Research Database –
International Updates

Acupuncture

Issue 49

YONG and colleagues, Acupuncture Research Clinic (ARC), AngMo Kio Community Hospital, Singapore report their initial experience with acupuncture treatment at their Acupuncture Research Clinic.
Methods: 1128 patients received a total of 12,172 acupuncture treatment sessions between September 1995 and December 1996. Most patients had either painful conditions (58%) or stroke-related dysfunction (23%). Amongst the painful conditions, arthritis (25%), low backpain (22%) and other musculo-skeletal pain (12%) were the most common. Prior to their treatment, about 75% of patients believed that acupuncture would benefit them and 40% had tried acupuncture previously.
Results: Following completion of treatment, 70% of all patients considered acupuncture safe, 54% were satisfied with the overall result, 51% felt acupuncture was beneficial, and 54% would recommend acupuncture to others with similar conditions. Within a subgroup of patients treated for painful conditions, >90% reported improvement. Near-syncope (sudden loss of strength, often caused by reduced cerebral circulation) occurred in 2 patients or during 2 treatment sessions. There were no other acupuncture-related complications.
Conclusions: The preliminary clinical experience demonstrated that acupuncture is safe, and appeared to be beneficial to patients with painful conditions. The authors present an overview of acupuncture treatment, and discuss issues of safety, efficacy the need to conduct randomised controlled clinical trials.
Yong D et al. Acupuncture treatment at Ang Mo Kio Community Hospital – a report on our initial experience. Singapore Medical Journal 40(4): 260-4. Apr 1999.

GILES and MULLER, National Unit for Multidisciplinary Studies of Spinal Pain, Townsville General Hospital, Queensland, Australia compared needle acupuncture, drug medication and spinal manipulation for the management of chronic spinal pain.
Methods: the authors conducted a prospective, randomised, independently assessed preintervention and postintervention clinical pilot trial at a specialised out-patient unit in Queensland Australia. 77 patients, without contraindication to manipulation or medication (tenoxicam with ranitidine) were recruited into the pilot study. The interventions consisted of one of three: needle acupuncture, nonsteroidal anti-inflammatory medication, or chiropractic spinal manipulation. The main outcome measures were changes after 4 weeks following the 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: Randomisation was successful. Following the median intervention period of 30 days, spinal manipulation was the only intervention which achieved statistically significant improvements as follows: 1) Reduction of 30.7% on the Oswestry scale: 2) 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. None of the other interventions demonstrated any significant improvement on any of the outcome measures.
Conclusions: Despite several discussed shortcomings of this pilot study, the results demonstrate that for patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and drug therapy.
Giles LG and Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. Journal of Manipulative and Physiological Therapeutics 22(6): 376-81. Jul-Aug 1999.

Issue 46

LEAKE and BRODERICK, Department of Psychology at the State University of New York (SUNY), Stony Brook USA review the current licensure and certification standards for the practice of acupuncture in the United States.
Discussion: These serve as a current reference for the regulation of the practice of acupuncture, licensing of acupuncturists, and certification and training of physicians, chiropractors, dentists, podiatrists and naturopathic physicians to practise acupuncture. There are two national accreditation bodies responsible for the certification of acupuncture training and practice. The Accreditation Commission of Acupuncture and Oriental Medicine establishes accreditation criteria and curriculum evaluation of acupuncture training programmes. The national Certification of Acupuncture and Oriental Medicine certifies individuals to practise acupuncture in the US. Although national standards have been established, the regulations regarding training and the practice of acupuncture are determined individually by each state, and vary widely. The authors discuss typical acupuncture training curricula for physicians and chiropractors and provide variations in training requirements by state for acupuncturists and the other 5 disciplines.
Leake R and Broderick JE. Current licensure for acupuncture in the United States. Alternative Therapies in Health and Medicine. 5(4): 94-6. Jul 1999.

