Comments on Acupuncture in Post-Stroke Shoulder Pain Syndrome with Multiple Sclerosis: A Case Study

Dear Editor, I read with interest the case report titled “Acupuncture in Post-Stroke Shoulder Pain Syndrome with Multiple Sclerosis: A Case Study” by Gan and Santorelli [1] and would like to comment regarding the use of acupuncture in central poststroke pain (CPSP). First, it is an excellent consideration by Gan et al to choose acupuncture as a non-pharmacological modality to treat CPSP. CPSP leads to disabling pain, which can be spontaneous or evoked. It is well-established even in multiple sclerosis without cerebral vascular infarct that the central pain can cause disabling symptoms with a prevalence of approximately 30% [2]. While the pathophysiology of CPSP remains incompletely understood with central disinhibition and complex involvement of the spinothalamocortical pathway leading to allodynia or dysesthesia, the analgesic role of acupuncture cannot be underestimated [3]. The pain reduction in this case report illustrated the analgesic effects of acupuncture and I applaud the success in pain treatment and functional improvement observed at 6 weeks. Therefore, for patients diagnosed with CPSP, the use of acupuncture coupled with physical therapy and oral analgesics might be a useful combined treatment strategy. On the research front, I agree future high-quality randomized control trials with the three arms of acupuncture, i.e., acupuncture with conventional therapy, sham acupuncture with conventional therapy, and only conventional therapy, might further reveal the therapeutic effectiveness of acupuncture in reducing pain and restoring upper limb function. Second, I support the authors’ decision for not using the four acupoints in consideration of the patient’s safety. Having said so, it is important for acupuncturists to realize that very few strict contraindications have been documented for the use of acupuncture for various therapeutic aims. Therefore, it is paramount that acupuncturists exercise appropriate clinical judgement in conducting the acupuncture treatment and the choice of the acupuncture points [4]. Despite the lack of strict contraindications, the authors did exercise appropriate clinical judgement and adopt a flexible approach in choosing the acupuncture points, seeking the contralateral side of the body as an alternative acupuncture treatment site. Contralateral acupuncture is also known as opposite needling or cross needling. At present, evidence pertaining to the use of contralateral acupuncture being superior to ipsilateral acupunct