Research - Clinical application and efficacy of acupuncture therapy

“Acupuncture is one of the most time-tested treatments known to mankind. If the value of a treatment were based solely on how long it has been around, and how long people have thought that it was helpful, then acupuncture would probably be the most effective treatment known to humankind.”
Dr. Scott Fishman

Dr. Scott Fishman is Chief of the Division of Pain Medicine and Associate Professor of Anesthesiology at the University of California, Davis.

Research realities

Throughout history, research has been an essential and inevitable component in the quest for human knowledge. Over time research protocols change, thus effecting results. Yesterday's research results might be debunked by the most recent findings. Also, in today's competitive culture, research results may be co-opted by vested interests.

“Many drugs that are assumed to be effective are probably little better than placebos, but there is no way to know because favorable results were published and unfavorable results buried … Clinical trials are also biased through designs for research that are chosen to yield favorable results for sponsors. For example, a drug that is likely to be used by older people will be tested in young people, so that side effects are less likely to emerge. In short, it is often possible to make clinical trials come out pretty much any way you want … It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine.”
Marcia Angell, M.D.

Clinical studies on the efficacy of acupuncture

The following studies are from research initiatives from around the world. Presenting a range of projects done by independent groups provides a broader perspective, mitigates bias, and allows you to reach a more informed decision. Results should also be considered with an understanding of the limitations and shortcomings inherent in the modern medical research protocol.

Acupuncture for eczema (itch)

Acupuncture reduces hypersensitivity
itch in patients with atopic eczema

Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema – a blinded, randomized, placebo-controlled, crossover trial. Report excerpts:

Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial.

Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions.

Read original abstract, published 11 Dec 2009:
Original Abstract →

Acupuncture affects the brain’s ability to control pain

Brain imaging reveals acupuncture affects the brain’s ability to reduce and regulate pain

University of Michigan Chronic Pain and Fatigue Research Center and the University of Michigan Medical School

Authors: Richard E. Harris, Ph.D., Jon-Kar Zubieta, M.D., Ph.D., David J. Scott, Vitaly Napadow, Richard H. Gracely, Ph.D, Daniel J. Clauw, M.D.
Funding: Department of Army, National Institutes of Health
Reference: Journal of NeuroImage, Vol. 47, No. 3, 2009

Abstract: This study was the first of its kind to provide imaging of how acupuncture affects specific receptors in the brain that process and suppress pain signals. The researchers at the University of Michigan Chronic Pain and Fatigue Research Center and the University of Michigan Medical School showed that acupuncture increases the binding ability of mu-opoid receptors (MOR) in areas of the brain that are responsible for regulating pain signals. Morphine, codeine, and other opioid painkillers are believed to be effective because they bind to mu-opoid receptors in the brain and spinal cord, reducing or eliminating pain.

News release: http://media-newswire.com/

Download complete report:
Acupuncture effects µ-opioid receptors (MORs)

Acupuncture for treating acute and chronic spinal cord injuries

Acupuncture's Effects in Treating the Sequelae of Acute and Chronic Spinal Cord Injuries

A Review of Allopathic and Traditional Chinese Medicine Literature

Peter T. Dorsher and Peter M. McIntosh
Department of Physical Medicine and Rehabilitation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
eCAM Advance Access published online on February 25, 2009

Abstract: Each year, there are an estimated 12,000 individuals who sustain a spinal cord injury (SCI) in the United States. Improved understanding of the pathophysiology of SCI and its sequelae has over the past 50 years led to the development of medical treatments (especially urologic) that have enhanced short- and long-term survival from these injuries. The prevalence of individuals with SCI in this country is approximately 250,000 individuals; and beyond the incalculable personal consequences of these devastating neurologic injuries, substantial direct and indirect societal costs result from the sequelae of SCI including paralysis, sensory loss, chronic pain, decubiti and bladder and/or bowel incontinence. The purpose of this treatise is to review the allopathic and traditional Chinese medicine (TCM) literature available through MEDLINE, PubMed and eCAM search engines that discuss the potential uses of acupuncture to treat acute and chronic spinal cord injuries and their sequelae, and present the neurophysiologic mechanisms for acupuncture's beneficial effects. There is evidence that use of electroacupuncture in acute SCI may significantly improve long-term neurologic recovery from these injuries both in terms of motor, sensory and bowel/bladder function with essentially no risk. Acupuncture may even improve neurourologic function in individuals with chronic SCI, and help with management with chronic pain associated with these injuries.

