Acupuncture Protocol Research Articles

Ear acupuncture for hot flushes—The perceptions of women with breast cancer

Hot flushes and night sweats are a major problem for women having adjuvant hormonal treatment for breast cancer. We explored using a standardised ear acupuncture protocol delivered in small group clinics as an option to manage these side effects. Qualitative research aimed to elicit the opinions of women who received this treatment. Sixteen women took part in three focus groups, and discussed a range of topics including reasons for joining the study, experience of having acupuncture, effects of the treatment, the possible reasons for these, and their experience of group treatments. Transcripts of the groups were analysed using grounded techniques. The women, who had all been experiencing chronic multiple flushes and sweats, found the acupuncture helpful and relaxing. Many reported reductions in hot flush frequency, as well as improvements in overall emotional and physical well being. The group setting for treatment was regarded as supportive and encouraging.

Meta-analysis: Acupuncture for Osteoarthritis of the Knee

Knee osteoarthritis is a major cause of pain and functional limitation. To evaluate the effects of acupuncture for treating knee osteoarthritis. Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases to January 2007. No language restrictions were applied. Randomized trials longer than 6 weeks in duration that compared needle acupuncture with a sham, usual care, or waiting list control group for patients with knee osteoarthritis. Two authors independently agreed on eligibility, assessed methodological quality and acupuncture adequacy, and extracted outcome data on pain and function measures. Eleven trials met the selection criteria, and 9 reported sufficient data for pooling. Standardized mean differences were calculated by using differences in improvements from baseline between patients assigned to acupuncture and those assigned to control groups. Compared with patients in waiting list control groups, patients who received acupuncture reported clinically relevant short-term improvements in pain (standardized mean difference, -0.96 [95% CI, -1.21 to -0.70]) and function (standardized mean difference, -0.93 [CI, -1.16 to -0.69]). Patients who received acupuncture also reported clinically relevant short- and long-term improvements in pain and function compared with patients in usual care control groups. Compared with a sham control, acupuncture provided clinically irrelevant short-term improvements in pain (standardized mean difference, -0.35 [CI, -0.55 to -0.15]) and function (standardized mean difference, -0.35 [CI, -0.56 to -0.14]) and clinically irrelevant long-term improvements in pain (standardized mean difference, -0.13 [CI, -0.24 to -0.01]) and function (standardized mean difference, -0.14 [CI, -0.26 to -0.03]). Sham-controlled trials had heterogeneous results that were probably due to the variability of acupuncture and sham protocols, patient samples, and settings. Sham-controlled trials show clinically irrelevant short-term benefits of acupuncture for treating knee osteoarthritis. Waiting list-controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects.

Complementary Urologic Care: An Interview with Bruce R. Gilbert, M.D., Ph.D., FAAMA

Bruce R. Gilbert, M.D., Ph.D., FAAMA is a board-certified urologist who integrates acupuncture and other complementary protocols into his treatment procedures. He has been in private practice in Great Neck, New York, since 1989. He specializes in complex microsurgical procedures for male fertility and sexual function. Dr. Gilbert is a clinical associate professor of urology and of male reproductive medicine and surgery at Cornell University Medical College in New York City, and is an attending physician at several hospitals in the city. He is a Fellow of both the American College of Surgeons and the American Academy of Medical Acupuncture (AAMA), of which he has been a director for the past 3 years and is currently president of its New York chapter. Dr. Gilbert is the principal investigator in a number of clinical research protocols involving complementary medicine. He lives in Great Neck, New York, with his wife and two children, is an avid boater, and is an instrument-rated private aircraft pilot.

Correlated Change in Upper Limb Function and Motor Cortex Activation After Verum and Sham Acupuncture in Patients with Chronic Stroke

Acupuncture may improve motor function in patients with chronic hemiparetic stroke, yet the neural mechanisms underlying such an effect are unknown. As part of a sham-controlled, randomized clinical trial testing the efficacy of a 10-week acupuncture protocol in patients with chronic hemiparetic stroke, we examined the relationship between changes in function of the affected upper limb and brain activation using functional magnetic resonance imaging (fMRI). Seven (7) chronic hemiparetic stroke patients underwent fMRI and testing of function of the affected upper limb (spasticity and range-of-motion) before and after a 10-week period of verum (N=4) or sham (N=3) acupuncture. The correlation between changes in function of the affected upper limb and brain activation after treatment was tested across patients. We found a significant positive correlation between changes in function of the affected upper limb (spasticity and range of motion) and activation in a region of the ipsilesional motor cortex. Patients treated with verum acupuncture showed a trend toward a greater maximum activation change in this motor cortical area as compared to those treated with sham acupuncture. Acupuncture may improve function of the affected upper limb in chronic hemiparetic stroke patients by increasing activity in the ipsilesional motor cortex.

