Chinese herbs

Acupuncture Research

On this page you will find research abstracts for specific conditions. These are the most credible research studies currently published on acupuncture.

Please click on the condition you are interested in.

General Research on Acupuncture

NIH Consensus Panel. Acupuncture. NIH Consensus Development Statement. Bethesda, MD, Nov 3-5, 1997

OBJECTIVE: The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Acupuncture. The statement provides state-of-the-art information regarding the appropriate use of acupuncture, and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas of study that deserve further investigation. Upon completion, the reader should possess a clear working clinical knowledge of the state-of-the-art regarding this topic. The target audience of physicians for this statement includes, but is not limited to, family practitioners, medical acupuncturists, psychiatrists, and specialists in pain medicine. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health policy, epidemiology, statistics, physiology, biophysics, and the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1,200. EVIDENCE: The literature was searched through Medline, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.

CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel’s final revisions.

CONCLUSIONS: Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Ernst E. Acupuncture – a critical analysis. J Intern Med 2006;259:125

Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK.

Even though widely used in today’s clinical practice, acupuncture has remained a controversial subject. Many reviews are currently available but most lack a critical stance and some are overtly promotional. The aim of this overview is to provide a balanced, critical analysis of the existing evidence. Some of the original concepts of traditional acupuncture are not supported by good scientific evidence. Several plausible theories attempt to explain how acupuncture works but none are proved beyond doubt. The clinical effectiveness of acupuncture continues to attract controversy. Many controlled clinical trials and numerous systematic reviews of these studies have been published. Considerable problems are encountered when interpreting these data. Heterogeneity is a significant drawback of both clinical trials and systematic reviews. Some of the controversies may be resolved through the use of the new ‘placebo needles’ which enable researchers to adequately control for placebo effects of acupuncture. The majority of studies using such devices fails to show effects beyond a placebo response. Acupuncture has been associated with serious adverse events but most large-scale studies suggest that these are probably rare. Nonserious adverse effects occur in 7-11% of all patients. In conclusion, acupuncture remains steeped in controversy. Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response.

Sierpina VS, Frenkel MA. Acupuncture: a clinical review. South Med J 2005;98:330

Family Medicine Department, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA. This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.

Tsai HY et al. Further evidence for possible analgesic mechanism of electroacupuncture on neuropeptides and serotonergic neurons in rat spinal cord. Jpn J Pharmacol 1989;49:181

Department of Pharmacology, China Medical College, Taichung, Taiwan.

The possible mechanism of electroacupuncture (EAc) in reference to the effects of neuropeptides on serotonergic neurons in rat spinal cord was studied. The tested drugs were administered by intrathecal injection or spinal push-pull perfusion. The results showed that baclofen, substance P (SP) and naloxone administered intrathecally could reduce the tail pressure pain threshold. The pain threshold was increased by met-enkephalin (EK) and EAc. The action of EAc was antagonized by naloxone. The release of 5-HT in the spinal cord evoked by tail pressure pain stimulation (TP) was inhibited by EK, baclofen and EAc. However, naloxone could potentiate the 5-HT release evoked by TP. EAc reversed the naloxone potentiation of TP-evoked 5-HT release. The 5-HT release evoked by exogenous SP, however, was potentiated by EK and EAc. From these results, it is suggested that the influence of EAc on 5-HT release may be due to activation of enkephalin-interneurons, which presynaptically inhibit the primary sensory neurons in the spinal cord.

Hui KK et al. The integrated response of the human cerebrocerebellar and limbic systems to acupuncture stimulation at St 36 as evidenced by fMRI. Neuroimage 2005;27:479

Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Building 149, 13th Street, Room 2301, Charlestown, MA 02129, USA.

Clinical and experimental data indicate that most acupuncture clinical results are mediated by the central nervous system, but the specific effects of acupuncture on the human brain remain unclear. Even less is known about its effects on the cerebellum. This fMRI study demonstrated that manual acupuncture at ST 36 (Stomach 36, Zusanli), a main acupoint on the leg, modulated neural activity at multiple levels of the cerebro-cerebellar and limbic systems. The pattern of hemodynamic response depended on the psychophysical response to needle manipulation. Acupuncture stimulation typically elicited a composite of sensations termed deqi that is related to clinical efficacy according to traditional Chinese medicine. The limbic and paralimbic structures of cortical and subcortical regions in the telencephalon, diencephalon, brainstem and cerebellum demonstrated a concerted attenuation of signal intensity when the subjects experienced deqi. When deqi was mixed with sharp pain, the hemodynamic response was mixed, showing a predominance of signal increases instead. Tactile stimulation as control also elicited a predominance of signal increase in a subset of these regions. The study provides preliminary evidence for an integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 that correlates with the psychophysical response.

Pariente J et al. Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture. Neuroimage 2005;25:1161

Wellcome Department of Imaging Neuroscience, 12 Queen Square, WC1N 3BG London, UK.

Both specific and non-specific factors may play a role in acupuncture therapy for pain. We explored the cerebral consequences of needling and expectation with real acupuncture, placebo acupuncture and skin-prick, using a single-blind, randomized crossover design with 14 patients suffering from painful osteoarthritis, who were scanned with positron emission tomography (PET). The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient’s pain. The insula ipsilateral to the site of needling was activated to a greater extent during real acupuncture than during the placebo intervention. Real acupuncture and placebo (with the same expectation of effect as real acupuncture) caused greater activation than skin prick (no expectation of a therapeutic effect) in the right dorsolateral prefrontal cortex, anterior cingulate cortex, and midbrain. These results suggest that real acupuncture has a specific physiological effect and that patients’ expectation and belief regarding a potentially beneficial treatment modulate activity in component areas of the reward system.

Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec 2002;269:257

Department of Neurology, University of Vermont College of Medicine, Burlington, VT 05405, USA.

Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture’s mechanism of action and suggests a potentially important integrative role for interstitial connective tissue. Copyright 2002 Wiley-Liss, Inc.

Chernyak GV, Sessler DI. Perioperative acupuncture and related techniques. Anesthesiology 2005;102:1031

Outcomes Research Institute and Department of Anesthesiology, University of Louisville, Kentucky 40202, USA.

Acupuncture and related techniques are increasingly practiced in conventional medical settings, and the number of patients willing to use these techniques is increasing. Despite more than 30 yr of research, the exact mechanism of action and efficacy of acupuncture have not been established. Furthermore, most aspects of acupuncture have yet to be adequately tested. Therefore, considerable controversy remains about the role of acupuncture in clinical medicine. Acupuncture apparently does not reduce volatile anesthetic requirement by a clinically important amount. However, preoperative sedation seems to be a promising application of acupuncture in perioperative settings. Acupuncture may be effective for postoperative pain relief but requires a high level of expertise by the acupuncture practitioner. Acupuncture and related techniques can be used for treatment and prophylaxis of postoperative nausea and vomiting in routine clinical practice in combination with or as an alternative to conventional antiemetics when administered before induction of general anesthesia.

Lee H, Ernst E. Acupuncture analgesia during surgery: a systematic review. Pain 2005;114:511

Department of Medical Sciences, Graduate School of East-West Medical Science, KyungHee University, Yongin, South Korea. The aim of this systematic review is to assess the effectiveness of acupuncture as an adjunctive analgesic method to standard anaesthetic procedures for surgery and to determine whether acupuncture has any analgesic-sparing effect. Electronic literature searches for randomised clinical trials (RCTs) of acupuncture during surgery were performed in seven electronic databases. No language restrictions were imposed. All included studies were rated according to their methodological quality and validity. As the studies were clinically heterogeneous, no meta-analyses were performed. The evidence was classified according to four levels: strong, moderate, limited, or inconclusive. Nineteen RCTs were identified. Seven of them suggested that acupuncture is efficacious. Of nine high-quality RCTs, two studies had positive outcomes. There was no significant association between study quality and direction of outcome. One of eight high-validity trials reported a positive outcome and there was a significant relationship between validity and direction of outcome. The evidence that acupuncture is more effective than no acupuncture as an adjunct to standard anaesthetic procedures is therefore inconclusive. Strong evidence exists that real acupuncture is not significantly different from placebo acupuncture. For an analgesic-sparing effect of acupuncture, evidence remains inconclusive. In conclusion, this review does not support the use of acupuncture as an adjunct to standard anaesthetic procedures during surgery.

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Allergies

Chen CJ, Yu HS: Acupuncture treatment of urticaria. Archives of Dermatology 1998; 134:1397-1399.

Department of Internal Medicine, Kaohsiung Medical College, Taiwan.

Acupuncture has long been used to treat urticaria in the Asian world. Acute urticaria can be easily and effectively treated with acupuncture. L111 (Quchi), Sp10 (Xuehai), Sp6 (Sanyinjiao), and S36 (Zusanli) are the 4 acupuncture points most commonly prescribed. Chronic urticaria is a challenge for medical therapy. There are at least 6 kinds of acupuncture methods developed to overcome this challenge. The combination of ordinary acupuncture and auricular acupuncture has been observed to be a highly effective cure of chronic urticaria. Acupuncture point injection with thiamine hydrochloride (vitamin B1) is also an effective treatment. However, results of these clinical observations have not been systematically confirmed for lack of a control group and the need for standard classification of urticaria. Although these observational results have clinical limitations, they do offer insight into an alternative to conventional treatment of urticaria. In the future, acupuncture or acupuncturelike techniques may provide an effective alternative for treatment of patients with urticaria, particularly those refractory to medication therapy.

Wolkenstein E, Horak F: Protective effect of acupuncture on allergen provoked rhinitis. [German] Wiener Medizinische Wochenschrift 1998; 148:450-453.

Kaiserin-Elisabeth-Spitals der Stadt Wien, Österrreich/Austria.

A study of the protective effect of an acupuncture therapy against a nasal allergen-provoked rhinitis was undertaken on patients suffering from seasonal allergic rhinitis. The effects of a specific acupuncture therapy (“verum”) were compared with those of a non-specific acupuncture therapy (“placebo”). The allergen-provocation was carried out in the “Vienna Provocation Chamber” (VCC) (Horak, 1987). 24 patients suffering from seasonal allergic rhinitis were allocated at random either to Group B and given a specific (“verum”) acupuncture therapy or to Group A and given a non-specific (“placebo”) acupuncture therapy. A nasal allergen-provocation was carried out before onset and after completion of 9 treatments. The objective and subjective results of the allergen-provocation in the VCC were not able to verify a protective effect of the acupuncture therapy. The “Diary of Complaints (Symptoms)” which the participants had to keep over the 2 months following the treatment showed a definite reduction of the subjective complaints in the verum group during the second month. The range of scatter was too great for a statistically significant result.

Krop J, Lewith GT, Gziut W, Radulescu C: A double blind, randomized, controlled investigation of electrodermal testing in the diagnosis of allergies. Journal of Alternative & Complementary Medicine 1997; 3:241-248.

University Department of Medicine, Southampton General Hospital, England.

This investigation evaluates electrodermal (ED) testing in 41 polysymptomatic allergic patients. Electrodermal testing discriminated correctly 82% of the time between house dust mite and histamine (allergens) and saline or water (nonallergens) in our first study group involving 17 patients (p = 0.007). The second study involved 24 patients and used the same double-blind methodology discriminating 96% of the time between allergic and nonallergic substances (p = 0.000002). We conclude that ED testing is a reliable method of differentiating between allergic and nonallergic substances in the context of our study.

Arnetz BB, Berg M, Anderzen I, Lundeberg T, Haker E: A nonconventional approach to the treatment of “environmental illness.” Journal of Occupational & Environmental Medicine 1995; 37:838-844.

National Institute for Psychosocial Factors and Health, Stockholm, Sweden.

Twenty patients with symptoms of “environmental illness” were subject to a controlled study of deep versus superficial acupuncture. The patients were evaluated by a detailed questionnaire concerning their occupational, environmental, and medical history. Blood samples were taken as well. Patients were randomized to deep or superficial acupuncture. Both groups improved significantly in key variables during and after treatment. There were no group differences. There were no changes in biological variables apart from a gradual and continuous increase in serum cortisol and a decrease in neuropeptide Y, which was somewhat more accentuated in those receiving deep acupuncture. This rise in cortisol may have contributed to decreased dermal symptoms among the participants. It is hypothesized that the positive treatment results observed are partly due to weakening of the conditioned response, linking bodily symptoms to environmental agents. To date, a number of different methods have been tried in the management of patients with environmental illness. However, only rarely have the treatments been evaluated in controlled studies.

Lau BH, Wong DDS, Slater JM: Effect of acupuncture on allergic rhinitis: clinical and laboratory evaluations. American Journal of Chinese Medicine 1975; 3:263-270.

Of 22 subjects with allergic rhinitis who received a series of 6 acupuncture treatments, 11 (50%) were virtually symptom-free by the end of the series, 8 (36%) experienced a moderate reduction in symptoms, and 3 (14%) received no significant relief. Clinical assessment of symptoms was made on a 6-point scale before the first treatment and before each subsequent session. Laboratory tests included absolute blood eosinophils, percentage of nasal eosinophils, and radioimmunoassay of serum IgE, performed before the first treatment, at the end of the series, and 2 months later. A significant decrease in subjective clinical rating of symptoms correlated with a concurrent drop in absolute numbers of blood eosinophils and percentage of nasal eosinophils. IgE levels decreased in 64% of the subjects by completion of treatment and in 76% at 2-month follow-up.

Brinkhaus, B., et al. Acupuncture and Chinese herbal Medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial. Allergy, 2004:59 (9);953-960.

Department of Medicine I, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen Germany.

BACKGROUND: Patients with allergic rhinitis (AR) increasingly use complementary medicine. The aim of this study was to determine whether traditional Chinese therapy is efficacious in patients suffering from seasonal AR. METHODS: Fifty-two patients between the ages of 20 and 58 who had typical symptoms of seasonal AR were assigned randomly and in a blinded fashion to (i) an active treatment group which received a semi-standardized treatment of acupuncture and Chinese herbal medicine, and (ii) a control group which received acupuncture applied to non-acupuncture points in addition to a non-specific Chinese herbal formula. All patients received acupuncture treatment once per week and the respective Chinese herbal formula as a decoction three times daily for a total of 6 weeks. Assessments were performed before, during, and 1 week after treatment. The change in severity of hay fever symptoms was the primary outcome measured on a visual analogue scale (VAS). RESULTS: Compared with patients in the control group, patients in the active treatment group showed a significant after-treatment improvement on the VAS (P = 0.006) and Rhinitis Quality of Life Questionnaire (P = 0.015). Improvement on the Global Assessment of Change Scale was noted in 85% of active treatment group participants vs 40% in the control group (P = 0.048). No differences between the two groups could be detected with the Allergic Rhinitis Symptom Questionnaire. Both treatments were well-tolerated. CONCLUSIONS: The results of this study suggest that traditional Chinese therapy may be an efficacious and safe treatment option for patients with seasonal AR.

Chang TT, Huang CC, Hsu CH. Clinical evaluation of the Chinese herbal medicine formula STA-1 in the treatment of allergic asthma. Phytother Res. 2006 May;20(5):342-7.

Graduate Institute of Chinese Medical Science, China Medical University, Taichung, Taiwan.

Although some formulae of traditional Chinese medicines (TCM) have been used for antiasthma treatment, few of them have had sufficient discussion on their efficacy, safety and mechanisms. In this study, the availability of the TCM formula STA-1 for the treatment of allergic asthma was investigated by conducting a double-blind, placebo-controlled and randomized trial. One hundred and twenty patients between the ages of 5 to 20 years with mild-to-moderate asthma were included. These patients were treated with either STA-1 or placebo in a dose of 80 g/kg/day and were administered twice daily for 6 months. The main outcome measures were a daily diary record of symptoms, supplementary bronchodilator and glucocorticoid treatment, changes of pulmonary function (forced expiratory volume in 1 s), changes of total and Dermatophagoides pteronyssinus (DP)-specific IgE and side effects. The results showed a statistically significant reduction of symptom scores, systemic steroid dose, total IgE and specific IgE in the STA-1 group. Furthermore, STA-1 also improved the pulmonary lung function FEV(1) compared with the placebo group and only minimal side effects were shown. These results suggested that STA-1 is available for the treatment of mild-to-moderate chronic asthma. Copyright 2006 John Wiley & Sons, Ltd.

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Asthma

Biernacki W, Peake MD: Acupuncture in treatment of stable asthma. Respiratory Medicine 1998; 92:1143-1145.

Chest Unit, Pontefract General Infirmary, U.K.

Previous studies of acupuncture in asthma have reported conflicting results, some claiming benefit for some patients. We conducted a randomized, double-blind (patient and evaluator) study in 23 non-smoking asthmatics (10 M; 13 F) aged 43 +/- 15 years with forced expiratory volume in 1 s (FEV1) 59 +/- 16% pred. After initial assessment (respiratory function tests and Asthma Quality Life Questionnaire) patients were randomized to receive either ‘real’ or ‘sham’ acupuncture. The measurements were repeated within 1 h and after 2 weeks. Patients were recording peak expiratory flow rate (PEFR) throughout the period of the study. After 2 weeks patients who received ‘real’ treatment on the first visit received ‘sham’ treatment and vice versa. The measurements were again repeated within 1 h and after 2 weeks. There was no improvement in any aspects of respiratory function measured after either form of acupuncture. Despite this there was a significant improvement in AQLQ and parallel reduction in the usage of bronchodilators. We concluded that in some patients acupuncture could be useful in improving quality of life and reducing the need for using bronchodilators either by having a placebo effect or that the exact site of needle puncture on the chest is unimportant.

Christensen PA, Laursen LC, Taudorf E, Sorensen SC, Weeke B: Acupuncture and bronchial asthma. Allergy 1984; 39:379-385.

Seventeen patients with stable bronchial asthma were randomly assigned to receive either correct acupuncture or placebo acupuncture. The study lasted 11 weeks and consisted of a pre-therapy, therapy, and post-therapy period. The patients received 10 treatments during a 5-week period. The effect of therapy on pulmonary function was assessed daily by the patients at home. Morning and evening peak expiratory flow rate, number of puffs beta 2-agonist aerosol needed, as well as subjective symptoms of asthma were recorded in a diary. The correctly treated group improved significantly throughout the study. Also, compared with the placebo group, a significant improvement was found in all assessed parameters 2 weeks after beginning therapy. Hereafter, no differences could be shown.

Davis PA, Chang C, Hackman RM, Stern JS, Gershwin ME: Acupuncture in the treatment of asthma: a critical review. Allergologia et Immunopathologia (Madrid) 1998; 26:263-271.

University of California, USA.

BACKGROUND: Increasingly, patients are turning to treatments and drugs that are considered “alternative” or “complementary” as part of their healthcare. In response, the National Institutes of Health (NIH) established an Office of Alternative Medicine (OAM) in 1992 to facilitate identification and evaluation of alternative and complementary therapies. Acupuncture, a therapy that has been used to treat disease in China for approximately 2,500 years has attracted considerable attention. NIH in a consensus statement derived from a Fall of 1997 consensus conference to assess acupuncture has indicated that acupuncture was useful in pain control and maybe a useful adjunct treatment for the management of asthma. Further, the US Food and Drug Administration has removed acupuncture from the “experimental medical devices” category. METHODS: We have extensively searched the literature for reports addressing the use of acupuncture in asthma treatment. We sought these using the National Library of Medicine, the Office of Alternative Medicine’s database as well as other databases both English language based as well as other languages that catalog literature pertaining to alternative and complementary therapies. We then reviewed these reports and weighted the validity of the conclusions reached in the reports based on assessment of study design, number of subjects studied, duration of studies, types and number of controls, and statistical analyses used. RESULTS: Data presently in the literature do not provide sufficient support for a useful role for acupuncture in asthma management. CONCLUSIONS: Further properly designed clinical studies examining the use of acupuncture in asthma are extremely important and urgently needed.

Dias PL, Subramaniam S, Lionel ND: Effects of acupuncture in bronchial asthma: preliminary communication. Journal of the Royal Society of Medicine 1982; 75:245-248.

Twenty patients randomly assigned to an experimental and a control group participated in a double blind study to assess the effectiveness of acupuncture in bronchial asthma, using the peak expiratory flow rate (PEFR) as an index of bronchial patency. All patients in the control group showed a significant improvement in their PEFR while only 3 patients in the treated group showed an improvement. A subjective improvement and a reduction in drug dosages were observed in both groups. It is concluded that acupuncture has a placebo effect in bronchial asthma.

Fung KP, Chow OK, So SY: Attenuation of exercise-induced asthma by acupuncture. Lancet 1986; 2: 1419-1422.

A prospective randomised single-blind study of the effects of real and sham acupuncture on exercise-induced asthma was conducted in nineteen children. Forced expiratory flow in 1st second (FEV1), forced vital capacity (FVC), and peak expiratory flow rate (PEFR) were measured throughout acupuncture and after treadmill exercise. Neither real nor sham acupuncture affected the basal bronchomotor tone but both, when applied 20 min before exercise, attenuated exercise induced asthma: mean maximum percentage falls in FEV1, FVC, and PEFR were 44.4%, 33.3%, and 49.5% without acupuncture; 23.8%, 15.8%, and 25.9% after real acupuncture; and 32.6%, 26.1%, and 34.3% after sham acupuncture. Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture (p less than 0.05).

Jobst KA: A critical analysis of acupuncture in pulmonary disease; efficacy and safety of the acupuncture needle [published erratum appears in J Altern Complement Med 1995: 1(2):219]. Journal of Alternative & Complementary Medicine 1995; 1:57-85.

OPTIMA, Radcliffe Infirmary Trust, Oxford, UK.

Criteria for therapeutic efficacy and safety include significant amelioration of symptoms and, ideally, cure (i.e., patients’ belief in effective improvement of symptoms and quality of life, durable impact on symptoms, verifiable subjective and objective changes); improved patient management (e.g., diminishing, or ceasing medication, physiotherapy, and other interventions); safety for patient and practitioner and an acceptable side effect profile; cost-effectiveness of the therapy in practice and to teach to others. There is evidence that in bronchial asthma, chronic bronchitis, and chronic disabling breathlessness the use of acupuncture fulfills these to varying degrees. It can facilitate reducing pharmacologic medication and is safe, suggesting that acupuncture as an adjuvant in the treatment of respiratory disease might be safer than prolonged pharmaceutical maintenance therapy alone. Its cost-effectiveness has yet to be adequately researched. Twenty-one papers in English were obtained and 16 were further evaluated; eight were double-blind, five single-blind, and three unblinded. The remaining five, and most of the Chinese literature, were excluded on account of their poor quality. Acupuncture was effective in four of eight of the double-blind, three of five single-blind, and three of three unblinded studies (i.e., 10 of 16 [62.5%] overall). A previously unreported confounding variable was identified and concerned the designation of sham points. Most sham points were believed to be inactive but, according to traditional Chinese principles, many are active in pulmonary disease. Reappraised accordingly, the unequivocally positive studies were summed with those in which “real” and “sham” acupuncture were not significantly different but in which the combined effect of all acupuncture (i.e., real + sham) on breathlessness was significantly different from baseline. This yielded 13 of 16 (81%) [corrected] studies in which acupuncture led to significant improvement. In most studies, current pharmacologic treatment had a greater effect than acupuncture alone. However, in the 11 studies in which it was evaluated, medication could be significantly reduced by acupuncture in 10 (91%). Twenty-three of the 320 patients in the 16 studies (7%) reported minimal side effects, none requiring intervention. Current published evidence reveals no reason to withhold acupuncture as a safe and potentially effective treatment in patients with bronchial asthma and chronic obstructive lung disease. Further, more appropriately designed studies are urgently required. This would be facilitated in the United States by licensing the acupuncture needle as a therapeutic agent and might lead to important new insights and therapeutic opportunities.