Full article: http://ecam.oxfordjournals.org/

Acupuncture for headache relief vs. medication

Acupuncture Offers Headache Relief Over Medication

Published: Dec. 1, 2008

Acupuncture is more effective than medication in reducing the severity and frequency of chronic headaches, according to a new analysis conducted by Duke University Medical Center researchers.

"We combed through the literature and conducted the most comprehensive review of available data done to date using only the most rigorously-executed trials. Acupuncture is becoming a favorable option for a variety of purposes ranging from enhancing fertility to decreasing post-operative pain because people experience significantly fewer side effects and it can be less expensive than other options. This analysis reinforces that acupuncture also is a successful source of relief from chronic headaches."
Tong Joo (T.J.) Gan, MD
Duke anesthesiologist who lead the analysis

Researchers analyzed more than 30 studies to arrive at the findings published in the December issue of Anesthesia and Analgesia. The studies included nearly 4,000 patients who reported migraines (17 studies), tension headaches (10 studies) and other forms of chronic headaches with multiple symptoms (four studies).

In 17 studies comparing acupuncture to medication, the researchers found that 62 percent of the acupuncture patients reported headache relief compared to only 45 percent of people taking medication. These acupuncture patients also reported better physical well-being compared to the medication group.

Gan also has conducted research to determine the effect of acupuncture on post-operative pain, nausea and vomiting. His research has found that acupuncture can significantly reduce pain and the need for pain medications following surgery. He also found that acupuncture can be as effective as medication in reducing post-operative nausea and vomiting.

http://www.dukehealth.org/

Pediatrics: Use of complementary and alternative medicine

CLINICAL REPORT: The Use of Complementary and Alternative Medicine in Pediatrics (excerpts)

PEDIATRICS Vol. 122 No. 6 December 2008

Kathi J. Kemper, MD, MPH, Sunita Vohra, MD, Richard Walls, MD, PhD, the Task Force on Complementary and Alternative Medicine, the Provisional Section on Complementary, Holistic, and Integrative Medicine

The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine. Complementary medicine is used in conjunction with conventional medicine; for example, massage, guided imagery, and acupuncture may be used in addition to analgesic medications to help decrease pain. Alternative medicine is used in place of conventional Western medicine; for example, some adolescents use herbs rather than antidepressant medications to treat depression.

The distinction between CAM and mainstream medicine has lessened as many practices have undergone rigorous research and have been integrated increasingly into mainstream care. However, the term "CAM" has been replaced increasingly with "holistic" or "integrative" medicine. Holistic medicine refers to patient-centered care that includes consideration of biological, psychological, spiritual, social, and environmental aspects of health. Integrative medicine is relationship-based care that combines mainstream and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness to promote health for the whole person in the context of his or her family and community. Integrative medicine also reaffirms the importance of the relationship between the practitioner and the patient, emphasizes wellness and the inherent drive toward healing, and focuses on the whole person, using all appropriate therapies to achieve the patient’s goals for health and healing.

Epidemiology

The use of CAM in Western medicine has grown dramatically in recent decades. Many CAM therapies, such as herbal remedies, are mainstream or traditional in many parts of the world. The World Health Organization estimates that most of the world’s population regularly uses "traditional medicine" such as traditional Chinese medicine (TCM), Ayurvedic medicine, and Native American healing practices.

In the United States, more than one third of adults have used CAM. The total number of visits to CAM providers increased by 47.3%, from 420 million visits in 1990 to 629 million visits in 1997.
The number of visits to CAM providers in 1997 exceeded the total number of visits to primary care physicians in the same year.
Estimated expenditures for CAM services for adults increased by 45.2% between 1990 and 1997, with a conservative estimate of $21.2 billion spent in 1997. Of that total, out-of-pocket expenses were estimated to be $12.2 billion. This figure exceeded the 1997 out-of-pocket expenditures for all US hospitalizations.
More recent studies have described CAM use among adults as high as 62%, with 41% of adults using 2 or more CAM therapies in a 12-month period.

Patients’ Characteristics and Reasons for Using CAM

There are various reasons for the growing use of CAM. Many users of CAM reported use not so much as a result of being dissatisfied with conventional medicine, but largely because they found these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life. Parents’ reasons for seeking care for their children from CAM providers included, in decreasing order of frequency, word of mouth, particular treatment was considered effective, fear of drug adverse effects, dissatisfaction with conventional medicine, and the need for more personal attention. In addition, many cultural groups may use CAM because of cultural values and beliefs.

