The most obvious, and persistent, tradition of acupuncture is the idea of ‘correct’ acupuncture points for a particular condition. In a nicely performed RCT, Kim and colleagues used a consensus of ‘correct’ points for treating hot flushes and compared them with what they assumed were ‘incorrect’ points. In line with much of the evidence from other trials, they found no difference: hot flushes declined in both groups. Acupuncture's effect in this condition is a general effect on central nervous system mechanisms – by some (still unknown) combination of sensory nerve...]]>
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...]]>
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.
To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women.
The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes.
54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was –6.4±5.2 in the real acupuncture group and –5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period.
Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.
Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis.
To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging.
Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation.
In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points.
The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.
Traditional Chinese medicine (TCM) offers various treatment modalities guided by TCM diagnoses. In the United States, acupuncture is a commonly employed TCM method for treating a variety of chronic illnesses. Three systematic reviews have been reported recently, reaching differing conclusions about the efficacy of acupuncture for the treatment of fibromyalgia (FM). Among the FM acupuncture studies considered in these reviews, none used TCM diagnosis as an inclusion/exclusion criterion or adjusted treatment based on TCM diagnosis. Overlooking TCM diagnosis may be a reason for such disparate results.
To obtain TCM diagnoses in a sample of women meeting 1990 American College of Rheumatology criteria for FM who were recruited for a yoga study and to investigate whether there is significant variability.
Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM. A consensus diagnosis was reached based on standardised history, palpation and examination. Canonical discriminate analysis identified two baseline items which predicted TCM diagnosis.
School of Nursing, Oregon Health & Science University.
Women, ages 23–75, with FM recruited to a yoga intervention study
Three primary TCM diagnoses were found in the population: Qi and Blood Deficiency (46.4%, CI 33.0% to 60.36%), Qi and Blood Stagnation (26.8%, CI 15.8% to 40.3%), and Liver Qi Stagnation (19.6%, CI 10.2% to 32.4%).
It is likely that previous studies of FM were treating a heterogeneous study population where variable results might be expected. Future acupuncture studies should either control for TCM diagnosis or consider its usefulness as an inclusion/exclusion criterion.
To provide an in-depth analysis of seven well-reported studies that examined electrodermal activity (EDA) at acupuncture points with regard to three commonly held tenets of acupuncture: (1) EDA at pathology-related acupuncture points is distinguishable from non-pathology-related acupuncture points; (2) EDA at acupuncture points can assist in diagnosing and monitoring therapeutic progress; and (3) EDA at acupuncture points is able to identify substances that are either therapeutically beneficial or toxic to an individual.
Seven of 29 studies that scored >50% on their quality of reporting 54 essential technical and clinical details of EDA testing in human patients were identified from a previous literature review. Fourteen categories of data were extracted from these seven studies for further discussion.
Two studies compared EDA at pathology-related auricular acupuncture points to non-pathology-related sites. Two studies correlated EDA measurements at sites other than auricular acupuncture points with the presence of specific medical conditions. The final three studies assessed changes in EDA at acupuncture points on the fingers and toes when different substances were placed in the electrical circuit with the patient.
This review highlights the heterogeneity of approaches to EDA assessments and the discrepancies between common clinical practice and the scientific evidence to support that practice. It also provides pilot data that suggest EDA testing at auricular acupuncture points may distinguish pathology-related acupuncture points from non-pathology-related points; decreased skin conductance correlates with tiredness or low energy; and EDA testing at the Jing-Well acupuncture points, on the tips of the fingers and toes, may assist in monitoring effectiveness of acupuncture treatment. The evidence does not support the use of VEGA testing for allergic status.
Insulin resistance is frequently present in obesity and during the development of type 2 diabetes mellitus.
The purpose of the present study was to investigate the effect of electroacupuncture (EA) on high-fructose diet (HFD)-induced insulin resistance.
Male Wistar rats were fed HFD for 4 weeks and developed insulin resistance. Insulin sensitivity was assessed by clamp. The number of animals was seven, eight and seven in the control, HFD and HFD+EA groups, respectively. AMP-activated protein kinase (AMPK) and glucose transporter 4 (GLUT4) in skeletal muscle were measured by Western blotting analysis (n=7 in each group). EA stimulation was carried out 12 times over 4 weeks at an intensity of 1–3 mA and a frequency of 2/15 Hz in a conscious state without restraint.
There was no significant difference in mean body weight and fasting blood glucose concentration between groups at the end of the experiment. The mean glucose infusion rate during the clamp was significantly lower in the HFD group than in controls (p<0.05). There was no significant difference in expression of GLUT4 in skeletal muscle in the control and each group. Phosphorylated AMPKα (Thr172) in skeletal muscle showed a significant increase immediately after the final EA stimulation when compared with the control group (p<0.05).
Repeated application of EA is capable of improving diet-induced insulin resistance, probably through activation of AMPK signalling pathways in skeletal muscle. These results suggest that repeated application of EA may have beneficial effects on diet-induced insulin resistance.
Intravenous injection of lipopolysaccharide (LPS) stimulates macrophages to release proinflammatory cytokines and nitric oxide (NO). This results in hypotension, vascular hyporeactivity and multiple organ failure (eg, liver injury) in rats. In rats with endotoxin shock, electro-acupuncture (EA) of ‘Neiguan’ (PC6) retrieved blood pressure and reduced plasma concentrations of NO. The authors evaluated whether EA at PC6 could alleviate the development of liver injury and dysfunction in endotoxic rats.
A total of 28 male adult Wistar rats were included in this study. Rats received intravenous LPS (10 mg/kg for 4 h) or saline for 4 h followed by EA at PC6 acupuncture point.
Elevated biochemical parameters of liver injury and marked infiltration of neutrophils into liver tissues caused by LPS were significantly attenuated by EA. However, hypotension, tachycardia and raised production of plasma NO were not suppressed by EA at PC6 .
These results indicate that EA at PC6 should be further investigated as a possible adjuvant therapy for endotoxin-induced liver dysfunction. Its mechanism of action needs further investigation.
It is with very great sadness that the Society learnt of David Bowsher's death on 17 June 2011 at the age of 86. David, an honorary member of the Society (he was also a member of both the research committee and the international editorial board), made many important contributions to the British Medical Acupuncture Society (BMAS) by way of presenting talks, publishing papers and chapters on acupuncture, as well as on forms of stimulation-induced analgesia. He willingly and generously gave valuable advice, help, guidance, encouragement and inspiration to members and others. Those who were fortunate enough to hear him present a lecture or to have a discussion with him, quickly realised that he was someone with a multitude of exceptional gifts. He was a consultant neurologist, neuroanatomist and medical scientist who possessed that rare combination of a most erudite mind with an...]]>
Multicenter, randomised control trial (n=140) comparing traditional acupuncture with medication.
Adult patients diagnosed with migraine without aura who had previously not had prophylactic treatment were recruited from five hospital outpatient departments. They were randomised to two groups in equal numbers: (1) the treatment group had verum acupuncture plus placebo medication and (2) the control group had sham acupuncture plus flunarizine, a drug recommended as a first-line preventive treatment of migraine. The study period of 20 weeks included a baseline observation period of 4 weeks, a treatment period of 4 weeks, and follow-up period of 12 weeks.
Both verum and sham acupuncture groups had three treatment sessions lasting 30 min each week for 4 weeks which were conducted...]]>
Recent guidelines from NICE are encouraging the incorporation of acupuncture into pain management strategies within the NHS.
Ethical review by academic staff generated the opinions that the study raised no major ethical issues and that formal ethical approval was not needed. Ethical approval was, however, gained from the chairman of the Kensington and Chelsea Primary Care Trustand the doctors at the practice. I distributed the questionnaires to all patients attending the practice over five consecutive days. I expressed confidentiality verbally to...]]>
Herein we present additional clinical data supporting the idea that the effect of acupuncture is dependent on the...]]>
This was a pilot study...]]>
"Somewhere, something incredible is waiting to be known." Dr Carl Sagan, American astronomer, writer and scientist. 1934–1996
Planning and managing a research project can seem like a daunting undertaking, especially as we have little exposure to the techniques required for success during our professional training. It would be tempting to leave the research to those who find their career paths progressing into the world of laboratories and clinical trials. This seems a shame as there may be many of us who could provide interesting and important contributions, if we had a little help to start us off! With rising use of complementary and alternative treatments by the public, and little in the way of good clinical evidence to support, or indeed, fund it, it seems like a good time to encourage more professionals and practitioners to discover their ‘inner scientist’, and...]]>
The popular 1-day course with comprehensive presentations and demonstrations and a half-day practical session.
AS Super 4 Digital (illustrated) included with course fee
These courses follow a rolling programme of four days, focusing on practical needling of particular regions of the body. A selection of the four days will be covered over one year. The four days cover the core skills training for the Diploma of Medical Acupuncture (DipMedAc). Other self-directed study is...]]>
FOUNDATION COURSES last 4 days, spread either over two weekends or over a working week. While the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
York: York District General Hospital.
Two weekends: 11–12 February and 10–11 March 2012.
Bristol: Southmead Hospital.
Two weekends: 18–19 February and 17–18 March 2012.
London WC1: 33 Queen Square.
Four weekdays: 2–5 April 2012.