Kleijnen J, Ter Riet G, Knipschild P: Acupuncture and asthma: a review of controlled trials. Thorax 1991; 46:799-802.

Department of Epidemiology and Biostatistics, University of Limburg, Maastricht, The Netherlands.

BACKGROUND: Published controlled trials of acupuncture in asthma have often contained a small number of subjects and the results are contradictory. Controlled trials have been reviewed to determine whether clearer conclusions could be obtained by assessing as many studies as possible according to methodological criteria. METHODS: A literature search produced 13 trials on the efficacy of acupuncture in the treatment of patients with asthma. These studies were reviewed on the basis of 18 predefined methodological criteria. A maximum of 100 points for study design could be earned in three main categories: (a) adequate study population, (b) adequate intervention, and (c) adequate measurement of effects. RESULTS: The quality of even the eight better studies (more than 50% of the maximum score) proved to be mediocre. No study earned more than 72% of the maximum score. The results from the better studies are highly contradictory. CONCLUSIONS: Claims that acupuncture is effective in the treatment of asthma are not based on the results of well performed clinical trials.

Takishima T, Mue S, Tamura G, Ishihara T, Watanabe K: The bronchodilating effect of acupuncture in patients with acute asthma. Annals of Allergy 1982; 48:44-49.

The effectiveness of acupuncture therapy for asthmatic patients was studied by continuous monitoring of the respiratory function. Using the forced 5 Hz oscillating technique, the investigators could estimate the change of total respiratory resistance (Rrs) of asthmatic patients throughout their reception of acupuncture therapy. They performed a single-blind study consisting of a placebo acupuncture, a placebo stimulation and real acupuncture therapy For further control of this study, they selected an easily locatable point for needle placement among the many traditional meridian points. In 10 out of 26 acupuncture therapies. Rrs significantly decreased while in only one of 17 placebo treatments did Rrs decrease.

Tandon MK, Soh PF, Wood AT: Acupuncture for bronchial asthma? A double-blind crossover study. Medical Journal of Australia 1991; 154:409-412.

Thoracic Division, Repatriation General Hospital, Hollywood, WA.

The therapeutic effectiveness of classic Chinese acupuncture was compared with “placebo” acupuncture in 15 patients with stable bronchial asthma. The patients received treatments with real and placebo acupuncture in a randomly ordered, subject and evaluator-blind crossover fashion twice weekly for five weeks. Both real and placebo treatment periods were preceded by three week periods when no acupuncture was administered. Five patients felt better on real treatment, five patients preferred placebo and five did not feel any improvement on either of the two treatments. Treatment with real acupuncture when compared with no treatment and placebo treatment failed to provide any improvement in daily peak flow rates, asthma symptom scores, number of puffs of beta 2-agonist aerosol use, and pulmonary function results.

Tandon MK, Soh PF: Comparison of real and placebo acupuncture in histamine-induced asthma: A double-blind crossover study. Chest 1989; 96:102-105.

Thoracic Division, Repatriation General Hospital, Hollywood, Western Australia.

A double-blind crossover study of the effects of real and placebo acupuncture on bronchial reactivity to histamine was carried out on 16 patients with moderately severe asthma. Treatment with real or placebo acupuncture failed to modulate the bronchial hyperreactivity to histamine. These results suggest that a single treatment with acupuncture is unlikely to provide improvement in the management of acute bronchial asthma.

Tashkin DP, Kroening RJ, Bresler DE, Simmons M, Coulson AH, Kerschnar H: A controlled trial of real and simulated acupuncture in the management of chronic asthma. Journal of Allergy & Clinical Immunology 1985; 76:855-864.

In 25 patients with moderate to severe asthma, we compared the therapeutic effectiveness of classic Chinese acupuncture with that of “placebo” acupuncture administered in a randomly ordered, subject- and evaluator-blind, crossover fashion twice weekly for 4 weeks. Real and placebo acupuncture periods were each preceded and followed by 3- to 4-week periods during which no acupuncture was administered. Outcome variables consisted of the following: daily symptoms and medication use self-scored on patient diaries, spirometry and whole body plethysmography performed once weekly during the entire course of the study and repeated serially during 3 hours after real and placebo acupuncture treatment, patients’ self-assessment of acute efficacy of acupuncture therapy, and physician’s physical findings before and after acupuncture treatment. Two-way analysis of variance failed to reveal a significant effect of either form of acupuncture on symptoms, medication use, or lung function measurements. Similarly, no significant acute effect of acupuncture on lung function, self-ratings of efficacy, or physician’s physical findings was found by covariance analysis or the Wilcoxon signed-rank test. When data during the entire course of the study were examined on an individual basis by analysis of variance with repeated measures, only two subjects demonstrated significantly favorable responses to real versus placebo acupuncture, but one subject demonstrated the reverse, suggesting that these responses were not specifically related to acupuncture therapy. Thus, our findings failed to demonstrate any short- or long-term benefit of acupuncture therapy in the management of moderate to severe asthma.

Tashkin DP, Bresler DE, Kroening RJ, Kerschner H, Katz RL, Coulson A: Comparison of real and simulated acupuncture and isoproterenol in methacholine-induced asthma. Annals of Allergy 1977; 39:379-387.

In a double-blind (patient and evaluator), crossover study effects of real acupuncture, simulated acupuncture, nebulized isoproterenol, nebulized saline and no treatment in reversing methacholine-induced bronchospasm were compared in 12 asthmatics (ages 16 to 64). Saline and simulated acupuncture did not result in any significant improvement in specific airway conductance (SGaw), thoracic gas volume (Vtg) or forced expiratory flow rates compared with no treatment following methacholine-induced bronchospasm. Isoproterenol and real acupuncture were both followed by increases in SGaw and flow rates and decreases in Vtg which were significantly different from the changes observed following no treatment, saline or simulated acupuncture, although isoproterenol produced greater improvement than real acupuncture, although isoproterenol produced greater improvement than real acupuncture. These findings suggest that stimulation of specific acupuncture loci reduces methacholine-induced bronchospasm and hyperinflation to an extent greater than can be attributed to placebo phenomena.

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Carpal Tunnel Syndrome

Branco K, Naeser MA: Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve simulation, and other alternative therapies—an open protocol study. Journal of Alternative & Complementary Medicine 1999; 5:5-26.

Acupuncture Healthcare Services, Westport, Massachusetts, USA.

OBJECTIVE: Outcome for carpal tunnel syndrome (CTS) patients (who previously failed standard medical/surgical treatments) treated primarily with a painless, noninvasive technique utilizing red-beam, low-level laser acupuncture and microamps transcutaneous electrical nerve stimulation (TENS) on the affected hand; secondarily, with other alternative therapies. DESIGN: Open treatment protocol, patients diagnosed with CTS by their physicians. SETTING: Treatments performed by licensed acupuncturist in a private practice office. SUBJECTS: Total of 36 hands (from 22 women, 9 men), ages 24-84 years, median pain duration, 24 months. Fourteen hands failed 1-2 surgical release procedures. INTERVENTION/TREATMENT: Primary treatment: red-beam, 670 nm, continuous wave, 5 mW, diode laser pointer (1-7 J per point), and microamps TENS (< 900 microA) on affected hands. Secondary treatment: infrared low-level laser (904 nm, pulsed, 10 W) and/or needle acupuncture on deeper acupuncture points; Chinese herbal medicine formulas and supplements, on case-by-case basis. Three treatments per week, 4-5 weeks. OUTCOME MEASURES: Pre- and posttreatment Melzack pain scores; profession and employment status recorded. RESULTS: Posttreatment, pain significantly reduced (p < .0001), and 33 of 36 hands (91.6%) no pain, or pain reduced by more than 50%. The 14 hands that failed surgical release, successfully treated. Patients remained employed, if not retired. Follow-up after 1-2 years with cases less than age 60, only 2 of 23 hands (8.3%) pain returned, but successfully re-treated within a few weeks. CONCLUSIONS: Possible mechanisms for effectiveness include increased adenosine triphosphate (ATP) on cellular level, decreased inflammation, temporary increase in serotonin. There are potential cost-savings with this treatment (current estimated cost per case, $12,000; this treatment, $1,000). Safe when applied by licensed acupuncturist trained in laser acupuncture; supplemental home treatments may be performed by patient under supervision of acupuncturist.

Weintraub MI: Noninvasive laser neurolysis in carpal tunnel syndrome. Muscle and Nerve 1997; 20:1029-1031.

Department of Neurology, Phelps Memorial Hospital, Briarcliff Manor, New York 10510, USA.

The peripheral nervous system is photosensitive providing the scientific rationale for this study, which determines the efficacy and safety of laser light exposure in 30 cases with CTS. Nine joules of energy over five points (7-15 treatments) reversed CTS in 77% of cases with three-fold normalization of CMAP. A photobiologic response was seen in 80% of nerves. This unique and novel approach is cost-effective and will play a role in future management of CTS.

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Depression

Luo H, Meng F, Jia Y, Zhao X: Clinical research on the therapeutic effect of the electro-acupuncture treatment in patients with depression. Psychiatry and Clinical Neurosciences 1998; 52 (Suppl):S338-S340.

Department of Traditional Chinese Medicine, Institute of Mental Health, Beijing Medical University, PR China.

Electroacupuncture (EA) stimulation has been found to influence the brain (norepinephrine metabolism in experimental animals). Preliminary clinical research has shown that EA treatment is as effective as amitriptyline for patients with depression. In this study, two consecutive clinical studies on the treatment of depression with EA are conducted. The first study was double blind placebo controlled, in which 29 depressed inpatients were recruited. Patients were randomly divided into three groups: EA + placebo; amitriptyline; and EA + amitriptyline. They received EA and/or amitriptyline treatment for 6 weeks. The Hamilton Rating Scale for Depression, Clinical Global Impression and ASBERG scales for the side effect of antidepressants were used to evaluate the therapeutic efficacy and side effects. Based on the results and research protocol of the first study, a multi-centered collaborative study was conducted, in which 241 inpatients with depression were recruited. Patients were randomly divided into two treatment groups: the EA + placebo and the amitriptyline groups. The results from both studies showed that the therapeutic efficacy of EA was equal to that of amitriptyline for depressive disorders (P > 0.05). Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline (P < 0.05). Moreover, the side effects of EA were much less than that of amitriptyline (P < 0.001). The article suggested that EA treatment was an effective therapeutic method for depressive disorders. Particularly, it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects. The possible mechanism of EA treatment is discussed.

Ernst E, Rand Jl, Stevinson C: Complementary therapies for depression: an overview. Archives of General Psychiatry 1998; 55:1026-1032.

Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, England. .(JavaScript must be enabled to view this email address)

Depression is one of the most common reasons for using complementary and alternative therapies. The aim of this article is to provide an overview of the evidence available on the treatment of depression with complementary therapies. Systematic literature searches were performed using several databases, reference list searching, and inquiry to colleagues. Data extraction followed a predefined protocol. The amount of rigorous scientific data to support the efficacy of complementary therapies in the treatment of depression is extremely limited. The areas with the most evidence for beneficial effects are exercise, herbal therapy (Hypericum perforatum), and, to a lesser extent, acupuncture and relaxation therapies. There is a need for further research involving randomized controlled trials into the efficacy of complementary and alternative therapies in the treatment of depression.

Roschke J, Wolf C, Kogel P, Wagner P, Bech S: Adjuvant whole body acupuncture in depression. A placebo-controlled study with standardized mianserin therapy. [German] Nervenarzt 1998; 69:961-967.

Psychiatrische Klinik und Poliklinik, Universität, Mainz.

In order to examine the efficacy of whole body acupuncture additionally applied to drug treatment in depression, a single-blind placebo-controlled study with 70 inpatients administered to three different treatment groups has been carried out. All patients were pharmacologically treated with the tetracyclic antidepressant mianserin. The verum group (n = 22) received acupuncture at specific points considered to be effective in the treatment of depression. The placebo group (n = 24) was treated with acupuncture at non-specific locations and the control group (n = 24) received only pharmacological treatment. Acupuncture was applied three times a week over a period of four weeks. Psychopathology was rated by judges blind to verum/placebo conditions twice a week over eight weeks with the CGI, GAS, BRMS and BfS rating scales. Additionally applied acupuncture improved the course of depression more than pharmacological treatment with mianserin did by itself. However, we could not detect any differences between placebo and verum acupuncture.

Kurland HD. ECT and Acu-EST in the treatment of depression. American Journal of Chinese Medicine 1976; 4:289-292.

This paper presents three brief case histories from a three year study comparing electroconvulsive therapy (ECT) with acupuncture treatment in functional psychoses. Acupuncture effects were augmented by the simultaneous, non-painful electrical stimulation of eight acupuncture needles. The resulting treatment is called Acupuncture Electric Stimulation Therapy (Acu-EST). Each patient was utilized as her own control, treating exacerbations of depression alternately with ECT and Acu-EST. Acu-EST was not found to be a panacea and did not enable the discontinuation of antidepressant and neuroleptic medication. Individual Acu-EST treatments were often less effective than individual ECT treatments. However, series of Acu-EST did assist in producing significant remissions in depressive symptomatology. Because it did not produce the temporary disabling memory defects which occurred with ECT, Acu-EST was more easily adaptable to outpatient treatment.

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Fibromyalgia

Berman BM, Ezzo J, Hadhazy V, Swyers JP: Is acupuncture effective in the treatment of fibromyalgia? Journal of Family Practice 1999; 48:213-218.

Complementary Medicine Program, University of Maryland School of Medicine, Baltimore 21207, USA.

BACKGROUND: We conducted this study to assess the effectiveness of acupuncture in the treatment of fibromyalgia syndrome (FMS), report any adverse effects, and generate hypotheses for future investigation. METHODS: We searched MEDLINE, EMBASE, Manual Therapy Information System, the Cochrane registry, the University of Maryland Complementary and Alternative Medicine in Pain, the Centralized Information Service for Complementary Medicine, and the National Institutes of Health Office of Alternative Medicine databases for the key words “acupuncture” and “fibromyalgia.” Conference abstracts, citation lists, and letters supplemented the search. We selected all randomized or quasi-randomized controlled trials, or cohort studies of patients with FMS who were treated with acupuncture. Methodologic quality, sample characteristics, type of acupuncture treatment, and outcomes were extracted. Statistical pooling was not performed because of the differences in control groups. RESULTS: Seven studies (3 randomized controlled trials and 4 cohort studies) were included; only one was of high methodologic quality. The high-quality study suggests that real acupuncture is more effective than sham acupuncture for relieving pain, increasing pain thresholds, improving global ratings, and reducing morning stiffness of FMS, but the duration of benefit following the acupuncture treatment series is not known. Some patients report no benefit, and a few report an exacerbation of FMS-related pain. Lower-quality studies were consistent with these findings. Booster doses of acupuncture to maintain benefit once regular treatments have stopped have been described anecdotally but not investigated in controlled trials. CONCLUSIONS: The limited amount of high-quality evidence suggests that real acupuncture is more effective than sham acupuncture for improving symptoms of patients with FMS. However, because this conclusion is based on a single high-quality study, further high-quality randomized trials are needed to provide more robust data on effectiveness.

Finckh A, Morabia A, Deluze C, Vischer T: Validation of questionnaire-based response criteria of treatment efficacy in the fibromyalgia syndrome. Arthritis Care & Research 1998; 11:116-123.

Department of Internal Medicine, University of Geneva, Switzerland.

OBJECTIVE: To compare the validity of self-reported questionnaires as response criteria of treatment efficacy in patients with fibromyalgia syndrome. METHOD: At the beginning of the treatment period, 70 fibromyalgia patients, randomly allocated to electro-acupuncture or placebo, underwent a clinical evaluation by rheumatologists and answered 1) a generic quality of life questionnaire—the Psychological General Well-Being Index (PGWB), 2) a specific function and symptom questionnaire, and 3) a pain questionnaire—the Regional Pain Score (RPS). The same evaluation was repeated at the end of the treatment period. Severity of the condition was assessed by a composite outcome score, a combination of different clinical outcome measures forming a clinical severity index. The variations between these questionnaire scores before and after treatment and the variations between the clinical severity indices estimated by clinicians were used as measures of the treatment impact. The first rationale for the validation was a positive correlation between clinical and questionnaire score changes. Another rationale for validation of the new instruments was the ability to identify the different treatment interventions. RESULTS: The correlation between the clinical severity index and the RPS was good (r = 0.62). Moreover, the RPS demonstrated a good discriminant power in detecting patients with effective treatment: it showed a specificity of 74% and a sensitivity of 75%. The PGWB correlated less well with the clinical score and was less discriminant. The specific function and symptom questionnaire showed little additional validity. CONCLUSIONS: Outcomes of syndrome severity such as pain and subjective well-being, as measured by self-reported questionnaires, can be valid instruments to evaluate treatment efficacy in short-term clinical trials. In the current study, the RPS proved to be particularly useful to assess the widespread tenderness of fibromyalgia and demonstrated high discriminative power.

Zborovskii AB, Babaeva AR: New trends in the study of the primary fibromyalgic syndrome. [Russian] Vestnik Rossiiskoi Akademii Meditsinskikh Nauk 1996; 11:52-56.

Branch of Institute of Rheumatism RAMN, Volgograd.

The study of 1240 patients making complaints of osteomuscular pains showed that 9.6% had clinical signs of primary fibromyalgia (PF). It provided new data on the clinical signs of PF, clinical and biochemical changes in this syndrome. The diagnostic and informative values of some signs and symptoms of PF are compared and new approaches to optimizing diagnostic criteria are outlined in the paper. The paper also gives new data on the combined therapy for PF, including the use of dimexide with nonhormonal anti-inflammatory agents and sessions of acupuncture that promotes the normalization of dysfunctions. This may be useful for PF patients due to easy-to-use, available, and inexpensive treatment.

Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL: Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ 1992; 305:1249-1252.

Division of Physical Medicine and Rehabilitation, University Hospital, Geneva, Switzerland.

OBJECTIVE—To determine the efficacy of electroacupuncture in patients with fibromyalgia, a syndrome of unknown origin causing diffuse musculoskeletal pain. DESIGN—Three weeks’ randomised study with blinded patients and evaluating physician. SETTING—University divisions of physical medicine and rehabilitation and rheumatology, Geneva. PATIENTS—70 patients (54 women) referred to the division for fibromyalgia as defined by the American College of Rheumatology. INTERVENTIONS—Patients were randomised to electroacupuncture (n = 36) or a sham procedure (n = 34) by means of an electronic numbers generator. MAIN OUTCOME MEASURES—Pain threshold, number of analgesic tablets used, regional pain score, pain recorded on visual analogue scale, sleep quality, morning stiffness, and patient’s and evaluating physician’s appreciation. RESULTS—Seven of the eight outcome parameters showed a significant improvement in the active treatment group whereas none were improved in the sham treatment group. Differences between the groups were significant for five of the eight outcome measures after treatment. CONCLUSIONS—Electroacupuncture is effective in relieving symptoms of fibromyalgia. Its potential in long term management should now be studied.

Gabriel SE, Bombardier C: Clinical trials in fibrositis: a critical review and future directions. Journal of Rheumatology – Supplement. 1989; 19:177-179.

Rheumatic Disease Unit, Wellesley Hospital, University of Toronto, ON, Canada.

A critical appraisal of the design of clinical trials which examined the effectiveness of various interventions in fibrositis was conducted. Therapeutic interventions included physical fitness, biofeedback, acupuncture, dothiepin, imipramine, cyclobenzaprine, S-adenosylmethionine and amitriptyline. The design and analysis of the randomized, controlled studies render their results reliable. Major areas for methodologic improvement in future trials were identified. Standardized, validated and reliable diagnostic and outcome criteria need to be established. Factors which could predict response need to be identified to enable the selection of the most appropriate patient population for inclusion in future studies. Finally, the incorporation of measures of patient function will result in more clinically meaningful outcome evaluation.

Waylonis GW, Wilke S, O’Toole D, Waylonis DA, Waylonis DB: Chronic myofascial pain: management by low-output helium-neon laser therapy. Archives of Physical Medicine & Rehabilitation 1988; 69:1017-1020.

Physical Medicine Department, Riverside Methodist Hospital, Columbus, OH.

Therapeutic benefits of low-output helium-neon laser therapy have not been established, but laser therapy has been suggested as an effective means of treating many acute and chronic musculoskeletal pain syndromes. Although not released for general clinical use by the FA, the helium-neon laser has been promoted to physical therapists and athletic trainers as potentially useful for the treatment of pain syndromes. In particular, it has been proposed that it may be more effective than conventional measures such as medication and conventional physical therapy in the treatment of myofascial pain syndromes (fibrositis, fibromyalgia). The citations in the literature include only case reports. Sixty-two patients were treated by using acupuncture points. Two sessions of five treatments were given six weeks apart. A crossover double-blind technique was used in the treatments. The clinical responses were assessed using portions of the McGill Pain Questionnaire. No statistical difference between the treatment and the placebo groups could be determined.

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Headache

Tanaka TH, Leisman G, Nishijo K: The physiological responses induced by superficial acupuncture: a comparative study of acupuncture stimulation during exhalation phase and continuous stimulation. International Journal of Neuroscience 1997; 90:45-58.

Pacific Wellness Institute, Toronto, Ontario, Canada.

This study investigated the physiological effect of superficial acupuncture stimulation during a patient’s exhalation phase in a sitting position (SES). The response to SES was compared to the stimulation applied continuously without considering the respiratory phase (CONT). It evaluated a chronic tension-type headache patient’s static electromyographic (EMG) activity, pain response, heart rate, pulse height, and skin conductance level. The results indicated that SES stimulation significantly decreased headache intensity and demonstrated a strong trend towards decreasing static EMG activity compared to CONT stimulation. The study concluded that acupuncture, applied on the same point and at the same depth, produced different physiological effects, depending on whether the stimulation was applied during exhalation only or continuously applied. This suggests that the effect of acupuncture derives not only from point selection matching symptoms, but also from a consideration and utilization of the patient’s respiratory phase during stimulation.

Pintov S, Lahat E, Alstein M, Vogel Z, Barg J: Acupuncture and the opioid system: implications in management of migraine. Pediatric Neurology 1997; 17:129-133.

Department of Neurobiology; the Weizmann Institute of Science; Rehovot, Israel.

We investigated the effectiveness of acupuncture in childhood migraine in 22 children with migraine, randomly divided into two groups: a true acupuncture group (12 children) and a placebo acupuncture group (10 children). Ten healthy children served as a control group. Opioid activity in blood plasma was assayed by two methods: (1) determination of total (panopioid) activity with an opiate radioreceptor assay, and (2) determination of beta-endorphinlike immunoreactivity by radioimmunoassay. The true acupuncture treatment led to significant clinical reduction in both migraine frequency and intensity. At the beginning of the study, significantly greater panopioid activity was evident in plasma of the control group than in plasma of the migraine group. The true acupuncture group showed a gradual increase in the panopioid activity in plasma, which correlated with the clinical improvement. After the tenth treatment, the values of opioid activity of the true acupuncture group were similar to those of the control group, whereas the plasma of the placebo acupuncture group exhibited insignificant changes in plasma panopioid activity. In addition, a significant increase in beta-endorphin levels was observed in the migraine patients who were treated in the true acupuncture group as compared with the values before treatment or with the values of the placebo acupuncture group. The results suggest that acupuncture may be an effective treatment in children with migraine headaches and that it leads to an increase in activity of the opioidergic system.