Physician Awareness, Attitude, and Perception

In 1995, the American Medical Association passed a resolution suggesting that its 300,000 members become better informed regarding the practices and techniques of CAM. Many primary care physicians, including pediatricians, recommend and refer patients for complementary therapies. In the 2001 AAP Periodic Survey, "Complementary and Alternative Therapies in Pediatric Practice," pediatricians reported that they recognize patients’ frequent use of CAM therapies and expressed a strong desire for additional education on CAM topics. Topics of greatest immediate interest included herbs, dietary supplements, special diets, and exercise. More than one third of the pediatricians reported that they or their families used some type of CAM therapy. Of those reporting CAM use, 70% used massage therapy, 21% received chiropractic care, 13.5% consulted a spiritual or religious healer, and 13% had used acupuncture.

A growing number of pediatric generalists and subspecialists have begun to offer complementary therapies and advice as part of their practice. In addition, there is a growing number of academic pediatric integrative medicine programs and new initiatives to promote systematic sharing, support, and dissemination of information to improve collaborative and comprehensive care.

Conclusions

Pediatricians and other clinicians who care for children have the responsibility to advise and counsel patients and families about relevant, safe, effective, and age-appropriate health services and therapies regardless of whether they are considered mainstream or CAM. In the 2001 AAP Periodic Survey of Fellows, 73% of pediatricians agreed that it is the role of pediatricians to provide patients/families with information about all potential treatment options for the patient’s condition, and 54% agreed that pediatricians should consider the use of all potential therapies, not just those of mainstream medicine, when treating patients. Because most families use CAM services without spontaneously reporting this use to their clinician, pediatricians can best provide appropriate advice and counseling if they regularly inquire about all the therapies the family is using to help the child.

Pediatricians should seek continued and updated knowledge about therapeutic options available to their patients, whether they are mainstream or CAM, and about the specific services used by individual patients to ensure that issues of safety, appropriateness, and advisability of CAM can be addressed. Only then can pediatricians appreciate the concerns of their patients and families and offer them the thoughtful and knowledgeable guidance they may require.

Finally, if the pediatrician confirms that the patient is seeing a CAM provider, the pediatrician can (with the permission of the patient and family) include the CAM provider in overall care-coordination activities.

Download complete report: Clinical Report: Complementary Medicine in Pediatrics

Acupuncture for chronic low back pain

Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain

School of Health and Related Research, University of Sheffield, UK.

OBJECTIVES: To test whether patients with persistent non-specific low back pain, when offered access to traditional acupuncture care alongside conventional primary care, gained more long-term relief from pain than those offered conventional care only, for equal or less cost. Safety and acceptability of acupuncture care to patients, and the heterogeneity of outcomes were also tested.

DESIGN: A pragmatic, two parallel group, randomized controlled trial. Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists. The control group received usual care from their general practitioner (GP). Eligible patients were randomized in a ratio of 2:1 to the offer of acupuncture to allow between-acupuncturist effects to be tested.

SETTING: Three non-NHS acupuncture clinics, with referrals from 39 GPs working in 16 practices in York, UK.

PARTICIPANTS: Patients aged 18-65 years with non-specific low back pain of 4-52 weeks' duration, assessed as suitable for primary care management by their general practitioner.

INTERVENTIONS: The trial protocol allowed up to ten individualized acupuncture treatments per patient. The acupuncturist determined the content and the number of treatments according to patient need.

MAIN OUTCOME MEASURES: The Short Form 36 (SF-36) Bodily Pain dimension (range 0-100 points), assessed at baseline, and 3, 12 and 24 months. The study was powered to detect a 10-point difference between groups at 12 months post-randomisation. Cost--utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions (EQ-5D) and a preference-based single index measure derived from the SF-36 (SF-6D). Secondary outcomes included the McGill Present Pain Index (PPI), Oswestry Pain Disability Index (ODI), all other SF-36 dimensions, medication use, pain-free months in the past year, worry about back pain, satisfaction with care received, and safety and acceptability of acupuncture care.