Manchester: Wythenshawe Hospital.
Two weekends: 12–13 May and 16–17 June 2012.
Newcastle upon tyne: Freeman Hospital.
Two...]]>
It does seem that we are beginning to...]]>
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...]]>
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.
While it...]]>
Lymphoedema is a distressing problem affecting many women after breast cancer surgery. There is no cure and existing treatments are marginally beneficial, rarely reducing arm swelling in any meaningful way. Needling and even lifting of objects using the affected arm has been prohibited, but our clinical experience and that of others suggested that acupuncture was safe and that it might be a useful treatment for lymphoedema.
We sought to conduct a pilot study of the safety and effectiveness of acupuncture in women diagnosed with chronic lymphoedema for at least 6 months and less than 5 years.
Women with chronic lymphoedema (affected arm with >2 cm circumference than unaffected arm) after breast cancer surgery received acupuncture twice a week for 4 weeks. Response was defined as at least a 30% reduction in the difference in size between the affected and unaffected arms. Monthly follow-up calls for 6 months following treatment were made to obtain information about side effects.
Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious adverse events occurred during or after 73 treatment sessions.
This pilot study requires a larger, randomised follow-up investigation plus enquiries into possible mechanisms. Both are in development by our group.
Acupuncture appears safe and may reduce lymphoedema associated with breast cancer surgery.
A pilot study to document changes in symptoms after acupuncture or nurse-led supportive care in patients with incurable cancer.
Patients receiving palliative care with estimated survival of at least 3 months were screened with the Edmonton Symptom Assessment System (ESAS). Patients (n=20) with significant symptoms were randomised to receive weekly acupuncture or nurse-led supportive care for 4 weeks. ESAS scores were obtained before and after each treatment, and weekly for 6 weeks after treatment by telephone.
42 of 170 patients screened were eligible. 20 gave consent for recruitment. The compliance rate was 90% for acupuncture and 80% for nurse-led supportive care. Total symptom scores were reduced by an average of 22% after each acupuncture visit and by 14% after each supportive care visit. Compared with baseline, ESAS scores at the end of the follow-up period were reduced by 19% for the acupuncture arm and 26% for nurse-led supportive care.
Patients appear to benefit from incorporating acupuncture in the treatment of advanced incurable cancer. Acupuncture was well tolerated with no significant or unexpected side effects. Acupuncture had an immediate effect on all symptoms, whereas nurse-led supportive care had a larger impact 6 weeks after the final session. Both interventions appear helpful to this population and warrant further study.
To examine the effect of acupuncture and the relaxation response (RR) for treating gastrointestinal (GI) symptoms in HIV patients who are using highly active antiretroviral therapy (HAART).
The authors conducted a 4-arm 2x2 double-blind randomised controlled trial in an acupuncture clinic in the USA. Sham acupuncture and health education were used as the control conditions of real acupuncture and RR elicitation, respectively. Enrolled patients were randomised to real acupuncture+RR (AR), sham acupuncture+RR (SR), real acupuncture+health education (AE) or sham acupuncture+health education (SE) study arm. Participants listened to CDs with RR-eliciting instructions or health education while receiving acupuncture intervention. Interventions were provided twice weekly for 4 weeks and once weekly for another 4 weeks. Participants used daily diaries to record GI symptom severity ratings (0–10). The authors estimated the intervention effect as the changes in symptom rating per intervention session increase using a mixed-effects regression model.
A total of 130 people with HIV/AIDS who were on HAART and had persistent GI symptoms were enrolled and 115 started the study intervention. The AR group had greater intervention effects for loose stools symptoms than the other three groups (β=–0.149, –0.151 and –0.144, p value=0.013, 0.013 and 0.018 comparing AR to AE, SR and SE, respectively). The AR group also had significant intervention effects on reducing nausea symptoms when the intervention was given twice per week (β=–0.218, p=0.001).
Our trial provided preliminary data demonstrating the potential synergistic effects of acupuncture and RR for treating GI symptoms in HIV patients on HAART.
To report the therapeutic effectiveness and feasibility of electroacupuncture (EA) treatment in patients with urinary retention which is caused by cauda equina injury and refractory to conventional conservative treatments.
From 9 August 2007 to 10 May 2010 prospective evaluation was carried out in 15 patients with neurogenic urinary retention secondary to cauda equina injury who underwent EA treatment at bilateral points BL32, BL33 and BL35. All patients received five sessions of EA treatment each week for the first 4 weeks, three sessions a week for the following 2 weeks, and then were followed up for 6 months. Voiding abilities, postvoiding residual urine volume (RUV) and maximum urinary flow rate (Qmax) were documented as outcome measures.
After 6 weeks' EA treatment, 10/15 enrolled patients regained their self-voiding ability, and the mean postvoiding RUV for all patients decreased by 303.6±148.8 ml. In nine patients with documented data, Qmax increased by 11.0±6.3 ml/s. In nine patients, voiding difficulties changed from severe to mild. At the end of 6 months' follow-up, 8/10 patients retained their regained self-voiding ability, whereas two patients had lost their voiding ability again.
The results indicate that the EA treatment may have longlasting therapeutic effectiveness in the management of neurogenic urinary retention secondary to cauda equina injury.
Plantar heel pain (plantar fasciitis) is a common and disabling condition. A variety of treatment options are available to patients with plantar heel, however the evidence for these treatments is generally weak and the best way to manage plantar heel pain remains unclear. Trigger point dry needling is increasingly used as an adjunct therapy for musculoskeletal pain. In patients with plantar heel pain this technique is thought to improve muscle activation patterns, increase joint range of motion and alleviate pain. However, there have been no randomised controlled trials that have evaluated the effectiveness of dry needling for plantar heel pain.
In order to develop a treatment protocol to evaluate the effectiveness of dry needling for plantar heel pain we conducted a three stage modified Delphi process using a web-based survey technique. Over a series of three iterations, 30 experts (participants) worldwide indicated their level of agreement on specific issues relating to the use of dry needling for plantar heel pain including their treatment rationale, needling details and treatment regimen. Consensus for a dry needling protocol for plantar heel pain was achieved when >60% of participants (IQR ≤ 1.0 category on 5-point Likert scale) agreed the protocol was adequate.
The response rate was 75% (n=30), 100% (n=30) and 93% (n=28) in the first, second and third rounds respectively. Round 1 helped generate a list of 10 items that were deemed important for developing a dry needling protocol for plantar heel pain. These 10 items were subsequently presented in Round 2. Of these, 5 of the 10 items met the criteria to be included in a dry needling protocol for plantar heel pain that was presented in the final round, Round 3. Items that did not meet the criteria were either removed or amended and then presented in Round 3. In the final round, 93% of participants (IQR range = 1) agreed the proposed dry needling protocol for plantar heel pain was adequate. The protocol can now be used in future research projects designed to evaluate the effectiveness of dry needling for plantar heel pain.
A no-touch control needle in which the needle tip cannot reach the skin has been designed, and has been validated for practitioner blinding in a previous study but not for participant blinding.
To test whether the no-touch control needle can effectively blind subjects.
An acupuncturist applied, in turn, a no-touch control, skin-touch placebo and penetrating needle in one forearm of 80 healthy subjects. After removing each needle, the subjects were asked to judge the type of needle and rate the sensation of skin penetration/penetration-like or skin pressure/pressure-like pain on a 100 mm visual analogue scale.
The subjects correctly identified 67% of needles overall. 17 of the 80 no-touch control needles were judged as skin-touch, and one as penetrating. In addition, six skin-touch placebo needles, and no penetrating needles, were judged as no-touch. Half of the 80 skin-touch placebo needles and 65 of the 80 penetrating needles and two no-touch control needles elicited pain. Of 240 needles, the practitioner identified 120 correctly that did not fit the probability of 1/3 (2=30.00, p<0.01).
The no-touch control needles may be used as a blind control for the acupuncture procedure, or to test the physiological effect of the skin-touch needles, but are not suitable for double-blind testing of the needle effect.
To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing.
20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes–No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions.
The participants' discrimination accuracy between the real and sham needles was not statistically significant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t19=0.00, unadjusted p=1.00; combined: t19=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically significant from P(C)=0.5 for the upper limb acupoints alone comparison (t19=2.36, unadjusted p=0.03).
This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was significantly different from chance levels.
Although acupuncture is effective for treating several conditions, its site specificity is questionable.
To investigate whether acupuncture influences the brainstem auditory evoked potentials (BAEP).
10 healthy volunteers were enrolled according to inclusion criteria. One of four acupuncture points—TE3, GB43 (both auditory system-specific, according to traditional Chinese medicine) and non-specific acupuncture points HT7 and ST44—was needled during each session. Each volunteer received four sessions of acupuncture, with a 1-week interval between the sessions.
Peak latencies and amplitudes of the BAEP were registered before and during each session of acupuncture. Pain intensity and the incidence of paraesthesia (Qi sensation) during acupuncture were also registered. The peak latencies and amplitudes of the BAEP registered during acupuncture had not changed from the baseline levels. Needling of acupoint HT7 was most painful and induced the maximal incidence of Qi sensation.
Findings suggest that monitoring the BAEP is not a suitable technique for studying the immediate effects of acupuncture.