Hesse J, Mogelvang B, Simonsen H: Acupuncture versus metoprolol in migraine prophylaxis: a randomized trial of trigger point inactivation. Journal of Internal Medicine 1994; 235:451-456.

Pain Clinic and Medical Department, Skodsborg Sanatorium, Denmark.

OBJECTIVES. To compare the effects of dry needling of myofascial trigger points in the neck region to metoprolol in migraine prophylaxis. DESIGN. Randomized, group comparative study. patients, investigator and statistician were blinded as to treatment, the therapist was blinded as to results. SETTING. Outpatient pain clinic in the northern Copenhagen area. Patients were referred by general practitioners or respondents to newspaper advertisements. SUBJECTS. Included were patients with a history of migraine with or without aura for at least 2 years. Excluded were persons with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with acupuncture or beta-blocking agents. A total of 85 patients were included; 77 completed the study. INTERVENTIONS. After a 4-week run-in period, patients were allocated to a 17-week regimen either with acupuncture and placebo tablets or to placebo stimulation and metoprolol 100 mg daily. RESULTS. Both groups exhibited significant reduction in attack frequency (P

< 0.01). No difference was found between the groups regarding frequency (P >

0.20) or duration (P > 0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (P < 0.05). CONCLUSIONS. Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.

Tavola T, Gala C, Conte G, Invernizzi G: Traditional Chinese acupuncture in tension-type headache: a controlled study. Pain 1992; 48:325-329.

Department of Psychiatry, University of Milan, Italy.

Thirty patients with tension-type headache were randomly chosen to undergo a trial of traditional Chinese acupuncture and sham acupuncture. Five measures were used to assess symptom severity and treatment response: intensity, duration and frequency of headache pain episodes, headache index and analgesic intake. The five measures were assessed during a 4 week baseline period, after 4 and 8 weeks of treatment, and 1, 6 and 12 months thereafter. Before the start of the study, each patient was administered the MMPI. Split-plot ANOVAs showed that, compared to baseline, at 1 month after the end of treatment and for the 12 month follow-up, the frequency of headache episodes, analgesic consumption and the headache index (but not the duration or intensity of headache episodes) significantly decreased over time; however, no difference between acupuncture and placebo treatment was found. No single MMPI scale predicted the response to treatment, but the mean MMPI profile of acupuncture non-responders showed the presence of ‘Conversion V’.

Vincent CA: The treatment of tension headache by acupuncture: a controlled single case design with time series analysis. Journal of Psychosomatic Research 1990; 34:553-561.

Department of Psychology, University College London, U.K.

A single case design, with time series analysis, was employed to evaluate the efficacy of acupuncture in the treatment of tension headache. Fourteen patients were given eight weekly treatments, four of true acupuncture and four of sham in random order. Mean pain in medication scores were reduced by 52% and 54% respectively at initial follow-up. Reductions in pain scores of over 50% were achieved by half the patients and the significance of these changes confirmed by time series analysis. The majority of patients maintained their gains at four month follow-up. True acupuncture was shown to be significantly superior to sham, demonstrating a specific therapeutic action, in four patients. In the remainder no difference was observed. Possible mechanisms for these effects are discussed. Acupuncture is a potentially valuable treatment for tension headache but further research is needed.

Carlsson J, Fahlcrantz A, Augustinsson LE: Muscle tenderness in tension headache treated with acupuncture or physiotherapy. Cephalalgia 1990; 10:131-141.

Department of Neurology, University of Göteborg, Sweden.

Sixty-two female patients with chronic tension headache were randomized into two treatment groups—acupuncture and physiotherapy. The intensity of headache, muscle tenderness and neck mobility was assessed before and after treatment. Thirty healthy women were used for comparison. Before treatment it was found that muscle tenderness was increased and neck rotation was reduced in the patient group compared with controls. There was a significant correlation between the intensity of headache and muscle tenderness. After treatment, the intensity of headache and muscle tenderness were reduced in both treatment groups. The headache was more improved in the physiotherapy group, and there was a marked reduction in the intake of analgesics. The tenderness was reduced in all muscles tested in the physiotherapy group but only in some of the muscles after acupuncture. The limitation of neck rotation was not influenced by either treatment.

Vincent CA: A controlled trial of the treatment of migraine by acupuncture. Clinical Journal of Pain 1989; 5:305-312.

Department of Psychology, University College London, England.

A randomised controlled trial comparing true and sham acupuncture was conducted on 30 patients suffering from chronic migraine. Diary measures of headache and medication intake were recorded throughout the study, and measures of headache quality, anxiety, and pain behaviour were taken. The credibility of the true and sham treatment procedures was also assessed. True acupuncture was significantly more effective than the control procedure in reducing the pain of migraine headache. Posttreatment reductions in pain scores and medication of 43 and 38%, respectively, were recorded in the true acupuncture group and were maintained at 4-month and 1-year follow-up.

Hansen PE, Hansen JH: Acupuncture treatment of chronic tension headache: a controlled cross-over trial. Cephalalgia 1985; 5:137-142.

In a controlled trial the effect of traditional Chinese acupuncture v. placebo acupuncture was evaluated in 18 patients with chronic tension headache (mean disease duration 15 years). All patients suffered from daily or frequently recurring headache, the intensity of which was recorded by the patient over a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as by placebo acupuncture in a cross-over design following randomization. Each period of treatment comprised six treatments. Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture, according to the pain registration of the patients themselves. The pain reduction was 31%. Acupuncture is therefore found to be a reasonable treatment for chronic tension headache.

Dowson DI, Lewith GT, Machin D: The effects of acupuncture versus placebo in the treatment of headache. Pain 1985; 21:35-42.

Forty-eight patients were entered into a placebo (mock TNS) versus acupuncture study to assess the effect of these therapies on headache. Treatment was evaluated by the use of patient diaries; each patient completed a daily diary for 4 weeks prior to treatment during 6 weeks of therapy and for 24 weeks of follow-up. Thirty-nine patients completed treatment and follow-up. At most acupuncture appears to be approximately 20% more effective than a placebo in alleviating headache but no statistically significant difference between these two treatments could be demonstrated. The implications of this result particularly with respect to determining treatment success and study method employed are discussed.

Lenhard L, Waite PM: Acupuncture in the prophylactic treatment of migraine headaches: pilot study. New Zealand Medical Journal 1983; 96:663-666.

This study was planned as a pilot study to determine to what extent acupuncture might help in severe cases of migraine and, if possible, to see whether the mechanism was endorphin mediated. The study was carried out on 16 subjects who had severe and regular migraine for more than five years (mean duration 24 years). The study lasted eight months and was divided into four blocks of two months each: pre-treatment, treatment block I, treatment block II, and post-treatment. It was double-blind and cross-over in design. Acupuncture was found to cause a significant change in the number of headaches and their duration, with 40% of the subjects showing a 50%-100% reduction. Although pain sensation was not altered, attacks were less severe and less often accompanied by nausea and vomiting. At no stage was there any difference between subjects receiving saline or naloxone so that the possibility of a non-endorphin mechanism must be considered.

Jensen LB, Melsen B, Jensen SB: Effect of acupuncture on headache measured by reduction in number of attacks and use of drugs. Scandinavian Journal of Dental Research 1979; 87:373-380.

The experiment was performed in order to study the effect of acupuncture on headache by comparing the number of attacks during a 2-month period after acupuncture with the number of attacks during a similar period before treatment. Twenty-nine students (age: 19-24 years) all suffering from headache filled out questionnaires noting the days with attacks of headache and the amount and type of drugs used for 60 consecutive days. After acupuncture this observation procedure was repeated. One group of 10 students, however, received a placebo treatment instead of acupuncture but followed the identical questionnaire procedure. After 120 days acupuncture was given to this second group without revealing that the first treatment was a placebo. This treatment was again followed by a 60-day observation period. Comparison of the questionnaires before and after acupuncture showed a significant reduction in the number of days with headache. The placebo treatment resulted in a nonsignificant reduction in attacks of headache. A reduction in the amount of drugs used, especially the acetylsalicylate type, was noted following the acupuncture treatment. It is concluded that acupuncture is a relevant therapy for headache with a definite symptomatic effect.

Alecrim-Andrade, et al. Acupuncture in migraine prophylaxis: a randomized sham-controlled trial. Cephalalgia. May 2006; 26(5):520-9

Universitat Autonòma de Barcelona, Medicina Interna, and Hospital Clinic, Clinical Pharmacology Unit, Barcelona, Catalunya, Spain.

The purpose of the present trial was to evaluate semi-standardized acupuncture efficacy in migraine prophylaxis. Twenty-eight subjects with migraine were randomized to the real or sham acupuncture groups. Semi-standardized and standardized minimal acupuncture were used, respectively, in the two groups of patients. They were all treated with 16 acupuncture sessions in 12 weeks. Both groups exhibited similar reductions in: percentage of patients with reduction of migraine>or=40% and >or=50% regarding frequency of migraine attacks, days with migraine, frequency of migraine attacks, average duration of a migraine attack, rate of rescue medication used, average headache severity rate and other parameters compared with the baseline period. Associated symptoms, such as nausea and vomiting, also showed equal estimates in both groups. These findings showed that semi-standardized acupuncture shows no difference from sham acupuncture in preventing migraine attacks.

Coeytaux, R et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache. Oct 2005:45(9):1113-23

UNC School of Medicine, Chapel Hill, NC27599-7595, USA.

BACKGROUND: Approximately 4% of adults experience headaches nearly every day. Nonpharmacologic interventions for frequent headaches may be appropriate because medical management alone is often ineffective. OBJECTIVE: To assess the efficacy of acupuncture as an adjunct to medical management for chronic daily headache (CDH). METHODS: We conducted a randomized, controlled trial of 74 patients with CDH that compared medical management provided by neurologists to medical management plus 10 acupuncture treatments. Primary outcome measures were daily pain severity and headache-related quality of life (QoL). RESULTS: Patients who received only medical management did not demonstrate improvement in any of the standardized measures. Daily pain severity scores trended downward but did not differ between treatment groups (P= .60). Relative to medical management only, medical management plus acupuncture was associated with an improvement of 3.0 points (95% CI, 1.0 to 4.9) on the Headache Impact Test and an increase of 8 or more points on the role limitations due to physical problems, social functioning, and general mental health domains of the Short Form 36 Health Survey. Patients who received acupuncture were 3.7 times more likely (CI, 1.7 to 8.1) to report less suffering from headaches at 6 weeks (absolute risk reduction 46%; number needed to treat 2). CONCLUSION: Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL and the perception by patients that they suffered less from headaches.

Melchart, et al. Acupuncture for chronic headaches--an epidemiological study. Headache. Apr 2006; 46(4):632-41.

Department of Internal Medicine II, Centre for Complementary Medicine Research, Technische Universität München, Kaiserstr. 9, 80801 Munich, Germany.

OBJECTIVE: To investigate the characteristics and outcomes of patients undergoing acupuncture treatment for chronic headaches under conditions of routine care provided within the framework of statutory health insurance in Germany. Furthermore, we investigated correlations between different outcomes. PATIENTS AND METHODS: Patients with migraine, episodic or chronic tension-type headache (TTH), or several other forms of chronic headache (cluster, vascular, drug-induced headache; other specific headaches) treated with acupuncture (mean number of sessions 8.6 +/- 3.0) were included into an observational study. Detailed questionnaires including questions on headache days and instruments measuring disability (Pain Disability Index) and quality of life (SF-36) were completed before treatment, after treatment, and at 6 months after inclusion. RESULTS: A total of 2,022 patients (732 with migraine, 351 with episodic and 440 with chronic TTHs, and 499 with other diagnoses) treated by 1,418 physicians were included in the main analysis. Sociodemographic and baseline characteristics differed considerably in the four diagnostic groups. Statistically highly significant and clinically relevant improvements were seen for all clinical outcome measures in all diagnostic groups. In 52.6% of patients headache frequency decreased by at least 50% compared to baseline. The comparison of headache frequency, pain intensity, and generic outcome measures showed that some of these outcomes correlate only weakly. CONCLUSIONS: In this epidemiological study, headache patients reported clinically relevant improvements after receiving acupuncture. Randomized trials performed in parallel to this study confirm the relevant overall effect, however, the effect may largely be due to potent unspecific needling and placebo effects.

Sun Y, Gan TJ. Acupuncture for the management of chronic headache: a systematic review. Anesth Analg. 2008 Dec;107(6):2038-47. (2008)

Duke University Medical Center, Department of Anesthesiology, Box 3094, Durham, NC 27710, USA.

OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache. METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods. RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17). CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.

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Hypertension

Haker E, Egekvist H, Bjerring P: Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. Journal of the Autonomic Nervous System 2000; 79:52-59.

Department of Physical Therapy, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. .(JavaScript must be enabled to view this email address)

It has been postulated that sensory stimulation (acupuncture) affects the cardiovascular system via the autonomic nervous system. Previously, skin temperature, thermography, plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture. By using power spectral analysis, the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity. The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and/or parasympathetic nervous system in healthy subjects. MATERIALS AND METHODS: Twelve healthy volunteers, six men and six women, mean age 34.4 (range 23-48) participated in three balanced, randomly distributed sessions. At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11. The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation. The introduction was followed by three test sessions. SESSION A: A short acupuncture needle, (Seirin no 3, ∅0.20x15 mm) was inserted perpendicular into the earpoint, Lu 1, in the left inferior hemi-conchae. SESSION B: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular into the Hegu point (LI 4) in the middle of the right dorsal thenar muscle. SESSION C: An acupuncture needle (Hwato, ∅0.30x30 mm) was inserted perpendicular superficially into the skin overlying the Hegu point on the left hand. Results. Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min (P<0.05) and during the post-stimulation period of 60 min (P<0.05). No significant changes were observed in either the sympathetic activity, blood pressure or heart rate. Stimulation of the thenar muscle resulted in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period (P<0.01) and during the post-stimulation period (P<0.01 and P<0.001, respectively). A significant decrease in the heart rate frequency (P<0.05) at the end of the post-stimulation period was also demonstrated. The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min (P<0.01) while no changes were observed during the stimulation period. CONCLUSION: It is indicated that sensory stimulation (acupunctura) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation.

Knardahl S, Elam M, Olausson B, Wallin BG: Sympathetic nerve activity after acupuncture in humans. Pain 1998; 75: 19-25.

Department of Clinical Neurophysiology, Sahlgrenska University Hospital, University of Göteborg, Sweden. .(JavaScript must be enabled to view this email address)

The aim of the present study was to determine if acupuncture stimulation inhibits sympathetic nerve activity in humans. Multiunit efferent postganglionic sympathetic activity was recorded with a tungsten microelectrode inserted in a muscle fascicle of the peroneal nerve. Mean arterial pressure, heart rate and skin blood flow were also monitored. Pain thresholds were measured by electrical tooth pain stimulation. After a 30 min rest, acupuncture needles were inserted bilaterally into the Li 11 and the Li 4 acupuncture points, and manipulated until ‘chi’ cramp-like sensation was reported. Electrical stimulation (2 Hz, 0.6-0.8 ms duration, maximal tolerated stimulation without discomfort) was delivered for 30 min and the physiological recordings were continued for 90 min after the end of acupuncture. In a placebo control experiment, the same procedure was followed, except that acupuncture needles were inserted subcutaneously and no manipulation or stimulation was given. The stimulator delivered pulses to an unconnected channel, hence, the same audiovisual stimuli were experienced as with acupuncture, and care was taken to ask the same questions about sensations in the placebo and the acupuncture groups. Electroacupuncture produced an increase in pain threshold which was paralleled by a transient increase in muscle sympathetic nerve activity. During acupuncture, there was a small increase in heart rate and mean arterial pressure, but there was no post-acupuncture hypotension. The placebo control procedure did not change pain threshold or sympathetic nerve traffic. The findings suggest that electroacupuncture produces moderate hypoalgesia in humans paralleled by a significant increase in muscle sympathetic nerve activity.

Chiu YJ, Chi A, Reid IA: Cardiovascular and endocrine effects of acupuncture in hypertensive patients. Clinical & Experimental Hypertension (New York) 1997; 19:1047-1063.

Chiu General Hospital, Kaohsiung, Taiwan.

It has been reported that acupuncture can decrease blood pressure in patients with hypertension, possibly by an endocrine mechanism. The aim of the present study was to investigate the effects of acupuncture on arterial blood pressure and the secretion of renin, vasopressin and cortisol in hypertensive patients. Acupuncture was performed in fifty untreated essential hypertensive patients resting in the supine position. Thirty min after acupuncture there were decreases in systolic pressure from 169 +/- 2 to 151 +/- 2 mm Hg, diastolic pressure from 107 +/- 1 to 96 +/- 1 mm Hg, and heart rate from 77 +/- 2 to 72 +/- 2 bpm (P < 0.01). Plasma renin activity decreased from 1.7 +/- 0.4 to 1.1 +/- 0.2 ng/ml/2h (P < 0.01), but there were no significant changes in plasma vasopressin or cortisol concentrations. These results confirm that acupuncture decreases blood pressure in hypertensive patients, and suggest that the decrease results, at least in part, from a decrease in renin secretion.

Chiu YJ, Chi A, Reid IA: Cardiovascular and endocrine effects of acupuncture in hypertensive patients. Clinical & Experimental Hypertension (New York) 1997; 19:1047-1063.

Chiu General Hospital, Kaohsiung, Taiwan.

It has been reported that acupuncture can decrease blood pressure in patients with hypertension, possibly by an endocrine mechanism. The aim of the present study was to investigate the effects of acupuncture on arterial blood pressure and the secretion of renin, vasopressin and cortisol in hypertensive patients. Acupuncture was performed in fifty untreated essential hypertensive patients resting in the supine position. Thirty min after acupuncture there were decreases in systolic pressure from 169 +/- 2 to 151 +/- 2 mm Hg, diastolic pressure from 107 +/- 1 to 96 +/- 1 mm Hg, and heart rate from 77 +/- 2 to 72 +/- 2 bpm (P < 0.01). Plasma renin activity decreased from 1.7 +/- 0.4 to 1.1 +/- 0.2 ng/ml/2h (P < 0.01), but there were no significant changes in plasma vasopressin or cortisol concentrations. These results confirm that acupuncture decreases blood pressure in hypertensive patients, and suggest that the decrease results, at least in part, from a decrease in renin secretion.

Williams T, Mueller K, Cornwall MW: Effect of acupuncture-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study. Physical Therapy 1991; 71:523-529.

Havasu Samaritan Regional Hospital, Lake Havasu City, AZ 86403.

Electrical stimulation of four specific acupuncture points (Liver 3, Stomach 36, Large Intestine 11, and the Groove for Lowering Blood Pressure) was examined in order to determine the effect of this stimulation on diastolic blood pressure in 10 subjects with diastolic hypertension. Subjects were randomly divided into two groups: (1) an Acu-ES group, which received electrical stimulation applied to the four antihypertensive acupuncture points, and (2) a Sham-ES group, which received electrical stimulation applied to non-acupuncture-point areas. A repeated-measures analysis of variance revealed a significant, immediate poststimulation reduction of diastolic blood pressure for the Acu-Es group versus the Sham-ES group. Further studies are needed to determine whether there are other acupuncture points, stimulation characteristics, or modalities that can enhance this treatment effect and whether the treatment effect can last for a clinically significant period of time.

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Infertility

Stener-Victorin E. Anovulation in PCOS: Electro-acupuncture appears to be useful to help stimulate ovulation in women with PCOS. Acta Obstet Gynecol Scand. 2000;79(3):180-8.

Department of Obstetrics and Gynecology, Göteborg University, Sweden.

BACKGROUND: The present study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). METHODS: Twenty-four women (between the ages of 24 and 40 years) with PCOS and oligo-/amenorrhea were included in this non-randomized, longitudinal, prospective study. The study period was defined as the period extending from 3 months before the first EA treatment, to 3 months after the last EA treatment (10-14 treatments), in total 8-9 months. The menstrual and ovulation patterns were confirmed by recording of vaginal bleedings and by daily registrations of the basal body temperature (BBT). Blood samples were collected within a week before the first EA, within a week after the last EA and 3 months after EA. RESULTS: Nine women (38%) experienced a good effect. They displayed a mean of 0.66 ovulations/woman and month in the period during and after the EA period compared to a mean of 0.15 before the EA period (p=0.004). Before EA, women with a good effect had a significantly lower body-mass index (BMI) (p<0.001), waist-to-hip circumference ratio (WHR) (p=0.0058), serum testosterone concentration (p=0.0098), serum testosterone/sex hormone binding globulin (SHBG) ratio (p=0.011) and serum basal insulin concentration (p=0.0054), and a significantly higher concentration of serum SHBG (p=0.040) than did those women with no effect. CONCLUSION: Repeated EA treatments induce regular ovulations in more than one third of the women with PCOS. The group of women with good effect had a less androgenic hormonal profile before treatment and a less pronounced metabolic disturbance compared with the group with no effect. For this selected group EA offers an alternative to pharmacological ovulation induction.

Chang R, et al. Role of acupuncture in the treatment of female infertility. Fertil Steril, Dec 2002;78(6): 1149-53.

The Institute of East-West Medicine, New York, New York 10021, USA

OBJECTIVE: To review existing scientific rationale and clinical data in the utilization of acupuncture in the treatment of female infertility. DESIGN: A MEDLINE computer search was performed to identify relevant articles. RESULTS: Although the understanding of acupuncture is based on ancient medical theory, studies have suggested that certain effects of acupuncture are mediated through endogenous opioid peptides in the central nervous system, particularly beta-endorphin. Because these neuropeptides influence gonadotropin secretion through their action on GnRH, it is logical to hypothesize that acupuncture may impact on the menstrual cycle through these neuropeptides. Although studies of adequate design, sample size, and appropriate control on the use of acupuncture on ovulation induction are lacking, there is only one prospective randomized controlled study examining the efficacy of acupuncture in patients undergoing IVF. Besides its central effect, the sympathoinhibitory effects of acupuncture may impact on uterine blood flow. CONCLUSION: Although the definitive role of acupuncture in the treatment of female infertility is yet to be established, its potential impact centrally on the hypothalamic-pituitary-ovarian axis and peripherally on the uterus needs to be systemically examined. Prospective randomized controlled studies are needed to evaluate the efficacy of acupuncture in female fertility treatment.

Paulus W, et al. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility, April 2002;77(4):721-4.

Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany. .(JavaScript must be enabled to view this email address)

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

Stener-Victorin E, et al. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Human Reproduction, Vol.11, No.6, 1996.

Department of Obstetrics and Gynaecology, Fertility Centre Scandinavia, University of Gothenburg, S-413 45 Gothenburg, Sweden.

In order to assess whether electro-acupuncture (EA) can reduce a high uterine artery blood flow impedance, 10 infertile but otherwise healthy women with a pulsatility index (PI) >=3.0 in the uterine arteries were treated with EA in a prospective, non-randomized study. Before inclusion in the study and throughout the entire study period, the women were down-regulated with a gonadotrophin-releasing hormone analogue (GnRHa) in order to exclude any fluctuating endogenous hormone effects on the PI. The baseline PI was measured when the serum oestradiol was <=0.1 nmol/l, and thereafter the women were given EA eight times, twice a week for 4 weeks. The PI was measured again closely after the eighth EA treatment, and once more 10-14 days after the EA period. Skin temperature on the forehead (STFH) and in the lumbrosacral area (STLS) was measured during the first, fifth and eighth EA treatments. Compared to the mean baseline PI, the mean PI was significantly reduced both shortly after the eighth EA treatment (P < 0.0001) and 10-14 days after the EA period (P < 0.0001). STFH increased significantly during the EA treatments. It is suggested that both of these effects are due to a central inhibition of the sympathetic activity.

