Research Database –
International Updates

Acupuncture

Issue 67

KERR and colleagues, Rehabilitation Sciences Research Group, School of Health Sciences, University of Ulster, Jordanstown, Co. Antrim, Northern Ireland, have studied the use of acupuncture in physiotherapy.
Background: The researchers attempted to determine the current use of acupuncture as a pain-relieving modality within physiotherapy.
Methods: This was a two-phase study. In the first phase, the records of 599 patients who had attended an outpatient physiotherapy department over a period of 2 years were studied; in the second phase, a patient survey was conducted amongst 200 outpatients who had received acupuncture from outpatient physiotherapy.
Results: Acupuncture appeared to have been used in patients with spinal pain and soft-tissue injuries of peripheral joints as a secondary form of treatment where other modalities failed, rather than being used for best effect. Despite this, 60% of respondents (78% of those surveyed responded) reported pain relief following the acupuncture; in 31% this lasted to the time of the survey. 80% stated that they had achieved sufficient pain relief to be able to carry out daily activities at home, and 57% were able to work. 94% of respondents were either ‘very satisfied’ or ‘satisfied’ with their treatment.
Conclusion: The authors concluded that further research was necessary to adequately assess the efficacy of acupuncture as a pain-relief measure in physiotherapy.
Kerr DP, Walsh DM, Baxter GD. A study of the use of acupuncture in physiotherapy. Complementary Therapies in Medicine 9 (1):21-7. Mar 2001.

MATSUMOTO and TERASAWA, Department of Geriatric Acupuncture and Moxibustion, Meiji University of Oriental Medicine, Japan examined the effect of acupuncture and moxibustion on the quality of life of 35 elderly subjects.
Methods: Inpatients in nursing homes and elderly care homes were treated with acupuncture and moxibustion at points chosen according to symptoms. Changes in pain, body condition, appetite, sleep, bowel movement and activity of daily living were evaluated by questionnaires.
Results: A high rate of improvement was seen in pain and stiffness, with 86% improvement in low back pain, 84% improvement in knee pain and 82% improvement in shoulder stiffness. Decrease of fatigue, increase in relaxation, improvements of appetite, sleep and bowel movements were observed. Gait and activities of daily living were also improved.
Conclusion: Acupuncture and moxibustion are useful to improve the quality of life in the elderly.
Matsumoto T, Terasawa S. Influence of acupuncture and moxibustion on QOL of the elderly living in nursing home and care house. Nippon Ronen Igakkai Zasshi 38 (2):205-11, Mar 2001.
Comments: The above clinical results indicate that acupuncture and Chinese Medicine were able to significantly alleviate pain and quality of life, for elderly people. What is even more encouraging is that these studies were carried out in entirely different parts of the world – Northern Ireland and Japan.

Issue 66

JOHANSSON and colleagues, Department of Neurology, Lund University Hospital, Lund, Sweden investigated the effects of acupuncture and
transcutaneous electrical nerve stimulation (TENS) on functional outcome and quality of life after stroke.
Background: In limited design small studies, acupuncture has been reported to improve functional outcome after stroke.
Methods: In this multicentre, randomized, controlled trial involving 7
university and district hospitals in Sweden, the investigators studied the effects of acupuncture and TENS on functional outcome and quality of life in 150 patients with moderate to severe functional impairment after stroke. At 5-10 days after stroke, patients were randomized to receive: 1) acupuncture, including electroacupuncture; 2) sensory stimulation with high-intensity, low-frequency TENS that induces muscle contraction; or 3) low-intensity (subliminal), high-frequency electrostimulation (control group). 20 treatment sessions were performed over a 10-week period. Outcome measures included: motor function; activities of daily living function; walking ability; social activities; and life satisfaction, at 3-month and 1-year follow-up.
Results: Patients in each group were similar at baseline in all important prognostic variables. No clinically important or statistically significant differences between treatment groups were seen at 3-month and 1-year follow-ups. No major adverse effects were reported for any of the 3 treatment modalities.
Conclusions: In comparison with a control group that received subliminal electrostimulation, no beneficial effects of acupuncture or TENS with muscle contraction during the subacute phase of stroke were seen on functional outcome or life satisfaction.
Johansson BB et al. Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial. Stroke 32 (3): 707-13. Mar 2001.
Comment: A superficial reading of this research provides the conclusion that neither acupuncture nor TENS confer any objective benefit in stroke patients. However, the control group in this trial consisted of patients given low-intensity, high-frequency electrostimulation. These results would have been more meaningful, in my opinion, if the control group had not been provided with any electrical stimulation treatment, i.e. standard medical treatment, in order to truly see the benefits, if any, of acupuncture and/or electrical stimulation.

