Relief that Lasts

While the majority of research in acupuncture focuses on effects in general, this one takes the long view and examines efficacy after 24 months.

Research Shows Long-Term Benefits Of Acupuncture In Relieving Back Pain
September 15, 2006 4:56 p.m. EST
Shaveta Bansal - All Headline News Staff Writer

London, England (AHN) - Research by scientists at University of York in England, has shown that acupuncture can be effective therapy in treating patients suffering from lower back pain and that the benefits seem to improve with time.

Short-term benefits of acupuncture have been long known but to investigate the long-term effects of the therapy, Dr. Hugh MacPherson and his team studied a group of 241 back pain sufferers who underwent a short course of acupuncture.

Patients were divided into two groups: one group was subjected to take 10 acupuncture sessions over three months and the other group underwent the normal treatment for back pain, which included medication, physiotherapy and exercises. The satisfaction and pain levels of both groups were measured and recorded during the two-year study.

After three months there was not too much difference between the acupuncture group and patients who had the standard therapy.

A weak evidence of improvement in the acupuncture group was found at 12 months, according to the study published in the British Medical Journal.

By 24 months the difference between the two groups increased. "If you offer acupuncture to someone with back pain on average it is expected you are likely to benefit, not just in the short term but particularly in the longer-term of 12 and especially 24 months," MacPherson told Reuters in an interview.

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Doubting the Atom

Every once in a while I feel it is good to read what the skeptics have to say. There is something delightfully quaint about people who demand scientific proof that the reflection in the mirror is that of their own face, rather then trusting their own senses. They talk about scientific proof, but many cannot define basic concepts like statistical significance, independent variables, and random sampling. And the assumptions - wow - I am amazed at the lack of investigation and logic.

Normally, I pay little attention to those who dismiss complementary medicine outright - I prefer to spend my time helping people, not converting them. I know of very few practitioners who shun Western Medicine as of us have a yearly check-up with a regular doctor, and many take prescription medicine. Yes, there are some people who practice complementary therapies (including MDs) without proper training, but this is no different in allopathic medicine. Just because someone is an MD and says they are a plastic surgeon, does not mean they are trained and board certified. Frauds are everywhere, but at least with acupuncture, certification is easy to prove and most people who seek it out have a healthy amount of skepticism that helps them determine subjectively whether it is works for them. Individuals do not need a clinical trial to validate personal efficacy.

The gentlemen who wrote the following article brings up a good point if you can fish it out of the supercilious sarcasm: Medicine is medicine whether it came from the ground of from the factory - you need to know what your are putting into your body and to ensure your health by going to qualified medical professionals.

Of course, my first and last impression is that this guy would have gagged Galileo.

Talk of doctors can push buttons
2006-09-10

Generally speaking, I am slow to anger.

Some may argue differently but most people describe me as generally good-natured.
But when my buttons are pushed oh, my.

Recently, there was a photo in another newspaper that had this person with a number of acupuncture needles sticking into her face. It seems she was undergoing acupuncture because she ``didn't like doctors.''

OK. Let me see here.

She doesn't like the doctor that has been through four years of college, four years of medical school, and 3-7 years of residency training, but she will let someone without a college degree stick needles in her face?

She doesn't trust a trained health care professional yet allows someone to apply unproven and unconventional treatments to her?

I have a friend who states unequivocally ``I don't like to take medicine,'' yet pops four homeopathic pills in her mouth without even asking what is in them. And then wonders why she felt hot flashes all the way home.

Or the one who refuses to take an ibuprofen because he heard that ibuprofen damages the kidneys but knows intimately the dosage on Oxycodone?

Oh yeah my buttons are pushed.

Doesn't ``like doctors?'' To me, that's almost the same as not liking air -- definitely important and pretty unhealthy to do without.

Obviously, I'm firmly entrenched in the ``traditional'' side of medicine. Have been for almost 29 years. My daughter and her husband are both doctors, of the ``M.D.'' variety.

Oh, I'm definitely prejudiced.

Prejudiced because I am at heart a scientist and I want scientific evidence of what I do to or put in my body.

Prejudiced because I having a pretty good working knowledge of what medical training involves.

Prejudiced because I understand the importance of good, traditional medical care.

Don't take this as a complete indictment of non-traditional methods of health care. Oftentimes, we have learned more about how the body works by NOT doing things the way they've always been done.

For example, we have learned a lot about the body by exceeding what we always thought were physical limitations.

We've learned a lot by exploring home remedies and ancient forms of promoting healing.