There are many commercially available instruments for measuring electrical conductance, but there is little information about their reliability. The aim of this study was to quantify measurement variability and assess reliability of the AcuGraph system—a commonly used electrodermal screening device.
Four experiments were conducted to measure variability in electrical conductance readings obtained by the AcuGraph system. The first involved measuring known resistors. The second measured non-human organic matter. The third was a test–retest assessment of the Yuan-Source and Jing-Well points in 30 healthy volunteers who were measured by a single operator. The fourth was an interoperator reliability evaluation of seven acupuncturists at the Yuan-Source and Jing-Well acupoints on four individuals at two time points.
Against known resistors, the AcuGraph had an average coefficient of variability (CV) of 1.8% between operators and test–retests. On non-human organic material the AcuGraph had an average CV of 0.9% and 2.8%. When a single operator tested 30 participants, the average reliability for the Yuan-Source points was 0.86 and 0.76 for Jing-Well points with a CV of 23.2% and 25.9% respectively. The average CV for the seven acupuncturists was 24.5% on Yuan-Source points and 23.7% on Jing-Well points.
The AcuGraph measures known resistors and organic matter accurately and reliably. Skin conductance at acupoints recorded by one operator was also reliable. There was less consistency in electrodermal recordings obtained by seven different operators. Operator training and technical improvements to the AcuGraph may improve consistency among operators.
There are methodological problems in researching auricular acupuncture. In these days of evidence-based medicine, most studies in this area are explanatory randomised controlled trials, which is limited in capturing the complete benefits of the intervention. Furthermore, there is lack of consensus over definitions of the concept of ‘addiction’ and whether or not this should be perceived as a ‘disease’ that can be ‘cured’ by an intervention such as auricular acupuncture. Basic concepts such as these need to inform development of outcome measures, which should include retention of clients in treatment as an indicator of success.
It is argued here that the best approach will integrate research on physical effects with research on subjective experience of those with drug and alcohol problems. The challenge is to design large scale, high quality, pragmatic randomised controlled trials to assess the effectiveness of auricular acupuncture over the longer term in settings that mimic the delivery of treatment in practice and are informed by acupuncture's own diagnostic traditions, using a combination of objective, quantitative methods and subjective, qualitative methods.
]]>To clinically evaluate the effectiveness of acupuncture when used in the management of chemotherapy-induced peripheral neuropathy (PN).
During cancer treatment, certain chemotherapies can cause varying degrees of PN. Patients' quality of life can be seriously impaired through loss of sensation, pain or mobility problems. Conventional medications routinely used to manage neuropathic symptoms have poor side-effect profiles and there is little or no evidence justifying their use to treat chemotherapy-related neurotoxicities. There are studies suggesting that acupuncture may be an effective therapy in treating PN across a number of different aetiologies.
A retrospective service evaluation.
Patients (n=18) were referred for acupuncture by the medical staff and/ornurse specialists or they self-referred for treatment. A course of six weekly acupuncture sessions was offered to them, and their details were recorded on an evaluation form prior to session one. Points were selected by acupuncturists, based on patient presentation, and needles remained in situ for 30–45 min. Treatments took place in outpatient clinics, chemotherapy day case ward or a drop-in clinic based in a physiotherapy gym. The evaluation form was completed at the end of session 6 by a therapist who had not been involved in patient care.
82% (n=14) of patients reported an improvement in symptoms following their course of acupuncture; one patient with advanced disease died during the 6 weeks. Some patients derived additional benefits from the treatment including a reduction in analgesic use and improved sleeping patterns. The most common acupoints used were SP6 (n=18), ST36 (n=18) and LV3 (n=14).
Although these results are encouraging, they are uncontrolled. They suggest that acupuncture could be an option for these patients and controlled trials using validated patient-reported outcome measures are justified.
Auricular acupuncture for acute migraine (n=94).
The research group have piloted a technique called the Needle Contact Test (NCT): tender points on the ear are identified, for example, with the Sedatelec algometer, then a needle is held in contact with each tender point in turn for 10 s – looking for the one which produces the greatest immediate reduction in pain. That is the point chosen for needle insertion. In patients with acute migraine attacks, they found the majority of the points were located on the antero-internal part of the antitragus (area M in
Restless legs syndrome (RLS) can wreck people's lives by preventing them from sitting down for long to do anything in the afternoons and evenings and disrupting their sleep every night. It is not an insignificant condition, but it is often regarded as something of a Cinderella with many patients not reporting it and many doctors not treating it – often regarding it as minor, trivial or psychological or not realising that treatments are available.
Although there is considerable anecdotal evidence of the benefit of acupuncture in RLS, a Cochrane review in 2008
Case studies can bring added realism to conventional theory and practice. There is useful comparison between what you may have done compared with an expert in the field. Case Studies from the Medical Records of Leading Chinese Acupuncture Experts looks very briefly at 170 cases covering 73 diseases and syndromes, using the following template: Patient ‘type’ age and sex Chief presenting complaint History of present illness Current symptoms Tongue and pulse findings Differentiation, explanation and analysis in traditional Chinese terms Simple diagnosis both in traditional Chinese and Western terms Principle of treatment (eg, dispel wind) Acupuncture points used Effect of treatment Further information and rationale for treatment.
The first four cases cover ‘the common cold’ (Wind Cold, Exterior Cold and Interior Heat, Wind Heat attacking the Lungs and Wind Heat type)....]]>
FOUNDATION COURSES last four days, spread either over two weekends or over a working week. Whilst the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
BIRMINGHAM: Birmingham City Hospital
Two weekends: 15–16 October & 12–13 November 2011
SLOUGH: Wexham Park Hospital
Two weekends: 29–30 October & 3–4 December 2011
YORK: York District General Hospital
Two weekends: 11–12 February & 10–11 March 2012
BRISTOL: Southmead Hospital
Two weekends: 18–19 February & 17–18 March 2012
LONDON...]]>
Location: Royal College of Physicians, London NW1
Date: 22 October 2011
Includes presentations on joint hypermobility syndrome, moderating visceral blood flow with the acupuncture, group acupuncture clinics and de qi and the rubber hand illusion. Followed by the Annual General Meeting.
Location: London
Date : 23 November 2011
Location: Manchester
Date: 15 June 2012
The popular one-day course with comprehensive presentations and demonstrations and a half-day practical session.
AS Super 4 Digital (illustrated) included with course fee.
Location: London WC1
Date: 19 April 2012
BMAS POINTS PRACTICAL courses follow a rolling programme of four days, focussing on practical needling of particular regions of the body. Starting in 2012 a selection of the...]]>
The pregnancy debate is contentious, and attracts three articles, nicely illustrating a common dilemma of the modern acupuncturist. There is no shortage of traditions handed down from the ancient physicians, as discussed by Betts and Budd; some of these should be respected because they are based on close clinical observation – but which ones? We are revisionists, reinterpreting the mechanisms of acupuncture from our knowledge of human physiology, but Da Silva and colleagues have been vilified for doing this publicly: they argue that the concept of Yin/Yang expresses the principle that acupuncture ‘normalises’ the body's physiology and patients should not be denied useful therapy. The third approach is to appraise the evidence, which Cummings does: acupuncture might have some influence on uterine activity...]]>
The image shows the application of electroacupuncture in the treatment of secondary myofascial pain from iliopsoas. This 33-year-old lady had recurrent knee pain diagnosed as hip dysplasia for which she had four hip operations culminating in a resurfacing procedure. One year later, the knee pain recurred, and it was reproduced by pressure on a (secondary) myofascial trigger point in iliopsoas. It responded immediately to treatment. For a full description, see Cummings M. Referred knee pain treated with electroacupuncture to iliopsoas. Acupunct Med 2003; 21(1–2):32–35.
Image and text provided by Mike Cummings
Do you have any interesting images relating to any aspect of acupuncture that you would like to share with other acupuncturists?
If so, please contact the editor through
Correction: the Image of acupuncture in the previous issue (March 2011) was kindly provided by Jane (not Janet)...]]>
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...]]>
One method of rigorous research, increasingly used in behavioural and rehabilitation medicine, is the single subject research designs (SSRD). Enblom and colleagues
The essence of SSRD is to make careful, repeated...]]>
To examine the therapeutic effect of a novel therapeutic method based on electroacupuncture with intermittent direct current (DCEA) and associated adverse events in patients with peripheral nerve damage and a poor clinical prognosis.
In seven older patients with peripheral nerve damage (neurapraxia 2, axonotmesis 4, neuromesis 1), an acupuncture needle connected to an anode electrode was inserted proximal to the site of the injury along the route of the nerve, while the cathode electrode was inserted into the innervated muscle, and DCEA was performed (100 Hz for 20 min, weekly). Muscular paralysis was evaluated weekly with manual muscle testing, the active range of motion of joints related to the muscular paralysis and, when necessary, needle electromyography. Adverse events were also recorded during the course of the treatment.
Complete functional recovery was observed in the two cases with neurapraxia and two with axonotmesis, while one axonotmesis case achieved improvement and the other showed reinnervation potential without functional recovery. No improvement was observed in the neurotmesis case. Pigmentation of the skin where the anode needle was inserted occurred in three cases. Although there was no definite causal link, one case showed excessive formation and resorption of bone in the area close to the cathode needle site.