PHILLIPS and SKELTON, Department of Administrative and Clinical Nursing, College of Nursing, University of South Carolina, USA aimed to explore sleep quality in HIV disease, test the relationship between pain and sleep quality, and test the effectiveness of acupuncture in improving sleep quality in HIV disease.
Background: Sleep disturbances often appear early in HIV disease, contributing to decreased quality of life. Few studies have explored the complex nature of poor sleep quality in HIV disease or tested interventions to improve sleep quality.
Methods: A pretest, post-test, pre-experimental design was used to test the effects of acupuncture delivered in a group setting on sleep quality. Subjects were 21 HIV-infected men and women aged 29-50 years who reported sleep disturbance 3 or more times a week and who scored greater than 5 on the Pittsburgh Sleep Quality Index. Sleep activity was measured using the Wrist Actigraph, and sleep quality was measured for 2 nights before and after 5 weeks of acupuncture treatment (a total of 10 treatments) using the Current Sleep Quality Index. Acupuncture was individualized to address insomnia and other symptoms reported by participants.
Results: Sleep activity and quality improved significantly following 5 weeks of individualized acupuncture delivered in the group setting.
Phillips KD, Skelton WD. Effects of individualized acupuncture on sleep quality in HIV disease. The Journal of the Association of Nurses in AIDS Care 12 (1): 27-39. Jan-Feb 2001.

Issue 62

SPROTT and colleagues, Rheumaklinik und Institut fur Physikalische Medizin, Universitatsspital Zurich, Switzerland. ruzsph@ruz.unizh.ch investigated microcirculatory changes over the tender points in fibromyalgia patients after acupuncture therapy.
Background: Apart from widespread pain, which is the main symptom of fibromyalgia, a great variety of functional and vegetative changes occur with this disease. Such changes include alterations in microcirculation, which may cause pain. A preliminary study demonstrated a reduction in regional blood flow above ‘tender points’ in fibromyalgia patients compared with healthy controls. The National Institutes of Health states that acupuncture is a sufficient adjuvant method to treat patients with fibromyalgia. The aim was to determine parameters to measure the effectiveness of a specific treatment modality (such as acupuncture) in addition to the patient’s subjective assessment of acupuncture treatment.
Methods: Twenty patients with fibromyalgia according to the ACR and Muller/Lautenschlager criteria were included in the study. Acupuncture was performed to individual needs in accordance with a specific protocol. Five representative ‘tender points’ were examined before and after therapy by laser flowmetry, and the data were compared with temperature measurement and dolorimetry.
Results: Increased blood flow was registered above all ‘tender points’ after acupuncture. Skin temperature had increased in 10/12 ‘tender points’ by a mean of 0.45 degree C. The number of ‘tender points’ was reduced from 16.1 to 13.8 after therapy. The pain threshold increased in 10/12 ‘tender points’.
Conclusion: These data suggest that acupuncture is a useful method to treat patients with fibromyalgia. Besides normalization of clinical parameters, the improvement in microcirculation above ‘tender points’ may alleviate pain.
Sprott et al. Microcirculatory changes over the tender points in fibromyalgia patients after acupuncture therapy (measured with laser-Doppler flowmetry). Weiner Klinische Wochenschrift 112(13): 580-6. Jul 2000.