RESULTS: A total of 159 patients were in the 'acupuncture offer' arm and 80 in the 'usual care' arm. All 159 patients randomised to the offer of acupuncture care chose to receive acupuncture treatment, and received an average of eight acupuncture treatments within the trial. Analysis of covariance, adjusting for baseline score, found an intervention effect of 5.6 points on the SF-36 Pain dimension [95% confidence interval (CI) -1.3 to 12.5] in favour of the acupuncture group at 12 months, and 8 points (95% CI 0.7 to 15.3) at 24 months. No evidence of heterogeneity of effect was found for the different acupuncturists. Patients receiving acupuncture care did not report any serious or life-threatening events. No significant treatment effect was found for any of the SF-36 dimensions other than Pain, or for the PPI or the ODI. Patients receiving acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group. At 24 months, the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief. The acupuncture service was found to be cost-effective at 24 months; the estimated cost per quality-adjusted (QALY) was 4241 pounds sterling (95% CI 191 pounds sterling to 28,026 pounds sterling) using the SF-6D scoring algorithm based on responses to the SF-36, and 3598 pounds sterling (95% CI 189 pounds sterling to 22,035 pounds sterling) using the EQ-5D health status instrument. The NHS costs were greater in the acupuncture care group than in the usual care group. However, the additional resource use was less than the costs of the acupuncture treatment itself, suggesting that some usual care resource use was offset.

CONCLUSIONS: Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain. Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits relating to function or disability were identified. GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care (such as massage, chiropractic or physiotherapy), various aspects of cost-effectiveness, value to patients and implementation protocols.

http://www.ncbi.nlm.nih.gov/pubmed/16095547

Veteren's Administration WRIISC-DC acupuncture clinic

VA WRIISC-DC Acupuncture Clinic

The War Related Illness and Injury Study Center (WRIISC) DC offers an acupuncture clinic for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) combat veterans. In the WRIISC-DC acupuncture clinic, a licensed and experienced acupuncturist cares for the OIF and OEF combat veterans who may be experiencing chronic pain, post-traumatic stress disorder and/or other health concerns. During these sessions, the WRIISC-DC acupuncturist provides individualized acupuncture therapy to improve health symptoms and enhance overall quality of life.

In addition to individualized acupuncture sessions, the WRIISC-DC provides weekly OIF/OEF group acupuncture therapy sessions. There are two sessions which are offered on a walk-in basis on each Thursday from 12:30 p.m. to 1:30 p.m. and from 3:30 p.m. to 4:30 pm. Please contact the WRIISC office at (202) 745-8249 if you are an OIF or OEF veteran and are interested in individual acupuncture sessions or need more information about acupuncture therapy through the WRIISC Acupuncture clinic.

http://www.warrelatedillness.va.gov/dc/Clinical/acupuncture2-specifics-veteran.asp

Acupuncture Research Study at the Washington, D.C. VA Medical Center

WRIISC-DC is conducting a study to explore if acupuncture may help Veterans who have sleep problems that are related to Post-Traumatic Stress Disorder (PTSD). WRIISC-DC is looking for Veterans to participate in the study. More information:

http://www.warrelatedillness.va.gov/dc/Research/Acupuncture_Study_Recruiting_Veterans.asp

Acupuncture for PTSD: A randomized trial in a military population

Acupuncture for posttraumatic stress disorder: A randomized trial in a military population (Abstract #196398)

Paper presented at The International Society for Traumatic Stress Studies 25th Annual Meeting, Nov 14, 2008

Treatment Issues in Combat-Related Stress

Chair: Shay Lee Belik, BSc (HONS), Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

Paper Presentation:

(Clin Res, Mil Emer) Engel, Charles C., MD, MPH: Department of Psychiatry, Uniformed Services University of the Health Sciences, Deployment Health Clinical Center, Walter Reed Army Medical Center, Washington, District of Columbia, USA
Harper Cordova, Elizabeth, MA: Deployment Health Clinical Center, Walter Reed Army Medical Center,Washington, District of Columbia, USA
Benedek, David, MD, Ursano, Robert, MD: Department of Psychiatry, Uniformed Services University of the HealthSciences, Bethesda, Maryland, USA
Jonas, Wayne, MD: Samueli Institute for Information Biology, Alexandria, Virginia, USA