Westergaard LG, Mao Q, Krogslun M, Sandrini S, Lenz S, Grinsted J. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril, 2006 May;85(5):1341-6.

Fertility Clinic Trianglen, Hellerup, Denmark. .(JavaScript must be enabled to view this email address)

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture. DESIGN: Prospective, randomized trial. SETTING: Private fertility center. PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87). INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group. MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three groups. RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference. CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril, 2006 May;85(5):1352-8.

School of Health Science, The University of South Australia, South Australia, Australia. .(JavaScript must be enabled to view this email address)

OBJECTIVE: To evaluate the effects of acupuncture on clinical pregnancy rates for women undergoing ET. DESIGN: Single-blind, randomized controlled trial using a noninvasive sham acupuncture control. SETTING: Repromed, The Reproductive Medicine Unit of The University of Adelaide. PATIENT(S): Women undergoing IVF. INTERVENTION(S): Women were randomly allocated to acupuncture or noninvasive sham acupuncture with the placebo needle. All women received three sessions, the first undertaken on day 9 of stimulating injections, the second before ET, and the third immediately after ET. MAIN OUTCOME MEASURE(S): The primary outcome was pregnancy. Secondary outcomes were implantation, ongoing pregnancy rate at 18 weeks, adverse events, and health status. RESULT(S): Two hundred twenty-eight subjects were randomized. The pregnancy rate was 31% in the acupuncture group and 23% in the control group. For those subjects receiving acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control group, but the difference did not reach statistical significance. The ongoing pregnancy rate at 18 weeks was higher in the treatment group (28% vs. 18%), but the difference was not statistically significant. CONCLUSION(S): There was no significant difference in the pregnancy rate between groups; however, a smaller treatment effect can not be excluded. Our results suggest that acupuncture was safe for women undergoing ET.

Dieterle S, Ying G, Hatzmann W, Neuer A. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril, 2006 May;85(5):1347-51

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany. .(JavaScript must be enabled to view this email address)

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized, prospective, controlled clinical study. SETTING: University IVF center. PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI. INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates. RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%). CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Sinclair S. Male Infertility: Nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38. Green Valley Health, Hagerstown, MD 21742, USA.

Studies confirm that male sperm counts are declining, and environmental factors, such as pesticides, exogenous estrogens, and heavy metals may negatively impact spermatogenesis. A number of nutritional therapies have been shown to improve sperm counts and sperm motility, including carnitine, arginine, zinc, selenium, and vitamin B-12. Numerous antioxidants have also proven beneficial in treating male infertility, such as vitamin C, vitamin E, glutathione, and coenzyme Q10. Acupuncture, as well as specific botanical medicines, have been documented in several studies as having a positive effect on sperm parameters. A multi-faceted therapeutic approach to improving male fertility involves identifying harmful environmental and occupational risk factors, while correcting underlying nutritional imbalances to encourage optimal sperm production and function.

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does Acupuncture treatment affect sperm density in males with very low sperm counts? A pilot study. Andrologia. 2000, Jan;32(1):31-9.

Institute of Chinese Medicine, Tel Aviv, Israel.

Classic therapies are usually ineffective in the treatment of patients with very poor sperm density. The aim of this study was to determine the effect of acupuncture on these males. Semen samples of 20 patients with a history of azoospermia were examined by light microscope (LM) and scanning electron microscope (SEM), with which a microsearch for spermatozoa was carried out. These examinations were performed before and 1 month after acupuncture treatment and revealed that the study group originally contained three severely oligoteratoasthenozoospermic (OTA), two pseudoazoospermic and 15 azoospermic patients. The control group was comprised of 20 untreated males who underwent two semen examinations within a period of 2-4 months and had initial andrological profiles similar to those of the experimental group. No changes in any of the parameters examined were observed in the control group. There was a marked but not significant improvement in the sperm counts of severely OTA males following acupuncture treatment (average = 0.7 +/- 1.1 x 10(6) spermatozoa per ejaculate before treatment vs. 4.3 +/- 3.2 x 10(6) spermatozoa per ejaculate after treatment). A definite increase in sperm count was detected in the ejaculates of 10 (67%) of the 15 azoospermic patients. Seven of these males exhibited post-treatment spermatozoa that were detected even by LM. The sperm production of these seven males increased significantly, from 0 to an average of 1.5 +/- 2.4 x 10(6) spermatozoa per ejaculate (Z = -2.8, P < or = 0.01). Males with genital tract inflammation exhibited the most remarkable improvement in sperm density (on average from 0.3 +/- 0.6 x 10(6) spermatozoa per ejaculate to 3.3 +/- 3.2 x 10(6) spermatozoa per ejaculate; Z = -2.4, P < or = 0.02). Two pregnancies were achieved by the IVF-ICSI procedure. It is concluded that acupuncture may be a useful, nontraumatic treatment for males with very poor sperm density, especially those with a history of genital tract inflammation.

Fischl F, Riegler R, Bieglmayer C, Nasr F, Neumark J. Modification of semen quality by acupuncture in subfertile males. Geburtshilfe Frauenheilkunde, 1984 Aug;4498):510-2.

Our first attempt in treating subfertility by acupuncture was carried out on 28 males. The results obtained from the experiences in veterinary medicine encouraged us to attempt this type of therapy. Each patient received a total of 10 treatments for a period of three weeks. Several spermiograms were made after diagnosis subfertility. We checked spermiograms and hormone levels before and after acupuncture. Total count, concentration and motility were evaluated. In all cases we observed a statistically significant improvement of sperm quality. Having obtained these good results in our first studies, we now intend to continue acupuncture therapy in subfertile males for insemination or intercourse at the time of the ovulation of their female partners.

Gerhard I. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol. 1992;6(3):171-81.

Department for Gynecological Endocrinology and Reproduction, Women’s Hospital, University of Heidelberg, Germany.

Following a complete gynecologic—endocrinologic workup, 45 infertile women suffering from oligoamenorrhea (n = 27) or luteal insufficiency (n = 18) were treated with auricular acupuncture. Results were compared to those of 45 women who received hormone treatment. Both groups were matched for age, duration of infertility, body mass index, previous pregnancies, menstrual cycle and tubal patency. Women treated with acupuncture had 22 pregnancies, 11 after acupuncture, four spontaneously, and seven after appropriate medication. Women treated with hormones had 20 pregnancies, five spontaneously, and 15 in response to therapy. Four women of each group had abortions. Endometriosis (normal menstrual cycles) was seen in 35% (38%) of the women of each group who failed to respond to therapy with pregnancy. Only 4% of the women who responded to acupuncture or hormone treatment with a pregnancy had endometriosis, and 7% had normal cycles. In addition, women who continued to be infertile after hormone therapy had higher body mass indices and testosterone values than the therapy responders from this group. Women who became pregnant after acupuncture suffered more often from menstrual abnormalities and luteal insufficiency with lower estrogen, thyrotropin (TSH) and dehydroepiandrosterone sulfate (DHEAS) concentrations than the women who achieved pregnancy after hormone treatment. Although the pregnancy rate was similar for both groups, eumenorrheic women treated with acupuncture had adnexitis, endometriosis, out-of-phase endometria and reduced postcoital tests more often than those receiving hormones. Twelve of the 27 women (44%) with menstrual irregularities remained infertile after therapy with acupuncture compared to 15 of the 27 (56%) controls treated with hormones, even though hormone disorders were more pronounced in the acupuncture group. Side-effects were observed only during hormone treatment. Various disorders of the autonomic nervous system normalized during acupuncture. Based on our data, auricular acupuncture seems to offer a valuable alternative therapy for female infertility due to hormone disorders.

Beal MW: Acupuncture and acupressure: applications to women’s reproductive health care. Journal of Midwifery 1999; 44:217-230. Yale University School of Nursing, New Haven, CT 06536-0747, USA.

An introduction to the therapeutic applications, history, and theory of acupuncture and acupressure is presented. The traditional concepts that underlie treatment of imbalances of ch’i, or vital energy, are presented, along with the theories of yin and yang, meridians, vital substances, pathogenic factors, five phases, and the eight principle patterns. Contemporary Western research findings on the biochemical mediaries and effects of acupuncture are reviewed. Clinical applications to women’s reproductive care that are presented include treatment for dysmenorrhea, infertility, and childbearing. Data on clinical trials are reviewed, and licensure and educational preparation for practice of these modalities are discussed.

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B: Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Archives of Andrology 1997; 39:155-161.

Institute of Chinese Medicine, Tel Aviv, Israel.

The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment. Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations. The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05). Thus, patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment.

Riegler R, Fischl F, Bunzel B, Neumark J: Correlation of psychological changes and spermiogram improvements following acupuncture. [German] Urologe – Ausgabe A. 1984; 23:329-333.

The purpose of the study was to find the correlation between the effect of acupuncture on fertility and psychological effects. To investigate its influence on male subfertility, 28 patients received acupuncture treatment after informed consent. We evaluated subjective parameters by written psychological tests, while objective parameters consisted of measuring concentration, volume and motility in the spermiogram before and after acupuncture. There was a significant increase in sperm quality in all parameters but volume. The psychological test showed no change caused by acupuncture. Hence, we believe, that the effect of acupuncture on sperm quality is not caused by placebo-mechanisms.

Chen BY. Acupuncture normalizes Dysfunction of Hypothalamic-Pituitary-Ovarian Axis. Acupunct Electro-Ther Res 1997; 22:97-108

Institute of Acupuncture and Department of Neurobiology, Shanghai Medical University, Shanghai 200032, P.R. China

This article summarizes the studies of the mechanism of electroacupuncture (EA) in the regulation of the abnormal function of hypothalamic pituitary-ovarian axis (HPOA) in our laboratory. Clinical observation showed that EA with the effective acupoints could cure some anovulatory patients in a highly effective rate and the experimental results suggested that EA might regulate the dysfunction of HPOA in several ways, which rneans EA could influence some gene expression of brain, thereby, normalizing secretion of some hormones, such as GnRH, LH and E2. The effects of EA might possess a relative specificity on acupoints.

Yamanka M, et al. Direct Effects of Chinese herbal medicine “Hacheuekkito” on sperm movement. Nippon Hinyokika Gakkai Zasshi 1998, 89(7):641-6.

Chinese herbal medicine, “Hochuekkitto” is widely used for male infertility in Japan. There have been many reports concerning its clinical usefulness but very few reports of in vitro experiments studying the mechanism of its effects. In addition to stimulating germ cells, we analyzed its direct effects on sperm using computer assisted semen analyzer (CASA). MATERIALS AND METHODS: Motile sperm were prepared using swim up technique from semen collected from ten healthy volunteers. Sperm movements (motility, velocity, linearity) were analyzed by CASA after adding either serum containing anti-sperm antibody (ASA) or normal serum with or without Hochuekkito. RESULTS: Two hours after adding serum with ASA, the decrease of sperm motility was significantly reduced from 25.1% (92.8%–>67.7%) to 12.5% (92.9%–>80.6%) by adding Hochuekkito. No significant difference in velocity and linearity was observed between two groups. By adding normal serum, any of three parameters differed significantly with or without Hochuekkito. CONCLUSION: Protective effects of Hochuekkito on sperm was suggested. Although normal sperm with ASA was used in this report, since the sperm of infertile patients are said to be more fragile, this results imply that direct protective effect is one of the mechanism of Hochuekkito for male infertility.

Ishikawa H; Ohashi M; Hayakawa K; Kaneko S; Hata M. Effects of guizhi-fuling-wan on male infertility with varicocele. Am J Chin Med 1996, 24(3-4):327-31.

Department of Urology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.

Thirty-seven infertile patients with varicocele were treated with Guizhi-Fuling-Wan (7.5 g/day) for at least 3 months. Before and after the administration, semen qualities such as sperm concentration and motility were examined, and the varicocele was graded. A varicocele disappearance rate of 80% was obtained with 40 out of 50 varicocele, and improvement of sperm concentration and motility were found in 71.4% and 62.1% of patients, respectively. From these results, Guizhi-Fuling-Wan is considered to be effective for circulation disorders in varicocele as well as semen quality.

Battaglia C, Salvatori M, Maxia N, Petraglia F, Facchinetti F, Volpe A. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients.

Department of Obstetrics and Gynecology University of Modena, and Department of Surgical Sciences, University of Udine, Italy. The objective of the present study was prospectively and randomly to evaluate the role of L-arginine in improving uterine and follicular Doppler flow and in improving ovarian response to gonadotrophin in poor responder women. A total of 34 patients undergoing assisted reproduction was divided in two groups according to different ovarian stimulation protocols: (i) flare-up gonadotrophin-releasing hormone analogue (GnRHa) plus elevated pure follicle stimulating hormone (pFSH)(n = 17); and (ii) flare-up GnRHa plus elevated pFSH plus oral L-arginine (n = 17). During the ovarian stimulation regimen, the patients were submitted to hormonal (oestradiol and growth hormone), ultrasonographic (follicular number and diameter, endometrial thickness) and Doppler (uterine and perifollicular arteries) evaluations. Furthermore, the plasma and follicular fluid concentrations of arginine, citrulline, nitrite/nitrate (NO2-/NO3-), and insulin-like growth factor-1 (IFG-1) were assayed. All 34 patients completed the study. In the L-arginine treated group a lower cancellation rate, an increased number of oocytes collected, and embryos transferred were observed. In the same group, increased plasma and follicular fluid concentrations of arginine, citruilline, NO2-/NO3-, and IFG-1 was observed. Significant Doppler flow improvement wsa obtained in the L-arginine supplemented group. Three pregnancies were registered in these patients. No pregnancies were observed in the other group. It was concluded that oral L-arginine supplementation in poor responder patients may improve ovarian response, endometrial receptivity and pregnancy rate.

Eskenazi B, Kidd SA, Marks AR, Sloter E, Block G, Wyrobek AJ. Antioxidant intake is associated with semen quality in healthy men. Hum Reprod. 2005 Apr;20(4):1006-12. Epub 2005 Jan 21.

We seek to determine whether dietary and supplement intake of specific micronutrients (zinc and folate) and antioxidants (vitamins C, E and -carotene) is associated with semen quality. METHODS: Ninety-seven healthy, non-smoking men provided semen and were interviewed. Average daily nutrient intake from food and supplements was derived from a self-administered food frequency questionnaire. Intake levels were summarized as low, moderate and high. Semen volume, sperm concentration, total sperm count, motility, progressive motility and total progressively motile sperm count (TPMS) were measured. RESULTS: After controlling for covariates, a high intake of antioxidants was associated with better semen quality but, in almost all cases, there was no clear dose relationship in that moderate intake groups had the poorest semen quality. For example, positive associations were observed between vitamin C intake and sperm number as reflected in the higher mean count (P=0.04), concentration (P=0.05) and TPMS (P=0.09); between vitamin E intake and progressive motility (P=0.04) and TPMS (P=0.05); and between -carotene intake and sperm concentration (P=0.06) and progressive motility (P=0.06). Folate and zinc intake were not associated with improved semen quality. CONCLUSIONS: In a convenience sample of healthy non-smoking men from a non-clinical setting, higher antioxidant intake was associated with higher sperm numbers and motility.

Gurfinkel E, Cedenho AP, Yamamura Y, Srougi M. Effects of acupuncture and moxa treatment in patients with semen abnormalities. Asian J Androl 2003 Dec; 5: 345-348

Aim: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities. Methods: In a prospective, controlled and blind study, nineteen patients, aged 24 years ~ 42 years and married for 3 years ~ 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course. Results: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0). Conclusion: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

Tanaka T; Mizuno K; Umesaki N; Ogita S. A preliminary immunopharmacological study of an antiendometriotic herbal medicine, Keishi-bukuryo-gan. Osaka City Med J, 44(1):117-24 1998 Jun.

Changes in the specific antiendometrial IgM antibodies in an endometriotic patient, who were treated with leuproride acetate and in turn with Keishi-bukuyogan, were investigated by the flowcytometric analysis which was developed in our laboratory. The oriental therapy decreased the specific IgM antibody titer gradually and kept the patient symptom-free for more than 7 months without any suppression of serum CA125 and estradiol levels. On the other hand, leuproride acetate therapy suppressed both serum CA125 and serum estradiol levels but not the IgM antibody titer. The results suggest that the specific antiendometrial IgM autoantibody could be a pathogenic molecule in endometriosis and it could also serve as a clinical marker for the oriental therapy of endometriosis.

Magarelli CP, Cridennda DK, Cohen M. Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization-embryo transfer treatment. Fertil Steril Dec. 2009 in Press

OBJECTIVE: To determine whether changes in serum cortisol (CORT) and PRL are affected by acupuncture (Ac) in Ac-treated IVF patients. DESIGN: Prospective cohort clinical study. SETTING: Private practice reproductive endocrinology and infertility clinic and private practice acupuncture consortium. PATIENTS: Sixty-seven reproductive-age infertile women undergoing IVF. INTERVENTION(S): Blood samples were obtained from all consenting new infertility patients and serum CORT and serum PRL were obtained prospectively. Patients were grouped as controls (IVF with no Ac) and treated (IVF with Ac) according acupuncture protocols derived from randomized controlled trials. MAIN OUTCOME MEASURE(S): Serum levels of CORT and PRL were measured and synchronized with medication stimulation days of the IVF cycle (e.g., day 2 of stimulation, day 3, etc.). Reproductive outcomes were collected according to Society of Assisted Reproductive Technology protocols, and results were compared between controls and those patients treated with Ac. RESULT(S): CORT levels in Ac group were significantly higher on IVF medication days 7, 8, 9, 11, 12 and 13 compared with controls. PRL levels in the Ac group were significantly higher on IVF medication days 5, 6, 7, and 8 compared with controls. CONCLUSION(S): In this study, there appears to be a beneficial regulation of CORT and PRL in the Ac group during the medication phase of the IVF treatment with a trend toward more normal fertile cycle dynamics.

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Insomnia

Phillips KD, Skelton WD: Effects of individualized acupuncture on sleep quality in HIV disease. Journal of the Association of Nurses in AIDS Care 2001; 12:27-39.

Department of Administrative and Clinical Nursing, College of Nursing, University of South Carolina, USA.

Although it may begin at any point, sleep disturbance often appears early in HIV disease and contributes to decreased quality of life during the course of the illness. Relatively few studies have explored the complex nature of poor sleep quality in HIV disease or tested interventions to improve sleep quality. The purpose of this study was threefold: explore the nature of sleep quality in HIV disease, test the relationship between pain and sleep quality, and test the effectiveness of acupuncture delivered in a group setting for improving sleep quality in those who are HIV infected. A pretest, posttest, preexperimental design was used to test the effects of acupuncture on sleep quality. Participating in the study were 21 HIV-infected men and women between the ages of 29 and 50 years who reported sleep disturbance three or more times per week and who scored greater than 5 on the Pittsburgh Sleep Quality Index. The Wrist Actigraph was used to measure sleep activity, and the Current Sleep Quality Index was used to measure sleep quality for 2 nights before and after a 5-week acupuncture intervention (10 treatments). Acupuncture was individualized to address insomnia and other symptoms reported by the participants. Sleep activity and sleep quality significantly improved following 5 weeks of individualized acupuncture delivered in a group setting.

Cocilovo A: Colored light therapy: overview of its history, theory, recent developments and clinical applications combined with acupuncture. American Journal of Acupuncture 1999; 27: 71-83.

Acupuncture Clinic of Prescott, AZ 86305, USA.

Light therapy has a long history, dating from ancient Egypt to the contemporary treatment of seasonal affective disorder. In the early half of this century, Dinshah Ghadiali, MD PhD, refined a sophisticated system of color therapy. Influenced by a strong background in mathematics and physics, he determined specific “attributes” of the colors of the spectrum, i.e., their specific effects on human physiology. Later research has confirmed many of his concepts and spawned evolution of new systems for application of light therapy including irradiation of acupuncture points. According to the author, his system dovetails nicely with traditional Oriental medicine theory, relating colors to the internal organs and meridian system. Of particular note is recent Russian research which has shown that light is conducted within the body along the acupuncture meridians leading the authors to ponder: Do acupuncture meridians function as a light (photon) transferal system within the body, not unlike optical fiber? Case studies provide support for the clinical benefits of light therapy. The emerging contemporary color therapy systems of Mandel (Colorpuncture) and McWilliams (Chromo-pressure) are discussed, and a newly patented device is introduced.

Montakab H: Acupuncture and insomnia [German]. Forschende Komplementärmedizin 1999; 6 Suppl 1: 29-31.

40 patients with primary difficulties in either falling asleep or remaining asleep were diagnosed according to the traditional Chinese medicine, allocated to specific diagnostic subgroups and treated individually by a practitioner in his private practice. The patients were randomized into two groups, one receiving true acupuncture, the other needled at non-acupuncture points for 3-5 sessions at weekly intervals. The outcome of the therapy was assessed in several ways, first and foremost by an objective measurement of the sleep quality by polysomnography in a specialized sleep laboratory, performed once before and once after termination of the series of treatments. Additional qualitative results were obtained from several questionnaires. The objective measurement showed a statistically significant effect only in the patients who received the true acupuncture. The subjective, qualitative assessment was better in the proper treatment group than in the control group but was not calculated statistically for methodological reasons. Based on the results of this study, it can be concluded that true and individualized acupuncture indeed shows efficacy in primary sleep disorders. However, a direct influence by the therapist cannot be excluded.

Lin Y: Acupuncture treatment for insomnia and acupuncture analgesia. Psychiatry & Clinical Neurosciences 1995; 49: 119-120.

Department of Physiology, Shanghai Second Medical University, China.

Acupuncture is a simple and useful treatment for insomnia, with a success rate of around 90%. The acupuncture points applied vary depending on the doctor and on the case, but the usual points are Shenmen (HT7) and Anmien (extrapoint). The mechanism of this treatment has not been well elucidated. Acupuncture analgesia may be used as a great indicator, because in both practices needles are inserted in deep tissues as the common stimulation. The possible neuronal integration and transmitter effect in the acupuncture treatment for insomnia are discussed.

Montakab H, Langel G: The effect of acupuncture in the treatment of insomnia: clinical study of subjective and objective evaluation [French]. Schweizerische Medizinische Wochenschrift – Supplementum 1994; 62: 49-54.

The sleep-wake cycle is the most important circadian rhythm in man and thus constitutes an excellent indicator of internal equilibrium and of health. Sleep disorders, and particularly insomnia, affect a great percentage of the population. In daily practice, an inappropriate treatment may transform a bad sleeper into an insomniac dependent on pharmaceuticals for life. It is therefore necessary to give priority to non-chemical treatments in the management of insomnia. Acupuncture, which offers a personalized treatment, is particularly indicated for reharmonizing a disturbed sleep-wake cycle. Furthermore, there is an interesting similarity between the 5000-year-old theoretical basis of Chinese medicine and the recent scientific discoveries about man’s internal rhythms. Clinical and statistical studies of the effects of acupuncture on insomnia are rare and evaluate only the subjective appreciation of sleep. Objective analysis of sleep by polysomnography permits evaluation of sleep architecture and visualizes the site and depth of action of the therapeutic method. Such studies have only been conducted in relation to pharmaceutical treatments. No such study has been carried out for acupuncture. A scientific and objective evaluation of the effects of acupuncture on insomnia by polysomnography could be not only of academic but mainly of great practical interest. If the efficiency of acupuncture is thus verified, this method could be integrated and proposed along with other classical therapeutic techniques.