CREAMER and colleagues, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore USA write that although acupuncture has been found to be beneficial in the treatment of patients with knee osteoarthritis, response among patients is highly variable. The authors conducted a retrospective study to examine the relationship between demographic and psychosocial variables and response to acupuncture regarding reduction in pain and disability at the end of an 8-week course of acupuncture treatment.
Methods: Recruits to the study were 37 patients with symptomatic knee osteoarthritis who had previously participated in a controlled trial using acupuncture one year previously. The interventions included a structure interview, questionnaire and an examination. The main outcome measures were depression, anxiety, helplessness, self-efficacy and fatigue. Knee examination and pain threshold assessment were measured using dolorimetry.
Results: The response at 8 weeks was significantly related to duration of symptoms. A statistically nonsignificant trend was discovered for older and more educated individuals to have a better response; anxiety and fatigue were inversely related to response (statistically nonsignificant). People with localised medial pain had significantly better response in terms of pain and disability than did individuals with generalised knee pain.
Conclusions: Apart from a weak relationship with anxiety at 8 weeks only, there was no evidence found of a link between psychosocial variables and response to acupuncture. These results need to be confirmed by prospective studies.
Creamer P et al. Are psychosocial factors related to response to acupuncture among patients with knee osteoarthritis? Alternative Therapies in Health and Medicine 5(4): 72-6. Jul 1999.

BULLOCK and colleagues, Center for Addiction and Alternative Medicine Research, Department of Medicine, Hennepin County Medical Center, and the University of Minnesota, School of Medicine, Minneapolis 55415 USA MLBULL@SPRINTMAIL.COM write that musculoskeletal (MSk) disorders are among the more common conditions for which patients seek relief. Whereas nonsteroidal anti-inflammatory (NSAID) drugs are the conventional treatment of choice, more patients are now turning to complementary/alternative medicine (CAM). The authors conducted an evaluation study of MSk patients treated in a hospital-based outpatient clinic providing acupuncture and other alternative modalities.
Methods: 797 patients at the CAM clinic completed a structured questionnaire regarding demographic health history, as well as the nature and severity of their health complaints. One month following this baseline measurement and beginning CAM treatment, patients rated their complaint severity, improvement in their condition being treated and helpfulness of the CAM treatments. Of the 797 patients, 398 were treated for MSk complaints.
Results: At 1-month follow-up, severity of primary complaints decreased an average of 2 points on a 10-point numerical scale. 30% of patients reported reduction of severity by 50% or more of baseline. Self-reported improvement and severity change were moderately correlated; however baseline severity was inversely related to therapeutic helpfulness. Improvement increased with number of treatment, although due to time constraints, treatment frequency was limited.
Conclusions: Almost 50% of the clinic patients sought relief for MSk complaints. Acupuncture treatment provided significant improvement of presenting symptoms within a short time period. These results contribute toward a consensus opinion that Cam therapies help to alleviate the pain and discomfort of MSk disorders.
Bullock ML et al. Short-term outcomes of treatment for musculoskeletal disorders in a hospital-based alternative and complementary medicine clinic. Journal of Alternative and Complementary Medicine 5(3): 253-60 June 1999.

YAMASHITA and colleagues, Tsukuba College of Technology Clinic, Tsukuba City, Japan. Yamashsita@k.tsukuba-tech.ac.jp write that many of the frequently reported adverse effects of acupuncture are serious and severe, including pneumothorax, infection, spinal cord injury or cardiac injury. The authors reviewed all relevant cases reported by the therapists at their clinic over a 6-year period.
Methods: All acupuncture and moxibustion therapists at the Tsukuba College of Technology were required, over a 6-year period, to report all cases of adverse events immediately upon recognition.
Results: 84 therapists (13 preceptors and 71 interns) participated in the treatments. Th e total number of treatments was 65,482. There were 94 (0.14%) adverse events reported during that period. These were under 14 categories reported: failure to remove needles (27 cases) ecchymosis or haematoma without pain (9 cases), ecchymosis or haematoma with pain (8 cases), burn injury (7 cases), discomfort (7 cases), dizziness (6 cases), nausea or vomiting (6 cases), pain in the punctured region (6 cases), minor haemorrhage (4 cases), aggravation of complaint (4 cases), malaise (3 cases), suspected contact dermatitis ( 3 cases), fever (3 cases), numbness in the upper extremities (1 case).
Conclusions: No serious or severe cases such as pneumothorax, infection or spinal cord injury were reported by college preceptors or interns, indicating that serious or severe adverse events are rare in standard practice. The authors suggest that most severe or serious cases of adverse events caused by acupuncture reported in journals are actually cases of negligence. They further suggest that negligence should be discussed from the point of view of medical education and technical instruction for therapists, and adverse reactions should be discussed from the point of view of incidence and prevention bases on the results of further investigation.
Yamashita H et al. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. Journal of Alternative and Complementary Medicine 5(3): 229-36. Jun 1999.