10-17% of soldiers returning from the Iraq War experience PTSD in the year following deployment. Stigma and lack of confidence inexisting treatments often prevents soldiers from seeking care. We sought to assess the efficacy of acupuncture for PTSD amongmilitary personnel. Four weeks of twice weekly manualized Chinese medicine acupuncture were administered. Soldiers diagnosed with PTSD (CAPS) were randomized to acupuncture(ACU) or usual care (UC) with 12 weeks of follow-up. Primary outcome was PTSD symptom severity (PCL). Secondary outcomes were depression (BDI) and functioning (SF-36). 42 of 55 (76%) randomized soldiers provided complete follow-up data. Compared to UC, ACU was associated with a significantly greater decrease in PTSD symptoms, which was maintained through the 12-week follow-up (treatment X time, F (3, 128) = 10.92, p ‹ .001); mean PCL decreases were 19.4 (±11.7) at end treatment and 19.8 (±13.6) at 12-week follow-up in ACU vs. 4.0 (±12.3) at end treatment and 9.7(±13.1) at 12-week follow-up in UC.

Similar patterns of improvement were seen with symptoms of depression and psychological functioning. Brief acupuncture offers short-term benefit over usual care for military personnel with PTSD. Future studies should evaluate longer follow-up and acupuncture components.

Acupuncture for Posttraumatic Stress Disorder (PTSD)

Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial

A pilot study shows that acupuncture may help people with posttraumatic stress disorder. Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Michael Hollifield, M.D., and colleagues conducted a clinical trial examining the effect of acupuncture on the symptoms of PTSD. The researchers analyzed depression, anxiety, and impairment in 73 people with a diagnosis of PTSD. The participants were assigned to receive either acupuncture or group cognitive-behavioral therapy over 12 weeks, or were assigned to a wait-list as part of the control group. The people in the control group were offered treatment or referral for treatment at the end of their participation.

The researchers found that acupuncture provided treatment effects similar to group cognitive-behavioral therapy; both interventions were superior to the control group. Additionally, treatment effects of both the acupuncture and the group therapy were maintained for 3 months after the end of treatment.

The limitations of the study are consistent with preliminary research. For example, this study had a small group of participants that lacked diversity, and the results do not account for outside factors that may have affected the treatments' results.

References

Michael Hollifield, Nityamo Sinclair-Lian, Teddy D. Warner, and Richard Hammerschlag, "Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial." The Journal of Nervous and Mental Disease, June 2007.

http://nccam.nih.gov/research/results/spotlight/092107.htm

Acupuncture vs. conventional treatment for back pain

Acupuncture beats conventional treatment for back pain

A recent study finds that six months of acupuncture treatment — both traditional Chinese acupuncture and the sham variety — appears to be more effective than conventional therapy in treating low back pain. The authors of the study, published in the September 24, 2007 issue of Archives of Internal Medicine, stated:

“The superiority of … acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy.”
Archives of Internal Medicine — September 2007

Acupuncture for treating cocaine addiction

Study Finds Acupuncture Shows Promise For Treating Cocaine Addiction

In the continuing search for an effective therapy for cocaine addiction, acupuncture, an ancient Chinese therapy, combined with modern Western treatments, may hold promise.

In the August 14/28 issue of the Archives of Internal Medicine, researchers report that cocaine dependent patients who received a course of auricular acupuncture (acupuncture needles inserted into four specific points in the outer ear) were more likely to be free of cocaine during treatment than those not receiving acupuncture.

"This study shows that there may be merit in using acupuncture in combination with other therapies as a treatment for cocaine addiction."
Dr. Alan I. Leshner
Director, National Institute on Drug Abuse (NIDA)

The research team led by Arthur Margolin, Ph.D., at Yale University School of Medicine conducted a clinical trial enrolling 82 dually-addicted participants. These individuals were being treated with methadone for their heroin addiction and were referred to the study due to their unremitting cocaine use. Participants were randomly assigned to one of three groups: auricular acupuncture; "control" acupuncture (needles inserted into four ear points not thought to have a treatment effect); or a relaxation group (in which patients viewed commercially-available video-tapes, depicting relaxing imagery such as nature scenes). The treatment sessions were provided five times a week for eight weeks. Urine samples were taken three times a week to assess cocaine use.

Findings showed that participants who received auricular acupuncture were more likely to provide cocaine-negative urine screens over the course of the study compared to participants in either control group. Among the participants who completed the study, more than half of the acupuncture patients (53.8 percent) tested free of cocaine during the last week of treatment, compared to 23.5 percent of the control acupuncture group, and 9.1 percent of the relaxation group. Treatment completers receiving acupuncture also had longer periods of sustained abstinence compared to participants in the two control groups.

