Acupuncture in Medicine Commentaries

Infantile colic: more than the mother

Reinthal, M., Lund, I., Lundeberg, T. — 2011-11-23T04:52:00-08:00

Infantile colic is diagnosed in a seriously fussy or colicky infant who is otherwise healthy and well fed but has paroxysms of irritability and fussing or crying for more than 3 h a day, for more than 3 days a week for more than 3 weeks. Thus, the clinical diagnosis is based on the children's crying behaviour.1 2 Pathogenesis of infantile colic is unclear but may be related to food allergy, flatulence, intestinal hormonal imbalances, parental factors and deregulation of the autonomic nervous system.3 4

In a recent prospective single blind controlled study on the effects of minimal acupuncture in infantile colic it was found that light needling (minimal acupuncture) at LI4 significantly reduced the rated crying intensity as compared with the control group. Pain-related behaviour, such as facial expression, was also significantly less pronounced in the light needling group as...

Acupuncture and constitutional diagnosis: where now?

White, A. — 2011-11-23T04:52:00-08:00

The process of diagnosis based on clinical history and examination is known to be fallible. There are plenty of examples of this fallibility in conventional medicine, and it only took a few minutes searching PubMed to find a study showing that clinical diagnosis of pneumonia was only 75% reliable when compared with the ‘gold standard’ of x-ray image appearance.1

Similarly, Traditional Chinese Medicine (TCM) diagnosis has proved less than perfect in the past. One fairly typical study found 47–80% reliability in a clinical trial.2 In the absence of a gold standard, reliability has to be tested against another clinician, raising the chance of error. Also, much of the variability may be due to choosing conditions with multiple aetiology and presentations. With awareness of the problems leading to improved study design, diagnostic reliability seems to be improving. For example, inter-rater reliability in rheumatoid arthritis patients improved...

Acupuncture in palliative care

Filshie, J., Rubens, C. — 2011-08-29T05:52:51-07:00

Acupuncture is being increasingly used for a multiplicity of symptoms in patients with cancer and those requiring palliative care. An evidence base has been accumulating over recent years for symptoms such as acute and chronic pain, nausea and vomiting, xerostomia, vasomotor symptoms, fatigue and dyspnoea. Many symptoms occur in patients with cancer long after their initial treatment, which usually consists of a combination of surgery, radiotherapy and chemotherapy. Today, 45% of patients worldwide survive at least 5 years beyond their initial diagnosis and cancer is increasingly regarded as a chronic disease. As treatments become more successful, patients face the additional challenges of dealing with both the physical and psychological sequelae of their condition.1

Yet, anticancer treatment remains an intense experience for many patients and causes numerous side effects. Acupuncture, being a non-drug treatment, provides at least a partial solution for the increasing proportion of patients who turn...

Methodological advances needed in analysis and interpretation of sham acupuncture validation studies

Park, J. J., Bang, H. — 2011-08-29T05:52:51-07:00

Methods

Many challenges remain in the evaluation of the clinical efficacy of acupuncture: for example, how to define the particular form of acupuncture used, when there are so many varieties of practice that can be called ‘acupuncture’ and how to choose the control method appropriate to that particular form of acupuncture.1 Perhaps we are still some distance from closing the gap between the rigour of a study (internal validity) and its generalisability and real-world applicability (external validity). In this issue of Acupuncture in Medicine, two reports are presented on the validity of two sham acupuncture methods. In sincere appreciation of the efforts of Takakura et al2 3 and Tan et al,4 in this difficult area, we would like to offer a few general points concerning the validation of acupuncture sham control and to comment on the two studies.

While it...

Safety aspects of electroacupuncture

Cummings, M. — 2011-05-26T10:05:28-07:00

This issue of Acupuncture in Medicine includes three papers that describe adverse events related to the use of electroacupuncture (EA) (see articles on pages 88, 143 and 147).1–3 There are few reports in the literature of such adverse events, and this is likely to be as a result of relative under-reporting of the minor events. More serious adverse events were summarised in 2004,4 and include cardiac problems (angina, cardiac arrest, interference with a demand pacemaker) and deaths related to needle trauma during EA. It seems timely to review the theoretical and practical risks associated with the application of EA.

Needling for EAIncreased depth and altered angulation

Depth and angulation of needles is often modified for the application of EA in order to ensure that the needles can support the weight of the electrical...

Do single subject research designs hold any promise for acupuncture?

White, A. — 2011-05-26T10:05:28-07:00

There is little doubt that some forms of acupuncture treatment are effective, at least for some patients. But we know little about the best treatment to offer, and who is likely to respond best. This information would be really useful both in guiding practitioners in their everyday decisions about which treatments to offer which patients, and in guiding the design of randomised controlled trials (RCTs) so they have the best chance of finding any real effects that exist. But how can we get this information?

