rate and hiccup symptom score.

3.5.2. Bias test of hiccup symptom score concealment, and high heterogeneity among studies,
The bias test demonstrated P = 0.605 (P > 0.05), suggest­ potential publication bias may exist. With regard to out­
ing the absence of publication bias in this study. (Figure 5) come indicators, except for the hiccup symptom score,
the evidence level ranged from moderate to low.

3.6. Sensitivity analysis

3.6.1. Sensitivity analysis of the effective rate 4. Discussion
Sensitivity analysis of the 16 studies indicated no
Accumulating clinical studies have consistently
strong influence of any individual study on the results,
demonstrated the efficacy of acupuncture in
suggesting robustness in the study findings. (Figure 7)
addressing hiccups following strokes. A prior meta-
analysis indicated that acupuncture might be
3.6.2. Sensitivity analysis of hiccup symptom score a promising approach in managing post-stroke hic­
The sensitivity analysis of the 12 studies is as follows cups when compared to simple drug therapy.
(Figure 7). It was found that no literature will have However, the limited number of randomized con­
a strong impact on the results, suggesting that the trolled trials and the single outcome indicators in
results of this study are relatively robust. this study have compromised the overall quality of
evidence [32]. Therefore, we embarked on a more
comprehensive exploration of acupuncture’s effec­
3.7. The GRADE approach
tiveness in post-stroke hiccup treatment. The out­
The web version of GRADE pro was utilized to evaluate comes of the meta-analysis showcase that the
the evidence quality of outcome indicators. Due to acupuncture group exhibited a higher effective
a lack of blinding implementation, allocation rate compared to the control group, with
8 J. WANG ET AL.

Filled funnel plot with pseudo 95% confidence limits

1.5

theta, filled
1

.5

0
0 .1 .2 .3
s.e. of: theta, filled

Figure 6. Trim and fill method of the effective rate.

a statistically significant difference. Moreover, the [33,34], upper gastrointestinal bleeding [31], abnor­
acupuncture group demonstrated a relatively higher mal neurotransmitters function [35], and electrolyte
level of safety, contributing positively to the emo­ imbalances [36,37]. Ding proposed that acupuncture
tional well-being and quality of life of critically ill applied to the stomach area could inhibit the Vagus
rehabilitation patients. nerve through a reflex arc, leading to the reduction
Post-stroke hiccups arise from a complex inter­ of 5-HT receptor release in the phrenic nerve. This
play of various factors. Modern medical observa­ inhibition helps mitigate the diaphragm spasms
tions and research have indicated the close causing hiccups [38]. The acupuncture technique
interrelation between post-stroke hiccups and of ‘regulating the mind and stomach’ influences
other mechanisms, such as gastric disorders the visceral autonomic nerve center within the

Sensitivity analysis of the effective r ate

Meta-analysis estimates, given named study is omitted
Lower CI Limit Estimate Upper CI Limit
Chen Shuang (2017)
Chi Xiangfeng (2019)
Cui Meijuan (2021)
Guo Hongyan (2020)
Guo Zhengang (2018)
Liu Chaoyang (2009)
Liu Limei (2012)
Liu Yonggang (2021)
Su Changming (2007)
Wang Liang (2020)
Wang Zhenguo (2019)
Yang Jie (2015)
Yang Lanlan (2019)
Yang Qingtang (2017)
Zhang Honglei (2020)
Zhang Jun (2021)
1.19 1.21 1.27 1.33 1.35

Sensitivity analysis of hiccup symptom score

Meta-analysis random-effects estimates (linear form)
Study ommited
Chen Shuang

Chi Xiangfeng

Cui Meijuan

Guo Zhengang

Wang Jinhua

Wang Liang

Wang Zhenguo

Yang Jie

Yang Lanlan

Yang Qingtang

Zhang Jun

Zheng Desong
-1.71 -1.64 -1.28 -0.93 -0.86

Figure 7. Sensitivity analysis.

 LIBYAN JOURNAL OF MEDICINE 9

thalamus by modulating the mind. This, in turn, the clinical applicability and further promote the uti­
impacts the hiccup reflex arc and alleviates dia­ lization of acupuncture in post-stroke hiccup treat­
phragm spasms, effectively relieving hiccups [39]. ment. To achieve the most optimal clinical solution,
For the current meta-analysis, studies meeting the future research should delve into the interplay
inclusion criteria between 1995 and 2021 were incor­ between acupuncture and conventional drug thera­
porated to evaluate acupuncture’s efficacy in post- pies, seeking a comprehensive understanding of their
stroke hiccup treatment. In total, 18 studies with relationship.
1395 patients were included. As per the findings,
acupuncture potentially surpasses the efficacy of
Metoclopramide in managing post-stroke hiccups Disclosure statement
and appears to have a more favorable impact on hic­ The authors declared no potential conflicts of interest with
cup symptoms. Acupuncture interventions also seem respect to the research, authorship, and/or publication of this
to ameliorate patient anxiety, elevate their quality of article.
life, and exhibit low adverse event rates. Nevertheless,
the limited number of included studies and the rela­
Funding
tively low quality of evidence suggest that these out­
comes might be influenced by the severity of the This research did not receive any specific grant from fund­
ailment. Consequently, further research is imperative ing agencies in the public, commercial, or not-for-profit
to delve into whether acupuncture can substantially sectors.
enhance patients’ quality of life and emotional well-
being.
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