Accelerated nerve regeneration caused by DCEA may contribute to recovery. The skin pigmentation and callus formation suggest that the shape of the anode electrode, current intensity and other factors should be examined to establish a safer treatment method.
Many acupuncture studies are of weak methodological quality, possibly due to lack of pilot testing. This pilot study tested design features, including test of feasibility, compliance to treatment and data collection, level of blinding success and the patients' potential perceived effects of the treatment, in preparation for an efficacy study.
A modified single subject experimental design was conducted. 10 cancer patients were randomised to verum penetrating acupuncture or non-penetrating sham needles for 30 min 2–3 times/week during radiotherapy over abdomen/pelvis. They answered test-retested emesis questions (r=0.527–1.0) covering nausea, vomiting, use of antiemetics, wellbeing and activities of daily living.
Overall, the patients completed 98% of the 345 emesis-questionnaire days and 101 of the 115 offered treatments. All patients believed they received verum acupuncture. 10 patients experienced antiemetic effects, seven relaxation, five pain-reduction and five experienced sleep improvement. Two types of nausea questions showed absolute concordance (r=1.0) (n of observations=456). Nausea was experienced by one of five verum acupuncture treated patients (duration median 0% of the radiotherapy-days) and four of five sham acupuncture treated patients (duration median 24% of the radiotherapy-days). Patients experiencing nausea rated decreased wellbeing and performance of daily activities compared to patients free from nausea.
All patients were blinded, complied with verum/sham treatments and data-collection, and believed they had effects of the received treatment. The methods for verum/sham treatment and data collection may thus be used in an adequately powered randomised controlled study of the effect of acupuncture for radiotherapy-induced emesis.
To conduct a pilot study to assess the feasibility of a proposed design of an acupuncture trial to relieve symptoms of infantile colic.
An open randomised single-blinded controlled trial, using standardised bilateral treatment of the acupuncture point ST36. Infants fulfilling Wessel's definition of infantile colic were included.
Patients were randomised to active treatment or to no-treatment control. General practitioners (GPs) educated in Western medical acupuncture did the interventions. Parents and GPs' assistants were blinded. Active treatment was the bilateral insertion of 0.20x15 mm Seirin needles to 12 mm depth at ST36. The intervention consisted of daily treatments of 30 s duration for three consecutive workdays. Blinding was done with a red point mark on the skin and circular adhesive dressing covering. The parents were asked two blinding validation questions in the course of the study period. The primary end point was the effect of the intervention assessed as change in crying time per 24 h measured with a crying registration form.
The authors improved the standardisation and changed the blinding procedure as a result of the pilot study. Blinding validation questions were considered necessary. The changes made in the main study protocol are discussed.
The pilot study led to important changes that were implemented into the final trial protocol. Blinding validation is essential in no-treatment controlled trials of acupuncture on infants, where the parents are blinded assessors of symptom reduction. The authors suggest that blinding validation questions, and the answers to these questions, should be reported.
Clinical Trial Registry Identifier: NCT00907621.
The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI).
30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up).
Data were analysed on an intention-to-treat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping improved significantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference on the Multidimensional Pain Inventory improved. At follow-up no significant improvements were seen.
Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of acupuncture.
At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a favourable effect from the treatment.
Few side effects were reported and neither dropout from the study did this due to adverse events.
Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.
To determine whether any difference exists in responses to indirect moxibustion (IM) relative to thermal stimulation duration.
In experiment 1, 9 subjects attended two experimental sessions consisting of single stimulation with IM or triple stimulation with IM, using a crossover design. A K-type thermocouple temperature probe was fixed on the skin surface at the GV14 acupuncture point. IM stimulation was administered to the top of the probe in order to measure the temperature curve. In addition, each subject evaluated his or her subjective feeling of heat on a visual analogue scale after each stimulation. Experiment 2 was conducted on 42 participants, divided into three groups according to the envelope allocation method: single stimulation with IM (n=20), triple stimulation with IM (n=11) and a control group (n=11). A thermograph was used to obtain the skin temperature on the posterior trunk of the participant. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk.
In experiment 1, no significant difference in maximum temperature was found in IM and subjective feeling of heat intensity between single and triple stimulation with IM. In experiment 2, increases in skin temperature occurred on the posterior trunk, but no differences in skin temperature occurred between the groups receiving single and triple stimulation with IM.
No difference exists in the skin temperature response to moxibustion between the single and triple stimulation with IM.
The authors investigated the quality of reporting for randomised controlled trials of auriculotherapy for pain before and after the implementation of the Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) guidelines.
The authors identified randomised controlled trials of auriculotherapy that measured pain or pain medication use as a primary outcome and were published in English in peer-reviewed journals. Proportions of studies that reported STRICTA and CONSORT items were compared for the years before and after implementation of STRICTA (2001) using Fisher's exact tests. Global differences across all study factors were investigated using hierarchical clustering and principle component analysis (PCA).
15 studies met our inclusion criteria. On average, 11 studies (74%) reported STRICTA items and eight studies (54%) reported CONSORT items. Differences in reporting between pre and post-STRICTA studies were found for two CONSORT items (randomised sequence and treatment provider) but no STRICTA items. However, the results of cluster analysis and PCA detected global differences over time for both STRICTA and CONSORT items.
Quality of reporting for studies of auriculotherapy for pain appears to have generally improved since the implementation of STRICTA and CONSORT guidelines.
Skin pigmentation or dark spots appeared in these four cases: after 12 treatments in Case 4, during the 14 treatments in Case 3, after one treatment course (16 treatments) in Case 1 and during the sixth month in a long-term treatment of duration 2 years (one or two treatments per week) in Case 2. These skin changes faded gradually after cessation of a course of acupuncture or EA. Skin pigmentation was hardly seen in one case after 14 days, and in another case after 42 days. Pigmentation of the skin could still be seen in one case after 42 days and could still be seen in another case after 2 years, however, in both cases, pigmentation has reduced in size and colour intensity by more than 50%.
It is likely that pigmentation of the skin is a specific consequence of needling and may be closely linked to acupuncture dosage regardless of whether stimulation is given manually or by EA.
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Randomised controlled trial (RCT) of PC6 stimulation to promote gastric emptying (n=30).
Thirty mechanically ventilated neurosurgical intensive care unit (ICU) patients were recruited who had delayed gastric emptying, defined as a gastric residual volume (GRV) >500 ml for ≥2 days, after surgery for subarachnoid haemorrhage, intracranial haemorrhage or traumatic injury. They were randomised to two groups. The ‘acupuncture stimulation’ group had bilateral transcutaneous electrical acupuncture point stimulation at PC6 at 7 Hz and 7–13 mA depending on the patient's wrist size. This was given for one 30-min period daily then 5-min periods every 2 h. The conventional promotility drug treatment group (DTG) were given metoclopramide initially, followed, if unresponsive, with cisapride (until this drug was...]]>
Searching Google for traditional Chinese acupuncture returns 5.5 million results, while Amazon.co.uk reveals about 300 titles for acupuncture books in English. The most expensive is the leather bound Classic Acupuncture: The Standard Textbook, by Manfred Porkert at £400. This review considers a very affordable ‘cook book’ on acupuncture therapeutics featuring traditional Chinese acupuncture (TCA) principles. The book is the textbook of China Beijing International Acupuncture Training School (
Acupuncture Therapeutics is concise, clearly set out and syndrome orientated. It assumes good basic knowledge of acupuncture and practical application. It is a reference work covering a very short introductory section of general principles...]]>
‘There is no doubt that our body is a moulded river’ (Novalis, cited on p 125)
This is an unusual book, by an osteopath who went on to train in acupuncture but felt dissatisfied with the usual explanatory models of both treatments. Three primary themes weave their way through his writing: movement, archetypal postures and meridians.
As an osteopath, his focus remains biomechanical—on shape, posture and movement (or ‘coherent changing of shape’). In attempting to understand how the body moves in a holistic way, he has developed the conventional ‘muscle chains’ of osteopathy into what he calls ‘contractile fields’ (CFs), primary patterns of movement that span the whole body, as against the elements of movement or the different muscles in isolation (the ‘dissective paradigm’). Although he sees his CF model as only a starting point in mapping the...]]>
FOUNDATION COURSES last four days, either spread over two weekends or over a working week. Whilst the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
INTERMEDIATE SKILLS TRAINING DAYS follow a rolling programme of four days, grouped together in pairs. Each year a selection of the four days is covered at different locations in the UK. The four days cover the core skills training for the Diploma of Medical Acupuncture. Other self-directed study is required to cover the knowledge and research...]]>
Location: London WC1
Date: 9 September 2011
Led by Mike Cummings and Jens Foell
Location: Glasgow
Date: 2 September 2011
Location: London
Date: 23 November 2011
AS Super 4 Digital – included with course fee
Location: London WC1
Dates: Masterclass I (head/neck/shoulder girdle/elbow)
20–21 July 2011
Masterclass II (back/hip girdle/abdomen/knee)
23–24 July 2011
Robert Gerwin
Location: Royal College of Physicians, London NW1
Date: 22 October 2011
Further details Further details of all meetings may be obtained from the BMAS Administrative Office, or online: Telephone: 01606 786782. Fax: 01606 786783 Email: admin@medical-acupuncture.org.uk Web:
Our Image of acupuncture shows the resolution of a keloid scar with acupuncture needles. As clinicians, it would be easy to introduce this treatment, but will the researcher in each of us demand a control for the natural history of the condition?