Of the 82 participants who started the study, 63 percent completed the eight-week trial. Thirteen of 28 (46 percent) completed auricular acupuncture; 17 of 27 (63 percent) completed the needle insertion control; and 22 of 27 (81 percent) completed the relaxation control. Those who received auricular acupuncture completed significantly fewer (5.2) treatment weeks compared to 6.7 weeks for control acupuncture and 7 weeks for the relaxation therapy control groups.

"This study provides support for the use of acupuncture for the treatment of cocaine addiction. Further research is needed to replicate these findings and to determine how acupuncture and other treatments can be most effectively combined."
Dr. Arthur Margolin, Ph.D.

The full text of the paper, "A Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence, (Arch Intern Med. 2000;160:2305-2312)" is available at http://www.jama.com/ or by calling the AMA's Science News Department at: 312-464-5374

http://www.drugabuse.gov/MedAdv/00/NR8-13.html

German Acupuncture Trials (GERAC) for chronic low back pain

German Acupuncture Trials (GERAC)
for chronic low back pain

Randomized, multicenter, blinded, parallel-group trial with 3 groups

Orthopaedic Department, University of Regensburg, Bad Abbach, Germany.

BACKGROUND: To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain.

METHODS: A patient- and observer-blinded randomized controlled trial conducted in Germany involving 340 outpatient practices, including 1162 patients aged 18 to 86 years (mean +/- SD age, 50 +/- 15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). Primary outcome was response after 6 months, defined as 33% improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement.

RESULTS: At 6 months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs sham, 3.4% (95% confidence interval, -3.7% to 10.3%; P = .39); verum vs conventional therapy, 20.2% (95% confidence interval, 13.4% to 26.7%; P ‹ .001); and sham vs conventional therapy, 16.8% (95% confidence interval, 10.1% to 23.4%; P ‹ .001.

CONCLUSIONS: Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.

http://www.ncbi.nlm.nih.gov/pubmed/17893311

Acupuncture for knee oteoarthritis — NIH News Advisory

Acupuncture relieves pain and improves function
in knee osteoarthritis

Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. This landmark study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health. The findings of the study — the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted — were published in the December 21, 2004, issue of the Annals of Internal Medicine.

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee. These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."
Stephen E. Straus, M.D., NCCAM Director

The multi-site study team, including rheumatologists and licensed acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis of the knee. Participants had significant pain in their knee the month before joining the study, but had never experienced acupuncture, had not had knee surgery in the previous 6 months, and had not used steroid or similar injections. Participants were randomly assigned to receive one of three treatments: acupuncture, sham acupuncture, or participation in a control group that followed the Arthritis Foundation's self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians, including anti-inflammatory medications, such as COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain relievers.

"More than 20 million Americans have osteoarthritis. This disease is one of the most frequent causes of physical disability among adults. Thus, seeking an effective means of decreasing osteoarthritis pain and increasing function is of critical importance."
Stephen I. Katz, M.D., Ph.D., NIAMS Director

During the course of the study, led by Brian M. Berman, M.D., Director of the Center for Integrative Medicine and Professor of Family Medicine at the University of Maryland School of Medicine, Baltimore, Maryland, 190 patients received true acupuncture and 191 patients received sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture is a procedure designed to prevent patients from being able to detect if needles are actually inserted at treatment points. In both the sham and true acupuncture procedures, a screen prevented patients from seeing the knee treatment area and learning which treatment they received. In the education control group, 189 participants attended six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation's Arthritis Self-Help Course, a proven, effective model.

On joining the study, patients' pain and knee function were assessed using standard arthritis research survey instruments and measurement tools, such as the Western Ontario McMasters Osteoarthritis Index (WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14 a significant decrease in pain, compared with the sham and control groups. These results, shown by declining scores on the WOMAC index, held through week 26. Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments.

"This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis"
Brian M. Berman, M.D

www.nccam.nih.gov

Acupuncture for chronic headaches (largest study)

A German study published in the September, 2008 issue of Cephalalgia shows that people who suffer from chronic migraines may benefit from acupuncture to reduce the severity and frequency of their headaches.

The study is one of the largest to date on using acupuncture to ease headaches. Researchers from Charité University Medical Centre in Berlin followed more than 15,000 adults who had been suffering from either migraine or tension-type headaches at least twice a month for a year or more.