Effect of Acupuncture Treatment on the Immune Function Impairment Found in Anxious Women

It is presently accepted that emotional disturbances lead to immune system impairment, and that therefore their treatment could restore the immune response. Thus, the aim of the present work was to study the effect of an acupuncture treatment, designed specifically to relieve the emotional symptoms stemming from anxiety, on several functions (adherence, chemotaxis, phagocytosis, basal and stimulated superoxide anion levels, lymphocyte proliferation in response to phytohemagglutinin A (PHA) and natural killer (NK) activity) of leukocytes (neutrophils and lymphocytes) from anxious women. The acupuncture protocol consisted of manual needle stimulation of 19 acupoints, with each session lasting 30 min. It was performed on 34 female 30-60 year old patients, suffering from anxiety, as determined by the Beck Anxiety Inventory (BAI). Before and 72 hours after receiving the first acupuncture session, peripheral blood samples were drawn. In 12 patients, samples were also collected immediately after the first single acupuncture session and one month after the end of the whole acupuncture treatment, which consisted of 10 sessions during a year, until the complete remission of anxiety. Twenty healthy non-anxious women in the same age range were used as controls. The results showed that the most favorable effects of acupuncture on the immune functions appear 72 hours after the single session and persist one month after the end of the complete treatment. Impaired immune functions in anxious women (chemotaxis, phagocytosis, lymphoproliferation and NK activity) were significantly improved by acupuncture, and augmented immune parameters (superoxide anion levels and lymphoproliferation of the patient subgroup whose values had been too high) were significantly diminished. Acupuncture brought the above mentioned parameters to values closer to those of healthy controls, exerting a modulatory effect on the immune system.

Designing an Acupuncture Study: II. The Nationwide, Randomized, Controlled German Acupuncture Trials on Low-Back Pain and Gonarthrosis

In the nationwide German Acupuncture Trials (GERAC), verum acupuncture, mirroring the Traditional Chinese Medicine (TCM) acupuncture style, was tested against sham acupuncture and guideline standard therapy for the entities classified in the West as chronic low back pain (LBP) and gonarthrosis (GON). The objective was to develop broadly consensual acupuncture and control protocols for the treatment of LBP and GON in the GERAC trials. Extensive literature study and consultation with acupuncture experts were consulted. Personal interviews, both free and structured, e-mail discussions, and phone conferences were used as well. Broadly consensual acupuncture protocols for LBP and GON for verum and invasive sham acupuncture were developed. They included semistandardized point combinations with clearly described point selection rules based on TCM acupuncture diagnosis. A procedure was developed to help ensure homogenous treatment quality in a large multicenter trial. With 1162 randomized patients for LBP and 1039 patients for GON, the GERAC study design allowed acupuncture to be tested in a naturalistic environment. The rigorous study design and large number of physician investigators guaranteed a high external validity for the results. The results will help determine the significance of Chinese acupuncture in the context of Western medicine for the treatment of LBP and GON.

Acupuncture Treatment for Chemotherapy-Induced Peripheral Neuropathy – a Case Series

Chemotherapy induced peripheral neuropathy (CIPN) occurs in 10 to 20% of cancer patients treated with neurotoxic chemotherapy. A mixture of sensory, sensorimotor and autonomic nervous system dysfunction can occur, resulting in deterioration in function and worsened quality of life. A major feature is discomfort and pain. Early termination of treatment and dose reduction of chemotherapy may be necessary. The clinical course is variable and depends on the chemotherapy agents and their cumulative dose. Although symptoms can resolve completely, in most patients CIPN is either only partially reversible or completely irreversible. Current management for CIPN is symptomatic using membrane stabilising medications and antidepressants. The use of nerve growth factors is still experimental. Dysaesthesia and pain involving the feet and hands are described in both traditional Chinese medicine (TCM) and Western biomedicine. In TCM, the pathogenesis is related to the inability to direct Qi and Blood to the extremities, and is associated with Qi, Blood, Yang and Kidney deficiencies. Acupuncture is moderately effective in treating diabetic neuropathy. However, to date, there is no report of the usefulness of acupuncture for CIPN. We report the result of a pilot prospective case series of five patients treated with an acupuncture protocol that aims to correct Qi, Blood and Yang deficiencies and directs Qi and Blood to the extremities, with the goal of improving the symptoms of CIPN. The responses were encouraging, and cannot be easily explained by the known neurophysiological mechanisms of acupuncture.

Designing an acupuncture study: the nationwide, randomized, controlled, German acupuncture trials on migraine and tension-type headache.