Issue 61

Beal and Nield-Anderson, Yale University School of Nursing, New Haven, CT, USA investigated acupuncture for symptom relief in HIV-positive adults.
Background: Although acupuncture is used by many people with HIV disease as a complementary treatment to Western medicine, there is a lack of scientifically sound research on patient responses and outcomes. This study explored the feasibility of conducting a larger trial investigating the efficacy of acupuncture on symptom distress, psychological distress, and quality of life in HIV-infected individuals.
Methods: This pilot study used a block randomization, single-blinded design. There were 11 HIV-positive participants. Patients were grouped by CD4 cell counts and received acupuncture treatments twice each week for 3 weeks. The experimental group received a protocol with two components: one tailored to the individual’s symptoms and a second standardized component treatment designed to promote health and immune function. The control-needling group received a standardized treatment involving stimulation of acupuncture points identified as ‘clinically irrelevant’ in treating the conditions under investigation (i.e. acupuncture points that have consistently not been cited as helpful for symptoms of relevant conditions or immune disorders). The HIV-Symptom List was administered to gather data on symptom distress, the Brief Symptom Inventory was used to gather data on psychological distress, and the Functional Assessment of HIV Infection was administered to collect data on quality of life.
Results: Preliminary data from small numbers of participants showed trends toward improvement in symptoms and quality of life.
Conclusions: A follow-up pilot study will focus on the use of acupuncture to relieve gastrointestinal symptoms in people with HIV.
Beal MW and Nield-Anderson L. Acupuncture for symptom relief in HIV-positive adults: lessons learned from a pilot study. Alternative Therapies in Health and Medicine 6 (5): 30-1. Sep 2000.

FINK, KUNSEBECK and WIPPERMANN, Abteilung Physikalische Medizin und Rehabilitation Med. Hochschule Hannover, Hannover, Germany examined the effectiveness of needle acupuncture in reducing the symptoms of osteoarthritis of the hip.
Methods: This was a randomized, controlled, patient- and examiner-blinded clinical trial in 67 patients with osteoarthritis of the hip. One group of patients received traditional acupuncture needle placement and manipulation, while a second group received placement of needles away from classic acupuncture positions and the needles were not manipulated. In both groups, the needles were placed within dermatomes L2 to L5. Scores for pain, functional impairment, daily living activities, and overall satisfaction were made before treatment and 2 weeks and 2 months after treatment.
Results: Significant improvements were recorded on all scores in both groups at 2 weeks and 2 months compared with before treatment, and there were no significant differences between the classical acupuncture and the sham-acupuncture groups.
Conclusions: Needle placement in the area of the affected hip improves the symptoms of osteoarthritis. Following the rules of traditional acupuncture techniques appears to be less important.
Fink MG et al. Einfluss der Nadelakupunktur auf Schmerzwahrnehmung und Funktionseinschrankung bei Patienten mit Koxarthrose (Effect of needle acupuncture on pain perception and functional impairment of patients with coxarthrosis). Zeitschrift fuer Rheumatologie 59 (3): 191-9. Jun 2000.

Issue 58

EZZO and colleagues, University of Maryland School of Medicine, Kernan
Hospital Mansion, 220 Kernan Drive, Baltimore, MD 21207-6697, USA reviewed the effectiveness of acupuncture for the treatment of chronic pain.
Background: Pain is a major complaint of the estimated one million US
consumers who use acupuncture each year. Although acupuncture is widely
available in chronic pain clinics, its effectiveness remains in question.
Methods: Medline, two complementary medicine databases, 69 conference
proceedings, other article bibliographies and reviews were searched. Trials
were included if they were randomized, involved populations with pain
of greater than 3 months, used needle rather than surface electrodes and
were in English. Data were extracted by two independent reviewers using
a validated instrument. Disagreements were resolved by discussion.
Results: Fifty-one studies met the inclusion criteria. Clinical heterogeneity
precluded statistical pooling. Results were positive in 21 studies, negative
in 3 and neutral in 27. Three quarters of the studies received a low quality
score and low quality trials were significantly associated with positive
results (p=0.05). High-quality studies clustered in designs using sham
acupuncture as the control group, where the risk of false negative (type
II) error is high due to a large sample size requirement. Six or more
acupuncture treatments were significantly associated with positive outcomes
(p=0.03) even after adjusting for study quality.
Conclusions: The authors concluded there is limited evidence that acupuncture
is more effective than no treatment for chronic pain and inconclusive
evidence that acupuncture is more effective than placebo, sham acupuncture
or standard care. However, there was an important relationship between
the methodology of the studies and their results that should guide future
research.
Ezzo J et al. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain 86(3): 217-25. Jun 2000.