In our first of our eight (yes, eight!) original papers, Liodden and colleagues were...]]>
Figure 1 shows keloid scar six months after repair of a Colles' fracture to the left wrist of a 27 year old female. It was persistently sensitive, and plastic surgery had been offered. Figure 2 shows acupuncture needles ‘circling the dragon’: up to ten small needles (0.20x15mm, Seirin, without guide tube) were placed in healthy skin as close to the edge as possible and approximately 1cm apart, with no stimulation. The patient was aware of improvement straightaway, and after eight further treatments over four months the scar was flatter and much less sensitive. Figure 3 shows the scar after six months – free of pain or other symptoms and not needing surgery.
Image and text provided by Janet Hunter
Do you have any interesting images relating to any aspect of acupuncture that you would like to share with other acupuncturists?
If so,...]]>
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...]]>
Nociception is the term for pain that results from activation of nociceptors (high threshold peripheral...]]>
To investigate the effectiveness of acupuncture and acupressure as supplements to standard treatment for postoperative vomiting in children undergoing tonsillectomy and/or adenoidectomy.
A pragmatic, open, block-randomised controlled trial. The results were analysed according to the intention-to-treat principle. The study was conducted without extra resources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo. 154 children with an American Society of Anesthesiologists grade 1–2, weighing at least 10 kg, were included. Children with concomitant gastrointestinal diseases, emesis or antiemetic treatment <24 h preoperatively, rash or local infection over the actual acupuncture points were excluded together with patients whose parents' informed consent could not be obtained. The intervention group received acupuncture at pericardium 6 bilaterally, at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia, followed by acupressure wristbands for 24 h and standard treatment. The control group received standard treatment. The primary end point was the occurrence of vomiting or retching during 24 h postoperatively.
Children in the acustimulation group experienced less retching and vomiting than the control group—46.8% versus 66.2% (p=0.015). The effect of acustimulation was specifically pronounced in girls and children aged 1–3 years.
This trial indicates the effectiveness of acustimulation as an adjunct to standard treatment. The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy.
This study aims to evaluate the effects of preoperative electroacupuncture (EA) on the need for opioids in the postoperative stage of conventional cardiac surgery.
A prospective, randomised and controlled study was conducted at Unimed Hospital Centre in Joinville, SC, Brazil. The day before the surgery, 32 patients undergoing cardiac surgery were randomised into two groups: patients from the treatment group received preoperative EA at bilateral points (LI4–LI11, LR3–ST36, PC6–TE5) for 30 min with alternating frequencies of 3 and 15 Hz. Patients from the control group received sham transcutaneous electrical nerve stimulation (TENS). Use of fentanyl during the postoperative period was measured.
10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group. The average total doses of fentanyl given were 13.1±2.2 and 16.3±1.6 μg/kg in the treatment and control groups respectively (p<0.002). The doses of patient controlled analgesia were 4.1±2.0 and 6.9±1.7 μg/kg in the treatment and control groups respectively (p<0.003). The number of boluses issued also differed (treatment 13.9±7.0 vs control 24.8±7.0, p<0.002). Pain intensity scores differed between the groups (treatment 2.5±1.1 vs control 4.0±2.0, p<0.04). One patient from the control group experienced drowsiness that justified a change in fentanyl infusion, as decided by the anaesthetist.
Preoperative electro-acupuncture in conventional cardiac surgery may reduce the postoperative consumption of fentanyl.
Recurrent infections within a particular, well-localised body location are often seen in veterinary and medical practice. This condition could represent a localised or segmental immune deficiency. Recurrent canine otitis seems to be one example of this problem. It has been reported that acupuncture increased the efficacy of conventional treatment for canine otitis by >50%.
To assess whether the relapse rate of recurrent canine otitis over 1 year can be modified by acupuncture in adult dogs.
One-year follow-up of a randomised controlled trial. 31 dogs with a history of recurring otitis were randomised into two groups. In addition to conventional treatment, each group received four sessions of either real acupuncture, group A (n=16), or sham acupuncture, group B (n=15). The main outcome for the follow-up was the rate of acute otitis episodes in each group over 1 year, with blinded evaluation. A 2 test was used for statistical analysis.
There was one dropout in each group. Fourteen (93%) dogs in group A: were free of otitis relapses, compared with 7 (50%) in group B (p<0.01).
Acupuncture seems effective for preventing relapses in cases of recurrent canine otitis. This result suggests that acupuncture could be tested as a treatment of other recurrent localised infections. Given the ability of acupuncture to modulate neurotransmitters and opioid peptides, which can in turn modulate the immune system, the immune response to acupuncture also seems worth exploring.
Acupuncture is commonly used to treat menopausal symptoms and other gynaecological conditions. In this study, the authors aimed to investigate whether acupuncture has an effect on menopausal symptoms and to explore whether this effect is related to changes in hormone levels.
A total of 53 postmenopausal women were alternately assigned into two treatment groups: acupuncture (n=27) and sham acupuncture (n=26). Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). The serum oestradiol, follicular stimulating hormone (FSH) and luteinising hormone (LH) levels were measured at baseline and again after the first and last sessions. The Student t test was used for normally distributed data and the Wilcoxon signed rank test for not normally distributed data. The group differences in MRS scores were assessed using non-parametric Mann–Whitney U test.
After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels.
Acupuncture was effective in reducing menopausal complaints when compared to sham acupuncture and can be considered as an alternative therapy in the treatment of menopausal symptoms.
Studies indicate that menopausal symptoms are relieved by acupuncture. Additional studies have suggested that acupuncture may affect heart rate variability (HRV). This paper reports a pilot study that investigated whether menopausal symptoms responded to acupuncture, and if changes in the spectral analysis of HRV, either suppression of low frequency or augmentation of high frequency bands, corresponded with symptom report.
12 healthy menopausal subjects were enrolled in this feasibility study. At baseline, subjects were experiencing moderately distressing menopausal symptoms, scoring at least 22 of a possible 44 points on the Menopausal Rating Scale. 10 traditional Chinese medicine-based, protocol acupuncture treatments were administered over a 4 week period, three times a week for 2 weeks, followed by twice a week for 2 weeks.
Menopausal Rating Scale questionnaire, 11 menopausal symptoms were evaluated on a zero to four severity scale via self-administered daily checklist for 4 weeks. Dynamic measures of HRV (autoregressive model) were captured before, during and after acupuncture at each session. Spectral analysis of the heart rate was used to compute power in the low frequency and high frequency bands, and their ratio.
All subjects complied fully with the protocol without any reported adverse events. While all 11 symptoms showed significant improvement, and one HRV measure changed, on average over the study period, there was essentially no support for a relationship between HRV, menopausal symptom report and acupuncture intervention.
Acupuncture is an attractive treatment option for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) that has proved refractory to conventional medical treatments. Unfortunately, it is difficult to determine the benefit of acupuncture because few studies have employed controls or had physiological outcome measures.
To determine the feasibility of a sham, or minimally invasive, acupuncture as a control for studies evaluating the efficacy of acupuncture treatment for chronic pelvic pain.
Participants were recruited from a double-blind randomised trial comparing acupuncture with a sham procedure for patients with CP/CPPS. Acupuncture or sham procedures were performed over a 10-week period. Sham acupuncture involved placement of short needles at sites 0.5 cm away from true acupuncture points (CV1, CV4, SP6 and SP9). Participants were asked to determine their procedure allocation at the end of treatment. A total of 35participants also agreed to have blood analyses for cortisol, β-endorphin and leucine-enkephalin.
Thirty-five (78%) of the 45 participants randomised to the sham treatment thought they had received acupuncture compared with 27 (61%) of the 44 participants randomised to acupuncture (p=0.11). Biochemical data showed no differences between the groups immediately after treatment. Thirty-two (73%) of 44 acupuncture participants met the predefined clinical response criterion compared with 21 (47%) of 45 sham acupuncture participants (p=0.017, relative risk 1.81, 95% CI 1.3 to 3.1). At the end of the study, β-endorphin and leucine-enkephalin levels were both higher in the acupuncture group (p<0.01).
Minimally penetrating acupuncture was found to be a valid sham control and may prove useful for evaluating the efficacy of acupuncture for other conditions.
(ClinicalTrials.gov number, NCT00260637)
The aim of this study was to test whether acupuncture could modify the threshold of tolerance to thermal and electrical stimuli.
A randomised placebo-controlled single-blind trial was conducted in 36 healthy volunteers randomly distributed to control (no treatment), conventional acupuncture and sham acupuncture groups. The subjects were blind to the group allocation. The authors measured before and after treatment the pain threshold with the Painmatcher (Cefar Medical AB, Lund, Sweden) and the cold tolerance with the cold pressor test, together with the Visual Analogue Scale pain score.
Electrical stimulation threshold and cold pressor tolerance both increased significantly in the control and the true acupuncture groups, but not the sham group. The changes in the true acupuncture group were highly statistically significant and amounted to 24% (pain threshold) and 44% (cold tolerance) increases in threshold. The changes in the true group were significantly greater than the control group but not significantly different from the sham group. The changes in the sham and control groups were not significantly different from each other.