In the nationwide German Acupuncture Trials (GERAC) verum acupuncture, based on Traditional Chinese Medicine (TCM), was to be tested against sham acupuncture for the entities classified in the West as "migraine" (MIG) and "tension-type headache" (TTH). However, there were no generally accepted guidelines on how to perform a consistent verum or sham treatment. To design broadly consensual verum and sham acupuncture treatment protocols for MIG and TTH for the GERAC. Extensive literature study and consultation with acupuncture experts. Personal interviews, both free and structured, e-mail discussions, and phone conferences were used. Broadly consensual acupuncture protocols for MIG and TTH for verum and sham acupuncture were developed. They included semi-standardized point combinations with clearly described point selection rules based on TCM acupuncture diagnoses. A procedure was developed to help ensure homogenous treatment quality in a large multicenter trial. The GERAC study design allowed acupuncture to be tested in a naturalistic environment. The rigorous study design and the large number of physician investigators guaranteed a high external validity for the results. The results will help determine the significance of Chinese acupuncture in the context of Western medicine for the treatment of MIG and TTH.

Trauma care

trauma care

Trauma care

trauma care

Acupuncture and good prognosis IVF patients: Synergy

To determine the role of electro stimulation acupuncture and traditional combined with auricular acupuncture on IVF outcomes in good prognosis patients. Retrospective case controlled clinical study. Acupuncture Consortium for treatment standardization. Reproductive EndocrinologysInfertility IVF Private Practice and Traditional Chinese Medicine Acupuncture Clinics. One hundred fourteen infertile patients undergoing controlled ovarian hyperstimulation with gonadotropins and GnRH agonist and antagonist for IVF-ET (2001 to 2003) in private practice IVF clinic. Only IVF patients with normal Day 3 FSH, normal uterine artery pulsatility indices, sperm morphologies over 7% normal by Kruger Strict Criteria and good response to ovarian hyperstimulation protocols (i.e., E2 over 2000 pg/ml) were analyzed.Intervention (s): Electrostimulation acupuncture -- reduction of Pulsatility Index (PI) of the uterine artery and Traditional combined with Auricular acupuncture -- Pre/Post embryo transfer protocols were used alone or in combination and resultant pregnancy outcomes were measured after IVF treatments. Main Outcome Measure(s): Cycles were grouped according to those that received No Acupuncture (Non-Ac) and those that received either one or both acupuncture treatments (Ac). Comparisons were made between Acupuncture treated IVF patients and Non − Acupuncture treated IVF patients in clinical pregnancies, ongoing pregnancies and birth outcomes. The statistics used for this analysis included; Tests for normal distribution: chi-square test, Kolmogorov-Smirnov Test Unpaired T-tests Stepwise Multiple regression Variance ratio test (F-Test) One-Way analysis of variance (ANOVA) with Student-Newman-Keuls (SNK) test for pair wise comparison of subgroups. Total IVF cases 114, 53 with Acupuncture (Ac) and 61 without Acupuncture (Non-Ac). Demographics, Infertility Diagnoses, and Treatment Protocols were statistically the same between both groups and by design, the following parameters were similar: Sperm Morphology; Peak Day 3 FSH; Average Pulsatility Index; Peak E2 at hCG; and Post hCG P4. These parameters earned the designation of Good Prognosis group. Pregnancy rates (PR) and Miscarriage rates (SAB) were statistically improved at the p < 0.05 levels in those patients that received Acupuncture (51% v 36% PR and 8% v 20% SAB in the AC v Non-Ac groups). There were no ectopic pregnancies in the Ac group and 9% in the Non-Ac group, p < 0.008. Finally, Birth rates (BR) per cycle start and per pregnancy were significantly higher in the Ac group, with 23% more births/pregnancy significant at the p < 0.05 level. The use of adjunctive therapies in IVF protocols is gaining popularity. In previously published data, Acupuncture was reserved for Poorer Prognosis patients and enhanced outcomes were observed. In this study, we demonstrated that Good Prognosis patients would also benefit from inclusion of published Acupuncture protocols. This is also the first publication of Birth outcome data in Acupuncture treated IVF patients. Acupuncture significantly increased birth outcomes; it significantly decreased ectopic pregnancies and miscarriage rates. These data uniquely support a definitive role of both Electrostimulation and Traditional combined with Auricular Acupuncture in IVF in Good Prognosis IVF patients.