Not everything must pass the test of a double-blind study for us to know that it works.

But when it comes to health care, I just prefer to rely on the person who has dedicated 11-18 years in formal education in the pursuit of knowledge that makes him or her the absolute best person to help me make decisions about my health.

I want to live to be old but still be healthy and active.

That's why I get a physical examination every single year and have a good working relationship with a specific family practitioner.

Doesn't ``like doctors?''

Your doctor should be one of your favorite people.

Joe Black, PT, SCS, ATC, is a physical therapist and athletic trainer at Appalachian Therapy Center. Write to him at: Joe Black, c/o The Daily Times, P.O. Box 9740, Maryville, TN 37802-9740.

Making a Difference

It is wonderful to see how giving so many fellow professional acupuncturists can be not only in the midst of tragedy, but in its aftermath.

Healing hands help Katrina victims
By Jillian Fennimore/ Staff WriterFriday, September 8, 2006 - Updated: 09:55 AM EST

Known for their calm nature and healing hands, acupuncturists from across the country brought peace to an area still in chaos and repair one year later. Hurricane Katrina ravaged the Gulf Coast last August with record strength, leaving the people of New Orleans and coastal Mississippi in devastation, some homeless, and most stressed in the wake of its destruction.

Licensed acupuncturist Bella Rosner, whose practice is in Watertown at the Japanese Acupuncture Center, was one of the many who joined the worthy cause of Acupuncturists Without Borders to treat the traumatized with free community acupuncture in Louisiana both last November and February. Last Thursday, Rosner’s treatments were brought back to Watertown in order to help raise money for the organization’s continued success as the needs increase down south. Rosner treated several people throughout the day, with funds going to AWB.

Since last September, AWB has sent rotating teams of acupuncturists to benefit the evacuees, displaced residents, relief workers, emergency responders and others suffering from the devastating effects of hurricanes Rita and Katrina. They hope to continue with much-needed funding.

"We worked with the poorest of the poor, to FEMA workers staying at the Hyatt, and National Guard rescue workers," said Rosner about her two visits this past year to the more distressed areas of Louisiana. "But people were telling me that for the first time [since Hurricane Katrina] they got a good night’s sleep. They wanted us to come back."

Inside the serene treatment office on Watertown Street, a rock fountain flows in the corner and a can for AWB donations sits at a nearby table. Inside of a photo album, pictures of Katrina’s aftermath sit boldly behind their plastic pockets, displaying empty lots where homes used to be and the faces of those happy to help and happy to be alive. Rosner said she and a group of grassroots organizations visited emergency communities of the Lower 9th Ward and St. Bernard’s Parish, along with other venues, treating people with symptoms of acute stress and trauma.

Traveling on a bus to visit a community, Rosner found herself sitting with New Orleans residents driving past their homes and uncovering their neighborhoods for the first time, including a young couple with their newborn baby.

"They would point and say ’look there’s auntie’s house’ or ’that’s grandma’s house’," she said. "Entire communities were torn apart. We just want to give them peace of mind for one day."

Since their efforts on year ago, AWB members have treated more than 6,000 people in the aftermath of the hurricane and their appointment calendars are still full.

Blanket Marketing

One of the woes of living in the Midwest is selling people on the success of Acupuncture and Oriental medicine treatment. Unlike the coasts, where acupuncture is an established complementary therapy, many here regard the modality with suspicion and doubt. I have had people say to me flatly, "I don't believe in any of that." I have found that explaining acupuncture is not a belief system but a medical one makes little difference. The blank stare can be most frustrating.

On the up side, the majority of people who seek out treatment here have done their internet research and understand the potential and the limitations of treatment as well as the need to give ample time to allow the medicine to work. Some know very little and come because someone they know recommended it, but are eager to learn as much as they can. There are also those who may want to give it a try but put everything into a western medical context - I say "blood deficiency", they think "anemia." Needless to say, a big part of a practitioner's practice is education. The following article is must-have waiting room reading material.

Alternative Health: Making acupuncture connect



Written by Robert Gluck
Thursday, 31 August 2006

The theory behind the practice of acupuncture continues to confound Western science, but despite the lack of understanding, its popularity is on the up...

This therapy, originating in Asia, is based on the concept that currents of energy called meridians flow through your body. However, no one has ever been able to conclusively demonstrate the existence of these meridians.