Comments: The above results, with merely a tiny number of minor adverse events over 6 years out of 65,000 treatments, is highly encouraging, and should help to counter the frequent scare stories which feature in the media from time to time.

NEUMEISTER and colleagues, Abteilung fur Pneumologie, Allergologie und Schlafmedizin, Berufsgenossenschaftliche Kliniken Bergmannsheil-Universitatsklinik, Ruhr-Universitat Bochum, Germany conducted a prospective, randomised and placebo-controlled pilot study to quantify the effect of acupuncture upon patients suffering from chronic obstructive pulmonary disease (COPD).
Methods: 10 patients with stable COPD were randomised to a 2-week treatment of 7 verum acupuncture according to the rules of traditional Chinese medicine or placebo acupuncture sessions. Prior to and following treatment pulmonary function tests were performed as well as an interview using the chronic respiratory disease questionnaire. Mouth occlusion pressures (MOP) were taken on day 1, 5 and 7 prior to and following punction.
Results: Compared to the placebo group, which demonstrated only a slight improvement of quality of life, a deterioration of lung function parameters and a trend of higher demand of the respiratory pump, Patients receiving verum acupuncture improved significantly with FEV1 and RV/TLC. Additionally in the acupuncture group, there was an improvement of large magnitude in quality of life and a trend of lower demand of the respiratory pump.
Conclusions: The small number of patients does not permit further conclusions; however, the results of this pilot study suggests that acupuncture is worthy of further investigation for patients suffering from COPD.
Neumeister W et al. Effect of acupuncture on quality of life, mouth occlusion pressures and lung function in COPD . Medizinische Klinik 94(1 Spec No): 106-9. Apr 1999.

Issue 39

ROSTED, Sheffield University, UK conducted a review of the literature regarding the efficacy of acupuncture in dentistry.
Methods: A literature search, carried out by the Royal Society of Medicine and the University Library, Copenhagen Denmark identified 74 publications written in 8 European languages between the years 1966-96, under the search headings of acupuncture, electro-acupuncture, randomised controlled trials (RCT), dental pain, postoperative dental pain, painrelieving in dentistry and dental analgesia. From the 74 listed papers, 48 papers were reviewed in English, Danish, Swedish, Norwegian and German; 15 papers were excluded due to being written in French, Italian or Russian, and 11 were excluded due to not being a RCT or not of relevance to acupuncture. All papers were scored on the basis of predefined criteria; 92 points could be achieved. On this scale, papers were rated as Excellent (85-100%; Good (70-84%); Fair (60-69%; and Bad (<60%). 15 of the 48 papers met the inclusion criteria.
Results: There was only one study which met the criteria scoring more than 85%; 5 studies met the criteria with 70-84%; 3 studies scored 60-69% and 6 studies did not meet the criteria. Acupuncture in 11 out of 15 studies proved effective in the treatment of temperomandibular dysfunction (TMD) and as an analgesia. 4 studies showed no effect of acupuncture.
Conclusions: The value of acupuncture as an analgesic needs to be questioned. The effect of acupuncture for the treatment of TMD and facial pain appears to be real, and in these clinical conditions, acupuncture may be a valuable alternative to orthodox treatment.
Rosted P. The use of acupuncture in dentistry: a review of the scientific validity of published papers. Oral Dis 4(2): 100-4 June 1998.