Acupuncture at true, appropriate points was more effective than no intervention in raising pain threshold and tolerance in volunteers, and acupuncture at inappropriate points had an intermediate effect which was not significantly different from either. Thus acupuncture analgesia may not be a point specific effect.
Treatment of patients according to individual pattern diagnoses is an important feature of acupuncture rooted in traditional Chinese medicine (TCM). Little is known about the reliability of TCM pattern diagnoses.
To examine in a cross-sectional study the inter-rater reliability of TCM diagnoses and acupuncture point selection.
30 infertile and 24 previously pregnant women were examined for TCM patterns by two acupuncturists. An operational interview guide related to gynaecology was used. The acupuncturists independently decided on the TCM patterns (categorised as excess, deficiency and merged patterns) and the prescription of acupuncture points. Kappa Statistics were used in the analyses.
39 different TCM patterns and 36 different acupuncture points were used. For the choice of acupuncture points, poor to no agreement was found. Moderate to fair agreement was seen in excess/deficiency and merged patterns. Perfect match to moderate agreement on treatment was obtained when choosing meridians given certain TCM patterns.
The low agreement on diagnoses indicates that acupuncturists follow individual pattern differentiation processes. The selection of acupuncture points seem to be closely related to the choice of TCM pattern diagnoses. The results indicate that the poor reliability in the diagnoses and thus treatment received by a patient will vary individually, which in turn is a challenge for clinical trials of acupuncture.
A sham-controlled RCT of acupuncture on the day of embryo transfer, n= 635.
A total of 635 patients undergoing IVF or intracytoplasmic sperm injection (ICSI) were included. Embryo transfer was accompanied by either acupuncture or sham acupuncture. The acupuncture group were treated at GV20, ST29, PC6, SP8 and LR3 before embryo transfer, and GV20, LI4, SP6, SP10, and ST36 afterwards, all bilaterally except GV20. Depth of needling and method of stimulation were not described. The control group were given the Streitberger needle at the same points. Both interventions were applied for 30 minutes, before and after the embryo transfer. Conventional management of implantation followed one of two well known protocols.
Metastatic bone pain in cancer is often severe, unremitting and poorly controlled,
A non-randomised design was...]]>
The key to Dr Ma's approach is integrative systemic dry needling (ISDN), which he defines as ‘a unique medical procedure that is designed to restore and normalise soft tissue dysfunction’. It is based on simple dry needling, myofascial trigger point treatment with due credit to Travell and Simons, and intramuscular stimulation of Chan Gunn fame (but with no detail).
Chapters describe joint mechanics,...]]>
The People's Republic of China is a developing nation with several aid-related activities in Africa, Latin America and Southeast Asia. It has acquired international goodwill through its provision of financing or loans for infrastructure projects, trade agreements and major economic investments in these countries.
First introduced in 1998, the training course is held once or twice a year bringing together health professionals from several developing countries. The programme, which has trained...]]>
FOUNDATION COURSES last four or five days, either spread over two weekends or over a working week. Whilst the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
INTERMEDIATE SKILLS TRAINING DAYS follow a rolling programme of four days, grouped together in pairs. Each year a selection of the four days is covered at different locations in the UK. The four days cover the core skills training for the Diploma of Medical Acupuncture. Other self-directed study is required to cover the knowledge...]]>
Location: Dublin
Date: 6th–7th May 2011
Gresham Hotel, Dublin
Location: Dublin
Date: 8th May 2011
Presented by Lisa Stener-Victorin
Location: London SW3
Date: 15th April 2011
Location: London WC1
Date: 9th September 2011
Led by Mike Cummings and Jens Foell
Location: London SW3
Date: 12th May 2011
Led by Dr Jacqueline Filshie Consultant Anaesthetist & Honorary Senior Lecturer, Royal Mardsen Hospital
Location: MANCHESTER: Wythenshawe Hospital
Date: 24th June 2011
Presented by Mike Cummings, Medical Director of BMAS. Fee includes Primal Pictures DVD: Anatomy for Acupuncture...]]>
Glass bead sterilizer, of a type in widespread use in private clinics and teaching establishments when needles were reused over and over again. Disposable needles were not in routine use before the 1980s. Students were instructed to wipe needles before inserting them in the beads, to avoid pieces of human tissue baking on to the needle shafts. In busy multi-bed, multi-student clinics, there was no guarantee that each needle stayed in the sterilizer for any minimum duration. The two longer needles on the right hand side have a double layer of silver filigree winding on the handles, known as ‘coiled coil’. These handles provided easier grip for really strong manual stimulation. Image provided by Adrian White
Do you have any interesting images relating to any aspect of acupuncture? If so, please contact the editor through info@aim.bmj.com
]]>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.
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...]]>
In the auricular maps introduced over the past 50 years by the French and Chinese schools, most organs and systems overlap consistently. One exception is the reproductive system, which shows a markedly different somatotopic representation—for example, for the uterus and the ovary.
To identify the distribution of points with increased tenderness to pressure or with reduced electrical resistance, on the outer ear of a group of women undergoing hysteroscopy.
For diagnostic purposes the auricles of 78 women were examined before and after hysteroscopy using a pain–pressure test and electrical skin resistance test. The points identified were transcribed onto a graphic system called Sectogram. Spatial cluster analysis was used to identify the statistically significant clusters of sectors with a higher concentration of points appearing after hysteroscopy.
The points identified after hysteroscopy tend to be concentrated in specific areas not previously recognised and which only partially overlap with the French and Chinese representation of the uterus.
When auricular acupuncture is applied to reduce discomfort during hysteroscopy, particular attention must be paid when choosing the points/areas to be stimulated, which are not only those indicated in the Chinese or French maps.
To investigate whether acupuncture reduces the duration and intensity of crying in infants with colic.
90 otherwise healthy infants, 2–8 weeks old, with infantile colic were randomised in this controlled blind study. 81 completed a structured programme consisting of six visits during 3 weeks to an acupuncture clinic in Sweden. Parents blinded to the allocation of their children met a blinded nurse. The infant was subsequently given to another nurse in a separate room, who handled all infants similarly except that infants allocated to receive acupuncture were given minimal, standardised acupuncture for 2 s in LI4.
There was a difference (p=0.034) favouring the acupuncture group in the time which passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing was lower in the acupuncture group the first (74 vs 129 min; p=0.029) and second week (71 vs 102 min; p=0.047) as well as the duration of colicky crying in the second intervention week (9 vs 13 min; p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (193 vs 225 min; p=0.025) and the second intervention week (164 vs 188 min; p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (22 vs 6 min; p=0.028), for colicky crying in the second week (92 vs 73 min; p=0.041) and for TC in the second week (44 vs 29 min; p=0.024), demonstrating favour towards the acupuncture group.
Minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. Further research using different acupuncture points, needle techniques and intervals between treatments is required.
Acupuncture has recently been used as a complementary technique in the management of infertility. It has physiological and psychological effects and may be considered an alternative for stress reduction in women undergoing infertility treatments.
To examine the hypothesis that acupuncture treatment may increase the pregnancy rate in patients undergoing intracytoplasmic sperm injection cycles.
Patients enrolled in the study were stratified according to age and randomised to either a control group (n=208) or acupuncture group, (n=208). The pregnancy, implantation and abortion rates of the two groups were compared.
No influence of acupuncture treatment on clinical outcomes was seen; however, when cycles in which the causes of infertility were exclusively tubal-uterine or idiopathic were evaluated separately, a positive influence of acupuncture on pregnancy (OR=5.15, 95% CI 1.03 to 34.5; p=0.048) was noted. Moreover, trends toward an increase in implantation were seen when acupuncture was performed (regression coefficient: 0.645; p=0.092).
The results suggest that acupuncture treatment had no influence when performed immediately before and immediately after embryo transfer, on clinical outcomes overall. In a subgroup analysis, when the embryo was not affected by an ovarian or seminal influence, a benefit was noted.
Reactions to treatment are common following acupuncture. Understanding how these reactions are interpreted by patients is largely unexplored.
To examine patients' ratings of the severity and bothersomeness of a range of common treatment reactions, and to assess their impact on willingness to try acupuncture again.
Self-reported ratings of the frequency, severity and bothersomeness of treatment reactions from 133 patients in the acupuncture arm of a pragmatic randomised controlled trial of acupuncture for chronic back pain are described and analysed.
A total of 133 acupuncture patients reported at 3 months reactions that they had experienced at any time during a course of up to 10 acupuncture treatment sessions. They received a total of 1150 treatments, an average of 8.6 sessions per patient. All patients reported treatment reactions, most commonly relaxation (84%, n = 112), which was significantly associated with willingness to try acupuncture again, (2 = 7.860, df = 1, p = 0.005). Only 16% (n=21) were unwilling to experience a specific treatment reaction again, and 9% (n = 12) were unwilling to try acupuncture again. The most ‘bothersome’ reaction was a temporary worsening of symptoms (29%, n=38), though this was not associated with an unwillingness to try acupuncture again (2 = 0.382, df = 1, p>0.536). Those unwilling to try acupuncture again reported significantly less reduction in their pain at 3 months (mean (SE) SF-36 bodily pain score at 3 months 30.453 (3.598) vs 19.30 (1.128); p=0.003).