One method of rigorous research, increasingly used in behavioural and rehabilitation medicine, is the single subject research designs (SSRD). Enblom and colleagues1 used a modified form of this design in the linked paper, so it is opportune to consider whether this holds any promise for acupuncture (see article on page 94).

The essence of SSRD is to make careful, repeated...

Integrating the results of research on acupuncture for nausea at the research site

Norheim, A. J. — 2011-03-07T16:07:12-08:00

The efficacy of acupuncture as antiemetic treatment for postoperative nausea and vomiting might be regarded as evidence-based.1–3 This issue of AIM presents another study indicating the effectiveness of acupuncture and acupressure (acustimulation) as a supplement to ordinary perioperative treatment for children undergoing tonsillectomy, adenoidectomy or both (see article on page 9).4

In 2003, the Lovisenberg Diaconal Hospital performed an unpublished internal study to assess the incidence of postoperative nausea and vomiting among 2282 patients undergoing orthopaedic, general surgical and ear/nose/throat surgical procedures. Paediatric tonsillectomy and/or adenoidectomy had the highest incidence of all for nausea, retching and vomiting.

The hospital wanted to improve treatment and the nurse anaesthesiologist, Ingrid Liodden, at the department of anaesthesiology approached the National Research Centre in Complementary and Alternative Medicine (NAFKAM) at the University of Tromsø to collaborate in a study on acupuncture for postoperative...

Preoperative acupuncture: postoperative analgesia?

Lundeberg, T. — 2011-03-07T16:07:12-08:00

In the linked study by Coura and collaborators, it is reported that acupuncture the day before surgery can reduce postoperative pain (see article on page 16).1 Although the study is small and there are gender differences between the groups, the findings are novel, suggesting that acupuncture may be used the day before surgery rather than given in the immediate preoperative period. This suggestion is supported by results showing that acupuncture given to patients just before operative removal of impacted mandibular third molars resulted in increased pain as compared with a control group receiving no treatment.2 A relevant question is whether the results obtained may be explained from a physiological perspective—that is, if acupuncture given the day before surgery may be used to prevent or reduce the postoperative pain.

Nociception is the term for pain that results from activation of nociceptors (high threshold peripheral...

Acupuncture and heart rate variability

Alraek, T., Tan, C. O. — 2011-03-07T16:07:12-08:00

The rhythm of life in general, and that of the heart in particular, has always been of interest to physicians and lay people all over the world. Ancient Chinese physicians examined the pulse of the patient's radial artery as a part of their diagnostic procedure. Through interpretation of the pulse the physician could get access to knowledge, somehow tacit, in terms understood then as the primary disharmonies in patients. In ancient times, advice and treatment were given accordingly, and later an anticipated change in the pulse should be seen as necessary for a noticeable change in the patients' health. Balance is still, as in old times, an important aspect of acupuncture, but now formulated with questions like ‘Does acupuncture regulate autonomic functions?’ Quite a few studies indicate that it does.1–5 One aspect of this regulation is a change in...

On ears and Head

Usichenko, T. I., Mustea, A., Pavlovic, D. — 2010-12-08T10:29:26-08:00

The original empirical conjecture of auricular acupuncture (AA) consists of a claim that the entire human body is represented in a certain way on the auricle (eg, in the form of an inverted fetus, see figure 1A), and that the pathology of human organs leads to specific changes at these respective areas on the auricle. It is claimed that these changes can be identified as the areas with skin discolourations, which are tender on palpation. Moreover, the stimulation of these auricular areas, which are supposed to somehow be connected to the organ with ‘pathology’, is believed to improve the functioning of the impaired organ or relieve the related pain.1 The representation of the human body on the auricle is often called ‘somatotopic’, analogous to motor and sensory somatotops of precentral and postcentral gyri of the cortex, as described by Penfield and Rasmussen on the basis...

Acupuncture and xerostomia

Simcock, R., Jenkins, V. — 2010-12-08T10:29:26-08:00

Commentary

Xerostomia has Greek origins from ‘xeros’ (dry) plus ‘stoma’ (mouth); an innocuous description that does little to reflect the chronic and miserable state experienced by patients after radiotherapy for head and neck cancer.1 2 Radiotherapy is used as a curative treatment for head and neck cancers (see Figure 1). Incidence of these cancers is increasing (possibly due to rising human papillomavirus infection rates) but cure rates with radiotherapy are also rising.3

Figure 1

Patient in immobilisation mask being prepared for radiotherapy treatment on linear accelerator.

Radiotherapy doses used far exceed the tolerance of those salivary glands that lie in the path of the radiation beam causing permanent damage and consequent xerostomia.

Xerostomia debilitates and greatly impairs quality of life long after successful cancer treatment. It interferes with taste, chewing, swallowing, speaking, sleeping and...