ABUAISHA and colleagues, Department of Medicine, Manchester Royal Infirmary, University of Manchester, UK studied the use of acupuncture to determine its efficacy for pain relief for peripheral diabetic neuropathy.
Methods: 46 diabetic patients suffering chronic painful peripheral neuropathy participated in the study. 29 (63%) patients were already receiving standard medical treatment. Patients initially received up to 6 courses of classical acupuncture analgesia over a period of 10 weeks, using traditional Chinese Medicine acupuncture points.
Results: 46 patients completed the study. 34 (77%) showed significant improvement in primary and/or secondary symptoms (P <0.01). These patients were followed up for 18-52 weeks, following which 67% were able to stop or reduce their medications significantly. During the follow-up period only 8 (24%) patients required additional acupuncture treatment. 34 (77%) patients noted significant improvement to their symptoms, but only 7 (21%) reported that their symptoms cleared completely. All patients except finished the full course of acupuncture treatment without any reported or observed side effects. There were no significant changes either in the peripheral neurological examination scores, VPT or in HbA1c throughout the course of treatment.
Conclusions: These results suggest that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy; however the mechanism of action still remains to be elucidated.
Abuaisha BB et al. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract 39(2): 115-21 Feb 1998.

Issue 38

HELMS, Office of Continuing Medical Education, University of California- Los Angeles School of Medicine USA describes the theoretical structure and clinical value of the emerging discipline of medical acupuncture, the approach most commonly integrated by physicians into their conventional medical practice.
Results: Medical acupuncture respects contemporary understanding of neuromuscular anatomy and pain physiology while embracing the classical Chinese perception of a subtle circulation network of the force called qi. The hybrid acupuncture approach expresses the best of two worlds by describing a context whereby patients symptoms may be organised, which could frequently escape attention using standard medical evaluation. Musculoskeletal problems have been shown to be the most frequently and successfully disorders treated with acupuncture; however medical acupuncture is adaptable to the majority of clinical practices and may be used either as the primary or a complementary treatment. The physician acupuncturist can creatively intervene in a spectrum of medical disorders ranging from early premorbid symptoms to chronic organic or musculoskeletal conditions by activating the appropriate subunit of qi circulation.
Helms JM. An overview of medical acupuncture. Altern Ther Health Med. 4(3): 35-45. May 1998.

ZHEREBKIN, Eastern Europe, conducted a randomised controlled clinical trial to study the efficacy of the multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A) treatment.
Methods: Measures assessed included the number of the inflamed joints, the joint index, duration of morning rigidity and a visual scale of pain.
Results: Combining treatment of RA with A was found to more effectively lower the values for the joint index and the visual scale of pain.
Conclusions: The results of this trial indicated that acupuncture may improve the results of drug treatment.
Zherebkin VV. The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis. Lik Sprava 6: 175-7. Nov-Dec 1997.

Issue 34

FURUGARD and colleagues, Norrlands Universitetssjukhus, Umea Norway studied the therapeutic effects of acupuncture upon tinnitus.
Methods: The authors compared the effects of a 3-month course of 15 acupuncture treatments with individualised physiotherapy, upon the severity of tinnitus and quality of life (QOL) in 22 patients suffering from disabling tinnitus. The study was a prospective, randomised cross-over trial, with follow-up for one year following the final treatment. Treatment results were evaluated by patients’ visual analogue scale (VAS) ratings, and replies to questionnaires, including the Nottingham Health Profile (NHP) which assessed the impact of tinnitus upon differing aspects of QOL.
Results: The baseline scores from the NHP indicated that tinnitus patients manifested pronounced depressive characteristics. Acupuncture yielded immediate relief, both in respect to loudness and disturbance of the tinnitus, and in resulted in significant improvement in QOL for three months following treatment conclusion. Individualised physiotherapy treatment yielded no significant reduction in tinnitus loudness nor disturbance due to tinnitus, not improvement in NHP scores, although many patients in the subgroup with concurrent muscle tension reported beneficial effects of physiotherapy. However, annoyance due to tinnitus and AOL scores returned to pre-treatment levels at one-year follow-up in both treatment groups.
Conclusions: These results indicate that tinnitus patients manifest depressive characteristics and that acupuncture may result in temporary improvement in tinnitus relief and QOL.
Furugard S et al. Acupuncture worth trying in severe tinnitus. Lakartidningen 95(17): 1922-8. Apr 22 1998.