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Irritable Bowel Syndrome

Chan, et al. The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study. Hepatogasteroenterology 44(17):1328-30. Sep-Oct 1997.

Gastrointestinal Research Unit, Leicester General Hospital, England.

BACKGROUND/AIMS: The aim of this pilot study was to investigate the potential value of acupuncture in the treatment of irritable bowel syndrome (IBS). METHODOLOGY: The study was an open design study of 7 patients with established irritable bowel syndrome in which assessment was by a diary card. RESULTS: The results showed a significant improvement both in general well-being and in symptoms of bloating. CONCLUSIONS: Acupuncture seems to be effective in the treatment of irritable bowel syndrome and merits further study.

Schneider, et al. Acupuncture treatment in irritable bowel syndrome. Gut. May 2006; 55(5):649-54.

Department of General Practice and Health Services Research, University Medical Hospital, University of Heidelberg, Vossstrasse 2, 69120 Heidelberg, Germany.

BACKGROUND AND AIMS: Despite occasional positive reports on the efficacy of acupuncture (AC) on functions of the gastrointestinal tract, there is no conclusive evidence that AC is effective in the treatment of irritable bowel syndrome (IBS). PATIENTS AND METHODS: Forty three patients with IBS according to the Rome II criteria were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the so-called “Streitberger needle”. Treatment duration was 10 sessions with an average of two AC sessions per week. The primary end point was improvement in quality of life (QOL) using the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36), compared with baseline assessments. QOL measurements were repeated three months after treatment. RESULTS: Both the AC and SAC groups improved significantly in global QOL, as assessed by the FDDQL, at the end of treatment (p = 0.022), with no differences between the groups. SF-36 was insensitive to these changes (except for pain). This effect was partially reversed three months later. Post hoc comparison of responders and non-responders in both groups combined revealed a significant prediction of the placebo response by two subscales of the FDDQL (sleep, coping) (F = 6.746, p = 0.003) in a stepwise regression model. CONCLUSIONS: Acupuncture in IBS is primarily a placebo response. Based on the small differences found between the AC and SAC groups, a study including 566 patients would be necessary to prove the efficacy of AC over SAC. The placebo response may be predicted by high coping capacity and low sleep quality in individual patients.

Takahashi, T. Acupuncture for functional gastrointestinal disorders. J Gasteroenterol. May 2006.; 41(5):408-18.

Department of Surgery, Duke University Medical Center, Durham, NC 27705, USA.

Functional gastrointestinal (GI) symptoms are common in the general population. Especially, motor dysfunction of the GI tract and visceral hypersensitivity are important. Acupuncture has been used to treat GI symptoms in China for thousands of years. It is conceivable that acupuncture may be effective in patients with functional GI disorders because it has been shown to alter acid secretion, GI motility, and visceral pain. Acupuncture at the lower limbs (ST-36) causes muscle contractions via the somatoparasympathetic pathway, while at the upper abdomen (CV-12) it causes muscle relaxation via the somatosympathetic pathway. In some patients with gastroesophageal reflux disease (GERD) and functional dyspepsia (FD), peristalsis and gastric motility are impaired. The stimulatory effects of acupuncture at ST-36 on GI motility may be beneficial to patients with GERD or FD, as well as to those with constipation-predominant irritable bowel syndrome (IBS), who show delayed colonic transit. In contrast, the inhibitory effects of acupuncture at CV-12 on GI motility may be beneficial to patients with diarrhea-predominant IBS, because enhanced colonic motility and accelerated colonic transit are reported in such patients. Acupuncture at CV-12 may inhibit gastric acid secretion via the somatosympathetic pathway. Thus, acupuncture may be beneficial to GERD patients. The antiemetic effects of acupuncture at PC-6 (wrist) may be beneficial to patients with FD, whereas the antinociceptive effects of acupuncture at PC-6 and ST-36 may be beneficial to patients with visceral hypersensitivity. In the future, it is expected that acupuncture will be used in the treatment of patients with functional GI disorders.

Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine. A prospective, randomised controlled, double-blind, placebo controlled study. JAMA. 1998;280:1585-1589.

Research Unit for Complementary Medicine, University of Western Sydney Macarthur, Campbelltown, New South Wales, Australia.

CONTEXT: Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment. OBJECTIVE: To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997. SETTING: Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group. MAIN OUTCOME MEASURES: Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients. RESULTS: Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. CONCLUSION: Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.

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Lower Back Pain

Hammerschlag R: Methodological and ethical issues in clinical trials of acupuncture. Journal of Alternative & Complementary Medicine 1998; 4:159-171.

Yo San University of Traditional Chinese Medicine, Santa Monica, California 90401, USA.

In this review, controlled clinical trials of acupuncture are placed into five categories on the basis of the treatment with which acupuncture is compared. Methodological and ethical issues relevant to each category are discussed. Wait list (or no treatment) controls, which are ethically acceptable for stable, chronic conditions, assess the efficacy of acupuncture relative to the natural history of the condition but do not control for nonspecific treatment effects. Placebo controls, defined here as noninvasive procedures such as inactive transcutaneous electrical nerve stimulation (TENS) or mock needling, assess whether acupuncture has an effect beyond that of the therapeutic milieu. Sham controls, defined as invasive but inappropriate procedures such as shallow needling at nonacupoint sites, assess whether acupuncture efficacy depends on the style and location of needling. Standard care comparisons assess whether acupuncture performs at least as well as a medication, medical device, or physiotherapy. Adjunctive care comparisons assess the efficacy of acupuncture plus standard care relative to standard care alone. From an ethical perspective, active debate surrounds placebo and sham controls. Those who argue against these procedures consider withholding treatment to be improper. They favor the wait list and both standard care designs in which all patients receive treatment. Others argue that testing a treatment prior to demonstrating its efficacy against a placebo is equally improper. From a methodological perspective, it should also be considered that most clinical trials of acupuncture have assessed its efficacy by administering a fixed course of treatment based on biomedical diagnosis. The challenge for future trials is to design conditions that more closely mimic the delivery of acupuncture in clinical practice, as individualized treatment informed by its own diagnostic traditions.

Ernst E, White AR. Acupuncture for back pain: A meta-analysis of randomized controlled trials. Arch Intern Med 1998;158;2235-2241.

Department of Complementary Medicine, Postgraduate Medical School, University of Exeter, England. .(JavaScript must be enabled to view this email address)

BACKGROUND: Acupuncture is commonly used to treat back pain, but there is no published meta-analysis of trials of its effectiveness for this condition. OBJECTIVE: To perform a meta-analysis of trials of acupuncture for the treatment of back pain. METHODS: A systematic literature search was conducted to retrieve all randomized controlled trials of any form of acupuncture for any type of back pain in humans. The adequacy of the acupuncture treatment was assessed by consulting 6 experienced acupuncturists. The main outcome measure for the meta-analysis was numbers of patients whose symptoms were improved at the end of treatment. RESULTS: Twelve studies were included, of which 9 presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30 (95% confidence interval, 1.28-4.13). For sham-controlled, evaluator-blinded studies, the odds ratio was 1.37 (95% confidence interval, 0.84-2.25). CONCLUSION: Acupuncture was shown to be superior to various control interventions, although there is insufficient evidence to state whether it is superior to placebo.

Thomas M, Lundberg T: Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiologica Scandinavica 1994; 38:63-69.

Department of Physiology II, Karolinska Institute, Stockholm, Sweden.

A controlled study of different modes of acupuncture stimulation was conducted on patients fulfilling clinical criteria for chronic low back pain of nociceptive origin. Forty patients were randomly entered into the study. Thirty had three trial treatments with manual stimulation of needles (MS), electrical low frequency stimulation at 2 Hz (LF), and high-frequency stimulation at 80 Hz (HF), and then continued treatment with the mode they felt most benefitted them. Ten patients were put on the waiting list for treatment but served as the untreated control group. The results were evaluated after 6 weeks and at 6 months for: activity related to pain; mobility; verbal descriptors of pain and the patient’s subjective assessment of his condition. After 6 weeks, patients receiving treatment showed significant improvement (P < 0.05 to P < 0.001) on three of the four measures compared to the untreated controls. After 6 months a similar measure of significant improvement was seen in patients continuing with low-frequency (LF) acupuncture, but not in those groups continuing with manual stimulation (MS) or high-frequency (HF) acupuncture. The results suggest that 2 Hz electrical stimulation is the mode of choice when using acupuncture in the treatment of chronic nociceptive low back pain.

Ulett GA, Han JS, Han S: Traditional and evidence-based acupuncture: history, mechanisms, and present status. Southern Medical Journal 1998; 91:1115-1120.

University of Missouri, Columbia, USA.

BACKGROUND: In 1983, the Southern Medical Journal advised its readers that a scientific basis might underlie the popular practice of ancient Chinese acupuncture. Recent studies have proven this to be correct, and a 1997 National Institutes of Health consensus panel recommended acupuncture as a useful clinical procedure. METHODS: Pertinent articles in the literature were reviewed, including our own research. Significantly, we had access to recent important studies from China. RESULTS AND CONCLUSIONS: Most of the 10,000 acupuncturists in the country today practice metaphysically explained “meridian theory” acupuncture using needles to supposedly remove blockages of a hypothesized substance “Qi.” Scientific research has shown that healing is not by manipulating Qi but rather by neuroelectric stimulation for the gene expression of neuropeptides. Needles are not necessary. Evidence-based neuroelectric acupuncture requires no metaphysical rituals. It is a simple, useful clinical tool for pain modulation and other conditions and can be easily taught to physicians.

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Menopause

Zell B, Hirata J, Marcus A, Ettinger B, Pressman A, and Ettinger KM: Diagnosis of symptomatic postmenopausal women by traditional Chinese medicine practitioners. Menopause 2000; 7:129-134.

Department of Obstetrics and Gynecology, Kaiser Permanente Medical Centers, Richmond, California 94801-2565, USA.

OBJECTIVE: To learn more about the way that practitioners of traditional Chinese medicine (TCM) diagnose women who have menopausal symptoms. DESIGN: We assembled a cohort of 23 postmenopausal women who had hot flushes and were otherwise healthy. Each woman was examined independently by nine practitioners of TCM on the same day. Examination consisted of medical history and physical examination. Diagnoses were recorded and counted. RESULTS: The most frequent diagnosis made by the practitioners of TCM was kidney yin deficiency, which was the diagnosis made after 168 of 207 visits (81%); 23 women seen by nine TCM practitioners. Practitioners showed good agreement regarding presence of kidney yin deficiency: in 12 women (52%), this diagnosis was made by eight of nine practitioners; in 16 women (70%), seven of nine practitioners made this diagnosis; and in all 23 women (100%), at least five of nine practitioners made this diagnosis. CONCLUSIONS: Practitioners of TCM who diagnose postmenopausal women with vasomotor symptoms are likely to make a diagnosis that includes kidney yin deficiency.

Seidl MM, Stewart DE: Alternative treatments for menopausal symptoms: Qualitative study of women’s experiences. Canadian Family Physician 1998; 44:1271-1276.

Toronto Hospital.

OBJECTIVE: To describe women’s experiences with alternative treatments for symptoms attributed to menopause. DESIGN: Descriptive qualitative study. SETTING: Personal interviews and focus groups were conducted in private rooms at the Toronto Hospital; telephone interviews were conducted at mutually convenient times. PARTICIPANTS: Thirteen perimenopausal women with a mean age of 52.6 +/- 2.6 years who were experiencing symptoms attributed to menopause and were using alternative therapies participated in the study. METHOD: Women using alternative therapies for menopausal symptoms were recruited via posted notices and were screened over the telephone. Data were collected during semistructured personal interviews, telephone interviews, and a focus group. All interviews were audiotaped, transcribed, and mailed to participants for verification. Recruitment continued until theme saturation was reached. MAIN FINDINGS: Because of their “natural” origin, the women perceived alternative treatments to be safe and considered them somewhat effective. Factors influencing use of alternative therapies included personal control over health, confidence in advice from nonphysicians, perceived pressure from physicians to use hormone replacement therapy, and physicians’ disinterest and frequently negative attitudes toward alternatives. CONCLUSION: Personal control was a central issue. Helping women during their menopausal years feel they have some control over their health, including their informed choice of treatments, might help them to trust their physicians more and to feel more confident in their ultimate treatment decisions, which might include improvements in health behavior.

Seidle MM, Stewart DE: Alternative treatment for menopausal symptoms: Systematic review of scientific and lay literature. Canadian Family Physician 1998; 44:1299-1308.

Toronto Hospital.

OBJECTIVE: To review the scientific literature on common alternative remedies for treatment of symptoms attributed to menopause and to contrast this with available lay literature. QUALITY OF EVIDENCE: Scientific articles were identified by searching MEDLINE, CINAHL, and HEALTH databases from 1966 to mid-1997 for English-language articles. More than 200 references were reviewed; 85 were selected for citation based on specific reference to alternative medicine for symptoms commonly attributed to menopause (e.g., hot flashes), to the effects of changing estrogen levels (e.g., irregular menses, vaginal dryness), and to reported side effects of the treatments. MAIN FINDINGS: The scientific literature was categorized under the headings nutritional supplements, herbal remedies, homeopathic remedies, and physical approaches. Some scientific evidence of the safety and efficacy of alternative treatments during menopause was uncovered, with the strongest evidence emerging in favour of phytoestrogens, which occur in high concentrations as isoflavones in soy products. CONCLUSIONS: In available controlled studies, the strongest data support phytoestrogens for their role in diminishing menopausal symptoms related to estrogen deficiency and for possible protective effects on bones and the cardiovascular system. Randomized controlled trials, standardization of dosage, and accurate safety and efficacy labeling are required to ensure proper use of alternative remedies.

Popivanov P: Menopausal indices as criteria for the effectiveness of acupuncture treatment of the climacteric syndrome (preliminary report). Vutreshni Bolesti 1983; 22:110-113.

Ten female patients with manifested climacteric syndrome (CS) were treated by acupuncture according to the traditional east methodology, the basic therapy making use of the points—Nai-Guan, Gun-Sun, Ha-Gu and Zsu-San-Li and for the determination of the severity of CS and the effect of its treatment—five of the most often applied menopause indices (MI) in the hormonal treatment of CS were used. Copperman, Blatt—modification of Neugarten and Kreins: Jones, Marshall and Nordin: Wenderlein and Striker. The favorable clinical results observed from the acupuncture treatment, determined by MI, are similar to the results, reported by the authors, making use of MI in the hormonal treatment of CS. That provided grounds to admit that they are suitable criteria also for the objectivization of the effect of the acupuncture treatment of climacteric syndrome.

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Neck Pain

Kjellman GV, Skargren El, Oberg BE: A critical analysis of randomized clinical trials on neck pain and treatment efficacy: a review of the literature. Scandinavian Journal of Rehabilitation Medicine 1999; 31:139-152.

Department of Neuroscience and Locomotion, Faculty of Health Sciences, Linköping University, Sweden.

The efficacy of physiotherapy or chiropractic treatment for patients with neck pain was analysed by reviewing 27 randomised clinical trials published 196-1995. Three different methods were employed: systematic analyses of; methodological quality; comparison of effect size; analysis of inclusion criteria, intervention and outcome according to The Disablement Process model. The quality of most of the studies was low; only one-third scored 50 or more of a possible 100 points. Positive outcomes were noted for 18 of the investigations, and the methodological quality was high in studies using electromagnetic therapy, manipulation, or active physiotherapy. High methodological quality was also noted in studies with traction and acupuncture, however, the interventions had either no effect or a negative effect on outcome. Pooling data and calculation of effect size showed that treatments used in the studies were effective for pain, range of motion, and activities of daily living. Inclusion criteria, intervention, and outcome were based on impairment in most of the analysed investigations. Broader outcome assessments probably would have revealed relationships between treatment effect and impairment, functional limitation and disability.

White AR, Ernst E: A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology (Oxford) 1999; 38:143-147.

Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK.

OBJECTIVE: To establish whether there is evidence for or against the efficacy of acupuncture in the treatment of neck pain. METHODS: A systematic literature review was undertaken of studies that compared needle or laser acupuncture with a control procedure for the treatment of neck pain. Two reviewers independently extracted data concerning study methods, quality and outcome. RESULTS: Overall, the outcomes of 14 randomized controlled trials were equally balanced between positive and negative. Acupuncture was superior to waiting-list in one study, and either equal or superior to physiotherapy in three studies. Needle acupuncture was not superior to indistinguishable sham control in four out of five studies. Of the eight high-quality trials, five were negative. CONCLUSIONS: In conclusion, the hypothesis that acupuncture is efficacious in the treatment of neck pain is not based on the available evidence from sound clinical trials. Further studies are justified.

Giles LGF, Muller R: Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of Manipulative & Physiological Therapeutics 1999; 22:376-381.

National Unit for Multidisciplinary Studies of Spinal Pain, Townsville General Hospital, Queensland, Australia.

OBJECTIVE: To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes. DESIGN: Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. SETTING: Specialized spinal pain syndrome out-patient unit at Townsville General Hospital, Queensland, Australia. SUBJECTS: Seventy-seven patients (without contraindication to manipulation or medication) were recruited. INTERVENTIONS: One of three separate, clearly defined intervention protocols: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation. MAIN OUTCOME MEASURES: Main outcome measures were changes (4 weeks vs. initial visit) in the scores of the (1) Oswestry Back Pain Disability Index, (2) Neck Disability Index, and (3) three visual analogue scales of local pain intensity. RESULTS: Randomization was successful. After a median intervention period of 30 days, spinal manipulation was the only intervention that achieved statistically significant improvements (all expressed as percentages of the original scores) with (1) a reduction of 30.7% on the Oswestry scale, (2) an improvement of 25% on the neck disability index, and (3) reductions on the visual analogue scale of 50% for low back pain, 46% for upper back pain, and 33% for neck pain (all P<.001). Neither of the other interventions showed any significant improvement on any of the outcome measures. CONCLUSIONS: The consistency of the results provides, in spite of several discussed shortcomings of this pilot study, evidence that in patients with chronic spinal pain syndromes spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.

David J, Modi S, Aluko AA, Robertshaw C, Farebrother J: Chronic neck pain: a comparison of acupuncture treatment and physiotherapy. British Journal of Rheumatology 1998; 37:1118-1122

Royal Berkshire Hospital NHS Trust and University of Reading.

OBJECTIVE: To evaluate the effectiveness of acupuncture, as compared with physiotherapy, in the management of chronic neck pain. DESIGN: Seventy adult patients with non-inflammatory neck pain of >6 weeks duration and with no abnormal neurology were randomly assigned to receive either of the treatments. Thirty-five patients were included in each group. OUTCOME MEASURES: Pain by visual analogue scale and neck pain questionnaire, improvement in range of movement of neck relative to baseline, and well-being (general health questionnaire). Measurements were recorded at the start of treatment, at 6 weeks and at 6 months. RESULTS: Both treatment groups improved in all criteria. Acupuncture was slightly more effective in patients who had higher baseline pain scores. CONCLUSIONS: Both acupuncture and physiotherapy are effective forms of treatment. Since an untreated control group was not part of the study design, the magnitude of this improvement cannot be quantified.

Petrie JP, Hazleman BL: A controlled study of acupuncture in neck pain. British Journal of Rheumatology 1986; 25:271-275.

Twenty-five out-patients with chronic neck pain participated in a prospective, randomized trial of acupuncture versus placebo transcutaneous nerve stimulation. A single-blind, non-cross-over design incorporated several outcome measures in an attempt to determine any particular facet of pain that responded to acupuncture. No significant difference between the two treatments was found either post-treatment or at follow-up. Whilst the small population studied limits the conclusions that may be drawn, these findings suggest that acupuncture may have no greater effect than that of a powerful placebo.

Petrie JP, Langley GB: Acupuncture in the treatment of chronic cervical pain: a pilot study. Clinical & Experimental Rheumatology 1983; 1:333-336.

Thirteen patients with neck pain of at least two years’ duration participated in the study. Patients were randomly assigned to either an acupuncture group or a placebo TNS (transcutaneous nerve stimulation) group. Initial pain scores revealed no significant difference between the groups with respect to pain severity. Patients were treated twice weekly for four weeks, at the end of which pain relief was measured using a simple descriptive scale. Even though an attempt was made to maximize the effect of placebo TNS using strong verbal suggestion, acupuncture still proved superior to placebo in the relief of cervical pain (p less than 0.01). The implications of these findings are discussed.

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Osteoarthritis

Ernst E: Acupuncture as a symptomatic treatment of osteoarthritis. A systematic review. Scandinavian Journal of Rheumatology 1997; 26: 444-447.

Department of Complementary Medicine, University of Exeter, U.K.

Acupuncture is a popular complementary treatment for osteoarthritis. In order to define its effectiveness, a systematic review of the literature was undertaken. Independent literature searches identified eleven studies of acupuncture for osteoarthritis. Their results are highly contradictory. Most trials suffer from methodological flaws. The most rigorous studies suggest that acupuncture is not superior to sham-needling in reducing pain of osteoarthritis: both alleviate symptoms to roughly the same degree. This could either mean sham-needling has similar specific effects as acupuncture or that both methods are associated with considerable non-specific effects. Future research should clarify which explanation applies.

Takeda W, Wessel J: Acupuncture for the treatment of pain of osteoarthritic knees. Arthritis Care & Research 1994; 7:118-122.

OBJECTIVE. The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis (OA) of the knee. METHODS. Forty subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and randomly assigned to either the experimental (real acupuncture) or control (sham acupuncture) groups. Subjects were treated three times per week for 3 weeks and evaluated at three test sessions. Outcome measures were: 1) the Pain Rating Index of the McGill Pain Questionnaire, 2) the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at four sites at the knee. RESULTS. The analyses of variance showed that both real and sham acupuncture significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups. CONCLUSIONS. Acupuncture is not more effective than sham acupuncture in the treatment of OA pain.

Fargas-Babjak AM, Pomeranz B, Rooney PJ: Acupuncture-like stimulation with codetron for rehabilitation of patients with chronic pain syndrome and osteoarthritis. Acupuncture & Electro-Therapeutics Research 1992; 17:95-105.

Department of Anaesthesia, McMaster University, Hamilton, Ontario, Canada.

Acupuncture is one of the oldest healing methods which is used in traditional medicine. In the modern medicine, we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. A number of modern technological changes are being applied to replace, or modify, the classical needle treatment. Among many modalities used today is the novel addition in Transcutaneous Electrical Nerve Stimulation (TENS) called CODETRON which delivers acupuncture-like stimulation in a random order. CODETRON was developed by a Canadian Scientist and had been evaluated in a clinical trial in a multidisciplinary pain clinic on patients who came for acupuncture therapy over a period of two years. Indications, effectiveness and experiences with this form of treatment are presented. In addition, results obtained from a six week double-blind randomized placebo controlled pilot trial of osteoarthritis of the hip/knee with CODETRON which was conducted later. The results were highly suggestive of the beneficial effect of this nonhabituating mode of therapy and confirmed our initial uncontrolled trial results.

Fargas-Babjak AM, Pomeranz B, Rooney PJ: Acupuncture-like stimulation with codetron for rehabilitation of patients with chronic pain syndrome and osteoarthritis. Acupuncture & Electro-Therapeutics Research 1992; 17:95-105.

Department of Anaesthesia, McMaster University, Hamilton, Ontario, Canada.

Acupuncture is one of the oldest healing methods which is used in traditional medicine. In the modern medicine, we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. A number of modern technological changes are being applied to replace, or modify, the classical needle treatment. Among many modalities used today is the novel addition in Transcutaneous Electrical Nerve Stimulation (TENS) called CODETRON which delivers acupuncture-like stimulation in a random order. CODETRON was developed by a Canadian Scientist and had been evaluated in a clinical trial in a multidisciplinary pain clinic on patients who came for acupuncture therapy over a period of two years. Indications, effectiveness and experiences with this form of treatment are presented. In addition, results obtained from a six week double-blind randomized placebo controlled pilot trial of osteoarthritis of the hip/knee with CODETRON which was conducted later. The results were highly suggestive of the beneficial effect of this nonhabituating mode of therapy and confirmed our initial uncontrolled trial results.

Gaw AC, Chang LW, Shaw L-C: Efficacy of acupuncture on osteoarthritic pain. A controlled, double-blind study. New England Journal of Medicine 1975; 293:375-378.

Forty patients, randomly assigned to an experimental and a control group, participated in a double-blind study to assess the effectiveness of acupuncture in reducing chronic pain associated with osteoarthritis. The experimental group received treatment at standard acupuncture points, and the control group at placebo points. Analysis before and after treatment showed a significant (P less than 0.05) improvement in tenderness and subjective report of pain in both groups as evaluated by two independent observers and in activity by one observer. Comparison of responses to treatment between the two groups showed no significant (P greater than 0.05) difference. Thus, both experimental and control groups showed a reduction in pain after the treatments. These results may reflect the natural course of illness, and various attitudinal and social factors.

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Pain – General

Berman BM et al. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee. A randomized controlled trial. Ann Intern Med 2004;141:901-910

University of Maryland School of Medicine, Baltimore, Maryland 21207, USA.

BACKGROUND: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal. OBJECTIVE: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. DESIGN: Randomized, controlled trial. SETTING: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. PATIENTS: 570 patients with osteoarthritis of the knee (mean age [+/-SD], 65.5 +/- 8.4 years). INTERVENTION: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks. MEASUREMENTS: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02). LIMITATIONS: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis. CONCLUSIONS: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

Mannheimer et al. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005;142:651

University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland 21207, USA.

BACKGROUND: Low back pain limits activity and is the second most frequent reason for physician visits. Previous research shows widespread use of acupuncture for low back pain. PURPOSE: To assess acupuncture’s effectiveness for treating low back pain. DATA SOURCES: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. STUDY SELECTION: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. DATA EXTRACTION: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. DATA SYNTHESIS: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. The principal [correction] measure of effect size was the standardized mean difference, since the trials assessed the same outcome but measured it in various ways. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture’s short-term effectiveness compared with most other therapies. LIMITATIONS: The quantity and quality of the included trials varied. CONCLUSIONS: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

Molsberger AF et al. Does acupuncture improve the orthopedic management of chronic low back pain? – A randomized, blinded, controlled trial with 3 months follow-up. Pain 2002;99:579-587

Orthopedic Surgery and Research, Kasernenstr 1b, 40213, Düsseldorf, Germany.

This prospective, randomised controlled trial, with three parallel groups, patient and observer blinded for verum and sham acupuncture and a follow up of 3 months raises the question: “Does a combination of acupuncture and conservative orthopedic treatment improve conservative orthopedic treatment in chronic low back pain (LBP). 186 in-patients of a LBP rehabilitation center with a history of LBP greater or = 6 weeks, VAS greater or= 50mm, and no pending compensation claims, were selected; for the three random group 4 weeks of treatment was applied. 174 patients met the protocol criteria and reported after treatment, 124 reported after 3 months follow up. Patients were assorted 4 strata: chronic LBP, less or = 0.5 years, 0.5-2 years, 2-5 years, greater or = 5 years. Analysis was by intention to treat. Group 1 (Verum+COT) received 12 treatments of verum acupuncture and conservative orthopedic treatment (COT). Group 2 (Sham+COT) received 12 treatments of non-specific needling and COT. Group 3 (nil+COT) received COT alone. Verum- and Sham acupuncture were blinded against patient and examiner. The primary endpoints were pain reduction greater or = 50% on VAS 3 months after the end of the treatment protocol. Secondary endpoints were pain reduction greater or = 50% on VAS and treatment efficacy on a four-point box scale directly after the end of the treatment protocol and treatment efficacy after 3 months. In the whole sample a pain relief of greater or = 50% on VAS was reported directly after the end of treatment protocol: Verum+COT 65% (95%CI 51-77%), Sham+COT 34% (95%ci 22-49%), nil+COT 43% (95%ci 29-58%) - results are significant for Verum+COT over Sham+COT (P less or = 0.02). The results after 3 months are: Verum+COT 77% (95%ci 62-88%), Sham+COT 29% (95%ci 16-46%), nil+Cot 14% (95%ci 4-30%) - effects are significant for Verum+COT over Sham+COT (P less or = 0.001) and for Verum+COT over nil+COT (P<0.001). No difference was found in the mobility of the patients nor in the intake of NSAID diclofenac. Our conclusion is that acupuncture can be an important supplement of conservative orthopedic treatment in the management of chronic LBP.

Carlsson C, Sjölund B. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clinic J Pain; 2001;17(4): 296-305.

Department of Rehabilitation, Lund University Hospital, Sweden. .(JavaScript must be enabled to view this email address)

OBJECTIVE: The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of chronic low back pain. DESIGN: A blinded placebo-controlled study with an independent observer. The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Subjects were examined and monitored by an investigator who was blinded to the treatment given. SETTING: A tertiary-level pain clinic at a Swedish university hospital. PATIENTS: Fifty consecutive patients (33 women, 17 men; mean age, 49.8 years) with chronic low back pain (mean pain duration, 9.5 years) and without rhizopathy or history of acupuncture treatment were included in the study. INTERVENTIONS: Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer. OUTCOME MEASURES: The independent observer made a global assessment of the patients 1, 3, and 6 months after treatment. The patients kept pain diaries to score pain intensity twice daily, analgesic intake, and quality of sleep daily, and activity level weekly. RESULTS: At the 1-month independent assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05). At the 6-month follow-up assessment, 14 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05). A significant decrease in pain intensities occurred at 1 and 3 months in the acupuncture groups compared with the placebo group. There was a significant improvement in return to work, quality of sleep, and analgesic intake in subjects treated with acupuncture. CONCLUSIONS: The authors found a long-term pain-relieving effect of needle acupuncture compared with true placebo in some patients with chronic nociceptive low back pain.

Hsieh LL et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ 2006;332:696

Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

OBJECTIVE: To evaluate the effectiveness of acupressure in terms of disability, pain scores, and functional status. DESIGN: Randomised controlled trial. SETTING: Orthopaedic clinic in Kaohsiung, Taiwan. PARTICIPANTS: 129 patients with chronic low back pain. INTERVENTION: Acupressure or physical therapy for one month. MAIN OUTCOME MEASURES: Self administered Chinese versions of standard outcome measures for low back pain (primary outcome: Roland and Morris disability questionnaire) at baseline, after treatment, and at six month follow-up. RESULTS: The mean total Roland and Morris disability questionnaire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score (- 3.8, 95% confidence interval - 5.7 to - 1.9) or mean change from the baseline (- 4.64, - 6.39 to - 2.89). Acupressure conferred an 89% (95% confidence interval 61% to 97%) reduction in significant disability compared with physical therapy. The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up. Statistically significant differences also occurred between the two groups for all six domains of the core outcome, pain visual scale, and modified Oswestry disability questionnaire after treatment and at six month follow-up. CONCLUSIONS: Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status. The benefit was sustained for six months.

Vickers AJ et al. Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess 2004;294:2118

Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, New York, USA.

OBJECTIVES: To determine the effects of a policy of using acupuncture, compared with a policy of avoiding acupuncture, on headache in primary care patients with chronic headache disorders. The effects of acupuncture on medication use, quality of life, resource use and days off sick in this population and the cost-effectiveness of acupuncture were also examined. DESIGN: Randomised, controlled trial. SETTING: General practices in England and Wales. PARTICIPANTS: The study included 401 patients with chronic headache disorder, predominantly migraine. INTERVENTIONS: Patients were randomly allocated to receive up to 12 acupuncture treatments over 3 months or to a control intervention offering usual care. MAIN OUTCOME MEASURES: Outcome measures included headache score; assessment of Short Form 36 (SF-36) health status and use of medication at baseline, 3 months and 12 months; assessment of use of resources every 3 months; and assessment of incremental cost per quality-adjusted life-year (QALY) gained. RESULTS: Headache score at 12 months, the primary end-point, was lower in the acupuncture group than in controls. The adjusted difference between means was 4.6. This result was robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year. SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication, made 25% fewer visits to GPs and took 15% fewer days off sick. Total costs during the 1-year period of the study were on average higher for the acupuncture group than for controls because of the acupuncture practitioners’ costs. The mean health gain from acupuncture during the year of the trial was 0.021 QALYs, leading to a base-case estimate of GBP9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial. CONCLUSIONS: The study suggests that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. It is relatively cost-effective compared with a number of other interventions provided by the NHS. Further studies could examine the duration of acupuncture effects beyond 1 year and the relative benefit to patients with migraine with compared to tension-type headache. Trials are also warranted examining the effectiveness and cost-effectiveness of acupuncture in patients with headache receiving more aggressive pharmacological management.

Vas J et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomized controlled trial. BMJ 2004;329:1216

Pain Treatment Unit, Centro de Salud Dos Hermanas A (Distrito Sanitario Sevilla-Sur), 41700 Dos Hermanas, Spain.

OBJECTIVES: To analyse the efficacy of acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee, with respect to pain relief, reduction of stiffness, and increased physical function during treatment; modifications in the consumption of diclofenac during treatment; and changes in the patient’s quality of life. DESIGN: Randomised, controlled, single blind trial, with blinded evaluation and statistical analysis of results. SETTING: Pain management unit in a public primary care centre in southern Spain, over a period of two years. PARTICIPANTS: 97 outpatients presenting with osteoarthritis of the knee. INTERVENTIONS: Patients were randomly separated into two groups, one receiving acupuncture plus diclofenac (n = 48) and the other placebo acupuncture plus diclofenac (n = 49). MAIN OUTCOME MEASURES: The clinical variables examined included intensity of pain as measured by a visual analogue scale; pain, stiffness, and physical function subscales of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index; dosage of diclofenac taken during treatment; and the profile of quality of life in the chronically ill (PQLC) instrument, evaluated before and after the treatment programme. RESULTS: 88 patients completed the trial. In the intention to treat analysis, the WOMAC index presented a greater reduction in the intervention group than in the control group (mean difference 23.9, 95% confidence interval 15.0 to 32.8) The reduction was greater in the subscale of functional activity. The same result was observed in the pain visual analogue scale, with a reduction of 26.6 (18.5 to 34.8). The PQLC results indicate that acupuncture treatment produces significant changes in physical capability (P = 0.021) and psychological functioning (P = 0.046). Three patients reported bruising after the acupuncture sessions. CONCLUSIONS: Acupuncture plus diclofenac is more effective than placebo acupuncture plus diclofenac for the symptomatic treatment of osteoarthritis of the knee.

Witt C et al. Acupuncture in patients with osteoarthritis of the knee: a randomized controlled trial. Lancet 2005;366:136

Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Centre, Berlin, Germany.

BACKGROUND: Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee. METHODS: Patients with chronic osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat. RESULTS: 294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26.9 (SE 1.4) in the acupuncture group, 35.8 (1.9) in the minimal acupuncture group, and 49.6 (2.0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture -8.8, [95% CI -13.5 to -4.2], p=0.0002; acupuncture vs waiting list -22.7 [-27.5 to -17.9], p<0.0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0.08). INTERPRETATION: After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.

Sprott H, Franke S, Kluge H, et al. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int 1998;18(1):35-6.

The lack of objective parameters makes the measurement of pain and the efficacy of pain treatment in patients with chronic pain very difficult. We performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. The parameters corresponded to patients’ self-report. Twenty-nine fibromyalgia patients as defined by ACR-criteria (25 women, 4 men) with a mean age of 48.2 +/- 2.0 years and a mean disease duration of 6.1 +/- 1.0 years participated in the study. Pain levels and positive tender points were assessed using the visual analogue scale (VAS, i.e., range 0-100 mm) and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0 +/- 3.4 mm before therapy to 34.5 +/- 4.3 mm after therapy (P < 0.001). Dolorimetry revealed a decreased number of tender points after therapy from 16.0 +/- 0.6 to 11.8 +/- 1.0, P < 0.01. Serotonin levels decreased from 715.8 +/- 225.8 micrograms/10(12) platelets to 352.4 +/- 47.9 micrograms/10(12) platelets (P < 0.01), whereas the serum concentration increased from 134.0 +/- 14.3 ng/ml to 171.2 +/- 14.6 ng/ml (P < 0.01). Substance P levels in serum increased from 43.4 +/- 3.5 pg/ml to 66.9 +/- 8.8 pg/ml (P < 0.01). Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS and dolorimetry. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia.

Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am Feb 2000;26(1):103-15, ix-x.

Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, USA.

Individuals with rheumatic disorders, particularly those with more severe, chronic conditions, are likely to be frequent users of complementary and alternative medical therapies. Although large-scale clinical trials have yet to be conducted, there is moderately strong evidence that acupuncture may be effective for treating both osteoarthritis and fibromyalgia. The utility of acupuncture in treating rheumatoid arthritis has not been demonstrated in large, randomized controlled trials. Physicians who treat patients with rheumatic conditions should become knowledgeable about the literature on both the effectiveness of acupuncture for these conditions as well as its potential to cause adverse side effects in particular patient groups.

Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med July 5, 2005;143(1):10-9.

The Group Health Cooperative Center for Health Studies, and University of Washington, Seattle, Washington, USA.

BACKGROUND: Fibromyalgia is a common chronic pain condition for which patients frequently use acupuncture. OBJECTIVE: To determine whether acupuncture relieves pain in fibromyalgia. DESIGN: Randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group. SETTING: Private acupuncture offices in the greater Seattle, Washington, metropolitan area. PATIENTS: 100 adults with fibromyalgia. INTERVENTION: Twice-weekly treatment for 12 weeks with an acupuncture program that was specifically designed to treat fibromyalgia, or 1 of 3 sham acupuncture treatments: acupuncture for an unrelated condition, needle insertion at nonacupoint locations, or noninsertive simulated acupuncture. MEASUREMENTS: The primary outcome was subjective pain as measured by a 10-cm visual analogue scale ranging from 0 (no pain) to 10 (worst pain ever). Measurements were obtained at baseline; 1, 4, 8, and 12 weeks of treatment; and 3 and 6 months after completion of treatment. Participant blinding and adverse effects were ascertained by self-report. The primary outcomes were evaluated by pooling the 3 sham-control groups and comparing them with the group that received acupuncture to treat fibromyalgia. RESULTS: The mean subjective pain rating among patients who received acupuncture for fibromyalgia did not differ from that in the pooled sham acupuncture group (mean between-group difference, 0.5 cm [95% CI, -0.3 cm to 1.2 cm]). Participant blinding was adequate throughout the trial, and no serious adverse effects were noted. LIMITATIONS: A prescription of acupuncture at fixed points may differ from acupuncture administered in clinical settings, in which therapy is individualized and often combined with herbal supplementation and other adjunctive measures. A usual-care comparison group was not studied. CONCLUSION: Acupuncture was no better than sham acupuncture at relieving pain in fibromyalgia.

Ho KY, Jones L, Gan TJ. The effect of cultural background on the usage of complementary and alternative medicine for chronic pain management. Pain Physician. 2009 May-Jun;12(3):685-8. (2009)

Chronic pain is a debilitating problem with significant impact on healthcare utilization in the US. OBJECTIVE: The aim of our study was to identify differences in the characteristics of usage of CAM for chronic pain control among several ethnic groups. DESIGN: We recruited 92 consecutive patients seeking treatment at the pain clinic and interviewed them using a questionnaire. RESULTS: The most common pain complaint was back pain (55.4%) and the mean pain duration for all chronic pain problems was 9.8 years. Approximately 81% of respondents were using or have used CAM before. The commonest CAM used by patients in our study included massage therapy, spiritual healing as well as the consumption of mineral and vitamin supplements. Sixty-three percent of them were satisfied with CAM treatment compared to 56% of patients who were satisfied with prescription therapy. However, there was no difference in the use of CAM among the different ethnic groups (P > 0.05). CONCLUSION: Our study demonstrates that CAM is used very frequently in patients with chronic pain. However, it did not show any ethnic or racial differences in CAM utilization.

Sun Y, Gan TJ, Dubose JW, Habib AS. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008 Aug;101(2):151-60. (2008)

Duke University Medical Center, Department of Anesthesiology, Box 3094, Durham, NC 27710, USA.

OBJECTIVE: The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache. METHODS: We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods. RESULTS: Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17). CONCLUSION: Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.

Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesth Analg. 2004 Oct;99(4):1070-5, table of contents. (2004)

Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. .(JavaScript must be enabled to view this email address)

In this study we evaluated the efficacy of electro-acupoint stimulation, ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV). Patients undergoing major breast surgery under general anesthesia were randomized into active electro-acupoint stimulation (A), ondansetron 4 mg IV (O), or sham control (placement of electrodes without electro-acupoint stimulation; placebo [P]). The anesthetic regimen was standardized. The incidence of nausea, vomiting, rescue antiemetic use, pain, and patient satisfaction with management of PONV were assessed at 0, 30, 60, 90, 120 min, and at 24 h. The complete response (no nausea, vomiting, or use of rescue antiemetic) was significantly more frequent in the active treatment groups compared with placebo both at 2 h (A/O/P = 77%/64%/42%, respectively; P = 0.01) and 24 h postoperatively (A/O/P = 73%/52%/38%, respectively; P = 0.006). The need for rescue antiemetic was less in the treatment groups (A/O/P = 19%/28%/54%; P = 0.04). Specifically, the incidence and severity of nausea were significantly less in the A group compared with the other groups, and in the O group compared with the P group (A/O/P = 19%/40%/79%, respectively). The A group experienced less pain in the postanesthesia care unit, compared with the O and P groups. Patients in the treatment groups were more satisfied with their management of PONV compared with placebo. When used for the prevention of PONV, electro-acupoint stimulation or ondansetron was more effective than placebo with greater degree of patient satisfaction, but electro-acupoint stimulation seems to be more effective in controlling nausea, compared with ondansetron. Stimulation at P6 also has analgesic effects.

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Premenstrual Syndrome

Singh BB, Berman BM, Simpson RL, Annechild A: Incidence of premenstrual syndrome and remedy usage – a national probability sample study. Alternative Therapies in Health and Medicine 1998; 4:75-79.

Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, USA.

CONTEXT: Premenstrual syndrome is believed to affect 30% to 80% of women. Studies in various cultures have used a variety of methodologies to determine prevalence, symptom profile, and effectiveness of available treatments. This study was designed to provide information on incidence of PMS and therapies used based on a national probability sample of US women. METHOD: In 1996 a national probability sample (N = 1052) of women aged 21 to 64 years was surveyed by telephone using random digit dial methods. The survey included demographic information, questions concerning respondent knowledge of premenstrual syndrome, incidence rates of common premenstrual syndrome symptoms, and any remedies that were used to control the symptoms. RESULTS: Forty-one percent of the women responded “yes” to the question, “Do you suffer from premenstrual syndrome?” An additional 17% indicated that they experienced symptoms prior to their menstrual cycle that are commonly associated with premenstrual syndrome (e.g., pain, bloating, feeling more emotional, weight gain, food cravings), though without associating these symptoms with premenstrual syndrome explicity. The most frequently noted severe symptom was that of “[feeling] more emotional.” Of those reporting premenstrual syndrome symptoms, approximately 42% took either prescription or over-the-counter medications to relieve them. Eighty percent of the women taking any type of medication relied on over-the-counter medications. Prescription drug use for premenstrual syndrome symptoms focused on medications to control pain; hormone supplements were the second most frequently prescribed rugs. Fewer than 3% of the respondents used prescription medications. Respondents were asked to indicate whether they had used a complementary medical therapy to control symptoms. Exercise was used most frequently (18%), and acupuncture was the least frequently used. Although only a small percentage of women used complementary therapies, for most of these therapies a near-perfect concordance was found between usage and belief in efficacy. CONCLUSIONS: Women were aware of symptoms related to premenstrual syndrome more frequently than they recognized a formalized medical syndrome. Less than half of the women reporting symptoms had taken either over-the-counter or prescription drugs. Those who tried complementary therapies generally found them to be effective.

Oleson T, Flocco W: Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstetrics and Gynecology 1993; 82:906-911.

Division of Behavioral Medicine, California Graduate Institute, Los Angeles.

OBJECTIVE: To determine whether reflexology therapy—the application of manual pressure to reflex points on the ears, hands, and feet that somatotopically correspond to specific areas of the body—can significantly reduce premenstrual symptoms compared to placebo treatment. METHODS: Thirty-five women who complained of previous distress with premenstrual syndrome (PMS) were randomly assigned to be treated by ear, hand, and foot reflexology or to receive placebo reflexology. All subjects completed a daily diary, which monitored 38 premenstrual symptoms on a four-point scale. Somatic and psychological indicators of premenstrual distress were recorded each day for 2 months before treatment, for 2 months during reflexology, and for 2 months afterward. The reflexology sessions for both groups were provided by a trained reflexology therapist once a week for 8 weeks, and lasted 30 minutes each. RESULTS: Analysis of variance for repeated measures demonstrated a significantly greater decrease in premenstrual symptoms for the women given true reflexology treatment than for the women in the placebo group. CONCLUSION: These clinical findings support the use of ear, hand, and foot reflexology for the treatment of PMS.

Lewers D, Clelland JA, Jackson JR, Varner RE, Bergman J: Transcutaneous electrical nerve stimulation in the relief of primary dysmenorrhea. Physical Therapy 1989; 69:3-9.

Spain Rehabilitation Center, University of Alabama Hospitals, Birmingham 35294.

The purpose of this study was to replicate a previous study to determine the effectiveness of acupuncture-like transcutaneous electrical nerve stimulation in treating primary dysmenorrhea. Twenty-one women with dysmenorrhea received a placebo pill or 30 minutes of acupuncture-like TENS. All subjects completed two pain questionnaires before treatment; immediately posttreatment; 30, 60, 120, and 180 minutes posttreatment; and the next morning upon awakening. Each woman also participated in a separate study measuring electrical resistance at four auricular acupuncture points before and immediately after treatment. The data were analyzed with a two-factor repeated-measures analysis of variance, which revealed statistical significance over time but not for group or interaction between group and time. Results revealed an average pain relief of at least 50% immediately posttreatment, indicating that acupuncture-like TENS may be useful for dysmenorrheic pain. This study also suggests that auriculotherapy via acupressure may relieve the pain of primary dysmenorrhea.

Helms JM: Acupuncture for the management of primary dysmenorrhea. Obstetrics and Gynecology 1987; 69:51-56.

The effectiveness of acupuncture in managing the pain of primary dysmenorrhea was investigated in a randomized and controlled prospective clinical study. Forty-three women were followed for one year in one of four groups: the Real Acupuncture group was given appropriate acupuncture and the Placebo Acupuncture group was given random point acupuncture on a weekly basis for three menstrual cycles; the Standard Control group was followed without medical or acupuncture intervention; the Visitation Control group had monthly nonacupuncture visits with the project physician for three cycles. In the Real Acupuncture group, 10 of 11 (90.9%) women showed improvement; in the Placebo Acupuncture group, 4 of 11 (36.4%); in the Standard Control group, 2 of 11 (18.2%); and in the Visitation Control group 1 of 10 (10%). There was a 41% reduction of analgesic medication used by the women in the Real Acupuncture group after their treatment series, and no change or increased use of medication seen in the other groups.

Steinberger A: The treatment of dysmenorrhea by acupuncture. American Journal of Chinese Medicine 1981; 9:57-60.

Forty-eight female patients suffering from dysmenorrhea in various degrees were treated by acupuncture. Seven standard acupuncture loci were selected. Acupuncture was given only 5 times to 44 of these patients. The results were analyzed after 6 to 12 months. Although the therapy was short, limited to only 7 points and uniform, satisfactory results were found in more than 80% of the cases.

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Rheumatology & Musculoskeletal Diseases

NIH Consensus Development Panel on Acupuncture. Acupuncture. JAMA 1998; 280:1518-24.

OBJECTIVE: To provide clinicians, patients, and the general public with a responsible assessment of the use and effectiveness of acupuncture to treat a variety of conditions. PARTICIPANTS: A nonfederal, nonadvocate, 12-member panel representing the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health policy, epidemiology, statistics, physiology, biophysics, and the representatives of the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1200. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that were part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. The conference was organized and supported by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md. EVIDENCE: The literature, produced from January 1970 to October 1997, was searched through MEDLINE, Allied and Alternative Medicine, EMBASE, and MANTIS, as well as through a hand search of 9 journals that were not indexed by the National Library of Medicine. An extensive bibliography of 2302 references was provided to the panel and the conference audience. Expert speakers prepared abstracts of their own conference presentations with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in the open forum and scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel’s final revisions within a few weeks of the conference. The statement is available at http://consensus.nih.gov. CONCLUSIONS: Acupuncture as a therapeutic intervention is widely practiced in the United States. Although there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Ghoname EA, Craig WF, White PF, Ahmed HE, et al. Percutaneous electrical nerve stimulation for low back pain: A randomized crossover study. JAMA 1999;281:818-823.

Eugene McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.

CONTEXT: Low back pain (LBP) contributes to considerable disability and lost wages in the United States. Commonly used opioid and nonopioid analgesic drugs produce adverse effects and are of limited long-term benefit in the management of this patient population. OBJECTIVE: To compare the effectiveness of a novel nonpharmacologic pain therapy, percutaneous electrical nerve stimulation (PENS), with transcutaneous electrical nerve stimulation (TENS) and flexion-extension exercise therapies in patients with long-term LBP. DESIGN: A randomized, single-blinded, sham-controlled, crossover study from March 1997 to December 1997. SETTING: An ambulatory pain management center at a university medical center. PATIENTS: Twenty-nine men and 31 women with LBP secondary to degenerative disk disease. INTERVENTIONS: Four therapeutic modalities (sham-PENS, PENS, TENS, and exercise therapies) were each administered for a period of 30 minutes 3 times a week for 3 weeks. MAIN OUTCOME MEASURES: Pretreatment and posttreatment visual analog scale (VAS) scores for pain, physical activity, and quality of sleep; daily analgesic medication usage; a global patient assessment questionnaire; and Health Status Survey Short Form (SF-36). RESULTS: PENS was significantly more effective in decreasing VAS pain scores after each treatment than sham-PENS, TENS, and exercise therapies (after-treatment mean +/- SD VAS for pain, 3.4+/-1.4 cm, 5.5+/-1.9 cm, 5.6+/-1.9 cm, and 6.4+/-1.9 cm, respectively). The average +/- SD daily oral intake of nonopioid analgesics (2.6+/-1.4 pills per day) was decreased to 1.3+/-1.0 pills per day with PENS (P<.008) compared with 2.5+/-1.1, 2.2+/-1.0, and 2.6+/-1.2 pills per day with sham-PENS, TENS, and exercise, respectively. Compared with the other 3 modalities, 91 % of the patients reported that PENS was the most effective in decreasing their LBP. The PENS therapy was also significantly more effective in improving physical activity, quality of sleep, and sense of well-being (P<.05 for each). The SF-36 survey confirmed that PENS improved posttreatment function more than sham-PENS, TENS, and exercise. CONCLUSIONS: In this sham-controlled study, PENS was more effective than TENS or exercise therapy in providing short-term pain relief and improved physical function in patients with long-term LBP.

Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Acupuncture for osteoarthritis of the knee: A systematic review. Arthritis Rheum 2001;44(4);819-825.

Project LEAD, Washington, DC, USA.

OBJECTIVE: To evaluate trials of acupuncture for osteoarthritis (OA) of the knee, to assess the methodologic quality of the trials and determine whether low-quality trials are associated with positive outcomes, to document adverse effects, to identify patient or treatment characteristics associated with positive response, and to identify areas of future research. METHODS: Eight databases and 62 conference abstract series were searched. Randomized or quasi-randomized trials of all languages were included and evaluated for methodologic quality using the Jadad scale. Outcomes were pain, function, global improvement, and imaging. Data could not be pooled; therefore, a best-evidence synthesis was performed to determine the strength of evidence by control group. The adequacy of the acupuncture procedure was assessed by 2 acupuncturists trained in treating OA and blinded to study results. RESULTS: Seven trials representing 393 patients with knee OA were identified. For pain and function, there was limited evidence that acupuncture is more effective than being on a waiting list for treatment or having treatment as usual. For pain, there was strong evidence that real acupuncture is more effective than sham acupuncture; however, for function, there was inconclusive evidence that real acupuncture is more effective than sham acupuncture. There was insufficient evidence to determine whether the efficacy of acupuncture is similar to that of other treatments. CONCLUSION: The existing evidence suggests that acupuncture may play a role in the treatment of knee OA. Future research should define an optimal acupuncture treatment, measure quality of life, and assess acupuncture combined with other modalities.

Berman BM, Singh BB, Lao L, Langenberg P, et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology 1999;38:346-354.

Complementary Medicine Program, University of Maryland School of Medicine, Baltimore 21207-6697, USA.

OBJECTIVE: The purpose of this study was to investigate the efficacy of acupuncture as an adjunctive therapy to standard care for the relief of pain and dysfunction in elderly patients with osteoarthritis (OA) of the knee. METHODS: Seventy-three patients with symptomatic OA of the knee were randomly assigned to treatment (acupuncture) or standard care (control). Analysis was performed on last score carried forward to account for patients who dropped out before completion. Patients self-scored Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne indices at baseline and at 4, 8 and 12 weeks. Patients in the control group were offered acupuncture treatment after 12 weeks. The data for these patients are pooled with those from the original acupuncture group for within-group analysis. RESULTS: Patients randomized to acupuncture improved on both WOMAC and Lequesne indices compared to those who received standard treatment alone. Significant differences on total WOMAC Scale were seen at 4 and 8 weeks. There appears to be a slight decline in effect at 4 weeks after cessation of treatment (12 weeks after first treatment). No adverse effects of acupuncture were reported. CONCLUSION: These data suggest that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with OA of the knee.

Christensen BV, Iuhl IU, Vilbek H, Bulow HH, Dreijer NC, Rasmussen HF. Acupuncture treatment of severe knee osteoarthrosis. A long-term study. Acta Anaesthesiol Scand 1992;36:519-525.

Department of Anaesthesiology, Central Hospital, Nykøbing-Falster, Denmark.

PURPOSE: Acupuncture treatment of patients waiting for arthroplasty surgery. METHODS: 29 patients with a total of 42 osteoarthritic knees were randomized to two groups. Group A was treated while Group B served as a no-treatment control group. After 9 weeks Group B was treated too. Analgesic consumption, pain and objective measurements were registered. All objective measures were done by investigators who were “blinded” as to Group A & B. In the second part of the study 17 patients (26 knees) continued with treatments once a month. Registration of analgesic consumption, pain and objective measurements continued. Total study period 49 weeks. RESULTS: Comparing Group A to B there was a significant reduction in pain, analgesic consumption and in most objective measures. In Group A + B combined there was an 80% subjective improvement, and a significantly increased knee range movement - an increase mainly in the worst knees. Results were significantly better in those who had not been ill for a long time. In the second part of the study, it was shown that it was possible to maintain the improvements. CONCLUSIONS: Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery. Seven patients have responded so well that at present they do not want an operation. (USD 9000 saved per operation).

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Shoulder Pain

Dyson-Hudson TA, Shiflett SC, Kirshblum SC, Bowen JE, Druin EL: Acupuncture and Trager psychophysical integration in the treatment of wheelchair user’s shoulder pain in individuals with spinal cord injury, Archives of Physical Medicine and Rehabilitation 2001; 82: 1038-1046.

Center for Research in Complementary and Alternative Medicine, Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ 07052, USA.

OBJECTIVE: To determine the effectiveness of acupuncture and Trager Psychophysical Integration (a form of manual therapy) in decreasing chronic shoulder pain in wheelchair users with spinal cord injury (SCI). DESIGN: A prospective clinical trial, with subjects randomized to acupuncture or Trager treatment condition. Subjects served as their own controls by including a 5-week pretreatment baseline period and a 5-week posttreatment follow-up period. SETTING: Rehabilitation hospital research department. PARTICIPANTS: Eighteen subjects with chronic SCI and chronic shoulder pain who used manual wheelchairs as their primary means of mobility. INTERVENTION: Ten acupuncture or 10 Trager treatments over a 5-week period. MAIN OUTCOME MEASURES: Changes in performance-corrected Wheelchair User’s Shoulder Pain Index (PC-WUSPI) scores during baseline, treatment, and follow-up periods were assessed by using analysis of variance. RESULTS: The mean PC-WUSPI score +/- standard deviation of the 18 subjects at entry was 48.9 +/- 24.6 (range, 8.0-94). No significant change in mean PC-WUSPI scores occurred during the pretreatment baseline period. Mean PC-WUSPI scores decreased significantly during the treatment period in both the acupuncture (53.4%; 23.3 points) and Trager (53.8%; 21.7 points) treatment groups. The reduced PC-WUSPI scores were maintained in both groups throughout the 5-week posttreatment follow-up period. CONCLUSION: Acupuncture and Trager are both effective treatments for reducing chronic shoulder pain associated with functional activities in persons with SCI.

Kleinhenz J, Streitberger K, Windeler J, Gussbacher A, Mavridis G, Martin E: Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendonitis, Pain 1999; 83: 235-241.

Clinic of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.

Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from -13 to 50), the control-group improved 8.37 points (SD 14.56, range from -20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.

Peng AT, Behar S, Yue SJ: Long-term therapeutic effects of electro-acupuncture for chronic neck and shoulder pain: double-blind study, Acupuncture & Electro-Therapeutics Research 1987; 12: 37-44.

Thirty-seven patients with chronic neck and shoulder pain were treated with a series of electro-acupuncture treatments. All patients had been unresponsive to previous conventional and placebo treatments for their pain. A double blind evaluation of acupuncture results and hypnotic profiles failed to demonstrate any correlation between the two. Twenty-four or 64.9% of our patients obtained significant long term improvement. An increase in regional microcirculation by peripheral sympathetic blockade from electro-acupuncture is thought to be responsible for the tissue healing and subsequent pain relief.

Fernandes L, Berry H, Clark RJ, Bloom B, Hamilton EB: Clinical study comparing acupuncture, physiotherapy, injection, and oral anti-inflammatory therapy in shoulder-cuff lesions, Lancet 1980; 1: 208-209.

In a single-blind trial, five treatments for painful stiff shoulder were compared for a 4-week assessment period in 60 patients. The treatments were acupuncture, steroid injection with placebo and with active tolmetin sodium, physiotherapy in the form of ultrasound and ‘placebo’ physiotherapy with placebo tolmetin sodium. Objective assessment was gained by use of goniometer readings to monitor shoulder abduction. Pain was measured by visual analogue scales and by a 4-point scale. Comparative assessment was also recorded and at the end of the study a success or failure was recorded for each patient’s treatment. With very few exceptions all patients improved markedly, both in terms of the subjective and objective parameters. No differences between the treatments were detected. The incidence and severity of side-effects was low. It is suggested that the results show that the painful stiff shoulder may be a self-limiting condition and that any beneficial effect was really due to natural recovery. This is an important consideration because patients do not always receive immediate attention when referred to an out-patient department and the use of physiotherapy and acupuncture in such cases, perhaps, should be critically examined.

Moore ME, Berk SN: Acupuncture for chronic shoulder pain: an experimental study with attention to the role of placebo and hypnotic susceptibility, Annals of Internal Medicine 1976; 84: 381-384.

One half of 42 subjects treated for painful shoulders received classic acupuncture, and one half received a placebo in which the needles did not penetrate the skin. Half of each of these groups was treated in a positive setting to encourage the subject, and half in a negative setting designed to keep encouragement at a minimum. All patients were independently rated for susceptibility to hypnosis. Although range of motion did not improve, the majority of patients reported significant improvement in shoulder discomfort to a blind evaluator after treatment; placebo and acupuncture groups did not differ in this respect, however. The positive and negative settings did not affect treatment outcome. In all groups, those who were not rated as highly susceptible to hypnosis tended to fail to achieve the highest levels of relief, but such differences were not statistically significant.

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Side-effects of Cancer

Vickers AJ. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med. 1996. 89.303-311

Research Council for Complementary Medicine, London, England.

The effects of acupuncture on health are generally hard to assess. Stimulation of the P6 acupuncture point is used to obtain an antiemetic effect and this provides an excellent model to study the efficacy of acupuncture. Thirty-three controlled trials have been published worldwide in which the P6 acupuncture point was stimulated for treatment of nausea and/or vomiting associated with chemotherapy, pregnancy, or surgery. P6 acupuncture was equal or inferior to control in all four trials in which it was administered under anaesthesia; in 27 of the remaining 29 trials acupuncture was statistically superior. A second analysis was restricted to 12 high-quality randomized placebo-controlled trials in which P6 acupuncture point stimulation was not administered under anaesthesia. Eleven of these trials, involving nearly 2000 patients, showed an effect of P6. The reviewed papers showed consistent results across different investigators, different groups of patients, and different forms of acupuncture point stimulation. Except when administered under anaesthesia, P6 acupuncture point stimulation seems to be an effective antiemetic technique. Researchers are faced with a choice between deciding that acupuncture does have specific effects, and changing from ‘Does acupuncture work?’ to a set of more practical questions; or deciding that the evidence on P6 antiemesis does not provide sufficient proof, and specifying what would constitute acceptable evidence.

Shen J, et al. Electroacupuncture for Control of myeloablative chemotherapy induced Emesis: A randomized controlled trial. JAMA, 2000. 284(21):2755-2761

National Institutes of Health, Laboratory of Clinical Studies/NIAAA, Room 6 S-240, Mail Stop 1610, 10 Center Dr, Bldg 10, Bethesda, MD 20892-1610, USA.

CONTEXT: High-dose chemotherapy poses considerable challenges to emesis management. Although prior studies suggest that acupuncture may reduce nausea and emesis, it is unclear whether such benefit comes from the nonspecific effects of attention and clinician-patient interaction. OBJECTIVE: To compare the effectiveness of electroacupuncture vs minimal needling and mock electrical stimulation or antiemetic medications alone in controlling emesis among patients undergoing a highly emetogenic chemotherapy regimen. DESIGN: Three-arm, parallel-group, randomized controlled trial conducted from March 1996 to December 1997, with a 5-day study period and a 9-day follow-up. SETTING: Oncology center at a university medical center. PATIENTS: One hundred four women (mean age, 46 years) with high-risk breast cancer. INTERVENTIONS: Patients were randomly assigned to receive low-frequency electroacupuncture at classic antiemetic acupuncture points once daily for 5 days (n = 37); minimal needling at control points with mock electrostimulation on the same schedule (n = 33); or no adjunct needling (n = 34). All patients received concurrent triple antiemetic pharmacotherapy and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine). MAIN OUTCOME MEASURES: Total number of emesis episodes occurring during the 5-day study period and the proportion of emesis-free days, compared among the 3 groups. RESULTS: The number of emesis episodes occurring during the 5 days was lower for patients receiving electroacupuncture compared with those receiving minimal needling or pharmacotherapy alone (median number of episodes, 5, 10, and 15, respectively; P<.001). The electroacupuncture group had fewer episodes of emesis than the minimal needling group (P<.001), whereas the minimal needling group had fewer episodes of emesis than the antiemetic pharmacotherapy alone group (P =.01). The differences among groups were not significant during the 9-day follow-up period (P =.18). CONCLUSIONS: In this study of patients with breast cancer receiving high-dose chemotherapy, adjunct electroacupuncture was more effective in controlling emesis than minimal needling or antiemetic pharmacotherapy alone, although the observed effect had limited duration. JAMA. 2000;284:2755-2761.

King CR. Nonpharmacologic management of chemotherapy-induced nausea and vomiting. Oncol Nurs Forum 1997;24 (suppl. 7):41-48.

Special Care Consultants, Highland Hospital, Rochester, NY, USA.

PURPOSE/OBJECTIVES: To review the nonpharmacologic interventions indicated to prevent or control chemotherapy-induced nausea and vomiting. DATA SOURCES: Journal articles. DATA SYNTHESIS: Despite improvements in antiemetic drug therapy, as many as 60% of patients with cancer who are treated with antineoplastic agents experience nausea and vomiting. Anticipatory nausea and vomiting are thought to be caused by the behavioral process of classical conditioning. Most nonpharmacologic interventions that are used to prevent or control nausea and vomiting in patients with cancer are classified as behavioral interventions. Behavioral interventions involve the acquisition of adaptive behavioral skills to interrupt the conditioning cycle. CONCLUSIONS: Nonpharmacologic interventions appear to be effective in reducing anticipatory and post-treatment nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: These behavioral interventions can be effective in reducing anticipatory and post-treatment nausea and vomiting. Oncology nurses must learn these nonpharmacologic techniques and teach their patients to use them in combination with their prescribed antiemetic therapy.

Fan CF, et al. Acupressure treatment for prevention of postoperative nausea and vomiting. Anesth Analgesia 1997;84:821-825.

Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York 11219, USA.

Postoperative nausea and vomiting are still common problems after general anesthesia, especially in ambulatory surgery. Drug therapy is often complicated with central nervous system symptoms. We studied a nonpharmacological method of therapy—acupressure—at the Pericardium 6 (P.6) (Nei-Guan) meridian point. Two hundred consecutive healthy patients undergoing a variety of short surgical procedures were included in a randomized, double-blind study: 108 patients were in the acupressure group (Group 1) and 92 patients were in the control group (Group 2). Spherical beads of acupressure bands were placed at the P.6 points in the anterior surface of both forearms in Group 1 patients, while in Group 2 they were placed inappropriately on the posterior surface. The acupressure bands were placed before induction of anesthesia and were removed 6 h postoperatively. They were covered with a soft cotton wrapping to conceal them from the blinded observer who evaluated the patients for presence of nausea and vomiting and checked the order sheet for any antiemetics prescribed. In both groups, the age, gender, height, weight, and type and duration of surgical procedures were all comparable without significant statistical difference. In Group 1, only 25 of 108 patients (23%) had nausea and vomiting as compared to Group 2, in which 38 of 92 patients (41%) had nausea and vomiting (P = 0.0058). We concluded that acupressure at the P.6 (Nei-Guan) point is an effective prophylaxis for postsurgical nausea and vomiting and therefore a good alternative to conventional antiemetic treatment.

Ezzo J et al. Acupuncture point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol 2005;23:7188

JPS Enterprises, Baltimore, MD 21209, USA. .(JavaScript must be enabled to view this email address)

PURPOSE: Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. Materials and METHODS: Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model. RESULTS: Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = -0.19; 95% CI, -0.38 to -0.01; P = .03) and most severe acute nausea, but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. CONCLUSION: This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

Dibble SL, Chapman J, Mack KA, Shih A. Acupressure for nausea: results of a pilot study. Oncology Nursing Forum Feb 2000;27(1):41-7.

Institute for Health and Aging, University of California, San Francisco, USA. .(JavaScript must be enabled to view this email address)

PURPOSE/OBJECTIVES: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. DESIGN: Single-cycle, randomized clinical trial. SETTING: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. SAMPLE: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). METHODS: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. MAIN RESEARCH VARIABLES: Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. FINDINGS: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. CONCLUSIONS: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. IMPLICATIONS FOR NURSING PRACTICE: This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.

Porzio G et al. Cancer Patients’ Quality of Life: Acupuncture improved anxiety, depression, somatic and vasomotor symptoms in tamoxifen-treated women. Tumor. 2002: 88(2):128-3

Medical Oncology Unit, University of L’Aquila, Italy. .(JavaScript must be enabled to view this email address)

Fifteen patients were enrolled in a pilot study to evaluate the safety and efficacy of acupuncture for the treatment of menopausal symptoms in tamoxifen-treated patients. Patients were evaluated before treatment and after one, three and six months with the Greene Menopause Index and were treated according to the traditional Chinese medicine. Anxiety, depression, somatic and vasomotor symptoms were improved by the treatment; libido was not modified. Acupuncture seems to be safe and effective for the treatment of menopausal symptoms in women with previous breast cancer taking tamoxifen. Confirmatory studies with a larger number of patients and with a placebo-treated group are warranted.

Vickers AJ, et al. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial. BMC Palliat Care, 2005 Aug 18,4:5.

Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA. .(JavaScript must be enabled to view this email address)

BACKGROUND: Dyspnea, or shortness of breath, is a common symptom in patients with advanced cancer. Pharmacologic management is of proven benefit, but it does not help all patients. Preliminary data suggest that acupuncture can relieve dyspnea in a variety of populations, including cancer patients. We conducted a pilot study (ISRCTN89462491) preparatory to a fully powered randomized, placebo-controlled trial to determine whether acupuncture reduces dyspnea in patients with lung or breast cancer. METHODS: The study sample was comprised of forty-seven patients with lung or breast cancer presenting with dyspnea. Patients receiving symptomatic treatments were not excluded as long as no changes in management were planned during the trial. Patients were randomized to receive a single session of true or placebo acupuncture in addition to their existing dyspnea treatments. Semi-permanent acupuncture “studs” were then inserted: patients applied pressure to these studs twice a day to provide ongoing stimulation to acupuncture points. The subjective sensation of dyspnea was assessed with a 0-10 numerical rating scale immediately before and after acupuncture treatment and daily for a week thereafter. RESULTS: All but two of 47 randomized patients provided follow-up data. Dyspnea scores were slightly higher for patients receiving true versus placebo acupuncture, for both the period immediately following acupuncture treatment and for the daily one week follow-up (differences between means of 0.34, 95% C.I. -0.33, 1.02 and 0.56, 95% C.I. -0.39, 1.51). The 95% confidence interval excludes the prespecified minimum clinically significant difference of a 20% greater improvement in dyspnea for patients receiving acupuncture. CONCLUSION: The acupuncture technique used in this trial is unlikely to have effects on dyspnea importantly larger than placebo for patients with advanced cancer.

Alimi D, et al. Analgesic effect of auricular acupuncture for cancer pain: A randomized, blinded controlled trial. J Clin Oncol, 2003. Vol 21(22):4120-4126.

Pain Management Unit, INSERM, U521, Villejuif, France.

PURPOSE: During the last 30 years, auricular acupuncture has been used as complementary treatment of cancer pain when analgesic drugs do not suffice. The purpose of this study is to examine the efficacy of auricular acupuncture in decreasing pain intensity in cancer patients. PATIENTS AND METHODS: Ninety patients were randomly divided in three groups; one group received two courses of auricular acupuncture at points where an electrodermal signal had been detected, and two placebo groups received auricular acupuncture at points with no electrodermal signal (placebo points) and one with auricular seeds fixed at placebo points. Patients had to be in pain, attaining a visual analog score (VAS) of 30 mm or more after having received analgesic treatment adapted to both intensity and type of pain, for at least 1 month of therapy. Treatment efficacy was based on the absolute decrease in pain intensity measured 2 months after randomization using the VAS. RESULTS: The main outcome was pain assessed at 2 months, with the assessment at 1 month carried over to 2 months for the eight patients who interrupted treatment after 1 month. For three patients, no data were available because they withdrew from the study during the first month. Pain intensity decreased by 36% at 2 months from baseline in the group receiving acupuncture; there was little change for patients receiving placebo (2%). The difference between groups was statistically significant (P <.0001). CONCLUSION: The observed reduction in pain intensity measured on the VAS represents a clear benefit from auricular acupuncture for these cancer patients who are in pain, despite stable analgesic treatment.

Wong R, Sagar CM, Sagar SM. Integration of Chinese medicine into supportive cancer care: a modern role for an ancient tradition. Cancer Treatment Reviews 2001;27:235-246.

Department of Medicine, McMaster University, Hamilton Regional Cancer Centre, Ontario, Canada.

Recent evidence suggests that many traditional Chinese medical therapies are effective for the supportive care of cancer patients. This is a review of some of the published literature (indexed in Medline) and our own practical experience. It is not intended to be a systematic review, but does provide various levels of evidence which support further research into a developing model of integrative care. The holistic approach of Traditional Chinese Medicine (TCM) may be integrated into conventional Western Medicine to supplement deficiencies in the current biomedical model. The philosophy of TCM proposes novel hypotheses which will support the development of a science-based holistic medicine. Copyright 2001 Harcourt Publishers Ltd.

Tagliaferri M. et al. Complementary and alternative medicine in early stage breast cancer. Seminars in Oncology, Vol 28, No 1(Feb), 2001:127.

University of California at San Francisco, 94143-1714, USA.

Complementary and alternative medicine (CAM) are becoming increasingly popular in many medical situations, particularly among patients with cancer. CAM encompasses a range of modalities including dietary and vitamin supplements, mind-body approaches, acupuncture, and herbal medicines. In contrast to standard chemotherapeutic and hormonal regimens used for the adjuvant treatment of early-stage breast cancer, controlled clinical trials have generated few data on the relationship between CAM and the outcomes of recurrence or survival, or even overall quality of life and safety. The objectives of CAM treatments are manifold: the reduction of toxicities of therapy, improvement in cancer-related symptoms, enhancement of the immune system, and even a direct anticancer effect. The primary basis of CAM rests on empirical evidence and case studies, as well as theoretic physiologic effects. In some cases, laboratory or clinical data lend support to these modalities. Some types of CAM are based on ancient Oriental forms of medicine founded on centuries of experience documented through oral and written text. Nevertheless, the paucity of evidence in the clinical setting limits firm conclusions about the effectiveness or safety of most CAM approaches in breast cancer. This review will summarize the basis for the application of certain CAM modalities in the therapy of early-stage breast cancer and will highlight some of the directions of investigative work that could lead to a rational integration of CAM into conventional adjuvant therapy.

Weiger W, Smith M, Boon H, et al. Advising patients who seek complementary and alternative therapies for cancer. Annals of Internal Medicine 2002;137:899-903.

Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Many patients with cancer use complementary and alternative medical (CAM) therapies. Physicians need authoritative information on CAM therapies to responsibly advise patients who seek these interventions. This article summarizes current evidence on the efficacy and safety of selected CAM therapies that are commonly used by patients with cancer. The following major categories of interventions are covered: dietary modification and supplementation, herbal products and other biological agents, acupuncture, massage, exercise, and psychological and mind-body therapies. Two categories of evidence on efficacy are considered: possible effects on disease progression and survival and possible palliative effects. In evaluating evidence on safety, two types of risk are considered: the risk for direct adverse effects and the risk for interactions with conventional treatments. For each therapy, the current balance of evidence on efficacy and safety points to whether the therapy may be reasonably recommended, accepted (for example, dietary fat reduction in well-nourished patients with breast or prostate cancer), or discouraged (for example, high-dose vitamin A supplementation). This strategy allows the development of an approach for providing responsible, evidence-based, patient-centered advice to persons with cancer who seek CAM therapies.

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Tennis Elbow

Molsberger A, Hille E: The analgesic effect of acupuncture in chronic tennis elbow pain. British Journal of Rheumatology 1994; 33:1162-1165.

Orthopädische Klinik, Universität Düsseldorf, Germany.

The immediate analgesic effect of a single non-segmental acupuncture stimulation treatment on chronic tennis elbow pain was studied in a placebo-controlled single-blind trial completed by 48 patients. Before and after treatment, all patients were examined physically by an unbiased independent examiner. Eleven-point box scales were used [13] for pain measurement. Patients in the verum group were treated at non-segmental distal points (homolateral leg) for elbow pain following Chinese acupuncture rules, whereas patients in the placebo group were treated with placebo acupuncture avoiding penetration of the skin with an acupuncture needle. Overall reduction in the pain score was 55.8% (S = 2.95) in the verum group and 15% (S = 2.77) in the placebo group. After one treatment 19 out of 24 patients in the verum group (79.2%) reported pain relief of at least 50% (placebo group: six patients out of 24). The average duration of analgesia after one treatment was 20.2 h in the verum group (S = 21.54) and 1.4 h (S = 3.50) in the placebo group. The results are statistically significant (P < 0.01); they show that non-segmental verum acupuncture has an intrinsic analgesic effect in the clinical treatment of tennis elbow pain which exceeds that of placebo acupuncture.

Haker E, Lundeberg T: Laser treatment applied to acupuncture points in lateral humeral epicondylalgia: A double-blind study. Pain 1990; 43:243-247.

Department of Physiology II, Karolinska Institutet, Stockholm, Sweden.

Forty-nine patients suffering from lateral humeral epicondylalgia were enrolled in a double-blind study to observe the effects of Ga-As laser applied to acupuncture points. The Mid 1500 IRRADIA laser machine was used, wavelength: 904 nm, mean power output: 12 mW, peak value: 8.3 W; frequency: 70 Hz (pulse train). Localization of points: LI 10, 11, 12, Lu 5 and SJ 5. Each point was treated for 30 sec resulting in a dose of treatment of 0.36 J/point. The patients were treated 2-3 times weekly with 10 treatments in all. Follow-ups were done after 3 months and 1 year. No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow-ups.

Haker E, Lundeberg T: Acupuncture treatment in epicondylalgia: a comparative study of two acupuncture techniques. Clinical Journal of Pain 1990; 6:221-226.

Department of Physiology II, Karolinska Institutet, Stockholm, Sweden.

The purpose of this study was to compare the pain-alleviating effect of classical acupuncture with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, two to three times weekly with 10 treatments in all. Five acupuncture points were treated: LI 10, 11, 12, Lu 5, and SJ 5. After 10 treatments significant differences were observed between the groups favoring the classical acupuncture technique in relation to subjective and objective outcome. No such differences could be observed at the follow-ups after 3 months and 1 year. This study showed that classical “deep” acupuncture is superior to superficial needle insertion in the short-term symptomatic treatment of lateral epicondylalgia, but not at 3- and 12-month follow-up.

Brattberg G: Acupuncture therapy for tennis elbow. Pain 1983; 16:285-288.

Acupuncture therapy for patients suffering from tennis elbow has shown itself to be an excellent alternative to steroid injections. Twenty-one out of 34 patients who were treated with acupuncture became much better—completely free of pain. Many of them had previously been given one or more steroid injections without improvement. In a control group of 26 patients who received only steroid injections, 8 patients reported a corresponding improvement. The ancient Chinese technique adapted to Western conditions has, in the above cases, neither caused any side effects nor worsened the condition of any patient, and is well worth trying as therapy for this disabling complaint.

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Upper Respiratory Infections

Takeuchi H, Jawad MS, Eccles R: The effects of nasal massage of the “yingxiang” acupuncture point on nasal airway resistance and sensation of nasal airflow in patients with nasal congestion associated with acute upper respiratory tract infection. American Journal of Rhinology 1999; 13:77-79.

Common Cold Centre, Cardiff University, Wales, United Kingdom.

The aim of our study was to determine whether nasal massage of the “yingxiang” acupuncture point in patients with nasal congestion had any effect on nasal airway resistance (NAR) measured by posterior rhinomanometry and sensation of nasal airflow measured on a visual analog scale (VAS). Twenty patients were randomized into two groups; one group self massaged the yingxiang point for 30 seconds, while the other group acted as control group without nasal massage. NAR and VAS were measured at baseline, and at 2 and 10 minutes after massage. At the end of the study, patients were asked to score any change in their nasal congestion. There was no statistically significant difference between the two groups in percentage change in NAR or VAS from baseline at any time during the study, although the massage group showed trends toward decongestion and relief from congestion. At the end of the study, more patients in the massage group than the control group felt their nasal congestion was improved (p < 0.005). It is interesting that all three measures (NAR, VAS, and end question) showed that the nasal massage group had greater relief from nasal congestion than the control group. The results of this study, when taken together, indicate that nasal massage may provide some relief from nasal congestion and that further studies involving a larger patient population are warranted to determine whether nasal massage has a significant effect on NAR.

Davies A, Lewith G, Goddard J, Howarth P: The effect of acupuncture on nonallergic rhinitis: a controlled pilot study. Alternative Therapies in Health & Medicine 1998; 4:70-74.

University of Southampton, United Kingdom.

The purpose of this pilot project was to evaluate the immediate effects of real acupuncture compared with two placebo controls (sham acupuncture and mock transcutaneous electrical nerve stimulation) in the treatment of nonallergic rhinitis patients. These three treatments were given in a nonrandomized order to the same patients at weekly intervals. Real acupuncture showed an improvement in nasal airways resistance after treatment in 9 of 13 patients, sham acupuncture in 2 of 9, and mock transcutaneous electrical nerve stimulation in 3 of 10 patients. With the exception of improvement in a minimal cross-sectional area (measured by acoustic rhinometry) in the real acupuncture group following treatment, the outcome was not statistically significant. This pilot study raised a number of issues related to the effects of acupuncture in nonallergic rhinitis that must be addressed by a study involving more patients in which the order of treatment is randomized and the two placebo control treatments are evaluated in relation to their credibility.

Mikhireva MM, Portenko GM: Electroacupuncture in combination with surgical intervention in the treatment of patients with polypous rhinosinusitis. [Russian] Vestnik Otorinolaringologii 1990; 2:40-42.

In 36 patients with polypous rhinosinusitis the olfactory function, mucociliary transport, humoral and local immunity were investigated before and after treatment that combined surgical intervention and electric acupuncture. The points were selected on an individual basis using diagnostic data, i.e. measurement of electric conductivity of representative points. In most cases the combined treatment led to improvement of the olfactory function, mucociliary transport and local immunity. During two-year follow-up recurrent polyps were detected in 4 patients whose general health condition remained good. These observations indicate the electric acupuncture can be recommended for the combined therapy of polypous rhinosinusitis.

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Women’s Health

Cardini F. Moxibustion for Correction of Breech Presentation. JAMA 1998;280:1580-1584.

CONTEXT: Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy. OBJECTIVE: To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation. DESIGN: Randomized, controlled, open clinical trial. SETTING: Outpatient departments of the Women’s Hospital of Jiangxi Province, Nanchang, and Jiujiang Women’s and Children’s Hospital in the People’s Republic of China. PATIENTS: Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation. INTERVENTIONS: The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks’ gestation and delivery. MAIN OUTCOME MEASURES: Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery. RESULTS: The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (P<.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (P<.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group (P = .02; RR, 1.21; 95% CI, 1.02-1.43). CONCLUSION: Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.

Pei J, Strehler E, Noss U, et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and Sterility July 2005;84(1):141-7.

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy. DESIGN: Prospective controlled study. SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy. PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. INTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group. MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics. RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment. CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

Ehling D, Singer K. Gauging a Woman’s Health by her Fertility Signals: Integrating Western with Traditional Chinese Medical Observations. Altern Ther Health Med. 1999;5(6):70-83.

This article presents observations of traditional Chinese medical and Western concepts of a woman’s fertility signals. A woman of child-bearing age cycles through processes of heating and cooling and moistening and drying to make her fertile. Her fertility signals—basal body temperature, cervical fluid, and cervix changes—can be observed and charted to gauge the woman’s gynecological health as well as to avoid or enhance her chances of achieving pregnancy. Introductory information about charting fertility signals, an introduction to traditional Chinese medicine theories, and various basal body temperature charts with analysis from traditional Chinese medicine and Western medical perspectives are included.

Wang L, Cardini F, Zhao W, Regalia AL, Wade C, Forcella E, Yu J. Vitamin K acupuncture point injection for severe primary dysmenorrhea: an international pilot study. Med Gen Med. 2004 Dec 27;6(4):45.

Obstetrics & Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China.

CONTEXT: Vitamin K acupuncture point injection, a menstrual pain treatment derived from traditional Chinese medicine, has been a standard treatment in some hospitals in China since the 1980s. OBJECTIVES: To investigate the effects of vitamin K acupuncture point injection on menstrual pain in young women aged 14 to 25 from different countries and cultural backgrounds who have had unmitigated severe primary dysmenorrhea for 6 months or more. DESIGN: Prospective, observational, clinical pilot study SETTINGS: One site in China (a hospital outpatient clinic in Shanghai) and 2 sites in Italy (a hospital clinic in Milan and a private gynecology practice in Verona). INTERVENTIONS: All subjects were treated with bilateral acupuncture point injection of vitamin K on the first or second day of menstrual pain. Vitamin K3 was used in China and vitamin K4 in Italy. MAIN OUTCOME MEASURES: Pain intensity, total duration, and average intensity of menstrual distress, hours in bed, normal daily activity restrictions, and numbers of analgesic tablets taken to relieve pain were recorded before the treatment and for 4 subsequent menstrual cycles. RESULTS: Noticeable pain relief was observed 2 minutes after treatment, and subsequent pain reduction occurred at 30 minutes (P < .001). Subjects reported significantly fewer daily life restrictions, fewer hours in bed, less consumption of analgesic tablets, and lower scores of menstrual pain duration and intensity (P < .001). There were no adverse events. Some women experienced mild, self-limited pain at the injection site. CONCLUSION: Acupuncture point injection with vitamin K alleviated acute menstrual pain, and relief extended through the nontreatment follow-up cycles in this uncontrolled pilot study conducted in 2 countries. Further investigation employing controlled experimental designs is warranted.

Wyon Y, et al. Menopausal Hot Flashes: Significant decrease in numbers of hot flashes in electro-acupuncture and in superficial needling acupuncture group. Lakartidningen. 1994: Jun 8;91(23):2318-22; and Wyon Y, et al. 1995 Menopause 2:3-12.

Hälsouniversitetet, Linköping.

Vasomotor symptoms are very common among perimenopausal women, but also among orchidectomized men. The cause of the symptoms is not the low steroid concentrations per se, but probably changes in central neuropeptide activity. Twenty-four healthy women with natural menopause, suffering from hot flushes, were included in the study and randomly assigned to either of two groups, one group received treatment with electrostimulated acupuncture (EA), the other with superficial needle position (SNP) acupuncture. Treatment was given for totally of eight weeks, twice a week during the first two weeks, and then once a week for the remaining six weeks. As recorded in logbooks kept by the participants, the frequency of flushes decreased significantly by more than 50 per cent in both groups, and remained decreased in the EA group, whereas in the SNP group it increased slightly again over the three months after treatment. Values for the Kupperman Index decreased in both groups during treatment, changes still evident at three-month follow-up, whereas the self-rated general climacteric symptoms (VAS) decreased significantly in the EA group only. The PGWB (Psychological General Well-Being) index did not change significantly in either group during treatment.

Kraft K, Coulon S. Postmenopausal High Blood Pressure: Standardized Acupuncture can reduce postmenopausal complaints, but does not alter blood pressure. Forsch Komplementärmed. 1999: Apr;6(2):74-9

Medizinische Poliklinik der Universität Bonn, Deutschland.

BACKGROUND: Acupuncture according to the Chinese syndrome is often used in patients with postmenopausal complaints. Often these patients have an increased blood pressure. As experienced therapists report that acupuncture is efficient also in hypertension, our aim was to investigate whether the acupuncture used for the treatment of postmenopausal syndrome also has an effect on blood pressure. PATIENTS AND METHODS: The efficacy of a standardized acupuncture according to the Chinese syndrome was evaluated in a randomized, single-blind, placebo-controlled cross-over study with 10 postmenopausal patients with mild hypertension. Blood pressure was measured by 24-hour ambulatory blood pressure measurement. Complaints and well-being were evaluated by validated questionnaires. In addition, serum lipids and excretion of catecholamines in the 24-hour urine were measured. RESULTS: Blood pressure was altered neither by verum nor placebo acupuncture, however, complaints were significantly reduced and well-being was improved after verum treatment. The improvement lasted less than two months. Serum lipids did not change, but the excretion of normetanephrine was reduced by verum acupuncture. CONCLUSIONS: Acupuncture with a standardized combination of acupuncture points according to the Chinese syndrome can transitorily reduce postmenopausal complaints, but does not alter blood pressure or serum lipids at the same tim

Ternov K, et al. Pain relief during Labor. Analgesic use less in Acupuncture group vs Standard care group: Acupunct Electrother Res. 1998;23(1):19-26]

Department of Anesthesia and Intensive Care, University Hospitals, Malmö, Sweden.

BACKGROUND: There are few studies on acupuncture in childbirth despite the generally established analgesic effect of acupuncture treatment. METHODS: The analgesic effect of acupuncture during childbirth was assessed by comparing the need for other pain treatments (epidural analgesia using bupivacaine, pudendal nerve block, intramuscular meperidine, nitrous oxide/oxygen, intracutaneous sterile water injections) in 90 women given acupuncture (acupuncture group) with that in 90 women not given acupuncture (control group). RESULTS: 52 women (58%) in the acupuncture group and 13 (14%) in the control group managed their deliveries without further pain treatment (p < 0.001). The groups were similar with respect to age, pariety, duration of delivery, use of oxytocine and incidence of Caesarean section. Acupuncture treatment was found to have no major side effects, and 85 women (94%) given acupuncture reported that they would reconsider acupuncture in future deliveries. CONCLUSION: Acupuncture reduces the need for other methods of analgesia in childbirth.

de Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by Neiguan point acupressure. Obstetrics and Gynecology 1992;80:852-854.

Department of Obstetrics and Gynecology, Bologna University, Italy.

OBJECTIVE: To evaluate the antiemetic effect of acupressure at the Neiguan point. METHODS: Sixty women in early pregnancy were entered into a randomized, double-blind, cross-over, placebo-controlled trial. During a 12-day period, organized in four steps of 3 days each, the women were divided into two homogeneous groups to test the effectiveness of unilateral and bilateral acupressure. RESULTS: Use of acupressure resulted in a significantly lower frequency of morning sickness compared with placebo treatment. More than a 60% positive effect was found with unilateral and bilateral acupressure, compared with an approximately 30% positive effect of placebo acupressure. Changing from unilateral to bilateral pressure on the Neiguan point caused no significant statistical difference. No noteworthy side effects occurred. CONCLUSION: Acupressure on the Neiguan point relieves morning sickness.

Belluomini J, et al. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstetrics and Gynecology 1994;84:245-248.

Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco.

OBJECTIVE: To evaluate the effectiveness of acupressure in reducing nausea and vomiting of pregnancy. METHODS: Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using an acupressure point (PC-6) and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive days, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 days were used as pre-treatment scores. Beginning on the morning of the fourth day, each subject used acupressure at her assigned point for 10 minutes four times a day. Data from day 4 were discarded to allow 24 hours for the treatment to take effect. Data from days 5-7 were used to measure treatment effect. RESULTS: Sixty women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58 = 10.4, P = .0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r = 0.261, P = .044) between maternal age and severity of nausea. CONCLUSIONS: Our results indicate that acupressure at the PC-6 anatomical site is effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women.

Riordan J, Nichols F: A descriptive study of lactation mastitis in long-term breastfeeding women. Journal of Human Lactation 6:53-8, 1990

This descriptive retrospective study surveyed women attending two lactation/breastfeeding conferences about their experiences with mastitis. One-third of the sample reported having mastitis while breastfeeding their last child. Episodes of mastitis occurred most often in the first three months postpartum; however, one-third occurred after six months and nearly one-quarter occurred after one year of breastfeeding. The outer upper quadrants of both breasts were found to be the most frequent sites of infection. The incidence of mastitis in the left and right breasts did not differ. More than one-third of the respondents did not contact their physician when they developed mastitis and and nearly half never used antibiotics for the infection. All respondents reported continuing to breastfeed through the infection. Mothers reported that the following factors (in order of importance) preceded their mastitis: fatigue, stress, plugged duct, change in the number of feedings, engorgement/stasis, an infection in the family, breast trauma and poor diet. Study findings indicate that the most important teaching areas for preventing mastitis are management and control of stress and fatigue.

Walker EM, Rodriguez AI, Kohn B, et al. Acupuncture Versus Venlafaxine for the Management of Vasomotor Symptoms in Patients With Hormone Receptor–Positive Breast Cancer: A Randomized Controlled Trial. J Clinic Oncology, 10.1200/JCO.2009.23.5150

From the Department of Radiation Oncology, Henry Ford Hospital, Detroit; Center for Integrative Wellness, Henry Ford Health System, Southfield; Center for Integrative Medicine, Henry Ford Health System, Northville; Waterford Center for Integrative Medicine, Waterford; Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit; and Michigan Acupuncture, Novi, MI. To whom correspondence should be addressed. E-mail: .(JavaScript must be enabled to view this email address)
PURPOSE: Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment in conventional breast cancer care. Hormone replacement therapy is contraindicated in patients with breast cancer. Venlafaxine (Effexor), the therapy of choice for these symptoms, has numerous adverse effects. Recent studies suggest acupuncture may be effective in reducing vasomotor symptoms in menopausal women. This randomized controlled trial tested whether acupuncture reduces vasomotor symptoms and produces fewer adverse effects than venlafaxine.
PATIENTS AND METHODS: Fifty patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment. Health outcomes were measured for up to 1 year post-treatment.
RESULTS: Both groups exhibited significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, including significant improvements in mental health from pre- to post-treatment. These changes were similar in both groups, indicating that acupuncture was as effective as venlafaxine. By 2 weeks post-treatment, the venlafaxine group experienced significant increases in hot flashes, whereas hot flashes in the acupuncture group remained at low levels. The venlafaxine group experienced 18 incidences of adverse effects (eg, nausea, dry mouth, dizziness, anxiety), whereas the acupuncture group experienced no negative adverse effects. Acupuncture had the additional benefit of increased sex drive in some women, and most reported an improvement in their energy, clarity of thought, and sense of well-being.
CONCLUSIONS: Acupuncture appears to be equivalent to drug therapy in these patients. It is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer.

 

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