Among this group of patients seeking help for low back pain, the experience of treatment reactions was universal. There was no evidence that the bothersomeness of treatment reactions was associated with patient's willingness to try acupuncture again. The benefit of pain reduction over the course of treatment appeared to outweigh self-rated bothersome reactions to treatment.
To provide information about the clinical use of acupuncture at an academic medical centre in the USA.
A retrospective review of 904 patients (receiving 6070 treatments) who were referred for acupuncture treatment at the Mayo Clinic (Rochester, Minnesota, USA) between 1 January 2004 and 31 December 2008. Data gathered included age, sex, primary diagnosis, number of treatments per diagnosis and health insurance carrier.
The mean (SD) age of the patients was 53.4 (16.2) years; 73.8% were female and 26.2% were male. The three most common diagnostic categories for which acupuncture was used were spinal pain (33.4%), pain (other) (25.1%) and joint pain (12.3%). About 42% of visits were not covered by health insurance carriers and hence patients had to pay themselves. For the remaining 58% of visits, health insurance carriers picked up all or part of the cost of the acupuncture treatments.
The results indicate that pain is the most common reason for use of acupuncture in an academic medical centre and that women use acupuncture more than men. This is one of the few reports of clinical use of acupuncture at academic medical centres in the USA.
Irradiation-induced xerostomia seriously reduces quality of life for patients with head and neck cancer (HNC). Anecdotal evidence suggests that acupuncture may be beneficial.
To systematically review evidence on clinical effectiveness and safety of acupuncture in irradiation-induced xerostomia in patients with HNC.
A detailed search was performed to identify randomised controlled trials (RCTs) and systematic reviews of RCTs on acupuncture in irradiation-induced xerostomia, using AMED, BNIA, CINAHL, Cochrane, Embase, HPSI, PsycInfo and Medline. Grey literature was explored and 11 journals hand searched. Search terms included: acupuncture, xerostomia, salivary hypofunction, hyposalivation, dry mouth, radiotherapy, irradiation, brachytherapy, external beam. Two authors independently extracted data for analysis using predefined selection criteria and quality indicators.
43 of the 61 articles identified were excluded on title/abstract. 18 articles underwent full-text review; three were deemed eligible for inclusion. Two trials had moderate risk of bias; one had high risk. Two trials compared acupuncture with sham acupuncture; one control arm received ‘usual care’. Outcome measurements included salivary flow rates (SFRs) in two trials and subjective questionnaires in three. All three trials reported significant reduction in xerostomia versus baseline SFR (p<0.05); one reported greater effect in the intervention group for stimulated SFR (p<0.01). Subjective assessment reported significant differences between real acupuncture and control in two trials (p<0.02–0.05). Insufficient evidence was presented to undertake risk/benefit assessment.
Limited evidence suggests that acupuncture is beneficial for irradiation-induced xerostomia. Although current evidence is insufficient to recommend this intervention, it is sufficient to justify further studies. Highlighted methodological limitations must be dealt with.
The aims of this study were to develop a sham cupping device and to validate its use as a placebo control for healthy volunteers.
A sham cupping device was developed by establishing a small hole to reduce the negative pressure after suction such that inner pressure could not be maintained in the cup. We enrolled 34 healthy participants to evaluate the validity of the sham cupping device as a placebo control. The participants were informed that they would receive either real or sham cupping and were asked which treatment they thought they had received. Other sensations and adverse events related to cupping therapy were investigated.
17 patients received real cupping therapy and 17 received sham cupping. The two groups felt similar sensations. There was a tendency for subjects to feel that real cupping created a stronger sensation than sham cupping (48.9±21.4 vs 33.3±20.3 on a 100mm visual analogue scale). There were only mild to moderate adverse events observed in both groups.
We developed a new sham cupping device that seems to provide a credible control for real cupping therapy by producing little or no negative pressure. This conclusion was supported by a pilot study, but more rigorous research is warranted regarding the use of this device.
This study (n=560) was designed to compare the effectiveness of real and sham acupuncture on osteoarthritis (OA) knee pain while simultaneously controlling expectation.
Acupuncturists were trained to interact in one of two communication styles: high expectations (such as ‘I think this will work for you’) or neutral expectations (such as ‘it may or may not work for you’). A brochure was given to each patient, written with expectations appropriate to their group. Patients were randomised to one of three communication style groups—waiting list, high or neutral—and nested within style, traditional Chinese acupuncture (TCA) or sham acupuncture twice a week over 6 weeks.
TCA consisted of points...]]>
A ‘vertical’ ascent with a 2 g acceleration (sensation of heaviness when it is impossible to raise the arms, and a feeling that one's ‘chin is dropping down’).
Microgravity (weightlessness) at 0 g (one literally floats up to the ceiling, without any control on body position or movements, and, as the head is the heaviest part of the body, one usually turns upside down, with feet up in the air ... this ‘amazing’ state lasts for about 25 s.
A violent dive and a period of hypergravity (2 g), when one falls down in whatever...]]>
In the Western world stroke is still the leading cause of disability in adults, often in the form of hemiparesis. The goal of this study was to correlate the effect of YNSA in patients with hemiparetic stroke to cortical activation visualised by functional magnetic resonance imaging (fMRI)
The neurological correlates of YNSA were studied in 17 patients with ischaemic stroke in the right hemisphere who had residual paresis of the left hand, and in 19 healthy volunteers. A new acupuncture needle for MRI developed by Schockert was...]]>
Subjects' characteristics Data are expressed as mean±SE.
In terms of the quality control of laboratory determination for salivary immunoglobulin A, we are sure it should be accurate...]]>
This is a book in three parts, with five background chapters on traditional Chinese medicine (TCM) and Western medical approaches followed by a core of chapters focused on clinical treatment in six different areas (acquired brain injury, Parkinson's disease, multiple sclerosis, spinal cord injury and disease, peripheral nervous system disorders and motor neuron disease), and concluding with a chapter on ‘pulling it together’. There is also a single brief appendix on outcome measures used in neurological rehabilitation, and an index.
The authors, both experienced and knowledgeable in the field of neurological rehabilitation, have open-mindedly set themselves the admirable, if unenviable, task of demonstrating how TCM and Western medical acupuncture (WMA) may both be appropriate, and even integrated,...]]>
Nogier then related...]]>
FOUNDATION COURSES last four or five days, either spread over two weekends or over a working week. Whilst the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
INTERMEDIATE SKILLS TRAINING DAYS follow a rolling programme of four days, grouped together in pairs. Each year a selection of the four days is covered at different locations in the UK. The four days cover the core skills training for the Diploma of Medical Acupuncture. Other self-directed study is required to cover the knowledge...]]>
Location: Dublin
Date: 6th–8th May 2011
Gresham Hotel, Dublin
Location: Dublin
Date: 23rd May 2011
Location: Glasgow
Date: 2nd September 2011
Location: London
Date: 23rd November 2011
AS Super 4 Digital – included with course fee
Location: London SW3
Date: 15th April 2011
Location: London WC1
Date: 9th September 2011
Led by Mike Cummings and Jens Foell
Further details Further details of all meetings may be obtained from the BMAS Administrative Office, or online: Telephone: 01606 786782. Fax: 01606 786783
Horse receiving acupuncture for excess eye-watering and blepharospasm due to keratitis and uveitis. The points shown are Extra points Tong-tang (on the dorsal midline at the level of the medial canthus of the eye), Chui-jing (Drooping Eye), Jing-shu (Eye Association Point), Bl1 and ST1 (ST2 was also needled but not shown here). Points from Veterinary Acupuncture by Xie, equine patient ‘Jaffa’, image provided by Bettina Teichmann.
]]>Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG).
To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA.
40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00.
The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group.
A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.
Insertion of an acupuncture needle into an acupuncture point typically generates a range of sensations called ‘de qi’. Most acupuncturists are taught that obtaining de qi is important when treating patients with pain but this can be quite uncomfortable for patients.
This study assesses the importance of the strength of de qi, on the clinical outcome in osteoarthritic pain.
This study was part of a larger randomised, single-blind, multifactorial trial involving three interventions: real acupuncture (RA), Streitberger needle (SN) and mock electrical stimulation for the treatment of patients with osteoarthritis (OA) of the hip and knee. Patients were treated twice a week for 4 weeks. The two outcomes relevant to this study were pain reduction assessed by visual analogue scale and the Park needling sensation questionnaire, both measured at completion of the study. Two arms of the trial were analysed (RA and SN). Reduction in pain was correlated against strength of de qi for both RA and SN. Those who felt de qi were compared with those who did not.
147 patients were recruited to the study (140 completed) with a mean pain reduction of 15.2 mm and mean de qi score of 6.2. There was no significant correlation between the strength of de qi and improvement in pain (p=0.49). There was also no significant difference in pain relief (p=0.52) between those who felt de qi and those who did not using the de qi subscale of the Park questionnaire.
These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA. This result may have implications for both acupuncture treatment and for future trial methodology.
Ah shi point acupuncture involves inserting needles at painful or pathological sites.
To evaluate the efficacy of ah shi point and general acupuncture point treatment of acne vulgaris.
