
==== Front
J Pain Res
J Pain Res
jpr
Journal of Pain Research
1178-7090
Dove

494648
10.2147/JPR.S494648
Response to Letter
Investigating the Effectiveness of Electroacupuncture for Diabetic Peripheral Neuropathy and Exploring the Feasibility of Infrared Thermography as an Efficacy Assessment Tool: Study Protocol for a Randomized Controlled Trial [Response to Letter]
Luo et al
Luo et al
http://orcid.org/0000-0002-6191-9411
Luo Ning 1 *
Low Je-Wie 2 *
Fang Jian-Qiao 1
1 The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
2 Institute of International Education of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
Correspondence: Jian-Qiao Fang, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, People’s Republic of China, Email fangjianqiao7532@163.com
* These authors contributed equally to this work

13 9 2024
2024
17 30033004
04 9 2024
09 9 2024
© 2024 Luo et al.
2024
Luo et al.
https://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
==== Body
pmcDear editor

We would like to express our sincere gratitude to the Editor-in-Chief for providing us with the opportunity to respond to the letter from Agusalim et al concerning our study. It is an honor to have our research thoroughly reviewed by fellow scholars, and we greatly appreciate the interest and thoughtful comments from Agusalim et al. In this response, we will address their comments systematically, presenting a detailed point-by-point reply in the areas they highlighted.

In their letter, Agusalim et al point out that one of the limitations of our study was the absence of a sham electroacupuncture (EA) group, which may have introduced a placebo effect and potentially influenced the trial outcomes. We acknowledge that the lack of a sham EA group represents a limitation in the original study design. However, previous sham-controlled trials of acupuncture have often encountered complex intervention protocols and methodological challenges, which may have contributed to inconclusive evidence regarding the efficacy of acupuncture in treating diabetic peripheral neuropathy (DPN) and, consequently, limited its broader clinical application.1,2 And a cross-sectional study concluded that while sham acupuncture has been widely used, a waiting list or no-treatment control can also be considered an appropriate comparison.3 Therefore, to address this limitation and improve the reliability of our results, we referred to previous research4,5 and implemented a waiting list group that received 12 sessions of the same EA treatment at the end of the study period. This approach helped maintain participants’ expectations of EA efficacy and minimized potential placebo effects. Second, we incorporated objective outcome measures, including nerve conduction velocity (NCV), regions of interest (ROIs), and glycated hemoglobin (HbA1c) levels, to further reduce bias and enhance the validity of our findings. In future studies, with adequate resources and funding, we plan to incorporate a well-designed sham EA group, which will allow for more rigorous control of placebo effects and provide clearer conclusions regarding the efficacy of acupuncture in treating DPN.

Secondly, this study was conducted primarily in three hospitals in Zhejiang Province because it is the first clinical trial to use infrared thermography (IRT) as an outcome measure for EA in treating DPN. Since environmental factors across regions may influence IRT data, we initiated this pilot study in hospitals within a single region to ensure more reliable results. We anticipate that the findings can be generalized to broader populations and different geographical areas.

Additionally, to minimize the potential for bias in the outcome assessment, as highlighted in the letter, we implemented blinding procedures for both the outcome assessors and the statistical analysts. We are confident that these measures are sufficient to ensure the objectivity and fairness of the study results.6

Finally, we sincerely thank you once again for your recognition and valuable suggestions. We look forward to future opportunities to conduct studies in diverse environments and cultural settings, further strengthening the generalizability and robustness of our findings.

Disclosure

The authors report no conflicts of interest in this communication.
==== Refs
References

1. Yu B, Li M, Huang H, et al. Acupuncture treatment of diabetic peripheral neuropathy: an overview of systematic reviews. J Clin Pharm Ther. 2021;46 (3 ):585–598. doi:10.1111/jcpt.13351 33511675
2. Ju ZY, Wang K, Cui HS, et al. Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;12 (12 ):CD12057. doi:10.1002/14651858.CD012057.pub2
3. Liu J, Li L, Luo X, et al. Specification of interventions and selection of controls in randomized controlled trials of acupuncture: a cross-sectional survey. Acupunct Med. 2022;40 (6 ):524–537. doi:10.1177/09645284221117848 36039602
4. Musil F, Pokladnikova J, Pavelek Z, et al. Acupuncture in migraine prophylaxis in Czech patients: an open-label randomized controlled trial. Neuropsychiatr Dis Treat. 2018;14 :1221–1228. doi:10.2147/NDT.S155119 29785113
5. Kwon HJ, Choi JY, Lee MS, et al. Acupuncture for the sequelae of bell’s palsy: a randomized controlled trial. Trials. 2015;16 (246 ). doi:10.1186/s13063-015-0777-z
6. Karanicolas PJ, Farrokhyar F, Bhandari M. Practical tips for surgical research: blinding: who, what, when, why, how? Can J Surg. 2010;53 (5 ):345–348.20858381