Despite the evasiveness of these energy streams, Traditional Chinese Medicine (TCM) holds that alterations in these energy flows can disrupt health and cause pain. Consequently, an acupuncturist punctures your skin with specialised needles to redirect the body's vital energy.

Alleviating Illness
Despite the fact that western scientists have not been able to find satisfactory evidence of the existence of these energetic meridians, studies show that acupuncture works and is especially effective at relieving pain. This therapy has been used to alleviate a variety of conditions including chronic pain, nausea and even mental illness. In addition, some practitioners apply it to those trying to shake off the chains of drug addiction. (More recently, many practitioners now also successfully use acupuncture to relieve physical problems in animals.)

Of course, no matter what your perspective on this therapy, acupuncture's no panacea.

While you might use acupuncture to relieve the discomforts of chemotherapy, you wouldn't use this technique as your primary weapon against a dangerous disease like cancer. Still, this reliable therapy occupies a welcome spot as an adjunct to many mainstream therapies.

Consequently, many mainstream practitioners accept the validity of using acupuncture and many managed care companies reimburse this therapy. Some HMOs even keep a list of approved acupuncturists that they make available to enrolees.

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For Just a Little Money Down . . .

. . . you can get rid of that pain in the neck. There is nothing like a large sample size to support a point (no pun intended)!

Yes, acupuncture really does have a point, study reveals
By Hannah Devlin from The Times Online

A study has found that acupuncture not only helps to relieve pain but is a cost-effective way of doing so.

More than 3,400 patients suffering from neck pain were studied over a three-month period by scientists based at the Berlin Institute of Social Medicine. About half received acupuncture in addition to routine care.

The researchers, whose study is reported in the journal Pain, found that the extra cost of the acupuncture treatment resulted in health benefits that were great enough to make the treatment cost-effective.

“Acupuncture isn’t controversial any more,” said Claudia Witt, who led the project. “We’ve shown that it works.” She added that it was in no way comparable to other alternative therapies. ”

One in five people in Britain suffers from long-term pain and about half of these have taken time off work because of it. While acupuncture is provided in the majority of pain clinics in Britain, access to the treatment is limited.

The Woes of Research Grant Money

If one were to believe the bevy of solicitous e-mails, one would surmise that to get a grant, you just need to fill out a few pieces of paperwork and send it off to various organizations that some internet company provides you for the low cost of $59.99. For the past two years, we have been trying to get funding though the government to continue the research started by Dr. Hollifield and Nityamo Lian concerning an acupuncture treatment protocol for PTSD, and the going is rough and frustrating.

We have applied for grants to "further research in several sites with several practitioners of each discipline is needed to confirm these results," but when the concerns on the part of the grant investigators are addressed and answered by our team, the investigators come up with additional concerns. The latest: To sham, or not to sham - that is the question.

A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert.

J Altern Complement Med. 2006 Apr;12(3):303-10.
Birch S.Stichting (Foundation) for the Study of Traditional East Asian Medicine (STEAM), Amsterdam, The Netherlands. sjbirch@gmail.com

Researchers examining the efficacy of medical procedures make assumptions about the nature of placebo. From these assumptions they select the sham interventions to be used in their trials. However, placebo is not well defined. A number of definitions are contradictory and sometimes misleading. This leads to problems in sham-controlled studies of medical procedures and difficulties interpreting their results. The author explores some of the contradictory definitions of placebo and assumptions and consequences of these. Principal among these is the assumption that the placebo is inert when it is not, which introduces bias against the tested medical procedures and devices. To illustrate the problem, the author examines the use of sham procedures in clinical trials of the medical procedures surgery and acupuncture in which the sham was assumed to be inert but was not. Trials of surgery and acupuncture should be re-examined in light of this.

More to come on this in the future. In the meantime, here is the abstract from the Journal of Alternative and Complementary Medicine on the protocol that was used in New Mexico (you need sign-on to access the full article - it has the specifics on the treatment points). If you would like to see some JAMA abstracts of acupuncture research fortunate enough to get funding, check out http://jama.ama-assn.org/cgi/search?fulltext=acupuncture or the Society for Acupuncture research http://www.acupunctureresearch.org/


Journal of Alternative and Complementary Medicine
Developing a Traditional Chinese Medicine Diagnostic Structure for Post-Traumatic Stress Disorder
Jan 2006, Vol. 12, No. 1: 45-57
Nityamo Sinclair-Lian, D.O.M. (N.M.)
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Behavioral Health Research Center of the Southwest, Albuquerque, NM.
Michael Hollifield, M.D.
University of Louisville, Department of Psychiatry and Behavioral Sciences, Louisville, KY.
Margaret Menache, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Teddy Warner, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Jenna Viscaya, D.O.M. (N.M.)
International Institute of Chinese Medicine, Sante Fe, NM.
Richard Hammerschlag, Ph.D.
Oregon College of Oriental Medicine, Portland, OR.