36 subjects were recruited and randomised in a double-blind (patient-blind and observer-blind) controlled trial to receive acupuncture either at general acupuncture points only, or at both general acupuncture points and ah shi points 12 times over 6 weeks. The subjects were evaluated using the following outcome measurements: an inflammatory lesion count, a quality-of-life scale (Skindex-29) and a subjective symptom score.
After 12 treatment sessions, there was a significant reduction in the inflammatory acne lesion counts, the Skindex-29 scores and the subjective symptom scores from baseline in both groups, but no significant difference between groups.
Acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life.
Musculoskeletal complaints are associated with a large medical and societal burden. Although acupuncture is a frequently used therapy for musculoskeletal complaints, little is known about the effect on health-related quality of life (HRQoL).
The aim of this study was to (i) compare the HRQoL of patients undergoing routine acupuncture treatment for musculoskeletal complaints with a Dutch population sample; (ii) investigate changes in HRQoL during the course of acupuncture treatment.
An observational study of 26 patients between 18 and 65 years of age in a single acupuncture practice was performed. HRQoL was measured on eight functional domains using a RAND-36 health survey at baseline and after six and 12 treatment sessions. Baseline RAND-36 scores were compared to data from a Dutch population sample (n=1063) using t test, and longitudinal data were analysed using repeated measurement analyses.
At baseline, patients had significantly lower RAND-36 scores compared to the Dutch population sample for three domains: role-physical limitations (51.9 vs 79.4; p<0.001), bodily pain (49.3 vs 79.5; p<0.001) and social functioning (75.5 vs 86.9; p=0.005). During the course of treatment, RAND-36 scores increased significantly for five domains: physical functioning (79.3 vs 97.4; p<0.001), role-physical functioning (51.4 vs 94.1; p<0.001), bodily pain (47.3 vs 95.7, p<0.001), social functioning (74.5 vs 92.0, p<0.001) and vitality (69.1 vs 85.7; p<0.001).
The observed improvements in HRQoL suggest a subjective, clinically relevant, benefit of routine acupuncture therapy in treating musculoskeletal complaints.
Depressive symptoms and myalgia are commonly seen in patients with chronic hepatitis B and chronic hepatitis C.
To investigate the efficacy of acupuncture treatment on depressive symptoms and myalgia in patients with hepatitis.
Of 44 patients with hepatitis screened for depression and myalgia, 28 were enrolled and included in the study. The main outcome measure for depressive symptoms was Beck's Depression Inventory (BDI). For pain/myalgia, patients rated their pain on a scale from 0 to 10. Patients with a score greater than the cut-off point in either score were allocated to acupuncture treatment. The Chinese method of acupuncture was used. Treatment continued for 6 weeks.
At baseline, 17/44 patients (39%) had a BDI score ≥17 and 24 (55%) had a pain score ≥5. A total of 28 patients were allocated to acupuncture treatment, forming three groups: group 1, 13 patients with high BDI and high myalgia scores; group 2, 11 patients with low BDI score but high myalgia score; group 3, 4 patients with high BDI score but low myalgia score. Adherence to treatment was good; all patients completed the sessions and there were no drop-outs. Significant improvements in end-treatment BDI and in myalgia scores compared with baseline levels was found.
Acupuncture seems to be a promising treatment for patients with hepatitis. Further studies are warranted in large populations to establish the therapeutic role of acupuncture.
Electrical stimulation is used to promote bone reunion, and is most effective when applied directly to the fracture site.
To examine the effects of electroacupuncture (EA) on the healing process of tibia fracture in a rat model.
Thirty 12-week-old male Wistar rats underwent unilateral open osteotomies of the tibiae. The rats were then assigned randomly to three groups: EA group (n=10), sham group (n=10) and control group (n=10). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously penetrated directly at the surgery site, while an acupuncture needle inserted at 15 mm proximal to the surgery site was used as an anodal electrode. EA (50 Hz, 20 μA, 20 min) was performed daily for 3 weeks. In the sham group the acupuncture needles were inserted at the same sites but no electrical stimulation was given and in the control group, no treatment was given. The response was evaluated at 1, 3, 4 and 6 weeks after surgery by radiographic, macroscopic and mechanical examinations.
The EA group showed accelerated bone healing (EA group 29.92±4.55 mm2, sham group 26.46±5.21 mm2, control group 26.19±2.81 mm2, p<0.05 at 3 weeks) and accretion of the callus (radiographic evaluation: EA group 35.66±4.37 mm2, sham group 32.60±5.73 mm2, control group 29.72±6.39 mm2, p<0.05 at 6 weeks) compared with the other groups. Mechanical testing also showed an excellent result (EA group 16.54±9.92 N, sham group 7.13±3.57 N, control group 6.67±3.12 N, p<0.05) at 6 weeks in the EA group compared with the other groups. There was no difference between the sham and control groups in any evaluation.
The use of EA enhanced callus development and bone mineralisation during the bone healing process.
The masking properties of a new, non-penetrating, double-blind placebo acupuncture needle were demonstrated. Practitioners correctly identified some of the needles; if they were confident in this opinion, they would be unblinded.
To investigate the clues that led to correct identification, and the confidence in this decision.
Ten acupuncture practitioners, blindly and randomly, applied 10 each of three types of needle to the shoulder: blunt, non-penetrating needles that pressed the skin (‘skin-touch placebo needle’); new non-penetrating needles that penetrated soft material (stuffing) but did not reach the skin (‘non-touch control needle’); matching penetrating needles. Afterwards, practitioners were asked to judge the type of needle, their confidence in their decision and what clues led them to their judgements.
Of the 30 judgements made by each practitioner, the mean number of correct, incorrect and unidentifiable answers were 10.4 (SD 3.7), 15.2 (SD 4.9) and 4.4 (SD 6.1), respectively. There was no significant difference in the confidence scores for 104 correct (mean, 54.0 (SD 20.2)%) and 152 incorrect (mean, 50.3 (SD 24.3)%) judgements. Twelve needles were identified with 100% confidence—three correct, and nine incorrect. For needles correctly identified, the proportions of non-touch (p = 0.14) and skin-touch (p = 0.17), needles were no greater than chance, but the proportion of penetrating needles correctly identified exceeded chance (p < 0.01). 53% of judgements were made from the "feeling of needle insertion", but 57% of these were wrong.
Practitioners had a slight tendency to guess the penetrating needles correctly, but were uncertain about most of their judgments, posing only a very small risk to double blinding.
Given the international focus and rigorous literature searches employed in Cochrane systematic reviews, this study was undertaken to evaluate strategies employed in Cochrane reviews and protocols assessing acupuncture as a primary or secondary intervention.
The Cochrane Collaboration of systematic reviews was searched in February 2009 for all reviews and protocols including information on acupuncture. Information was abstracted from all retrieved articles on review status, type and number of English and Chinese language databases searched, participation of at least one Chinese speaking author and language restriction. Frequencies were calculated and bivariate analyses were performed stratifying on interventions of interest to assess differences in search strategy techniques, language restrictions and results.
The search retrieved 68 titles, including 48 completed reviews, 17 protocols and three previously withdrawn titles. Acupuncture was the primary intervention of interest in 44/65 (67.7%) of the retrieved reviews and protocols. While all articles searched at least one English language database, only 26/65 (40.0%) articles searched Chinese language databases. Significantly more articles where acupuncture was the primary intervention of interest searched Chinese language databases (53% vs 9%, p<0.01). Inconclusive findings as to the effectiveness of acupuncture were found in 28/48 (58.3%) of all completed reviews; this type of finding was more common in reviews which did not search any Chinese language databases.
It is important for reviews assessing the effectiveness of acupuncture to search Chinese language databases. The Cochrane Collaboration should develop specific criteria for Chinese language search strategies to ensure the continued publication of high-quality reviews.
A pragmatic randomised controlled trial of 58 patients with cancer undergoing neck dissection for lymph node involvement. The main aim was to determine reduction in pain and dysfunction, the secondary aim was relief of dry mouth.
Patients were recruited at a tertiary cancer centre with chronic pain or dysfunction due to neck dissection performed at least 3 months previously. They were randomly assigned to weekly acupuncture versus usual care (eg, physical therapy, analgesia, and/or anti-inflammatory drugs, according to patient preference or doctor's recommendation) for 4 weeks. Acupuncture was given four times at weekly intervals, using compulsory points LI4, SP6, GV20, Louzhen (EX26, midline between...]]>
FOUNDATION COURSES last four or five days, either spread over two weekends or over a working week. Whilst the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
INTERMEDIATE SKILLS TRAINING DAYS follow a rolling programme of four days, grouped together in pairs. Each year a selection of the four days is covered at different locations in the UK. The four days cover the core skills training for the Diploma of Medical Acupuncture. Other self-directed study is required to cover the knowledge...]]>
Led by Mike Cummings and Jens Foell
Location: London
Date: 23 September 2010
Detail from the Charter, Act and Ordinance Book 1605 With permission of the Worshipful Company of Barbers, London
Location: Barber Surgeons' Hall, London EC2
Date: 30 October 2010
AS Super 4 Digital – included with course fee
Location: London
Date: 25 November 2010
Further details Further details of all meetings may be obtained from the BMAS Administrative Office, or online: Telephone: 01606 786782 Fax: 01606 786783