Of these patients, 1613 were assigned to receive acupuncture in 15 sessions over 3 months in addition to usual care, while 1569 continued with usual care alone.

After 6 months, acupuncture patients reported significantly greater reductions in headache pain than those who continued with usual care.

Headache frequency fell significantly in patients assigned to acupuncture, from 8.4 headache days over 3 months at the start of the study to 4.7 headache days over 3 months at the end.

In contrast, headache frequency remained almost constant, at nearly 8 headache days every 3 months, in patients assigned to usual care alone.

"Our study has shown that treating patients with headache in routine primary care in Germany with additional acupuncture resulted in a clinically relevant and persistent benefit." Lead researcher, Dr. Stefan Willich concluded. "Therefore, acupuncture should be considered a viable option for patients with headache."

Source: Cephalalgia, Volume 28 Issue 9, Pages 911 - 913

Acupuncture for treatment of insomnia

Role of acupuncture in the treatment of insomnia:
A comprehensive review

Institute: Department of Psychiatry-H073, Penn State University College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA.

Author(s): Kalavapalli R, Singareddy R.

Journal: Complementary Therapies in Clinical Practice 2007 Aug;13(3):184-93.

Abstract: Insomnia is a common sleep disorder with devastating socioeconomic consequences. Even though there are pharmacological and behavioral treatments for insomnia, most of the patients are treated with medications. However, the long-term use of medications to treat insomnia is questioned and has potential side effects. More and more Americans are seeking complementary/alternative treatments for many conditions including insomnia and there are anecdotal reports/case series of use of acupuncture in treating insomnia.

To examine critically the role of acupuncture in treatment of insomnia, we performed a systematic review of published literature. Among the selected studies for review many were clinical case series and few open or randomized clinical trails. Even though several of these studies did not clarify the nature of insomnia (primary vs. secondary), it seemed that many of the subjects enrolled in these studies had co-morbid other psychiatric (depression or anxiety disorders) and/or medical conditions (Hemodialysis, Stroke, Pregnancy). Except for few, several of these studies had methodological limitations.

Despite the limitations of the reviewed studies, all of them consistently indicate significant improvement in insomnia with acupuncture. Further methodologically strong, randomized controlled studies with large sample size are needed to assess the usefulness of acupuncture in treatment of insomnia and explore the possible mechanisms underlying the effects of acupuncture on sleep and sleep disorders.

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Acupuncture for pulmonary disease: Efficacy and safety

A critical analysis of acupuncture in pulmonary disease: efficacy and safety of the acupuncture needle.

Author: Jobst KA.

OPTIMA, Radcliffe Infirmary Trust, Oxford, UK.

Criteria for therapeutic efficacy and safety include significant amelioration of symptoms and, ideally, cure (i.e., patients' belief in effective improvement of symptoms and quality of life, durable impact on symptoms, verifiable subjective and objective changes); improved patient management (e.g., diminishing, or ceasing medication, physiotherapy, and other interventions); safety for patient and practitioner and an acceptable side effect profile; cost-effectiveness of the therapy in practice and to teach to others.

There is evidence that in bronchial asthma, chronic bronchitis, and chronic disabling breathlessness the use of acupuncture fulfills these to varying degrees. It can facilitate reducing pharmacologic medication and is safe, suggesting that acupuncture as an adjuvant in the treatment of respiratory disease might be safer than prolonged pharmaceutical maintenance therapy alone.

Its cost-effectiveness has yet to be adequately researched. Twenty-one papers in English were obtained and 16 were further evaluated; eight were double-blind, five single-blind, and three unblinded. The remaining five, and most of the Chinese literature, were excluded on account of their poor quality. Acupuncture was effective in four of eight of the double-blind, three of five single-blind, and three of three unblinded studies (i.e., 10 of 16 [62.5%] overall).

A previously unreported confounding variable was identified and concerned the designation of sham points. Most sham points were believed to be inactive but, according to traditional Chinese principles, many are active in pulmonary disease. Reappraised accordingly, the unequivocally positive studies were summed with those in which "real" and "sham" acupuncture were not significantly different but in which the combined effect of all acupuncture (i.e., real + sham) on breathlessness was significantly different from baseline. This yielded 13 of 16 (81%) [corrected] studies in which acupuncture led to significant improvement. In most studies, current pharmacologic treatment had a greater effect than acupuncture alone. However, in the 11 studies in which it was evaluated, medication could be significantly reduced by acupuncture in 10 (91%). Twenty-three of the 320 patients in the 16 studies (7%) reported minimal side effects, none requiring intervention.

