title: Is the diurnal profile of salivary cortisol concentration a useful marker for measuring reported stress in acupuncture research? A randomized controlled pilot study.
abstract: OBJECTIVE
  This pilot study on the use of traditional Chinese acupuncture (TCA) to treat chronic stress explored the use of the diurnal salivary cortisol profile as a potential outcome measure.
  
  
  METHODS
  Adult volunteers (n=18) with high self-reported stress levels, ascertained by screening with the Perceived Stress Scale 14, were randomized into three groups. Group 1 received weekly sessions of TCA for 5 weeks; Group 2 received attention only weekly (practitioner present and subject supine) for 5 weeks, and group 3 acted as a waiting-list control. A diurnal cortisol profile was constructed for each individual at nine data points: two at baseline, five during the intervention, and two postintervention. A salivary cortisol sample was taken at four time points (on waking, 30 minutes, 3 hours, and 12 hours after waking).
  
  
  METHODS
  Salivary cortisol concentrations were measured using a high-sensitivity salivary cortisol enzyme immunoassay.
  
  
  RESULTS
  The cortisol awakening response showed an average increase during the intervention for both TCA and attention groups, indicating that for these two groups the cortisol response had normalized and they were in a lower state of stress. These trends did not reach statistical significance due to individual variation and the small number of study participants. The control group showed an overall decrease in the average morning increase over the same period. No significant difference in the day decline in cortisol was found between groups at any point in the study.
  
  
  CONCLUSIONS
  This pilot study suggests that TCA could reduce stress and increase the morning rise of the cortisol profile; however, this was not distinguishable from the effect of attention only. Further work with a larger sample is necessary to provide a definitive answer regarding whether this could be sustained with more TCA treatments. The morning cortisol increase could be a useful outcome measure for monitoring the effects of treatment on perceived stress.
authors.affiliation: Department of Allied Health Sciences, Faculty of Health & Social Care, London South Bank University, London, United Kingdom. huangw5@lsbu.ac.uk
authors.forename: Weidong
authors.initials: W
authors.lastname: Huang
authors.forename: Alyx
authors.initials: A
authors.lastname: Taylor
authors.forename: Judith
authors.initials: J
authors.lastname: Howie
authors.forename: Nicola
authors.initials: N
authors.lastname: Robinson
mesh_terms: D015670:Acupuncture Therapy; D000293:Adolescent; D000328:Adult; D001288:Attention; D015415:Biomarkers / Q000378:metabolism*; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological / Q000628:therapy*; D014851:Wakefulness / Q000502:physiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone