Acupuncture For Cynics

Acupuncture For Cynics

Have You Always Been Curious About Acupuncture, But Were Never Quite Sure Where To Stick The Needles? If you associate acupuncture with needles, pain and weird alternative medicine then you are horribly misinformed about the benefits of the world's oldest form of medicinal treatment.

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Acupuncture Technique

The acupuncture group was given bilateral needling of the acupoints LR3, LI4, and GV20, in addition to one or two points based on individual diagnoses. The needles were traditional Chinese acupuncture needles, diameter 0.3 millimeters and length 25 to 55 millimeters, placed at variable depths. The needles were rotated or stimulated manually to obtain the needling sensation (Te chi). As part of the individualized treatment, the patients also could have scalp needling or electroacupuncture using a standard transcu-taneous nerve stimulation apparatus with acupuncture needles as electrodes. For elec-troacupuncture, we used an Elpha 2000 instrument (3 hertz, 3-20 milliamperes). The patients in the control group received sham (imitation) acupuncture. They were given bilateral needling of three sham acupoints chosen by a group of Chinese and Norwegian acupuncturists S1-2.5 cun to the side of the umbilicus, S2-3 cun above the midpoint of the patella, and S3-1 cun below the midpoint between...

Acupuncture and Traditional Chinese Medicine

NIH Consensus Development Panel on Acupuncture. JAMA 1998 280 1518-1524. 2. Spoerel WE, Paty DW, Kertesz A, et al. Acupuncture and multiple sclerosis. CMA Journal 1974 110 751. 3. Smith MO, Rabinowitz N. Acupuncture treatment of multiple sclerosis Two detailed clinical presentations. Am J Acupuncture 1986 14 143-146. 4. Miller RE. An investigation into the management of the spasticity experienced by some patients with multiple sclerosis using acupuncture based on traditional Chinese medicine. Compl Ther Med 1996 4 58-62. 5. Steinberger A. Specific irritability of acupuncture points as an early symptom of multiple sclerosis. Am J Chinese Med 1986 14 175-178. 6. Bowling AC, Stewart TM. Efficacy, safety, and prevalence of acupuncture use among a group of people with MS a web-based survey. Int J MS Care 2002 4 95. 7. Wang Y, Hashimoto S, Ramsum D, et al. A pilot study of the use of alternative medicine in multiple sclerosis patients with special focus on acupuncture. Neurology 1999 52...

CAM Approaches for Pediatric Pain 21 Acupuncture

In adults, acupuncture is among the most frequently used CAM treatments for chronic medical conditions (15-17), and its effectiveness has been supported for several specific pain problems, such as headaches (18) and chronic back pain (19). Reports of serious adverse effects are rare (20,21). Although the exact mechanisms by which acupuncture exerts analgesic effects have not been specified, numerous investigations have demonstrated that the nervous system, neurotransmitters, endogenous substances, and Jingluo (meridians) may respond to needling stimulation and electroacupuncture (EA) (22), in which an acupuncture needle is attached to a low-voltage electricity source. As reviewed by Ma (22), early studies demonstrated that the analgesic effects of EA are mediated by opioid peptides in the periaqueductal gray more recent evidence showed that nitric oxide plays an important role in mediating cardiovascular responses to EA stimulation through the gracile nucleus-thalamic pathway. Several...

Acupuncture

A published meta-analysis of acupuncture in the treatment of FMS found that this treatment modality is a useful adjunctive treatment for FMS on a short-term basis (164). Another study looked at FMS patients' treatment with acupuncture for six weeks and found decreased pain levels and number of TPs associated with increased serum serotonin and substance P levels (165). The results of another study (166) indicated that use of traditional acupuncture led to positive improvement in the visual analogue scale (VAS), myalgia index, number of TPs, and improvements in quality of life. A more recent study found that acupuncture was no better than sham acupuncture in relieving the pain of FMS (167). Martin et al. (168) used the Fibromyalgia Impact Questionnaire (FIQ) in patients given acupuncture and in control groups and found that the fatigue and anxiety scores of the FIQ were most improved. The activity and physical function scores did not change. The National Institutes of Health consensus...

Indication Risks and Contraindications

Substantial differences occur with regard to the types of massage that are effective for various conditions. The choice of acupoints may depend on whether consciousness is lost during seizures, and there are points and sequences of points primarily suitable for preventing seizures or seizure-favoring factors, such as sleep deprivation. Massage can be an effective component of successful psychological approaches to control nocturnal epileptic seizures. The complexity and interactions of epilepsy, personality, and environment suggest, however, that massage must be based on individual behavioral analyses this field is not suitable for therapeutic cookbooks. Some authors consider the stimulation of several acupoints contraindicated in treating epilepsy, especially during certain stages of pregnancy (73). A careful assessment is particularly needed in this area due to the paucity of controlled studies and the disparate recommendations for both acupressure and classical massage (74-77).

Use in Prevention and Therapy

The D-isomer of PA is an effective pain reliever.1 It is found in supplements of D,L-phenylalanine (DLPA). It can enhance the activity of brain enkephalins and the pain-reducing effects of acupuncture and transcutaneous electrical nerve stimulation (TENS). DLPA may reduce headaches and peripheral aches associated with PMS.

Psychopharmacotherapy General Considerations

There are numerous approaches to smoking cessation and many comprehensive reviews of the literature (e.g., Hymowitz, 1999 Lando, 1993 Leventhal & Cleary, 1980 Schwartz, 1987). Although many approaches to smoking cessation have been successful in the short run, few, if any, have proved satisfactory in the long term. This is true for traditional group and individual counseling programs, hypnosis and acupuncture, self-help stop-smoking strategies, multi-component behavioral interventions, and pharmacological therapies (Hunt & Bespalec, 1974 Hymowitz, 1999 Yudkin et al., 2003). The tendency of smokers to quit, relapse, and quit highlights the cyclic nature of the quitting process and serves as a reminder that as much care and effort must go into helping smokers remain cigarette-free as into helping them stop smoking in the first place.

Routes of Transmission

Parenteral transmission included needlestick injuries, bites, unscreened blood transfusions, tattooing, acupuncture, and dental procedures where equipment is inadequately sterilized. Risk of transmission is increased with deep penetrating injuries with hollow bore needles that are visibly bloodstained,

Additional Readings Journal Article

Acupuncture and Trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury. Arch Phys Med Rehabil 2001 82 1038. Foster KA, Liskin J, Cen S, et al. The Trager approach in the treatment of chronic

Medical Acceptance of CAM Approaches

Studies indicate an increased interest in and acceptance of CAM within the medical community. For example, of the 117 (of 125) medical schools in the United States that responded to a survey documenting information about CAM education within their curricula, 64 offered some kind of CAM instruction (3). Most classes offered were electives, although some institutions provided information within required courses. Common topics included chiropractic, acupuncture, homeopathy, herbal therapies, and mind-body techniques. In another study, when asked, 39 of medical physicians described chiropractic as a legitimate medical practice (3). In addition, a growing number of prestigious journals, including the New England Journal of Medicine, the Journal of the American Medical Association, and the Archives of Internal Medicine are devoting more and more space to CAM.

Traditional Chinese Medicine

Traditional Chinese medicine (TCM) is the study of human physiology and pathology, and the prevention, diagnosis, and treatment of human diseases. It is a system that consists of the clinical and theoretical investigation of the physiology and pathology of organs and functions. Current TCM practice is based on the cosmologic principles of Chinese philosophy, including holism, differentiation, yin yang, and the five elements. Herbal medicine, acupuncture, and moxibustion are the treatment methods employed in TCM, in order of frequency. TCM has a more than 2,500-year history consisting of the development of major theories and clinical investigations that have been carried out by generations of practitioners and investigators. The theoretical basis for TCM is beyond the scope of this chapter. A detailed discussion may be found in the work of Bensky, et al. (1-3). The principle of differentiation allows a properly trained TCM practitioner to find the differentiating patterns of signs and...

Modern Research on TCM Herbal Treatment in Epilepsy

As practiced in China today, TCM relies on herbal formulas as the principal treatment method for all diseases, including epilepsy. Acupuncture is used as a supplemental treatment (4). During the past few decades, many studies in China have examined the clinical effectiveness and pathophysiologic effects of the TCM herbal formulas used in treating epilepsy. One focus of modern research has been to compare the effectiveness of TCM herbal treatment to conventional Western pharmacotherapies. Although conventional medications can provide a more rapid initial clinical response, TCM can provide a long-term clinical benefit equivalent to conventional medications, but with significantly fewer side effects (5). In China, it is common to use Western medications initially and then replace or supplement these by TCM herbal formulas.

Additional Resources Books

Medical Acupuncture A Western Scientific Approach. Edinburgh Approach. St. Louis Mosby, 2001, pp. 333-369. Hsu DT, Cheng RL. Acupuncture. In Weintraub MI, Micozzi MS, eds. Alternative and Complementary Treatments in Neurologic Illness. New York Churchill Livingstone, 2001, pp. 11-26. Lin Y-C. Acupuncture and traditional Chinese medicine. In Oken BS, ed. Complementary Therapies in Neurology. London Parthenon Publishing, 2004, pp. 113-125. Checkmark Books. 2005, pp. 2-5. Nielsen A, Hammerschlag R. Acupuncture and East Asian medicine. In Kligler B, Lee R, eds. Integrative Medicine Principles for Practice. New York McGraw Hill, 2004, pp. 177-217. Miller RE. An investigation into the management of the spasticity experienced by some patients with multiple sclerosis using acupuncture based on traditional Chinese medicine. Compl Ther Med 1996 4 58-62. NIH Consensus Development Panel on Acupuncture. JAMA 1998 280 1518-1524. Rabinstein AA, Shulman LM. Acupuncture in clinical...

Studies in MS and Other Conditions

Study of headache, which did include a control group, Trager treatment was associated with decreased headache frequency, improvement in the quality of life, and decreased use of headache medication (2). In a study of people with spinal cord injury and shoulder pain from wheelchair use, shoulder pain was decreased with either acupuncture or Tragerwork (3).

MMagnets and Electromagnetic Therapy

The use of magnets and electromagnetic fields is a type of energy medicine. Magnets and electricity have been used for medicinal purposes for thousands of years. They were used in ancient China to stimulate acupuncture sites. In the eleventh and twelfth centuries, it was claimed that lodestones, minerals with natural magnetic qualities, relieved a variety of medical conditions. Paracelsus, a sixteenth-century Swiss physician and alchemist, used magnets to treat seizures. In the eighteenth century, Franz Mesmer, an Austrian physician, proposed a theory of animal magnetism and wrote a book on the subject, On the Medicinal Uses of the Magnet. It was later found that his therapy was based on hypnotism (see the chapter on Hypnosis), not on any therapeutic effects of magnets. A large number of magnetic and electrical devices were promoted during the nineteenth century, which is sometimes referred to as the golden age of medical electricity. These devices included magnetic insoles, belts,...

Neurophysiologic Studies

Ing the well-defined stimulation of specific acupoints (55). Study data support electrophysiologic and electromagnetic correlates of acupoints for diagnosis and treatment, thus making acupressure a plausible therapeutic option in the short- and long-term reduction or normalization of cerebral excitability (56,57). Neuroanatomic, scintipho-tographic, thermographic, functional neuroimaging, and transcranial Doppler ultrasound studies that investigate the locations of acupoints or the effects of their stimulation may further contribute to an understanding of seizure threshold regulation by means of acupressure (58-61).

Treatment by CAM Providers

An eclectic approach to the treatment of epilepsy is not a phenomenon unique to the modern era. For example, the first known documented case of epilepsy in China appeared in The Yellow Emperor's Classic of Internal Medicine, written by a group of physicians around 770 b.c. (32). At that time, the treatment of epilepsy, based on the principles of Ying Yang Wu Xing, consisted of herbs, acupuncture, and massage (32). Centuries later, accounts of epilepsy were reported in pre-Columbian America (33). Both the Aztecs and Incas associated epilepsy with magic and religion. Both these ancient cultures used magical therapies, as well as botanical medicines that may have had an empirical benefit. In additional to a plethora of antiepileptic drugs (AEDs) commonly used today, a number of nonpharmacological options are available. Two of these approaches, the ketogenic diet (high-fat, low-protein, and low-carbohydrate) and vagal nerve stimulation (implantation of a stimulating device in the chest...