Current published evidence reveals no reason to withhold acupuncture as a safe and potentially effective treatment in patients with bronchial asthma and chronic obstructive lung disease. Further, more appropriately designed studies are urgently required. This would be facilitated in the United States by licensing the acupuncture needle as a therapeutic agent and might lead to important new insights and therapeutic opportunities.

http://www.ncbi.nlm.nih.gov/pubmed/9395603

Acupuncture for fibromyalgia

A randomized controlled trial of acupuncture
added to usual treatment for fibromyalgia

Departamento de Patologia
Avenida Doutor Arnaldo 455
Sao Paulo, Brazil
targino@usp.br

OBJECTIVE: To evaluate the effectiveness of acupuncture for fibromyalgia.

METHODS: Fifty-eight women with fibromyalgia were allocated randomly to receive either acupuncture together with tricyclic antidepressants and exercise (n=34), or tricyclic antidepressants and exercise only (n=24). Patients rated their pain on a visual analogue scale. A blinded assessor evaluated both the mean pressure pain threshold value over all 18 fibromyalgia points and quality of life using SF-36.

RESULTS: At the end of 20 sessions, patients who received acupuncture were significantly better than the control group in all measures of pain and in 5 of the SF-36 subscales. After 6 months, the acupuncture group was significantly better than the control group in numbers of tender points, mean pressure pain threshold at the 18 tender points and 3 subscales of SF-36. After one year, the acupuncture group showed significance in one subscale of the SF-36; at 2 years there were no significant differences in any outcome measures.

CONCLUSION: Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment. Future research is needed to evaluate the specific effects of acupuncture for fibromyalgia.

PMID: 18758677 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/18758677

Acupuncture for primary dysmenorrhea

Efficacy of Acupuncture for the
Treatment of Primary Dysmenorrhea

Results: The results of a study published in Gynakol Geburtshilfliche Rundsch. 2003;43(4):250-3 by Habek et al entitled "Efficacy of Acupuncture for the Treatment of Primary Dysmenorrhea" concluded that the success rate of acupuncture for the treatment of primary dysmenorrhea symptoms within 1 year after the acupuncture treatment is 93.3% compared with 3.7% in the placebo group.

The results of a study published in Obstet Gynecol. 1987 Jan;69(1):51-6 by Helms entitled "Acupuncture for the management of primary dysmenorrhea" found that in the Real Acupuncture group 90.9% of the women showed improvement; in the Placebo Acupuncture group, 36.4% and in the Standard Control group 18.2%. There was a 41% reduction of analgesic medication used by the women in the Real Acupuncture group after their treatment series, and no change or increased use of medication seen in the other groups.

The results of a study published in Croatian in Jugosl Ginekol Opstet. 1984 Sept-Dec; 24(5-6):104-6 by Maric entitled "Use of acupuncture in the treatment of primary dysmenorrhea" concluded that a relief of dysmenorrheal pain was already evidenced after the first menstruation. One year after the completed therapy there was a full disappearance of dysmenorrheal pain in 93% of the cases and a partial one in 7% of the cases.

The results of a study published in Bulgarian in Akush Ginekol (Sofia). 1996; 35(3):24-5 by Tsenov entitled "The effect of acupuncture in dysmenorrhea" found that the effect of acupuncture treatment on dysmenorrhea depends on its kind — primary dysmenorrhea is influenced very well, while secondary dysmenorrhea is influenced satisfactorily.

World Health Organization recommendations

Numerous diseases, symptoms and conditions, where the efficacy of acupuncture has been well-researched: World Health Organization Recommendations →

NCCAM: National Institutes of Health

According to a National Institutes of Health (NIH) panel, clinical studies have concluded that acupuncture is effective for treatment and management of many conditions, including:

addiction
asthma
carpal tunnel syndrome
dental pain after surgery
fibromyalgia
headaches
lower back pain
menstrual cramps
myofascial (connective tissue) pain
nausea caused by surgical anesthesia and cancer chemotherapy
osteoarthritis
tennis elbow
assist in stroke rehabilitation

The National Institutes of Health (NCCAM) website provides introductory information about acupuncture, and additional research studies.

National Institutes of Health (NCCAM) Introduction to Acupuncture →

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