AUNE and colleagues, Bryggen Medisinske Senter, Bergen, Norway, studied whether acupuncture is effective for recurrent lower urinary tract infection (UTI).
Methods: The authors conducted a randomised trial with 67 adult women with a history of UTI. The women were randomised for acupuncture treatment, sham acupuncture or no treatment. The incidence of UIT was noted over the following 6 months.
Results: Within the acupuncture group 85% of women were free of cystitis during the 6-month observation period, compared to 58% in the sham and 36% in the control groups. In comparison to the acupuncture group, there were twice the number of cystitis incidents in the sham group and three times as many in the control group.
Conclusions: Acupuncture appears to be a worthwhile alternative treatment for the prevention of frequently recurring cystitis in women.
Aune A et al. Can acupuncture prevent cystitis in women? Tidsskr Nor Laegeforen 118(9): 1370-2. Mar 30 1998.

KJENDAHL and colleagues, Sunnaas Sykehus, Nesoddtangen, Norway had previously reported in 1995 that acupuncture treatment for stroke patients in the subacute stage was therapeutic. The present study investigated whether acupuncture treatment continued to have benefit one year following discharge.
Methods: 45 patients suffering from stroke were included in the study, a median 40 days following stroke. Patients were randomised into acupuncture and control groups, considering sex and actual lesion site. All patients received an individually adapted, multidisciplinary rehabilitation programme. The acupuncture patients received, additionally, classical acupuncture treatment for 6 weeks. Thereafter, patients were provided individual treatment at the rehabilitation centre and the primary health care service. 41 patients were available for further study one year after treatment ended, 21 from the acupuncture and 20 from the control groups.
Results: Compared to the control group, there was a significantly greater improvement in the acupuncture group, during the 6-week treatment period and even more so during the following year. These assessments were based upon the Motor Assessment Scale, the Sunnaas Index of Daily Living (ADL), the Nottingham Health Profile and the patients’ social circumstances.
Kjendahl A et al. Acupuncture in stroke. Tidsskr Nor Laegeforen 118(9): 1362-6. Mar 30 1998.

CASSIDY writes that Chinese medicine is growing in popularity, offering an important alternative of complementary approach to health-care, but that little is known of users or their reason for using it. The author reports on the first in-depth, large survey (n = 575) of United States users of acupuncture.
Methods: A mixed quantitative-qualitative survey questionnaire assessed user demographics, the modalities of Chinese medicine used, their complaints, response to care, other types of health-care used and satisfaction with care in 6 general-service clinics in 5 states in the US.
Results: The demographic profile of the Chinese medicine user was of middle-age, well-educated, employed, middle-income patients who sought care for a wide variety of conditions. The most prevalent uses were for relief of musculoskeletal dysfunction, mood and wellness care. A large majority of users reported the “disappearance” or “improvement” of symptoms, improved quality of life and reduced use of prescription drugs and surgery. While expressing extremely high satisfaction with Chinese medicine, respondents also reported using a wide array of other therapeutic practices.
Conclusions: These respondents behave as astute consumers within a plural health care system. Details provided in Part II (in press) describe reasons given for satisfaction and places attitudes within a larger sociocultural framework.
Cassidy CM. Chinese medicine users in the United States. Part I: Utilization, satisfaction, medical plurality. J Altern Complement Med 4(1): 17-27. Spring 1998.

Comments: The above published research demonstrates the therapeutic effectiveness of acupuncture for the relief of major health problems, including stroke, cystitis and tinnitus. The last study’s survey indicates that acupuncture, in addition to alleviating symptoms, can improve quality of life and diminish to requirement for prescription drugs and even surgery.