History of Epilepsy Treatment Using TCM

Because conditions and situations vary within the same patient, so do the clinical presentations. In all cases, the treatment formula is modified according to the patient's overall situation. The TCM treatment approach for epilepsy is threefold. First, treat the seizure disorder with herbs and acupuncture, as determined by the clinical diagnosis and differentiation. Second, following improvement and or remission of seizures, regulate the overall functions of the organs and channels with the use of herbs, acupuncture, and mox-ibustion. Third, encourage the patient to adopt daily life guidelines to prevent relapse.

Training and Licensure

Four accredited colleges of Naturopathic Medicine are located in North America Bastyr University in Seattle (www.bastyr.com) (established in 1978) the Canadian College of Naturopathic Medicine in Toronto (www.ccnm.edu) (established in 1979) National College of Naturopathic Medicine in Portland, Oregon (www.ncnm.edu) (established in 1956) and the Southwest College of Naturopathic Medicine in Tempe, Arizona (www.scnm.edu). All four institutions are graduate schools that require either a bachelor's degree or a minimum of 3 years of undergraduate studies. A naturopathic medical program includes four and a half years of studies in the medical sciences, diagnosis, natural therapies, and over 1,500 hours treating patients. Graduates of this program earn the title Naturopathic Doctor (N.D.). The curriculum covers clinical nutrition, Western and Eastern botanical medicine, homeopathy, counseling, acupuncture, traditional Chinese medicine, minor surgery, obstetrics, and several different...

Triggerpoint Injection Therapy

A systematic review (NIN Consensus Development Panel on Acupuncture) found acupuncture, or deep, dry needling, useful in the treatment of myofascial pain (and fibromyalgia) (21). A different RCT found that Japanese acupuncture associated with heat will yield a modest pain reduction in patients with myofascial neck pain. Previous patients' experience with acupuncture and their confidence in it helped to predict beneficial clinical outcomes (22).

Towards an Integrative Pain Medicine

Should safe and effective CAM therapies be integrated into pain clinic services Are they cost effective A 2005 survey of 39 US academic health centers found that while 23 offered CAM services (particularly acupuncture, massage, dietary supplements, mind-body therapies, and music therapy), none had written policies concerning malpractice liability or credentialing practices 61 Nothing is currently known of the policy issues regarding integration of such practices in chronic pain centers in Canada. The mechanics of providing integrated (CAM plus conventional) care in Canada deserve to be further explored.

Results

In CAM, many articles are incorrectly classified as double-blind. We reviewed 40 articles in different CAM modalities acupuncture (6-22), acupressure (5,23-28), osteopathy (29-31), and chiropractic manipulation (32-38), as well as other manual techniques (3,39-42). We could not find one study using these modalities that was truly doubleblind, yet all claimed this methodology in their title or abstract. The initial hypothesis that true double-blind methodology was unlikely in these therapeutic modalities was supported. All these studies are more accurately classified as dual-blind.

Placebos and CAM

In contrast to physicians, many practitioners of CAM probably spend more time with patients and rely more on positive interpersonal skills to interact with and treat them. This may be true for practitioners in areas such as acupuncture, homeopathy, and massage. A single session with these practitioners may last 60 minutes or longer and involve a detailed discussion of many topics, whereas physician visits are often 10 to 20 minutes or shorter and focus exclusively on diseases, symptoms, diagnostic tests, and drug therapies. Regardless of the effectiveness of their therapies, some practitioners of CAM may be more skilled and more comfortable than are physicians with using the power of the placebo effect.

Massage Therapy

Strokes, kneading of individual muscles, friction, hacking or tapping, and vibration. Massage therapy has been studied in systematic reviews for tendonitis 23 , chronic low back pain 24 , and mechanical neck disorders 25 . Massage, particularly acupressure massage, may be beneficial in the treatment of chronic low back pain, especially when combined with exercise and education, although it is not necessarily better than other types of treatment. The evidence for massage therapy in neck pain and tendonitis is lacking. Long-term effects of massage therapy are unclear. Massage therapy in conjunction with other therapies (such as relaxation therapy, acupuncture and self-care education) may be of benefit.

