Monday, December 24, 2007

Tuesday, December 18, 2007

Acupuncture in patients with osteoarthritis of the knee: a randomised trial

Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee.

Methods


Patients with chronic osteoarthritis of the knee (Kellgren grade ≤2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat.
Results

294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26·9 (SE 1·4) in the acupuncture group, 35·8 (1·9) in the minimal acupuncture group, and 49·6 (2·0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture −8·8, [95% CI −13·5 to −4·2], p=0·0002; acupuncture vs waiting list −22·7 [−27·5 to −17·9], p<0·0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0·08).
Interpretation

After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.

The Lancet, Volume 366, Issue 9480, 9 July 2005-15 July 2005, Pages 136-143

Saturday, December 15, 2007

Clinical Trials - Acupuncture

ClinicalTrials.gov provides patients, family members, and members of the public easy and free access toinformation on clinical studies for a wide range of diseases and conditions.

Thursday, December 13, 2007

Hold the Chemicals, Bring on the Needles



By NORA ISAACS; Published: December 13, 2007, NY Times
More and more women are using facial acupuncture instead of Botox to attack wrinkles.

Thursday, December 6, 2007

Acupuncture Cuts Need for Post-Op Painkillers

It also eases nausea linked to these drugs, research shows


WEDNESDAY, Oct. 17 (HealthDay News) -- Powerful opioids taken after surgery can have powerful side effects, but new research finds that using acupuncture before and during an operation cuts a patient's need for the painkillers.

"From a pain perspective, you can reduce the amount of morphine that the patient uses and improve the quality of analgesia and pain control," said lead researcher Dr. Tong J. Gan, a professor and vice chairman of anesthesiology at Duke University Medical Center, in Durham, N.C.

Gan was to present the findings Tuesday at the American Society for Anesthesiology conference in San Francisco. [ for full story]

Acupuncture: Can it help?

Mayo Clinic

Acupuncture involves inserting hair-thin needles into your skin to relieve pain. Find out how acupuncture works and what conditions it can treat.

Acupuncture involves the insertion of extremely thin needles through your skin, to various depths at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past two decades its popularity has grown significantly within the United States. Although scientists don't fully understand how or why acupuncture works, some studies indicate that it may provide a number of medical benefits — from reducing pain to helping with chemotherapy-induced nausea.

What happens during an acupuncture session?

Acupuncture therapy usually involves a series of weekly or biweekly treatments in an outpatient setting. It's common to have up to 12 treatments in total. Although each acupuncture practitioner has his or her own unique style, each visit typically includes an exam and an assessment of your current condition, the insertion of needles, and a discussion about self-care tips. An acupuncture visit generally lasts about 30 minutes.

Before the needles are placed, you'll lie down on a comfortable surface. Depending on where the needles are to go, you will lie facedown, faceup or on your side. Make sure that your acupuncturist uses single-use sterile packaged needles. You may feel a brief, sharp sensation when the needle is inserted, but generally the procedure isn't painful.

It's common, however, to feel a deep aching sensation when the needle reaches the correct depth. After placement, the needles are sometimes moved gently or stimulated with electricity or heat. As many as a dozen needles may need to be placed for each treatment. Once the needles are inserted, they're usually left in place for five to 20 minutes.

How does acupuncture work?

The traditional Chinese theory behind acupuncture as medical treatment is very different from that of Western medicine. In traditional Chinese medicine, health results form a harmonious balance between the complementary extremes (yin and yang) of the life force known as qi or chi.

Qi is believed to flow through pathways (meridians) in your body. These meridians and the energy flow are accessible through more than 350 acupuncture points. Illness results from an imbalance of the forces. By inserting needles into these points in various combinations, acupuncture practitioners believe that your energy flow will rebalance.

In contrast, the Western explanation of acupuncture incorporates modern concepts of neuroscience. Many practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body's natural painkillers and increase blood flow.

Who is acupuncture for?

Acupuncture seems to be useful as a stand-alone treatment for some conditions, but it's also increasingly being used in conjunction with more conventional Western medical treatments. For example, doctors may combine acupuncture and drugs to control pain and nausea after surgery.

Scientific studies generally test treatments against placebos, such as sugar pills. It's difficult to conduct valid scientific studies of acupuncture, because it's difficult to devise sham versions of acupuncture. In fact, several studies have indicated that sham acupuncture works as well or almost as well as real acupuncture.

This makes it hard to create a definitive list of the conditions for which acupuncture might be helpful. However, preliminary studies indicate that acupuncture may offer symptomatic relief for a variety of diseases and conditions, including low back pain, headaches, fibromyalgia, migraines and osteoarthritis.

In addition, research shows acupuncture can help manage postoperative dental pain and alleviate chemotherapy-induced nausea and vomiting. It also appears to offer relief for chronic menstrual cramps and tennis elbow.