Issue 55

EICH and colleagues, Klinik fur Psychiatrie und Psychotherapie, am Evangelischen Krankenhaus Gelsenkirchen Universitatsklinik der Ruhr-Universitat Bochum studied the effects of acupuncture for patients with minor depression and generalized anxiety.
Methods: The authors conducted a placebo-controlled, randomized, modified
double-blind study to study the effects of body needle acupuncture (n
= 10) in 43 patients with minor depression and 13 patients with generalized
anxiety disorders. Severity of disease was assessed using the Clinical
Global Impression Scale (CGI). Treatment response was defined as a significant
improvement in CGI. An intent-to-treat analysis was performed to compare
treatment responses between verum and placebo acupuncture.
Results: Following the completion of 10 acupuncture sessions, the verum
acupuncture group (n = 28) showed a significantly larger clinical improvement
compared to the placebo group. There were significantly more responders
in the verum-compared to the placebo group (60.7% vs. 21.4%). There
were no differences in the response rates just following 5 acupuncture
sessions. Multivariate analysis and results of the additional rating
scales (HAMA) revealed a clear trend towards lower HAMA scores in the
verum group following the completion of 10 acupuncture sessions. This
corresponds well to the high response rate of 85.7% in patients with
generalized anxiety disorders, in whom verum acupuncture was used.
Conclusions: These results indicate that needle acupuncture (Du.20,
Ex.6, He.7, Pe.6, B1.62) leads to a significant clinical improvement
as well as a significant reduction in anxiety symptoms in patients with
minor depression or with generalized anxiety disorders. The total sum
of acupuncture sessions and the specific location of acupuncture needle
insertions may be important factors for bringing about therapeutic improvement.
Eich H et al. Acupuncture in patients with minor depressive episodes
and generalized anxiety. Results of an experimental study. Fortschritte
der Neurologie-Psychiatrie 68(3): 137-44. Mar 2000.

LEE, Department of Anaesthesia, National University Hospital, Singapore.
analeetl@nus.edu.sg reviewed the literature (35 references) to assess
whether acupuncture is an effective treatment for chronic pain.<br>
Background: Acupuncture has been widely used to treat a variety of pain
conditions; however, convincing scientific evidence for its efficacy
is lacking. Earlier randomized controlled trials attempted to follow
a double-blind, placebo-controlled model. This approach has encountered
many problems including the virtual impossibility of blinding the acupuncturist
and the uncertainties inherent in choosing control acupuncture points.
The authors based their review upon the result of previous reviews,
meta-analyses and consensus conferences. The search was conducted with
MEDLINE from 1966, EMBASE from 1980 and Cochrane library 1999, volume 1. Only randomized trials of acupuncture involving needling for subjects
with chronic pain published in English were included.
Results: Basic scientific research has demonstrated convincingly that
within the context of acute pain, acupuncture's effects are related
to the release of a variety of natural opioids. Acupuncture has been
shown to be effective for postoperative dental pain. There are reasonable
studies showing relief of pain with acupuncture upon diverse pain conditions
including menstrual cramps, tennis elbow, low back pain and fibromyalgia.
This suggest that acupuncture may have a more general effect upon pain.
There are also studies, however, which provide equivocal results due
to design, sample size and other factors. The issue is further complicated
by inherent difficulties in the use of appropriate controls, including
placebo and sham acupuncture groups
Conclusions: Most of the studies were of poor methodological quality;
therefore there is a need for further high quality randomized controlled
trials. Future studies should also have larger sample sizes, use a valid
acupuncture treatment, and have both a short-term and long-term follow-up.
Lee TL. Acupuncture and chronic pain management. Annals of the Academy of Medicine, Singapore 29(1): 17-21. Jan 2000.