Abstract 4: Acupuncture analgesia and electromyography

Objectives: To evaluate the analgesic effect of a simple acupuncture protocol with needle electromyography and to validate independently a telescopic sham acupuncture needle. Design: Randomized, double-blinded, controlled study. Setting: University-based electrodiagnostics laboratory. Participants: 38 subjects referred for electrodiagnostic evaluation. Intervention: Before the electromyographic examination, an independent provider applied either real acupuncture needles or telescopic sham needles to the acupuncture points Large Intestine 4 and Liver 3 bilaterally. Main Outcome Measures: 100-mm visual analog scale (VAS) of the subjects’ pain before electromyography as well as pain and unpleasantness related to electromyography after 3 muscles were examined. Subjects were also asked if they thought they had received true acupuncture or sham needles. Pretest pain was subtracted from electromyography-related pain to give a measurement of pain attributable to the electromyography. Results: 21 subjects were randomized to the treatment group and 17 to the sham group. The subjects in the two treatment arms did not differ by age ( P=0.9) or gender ( P=0.4). The pain attributable to electromyography in the treatment group (mean, −5.38±27.6) was significantly less than the pain attributable to electromyography in the control group (mean, 11.3±17.3) ( P=.037; 95% CI, −32.3 to −1.1) The percentage of subjects who thought they had received real needles in the acupuncture group (67%) did not differ from the proportion in the control group (53%) (Fisher exact test, P=.51). Conclusion: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study of which we are aware that independently validates the telescopic sham acupuncture needle as an effective control.

Acupuncture As A Promising Treatment For Below-Level Central Neuropathic Pain: A Retrospective Study

Background/Objective: Below-level central neuropathic pain, a diffuse pain characterized by generalized burning, is commonly experienced by individuals with spinal cord injury (SCI) . The objective of this study was to investigate the effects of an electroacupuncture protocol for the treatment of below-level central neuropathic pain developed at the Toronto Rehabilitation Institute, Lyndhurst Center, Toronto, Ontario, Canada.Method: Retrospective chart review.Results: Thirty-six individuals with traumatic and nontraumatic SCI met the inclusion criteria. Of these, 24 showed improvement after treatment with the electroacupuncture protocol. Type of injury, level of injury, and duration of below-level central neuropathic pain was not correlated with improvement. However, individuals whose pain was described as bilateral (vs unilateral; P = 0 .01 4) or symmetric (vs non symmetric; P = 0.02 6) were more likely to improve after acupuncture treatment. Overall, patients whose burning pain was bilateral, symmetric, and constant (P = 0 .005) were the most likely to improve.Conclusion: This retrospective study suggests that the Lyndhurst Center Central Neuropathic Pain Acupuncture Protocol may be an effective treatment option for patients with SCI who are experiencing below-level central neuropathic pain. Additional prospective clinical studies are needed to confirm these findings.J Spinal Cord Med. 2003;26:21-26

Impact of acupuncture as add-on therapy to pharmacological treatment of migraine: A pilot study

AbstractAcupuncture is often recommended as an effective therapy to migraineurs without having an evidence-based rationale. The main objective of this pilot study was to evaluate the effect of standard acupuncture as add-on therapy to pharmacological attack-treatment in migraineurs. A secondary objective was to identify potential pitfalls that could be addressed when planning the protocol of a larger acupuncture study.Thirty-nine patients with a diagnosis of migraine without aura (32 women and 7 men, aged between 26 and 50 years, mean age 41 years) were recruited at a headache clinic. The patients were randomised to two treatment groups: a group (n = 20) where acupuncture was given as add-on therapy to pharmacological attack-treatment and a control group (n = 19), where no acupuncture was used. Acupuncture was given once or twice a week for 4-6 weeks, making a total of 7-10 sessions. The participants were instructed to keep headache diaries in which they registered days with migraine throughout the study....

Akupunktur zur Plazentalösung? - Eine prospektiv randomisierte Untersuchung -

Fragestellung: Läßt sich die Feststellung, Akupunktur führe zu einer Beschleunigung der postpartalen Plazentalösung naturwissenschaftlich belegen? Krankengut und Methodik: Im Rahmen einer prospektiv randomisierten Untersuchung (n = 836) an acht Kliniken mit jeweils mehr als 1000 Geburten wurde untersucht, ob mit den in der Literatur angegebenen Protokollen zur Akupunktur post partum die Plazentalösung beschleunigt werden kann oder nicht. Im Rahmen dieser Untersuchung wurde ein einheitliches Vorgehensprotokoll erstellt, in dem die speziellen Punkte zur Plazentalösung, wie in der Literatur angegeben, Berücksichtigung fanden (Junghanns, 1994 [2], Schuler, 1989 [5]). Ziel war es also, in einer rein vergleichenden Analyse die Plazentalösungszeit mit und ohne Akupunktur zu untersuchen. Als Besonderheit dieser Untersuchung ist zu berücksichtigen, daß an den verschiedenen Kliniken auch unterschiedliche Vorgehensweisen post partum in bezug auf die Plazentalösung geübt wurden. Hieraus resultiert ein Studienarm mit und ohne Oxytocingebrauch, ein Studienarm mit und ohne Methergingebrauch, und ein Studienarm mit und ohne Ausblutenlassen der Plazenta, bzw. lediglich Zuwarten bei nicht blutendem Befund. Ergebnisse: Die Analyse der 836 auswertbaren Geburten ließ erkennen, daß keine der genannten Methoden alleine oder in Kombination mit Akupunktur zu einer Beschleunigung der Plazentalösung post partum führt.