Background: Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.

Methods: Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.

Results: The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation—Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire—and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.

Conclusions: The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.

German Survey

Our Teutonic friends have been busy lately in collecting research covering a wide range of acupuncture effects and techniques. From one side of the pond to the other, a lot of great investigation is being done and I have included links to some of my favorites.

Measurement of acupuncture needle grasp at acupuncture points and control points
http://www.akupunktur-aktuell.de/fb0112_1.htm

One of the most controversial aspects of acupuncture is whether the location of acupuncture needling sites is important, ie: does the needling of classically defined acupuncture points have an enhanced therapeutic effect as compared with the needling of any other set of points on the body. Resolving this issue is of fundamental importance, since the specificity of acupuncture points is implied in some of the most basic principles underlying the traditional practice of acupuncture.

These results provide objective evidence that acupuncture points have different biomechanical behavior than control points. Whether this is due to anatomical and/or physiological differences between acupuncture points and surrounding tissues, and what these differences are, remains unknown. Our results also show that needle manipulation strongly influences needle grasp, and does so at control points as well as at acupuncture points. We are planning to use the results of this study as a first step to understand the mechanisms underlying needle grasp, and the therapeutic significance of both de qi and acupuncture points.

As someone trained in TCM, I have always believed if there is no Qi, there is no treatment. Perhaps it is Western programming to believe “no pain, no gain,” but I see better results with patients who report feeling sensation over ones that feel nothing. In my experience, I find the patient will have the Qi sensation a moment after I feel the needle “grab.” For those patients that I know are sensitive, I try to keep the needle positioned at that threshold between the grab and the sensation so that they can reap the maximum benefit with the minimum discomfort. Of course, there are those others that can’t get enough Qi either, or as one of my patients says, “Give me the ju-ju!”

DESCRIPTION AND VALIDATION OF A NON-INVASIVE PLACEBO ACUPUNCTURE PROCEDURE
http://www.akupunktur-aktuell.de/fb0202_1.htm

Objective: To evaluate a simulated acupuncture technique for use in randomized controlled trials assessing the efficacy of acupuncture for low back pain.

Experimental Design: In the first experiment, subjects received six insertions of real needles and six pokes with a toothpick in a guidetube in a two-period crossover design. In the second experiment, subjects were randomized to receive either a complete treatment with real acupuncture needles or a simulated treatment using a toothpick in a guidetube.

Conclusions: The simulated acupuncture procedure evaluated in this study represents a reasonable control treatment for acupuncture-naïve individuals in randomized controlled trials assessing the efficacy of acupuncture for low back pain.

Having sat in on some design planning for a few different research projects, I know the use of sham acupuncture is a controversy. A placebo pill in a drug trial is not analogous to random needling. This sounds like a promising (an somewhat humerous) alternative for those who have research aspirations.

CLINICAL STUDY OF HERPES ZOSTER TREATMENT USING ACUPUNCTURE OF THUMB-JOINT ACUPOINT AND FIRE-TWINKLING METHOD
http://www.akupunktur-aktuell.de/fb0224_1.htm

This paper is the summary of clinical results of using Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling for 27 cases of Herpes Zoster, a virulent skin disease called "Yao Chan Huo Dan" and "She Du Cang" in traditional Chinese medicine. The condition usually results from decreased immune function, emotional depression, dietary disorder, malfunctional spleen and liver, or virus infection. The course of the illness lasts from two to fifteen days. The purpose of using Acupuncture of Thumb-joint Acupoint locally is to stimulate the infected region, improve the overall body immune system, and thus kill the virus using the body’s own immune functionality. Additionally, the Fire-Twinkling method utilizes the flame’s radiating and heating effect to enlarge local blood vessels, accelerate blood circulation and energize body cells.

The outcome of the treatment and observation study showed that Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling was a very effective treatment method for Herpes Zoster: among the 27 cases studied, 24 (88.8%) were completely cured, 2 cases (7.4%) showed evident improvement, and only one case (3.8%) showed no sign of improvement. The overall efficiency of the treatment was 96.8%.

“Fire-Twinkling” - I have always been a sucker for TCM technique descriptions!