KEMPER and colleagues, Department of Pediatrics, Harvard Medical School,
and the Center for Holistic Pediatric Education and Research, Children's
Hospital, Boston, Massachusetts 02115 USA. kemper_k@al.tch.harvard.edu
set out to describe paediatric pain patients' experience with acupuncture
treatment for chronic pain.
Background: Despite its increasing use as a complementary therapy to
treat pain, acupuncture is rarely considered by paediatricians, partly
due to perceptions that it will not be acceptable to paediatric patients.
Methods: The authors conducted a retrospective case series. Subjects
were paediatric pain patients referred by the Pain Treatment Service
at Children's Hospital in Boston, who went to a paediatric acupuncturist.
A research assistant not involved in the patient's care conducted
the survey by telephone. Data were analyzed qualitatively and descriptively.
Results: Of 50 eligible patients, 47 families were reached by telephone;
all agreed to be interviewed. Patients had a median age of 16 years
at the time of referral; 79% were female and 96% were white. The three
most common diagnoses were migraine headache (n = 7), endometriosis
(n = 6) and reflex sympathetic dystrophy (n = 5). The patients had a
median of 8 treatments within 3 months; 85% of families paid out-of-pocket.
Acupuncture therapies included needle insertion (98%), heat/moxa (85%),
magnets (26%) and cupping (26%). Most patients and parents rated the
therapy as pleasant (67% children/60% parents) and most (70% children/59%
parents) felt the treatment had helped their symptoms. Only one said
that the treatment had made the symptoms worse.
Conclusions: Paediatric patients with chronic, severe pain found acupuncture
treatment pleasant and helpful. Additional, prospective studies are
needed to quantify the costs and effectiveness of acupuncture treatment
for paediatric pain.
Kemper KJ et al. On pins and needles? Pediatric pain patients' experience with acupuncture. Pediatrics 105(4 Pt 2): 941-7. Apr 2000.

Comments: The above studies demonstrate the variety of acupuncture clinical
research being conducted, particularly with regard to chronic pain,
depression and anxiety.

PARK, WHITE and ERNST, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter,
UK. J.B. Park@exeter.ac.uk summarized and critically reviewed all randomized
controlled trials regarding the efficacy of acupuncture treatment for
tinnitus.
Background: Tinnitus is a prevalent condition with no effective conventional
treatment, for which patients may seek acupuncture treatment.
Methods: The authors conducted 4 independent computerized literature
searches in December 1998 on MEDLINE, Cochrane Controlled Trials Register, Embase and CISCOM databases, using the key words acupuncture and tinnitus. All randomized controlled trials which compared any form of acupuncture
with any control intervention in the treatment of tinnitus were included.
Data were extracted by two authors independently, and the methodological
quality of the included trials were assessed using the Jadad score.
Six randomized controlled trials were included in the review, four of
which used crossover design. Four studies used manual acupuncture and
two used electroacupuncture. Five of six studies used inconsistent acupoints;
three studies scored 3 points or more on the Jadad scale. The Outcome
measurements were visual analog scale scores for loudness, annoyance,
an awareness of tinnitus; subjective severity scale scores for tinnitus,
or Nottingham Health Profile scores.
Results: Two unblinded studies showed a positive result, whereas four
blinded studies showed no significant effect of acupuncture.
Conclusions: Acupuncture has not been demonstrated to be efficacious
as a treatment for tinnitus on the evidence of rigorous randomized controlled
trials.
Park J, White AR, and Ernst E. Efficacy of acupuncture as a treatment for tinnitus: a systematic review. Archives of Otolaryngology – Head and Neck Surgery 126(4): 489-92. Apr 2000.

Issue 51

GAO and colleagues, Heilongjiang Academy of Chinese Medicine, Harbin, People’s Republic of China write that according to Chinese medicine, the differential diagnosis of migraine headache may be classified based upon the state of the viscera, channels and collaterals. The authors conducted a study to test the efficacy of acupuncture treatment for migraine headache.Methods: 64 patients were divided into 2 equal groups: one group received acupuncture and the other group received conventional drug treatment. Acupuncture treatment prescriptions combining distant and local acupoints were selected according to the differential diagnosis.
Results: The efficacy rates in the acupuncture and control groups respectively were as follows: Cure: 75% versus 34.4%; marked improvement: 18.8% versus 28.1%; no effect: 6.3% versus 37.5%. The overall effective rates for the acupuncture and control groups were 93.8% and 62.5% respectively, indicating a significantly greater effect in the acupuncture group.
Conclusions: The results of the above small study suggests that acupuncture may be an effective treatment for migraine headache.
Gao S et al. A comparative study on the treatment of migraine headache with combined distant and local acupuncture points versus conventional drug therapy. American Journal of Acupuncture 27(1-2): 27-30. 1999.

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