Treatment Method

Multiple hypotheses exist about how magnets could produce therapeutic effects. For strong magnets placed on the spine, it has been proposed that the magnetic field alters nerve activity in the spinal cord in such a way that it decreases muscle stiffness. For weaker magnetic devices, it is often claimed that they correct disease-causing electrical imbalances in the body. For devices placed on acupuncture points, it is proposed that acupuncturelike effects occur, such as increases in the release of pain-relieving chemicals (opioids) in the body. Multiple other mechanisms have been proposed, including an alteration of the flow of electrically charged atoms (such as calcium) and changes in hormone levels and immune-system function.

Patients

Thirty-nine adult patients recruited from the outpatient population at the National Center for Epilepsy, a tertiary referral center, entered the study. All had difficult-to-treat partial or generalized epilepsy. Mean age was 39 years mean age at onset of epilepsy was 11.5 years mean duration of epilepsy was 27.5 years and mean number of seizures per week in the baseline period was 2.5. During the 12-week baseline period, but before randomization, five patients withdrew from the study because they found participation inconvenient. Thus, 34 patients were randomized into two treatment groups. At baseline, these groups were comparable with regard to age, gender, duration of epilepsy, age at onset of epilepsy, seizure frequency, and proportion of patients who had previously received acupuncture.

Limitations of Study

The choice of placebo or intervention for the control group in trials of acupuncture is controversial. In 28 controlled trials, 28 different acupuncture placebos were used (15), making comparisons between studies difficult. In this study, we chose needling as treatment of the control group using a minimalist approach piercing the skin outside the usual acupuncture points, using fine needles without any stimulation, and not obtaining the needling sensation. Nevertheless, we can still not exclude the physiologic effects of sham acupuncture. The small sample size in our study enabled us to detect differences between the groups of 1 SD, normally a very large difference. (SD, standard deviation, is a common descriptive measure of the spread or dispersion of data results from a scientific study.) With a larger sample size, we might have detected smaller differences at the chosen power level. There were variations in the treatments given and acupoints used within the groups however, these...

Other CAM Approaches

Several studies have investigated the benefits of acupuncture, yoga, and various supplements in epilepsy patients. In general, these studies show minimal, if any, clinical benefits derived from any of these approaches. One study investigating the effects of acupuncture in chronic intractable epilepsy reported that patients receiving true acupuncture and patients receiving sham acupuncture both had a reduction in seizure activity, as well as an increase in the number of seizure-free weeks (41). A more recent study monitoring changes in quality of life found no benefit from acupuncture (42). A few studies, however, reported reduced seizure activity in dogs after acupuncture (43,44).

Conclusion

On the basis of current evidence, acupuncture and Asian herbal medicine, both of which are components of traditional Chinese medicine (TCM), should be approached differently by people with MS. Acupuncture is of low risk, is possibly beneficial, and may be a reasonable treatment option for some people with MS. In contrast, Asian herbal medicine should be considered with caution by people with MS, especially for use on a long-term basis. Reports of treatment benefits using this therapy cannot be fully evaluated because of the lack of published information in English. Some herbs may be toxic or may stimulate the immune system, and the safety of long-term treatment has not generally been established.

Study Design

The study included a baseline period of 10 weeks, a treatment period of 8 weeks, and a follow-up of 12 weeks. The patients were divided into two groups by four-block randomization one acupuncture group with 18 patients and one control group with 16 patients. (In block randomization, the unit of randomization is not the individual, but a large group.) Two Chinese acupuncturists, both senior staff members of the Shanghai University of Traditional Chinese Medicine, gave the treatment. All the patients were also diagnosed according to the principles of traditional Chinese medicine. One of five diagnoses was given to each patient. As outpatients, all received 20 treatments (three treatments per week for 3.5 weeks, 1 week pause, and another series of treatments over 3.5 weeks). Each treatment lasted about 30 minutes. The patients' antiepileptic medication was held stable throughout the study, and both patients and epileptologists were blinded.

Dry Needling

Acupuncture, the insertion of needles into MTrPs for pain relief, is an old treatment utilized for centuries (15,16). Intramuscular stimulation, also known as deep dry needling (DDN) relates dry needle insertion to pain relief (18). Gunn (19) notes that a solid 30-gauge acupuncture needle with a pointed tip is less traumatic to use than the beveled edge of a hollow needle.