Pros and cons

As with most medical therapies, acupuncture has both benefits and risks. Consider the benefits:

  • Acupuncture is safe when performed properly.
  • It has few side effects.
  • It can be useful as a complement to other treatment methods.
  • It's becoming more available in conventional medical settings.
  • It helps control certain types of pain.
  • It may be an alternative if you don't respond to or don't want to take pain medications.

Acupuncture may not be safe if you have a bleeding disorder or if you're taking blood thinners. The most common side effects of acupuncture are soreness, bleeding or bruising at the needle sites. Rarely, a needle may break or an internal organ might be injured. If needles are reused, infectious diseases may be accidentally transmitted. However, these risks are low in the hands of a competent, certified acupuncture practitioner.

Choosing an acupuncture practitioner

If you're considering acupuncture, do the same things you would do if you were choosing a doctor:

  • Ask people you trust for recommendations.
  • Check the practitioner's training and credentials. Most states require that non-physician acupuncturists pass an exam conducted by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
  • Interview the practitioner. Ask what's involved in the treatment, how likely it is to help your condition and how much it will cost.
  • Find out whether the expense is covered by your insurance.

Don't be afraid to tell your doctor you're considering acupuncture. He or she may be able to tell you about the success rate of using acupuncture for your condition or recommend an acupuncture practitioner for you to try.

Wednesday, December 5, 2007

Acupuncture Applied to Treat Pain due to Whiplash Injuries


by Yemeng Chen, L. Ac., FICAE, President, New York College of Traditional Chinese Medicine

In our car-oriented society, whiplash injury cases are commonly seen in acupuncture practice. These patients typically have long-term physical and subjective symptoms for which acupuncture treatment is a useful modality.

1. Factors

According to 1994 estimates, upwards of 1 million people sustain whiplash-type injuries per year in United States. Of more than 11 million motor vehicle accidents that year, 2.6 million involved rear-end collisions in. Women (especially 20- to 40-year age group) have persistent neck pain more often than men, by a ratio of 7:3. (1)

Whiplash injury refers to neck injury, resulting from hyperextension followed by flexion that occurs when an occupant of a motor vehicle is hit from behind by another vehicle. Other terms have been used such as cervical sprain, cervical myofacial pain Syndrome, acceleration-deceleration injury, hyperextension injury and soft tissue cervical hyperextension injury. (2)

One study (3) showed the ten most-reported symptoms with their estimated prevalence: neck pain (97%), headache (97%), TMJ (82%), Shoulder pain (65%), anxiety (55%), back pain (42%), depression (41%), visual symptoms (blurred vision) (35%), and dizziness (23%). The clinical features of whiplash injury include myofascial injury (cervical strain, muscle tears, and/or rupture of ligaments), cervical disc herniation, cervical spine fracture and cervical facet-joint injury. Acupuncture has demonstrated a significant therapeutic effect on myofascial injuries.

Long-term, positive outcomes of whiplash injury are elusive. One clinical trial (4) showed the percentage of patients with residual pain: 44% had pain at three months, 30% at six months, 24% at twelve months, and 18% at two years. But only 4% of the patients were considered disabled at two years. If the head was inclined or rotated at the time of collision, patients were more likely to have pain at a two-year follow-up. A history of pre-traumatic headache predicted a worse outcome. Patients with long-term symptoms were more likely to have radicular symptoms, anxiety, sleep disturbance, and blurred vision.

2. Therapeutic Effect of Acupuncture

Although whiplash injury patients are commonly seen in acupuncture clinics, only a few clinical trials and research projects has been conducted. Greenwood, et al, reported that 25 patients with whiplash injury, most of whom had twelve treatments at twice weekly intervals. Improvement was noted in 84% of patients. Observed phenomena included myoclonic jerking, emotional releases and regression. (5) Rabl V, et al, had a trial with 153 patients suffering from pain, edematous conditions, and impaired movement following traumas sustained in accidents who were treated or “after-treated” with acupuncture. With a standardized acupuncture program, the improvement was significant in all nine groups Acupuncture also proved itself to be an effective form of therapy for after-treatment. (6) Ayuzawa S, et al, reported that the Bi-Digital O-Ring test successfully used in the diagnosis and treatment for patients with pain after whiplash injury. (7) Hertz H, et al, treated 30 whiplash injury patients with auricular acupuncture, demonstrating its effectiveness as a form of therapy for treatment of accident patients with whiplash. (8) Fattori B, et al, had a trial of 15 patients with a control group of balance disorders following whiplash injury, and observed a significant difference between the two groups regarding the reduction of the CER (closed eyes with retroflexed head) length of the statokenisigram. (9) Recently, Fattori, et al, (10) had a further study with 27 patients with a control group of 25 patients, who were treated with a non-steroidal anti-inflammatory drug and myorelaxation or with physiotherapy only. [read more]