2. Cognitive Objectives
• List 3 stated benefits of acupuncture.
• Define sham acupuncture.
• Describe what Qi is.
• Identify the most significant adverse effect
related to safety and explain what it was related
to.
• Explain which treatment application (Back pain,
OA of the Knee, or PONV) has the most
evidence of benefits based on results, strengths
and limitations.
3. Origins
• Trace back more than 2000 years in China
• 6th
Century spread to Korea and Japan
• 8th
and 10th
Century trade into Vietnam
• 16th
Century Western France by Jesuit
missionaries
• 1972- Visit to China from President Nixon-
– Member of US Press Corps with emergency
appendectomy received acupuncture.
– Experienced shared with New York Time
5. Techniques and Practices
• Sham acupuncture
• Okibari - Japanese style
• Moxibustion
• Cupping
• Electroacupuncture (EA)
6. Needles
• Needles made of flint, thorns of plants, bamboo
slivers or bone
• Very fine and flexible about 1/2in (0.6cm) to 1 ½
in (38cm)
• Attract or disburse energy along meridians
• FDA approved needles by use of licensed
practitioners in 1996. Sterile, non toxic, single
use only
8. Traditional Chinese Medicine
• Qi: Life force, vital energy behind all
physiological processes.
– warms body, pathogen protection, promotes
growth
– Meridian network system
– Disruption of flow results in illness
– Mechanism of Qi still mysterious
9. Traditional Chinese Medicine
• Meridians
– Term for each of 20 pathways through body
for flow of qi, accessed through acupuncture
points
– 12 main and 8 secondary
– Up to 2000 points along meridian complex
– Points regulate different areas of the body
10. Theory
• Stimulation of the nervous system to
release chemicals in the muscles, spinal
cord, and brain.
– Beta-endorphin
• Analgesia.
• Placebo effect.
11. Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
• Method
–202 cases reported (40% from US) from
1965-1999,
–First hand reports included, case reports
12. Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
• Results
– Infection: Hepatitis 80% (94cases/35
years)
• Needles not cleans/ repeated use/ inadequateNeedles not cleans/ repeated use/ inadequate
sterilizationsterilization
–Internal Organ/tissue injury
–Fewer complications after 1988: no further
Hepatitis reports.
– 20% of practitioners with no recognized qualifications
13. Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241
• Methods
– Randomized controlled trials of acupuncture of back
pain in humans
– 377 subjects, mostly with chronic poor prognosis back
pain
– Consulted by 6 experienced acupuncturists
– 12 studies included (9 suitable for meta-analysis)
• Conclusion
– Insufficient evidence to state whether superior to
placebo
– Long term effect of back pain with acupuncture
uncertain
14. Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241
15. Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic
low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al.
Archives of internal medicine. 2001; 161, 8: 1081-1088.
• Design
– Only 17% of invited Washington State Group Health
HMO patients participated (262 patients, age 20-70
years).
– Ten acupuncture or massage visits in a 10 week
period.
– 95% of patients w/ Follow-up after 4, 10, and 52
weeks.
• Symptoms and dysfunctions assessed
• Results
– F/U with 95% of participants
– massage is an effective short-term treatment for
chronic low back pain with benefits to last at least 1
year
16. Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic low
back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of
internal medicine. 2001; 161, 8: 1081-1088.
• Results
– If acupuncture has a positive effect it seems
to be during the first 4 weeks with limited
improvement thereafter.
• Strengths- randomized design, involvement of
therapist with protocol development, and high
compliance rate.
• Limitations -absence of control group, restriction
of single form of acupuncture (TCM), possibility
of atypical therapists, use of protocols that
excluded treatments often used by some TCM
acupuncturist.
17. Osteoarthritis
• OA most prevalent form of arthritis
• Common site is knee joint and a leading
cause of disability in the elderly
• Acupuncture for OA is a therapeutic
approach common in Asian societies
18. A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354
• Design
– 73 patients from the Baltimore area (average
age 65 years).
– Inclusion criteria ≥ 50 older Dx of OA ≥ 6
months, moderate pain in knee most days in
the last month, taking analgesic or anti-
inflammatory agents for pain control at least
one month.
– protocol included TCM treatment for Bi
syndrome which uses local and distal points
on channels that cross the area of pain
19. A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354
– Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC)
– The patient’s scores were determined at 0, 4, 8 and
12 weeks during trial.
• Results
– the acupuncture group with about 34% ↓ on WOMAC
at week 4 and 42% at week 8.
– There were no significant changes in the control
group from baseline to week 12.
– Limitations noted lack of placebo control group.
20.
21. Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial.
Berman BM, Lao L, Langenberg P, et al. Annals of Internal
Medicine. 2004
• Design
– Reduce pain/improve function among patients
with knee OA as compared to both sham
acupuncture and education control groups
– 8 week intense acupuncture treatment,
followed by an 18 week tapering regime
– 570 participants
– Assessments conducted at baseline, 4, 8, 14,
and 26 weeks
22. Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial. Berman
BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004
• Results
– True acupuncture groups improvement from baseline
was significantly greater than the sham control group
at weeks 8 (P=0.01), 14 (P=0.04), 26 (P=0.009)
– Most believe they received true acupuncture at both
times, suggesting the sham acupuncture to be a
credible blinding strategy
• At 4 weeks 67% of the true acupuncture group and 58% of
sham believed they were receiving true acupuncture
(P=0.06) and at 26 weeks 75% in acupuncture group and
58% in sham (P=0.003).
23. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Design
– Stimulation of wrist at pericardium (P6)
– Systemic review 24 randomized controlled
trials (1679 patients)
• Nonphamacologic- acupuncture, electroacupuncture,
transcutaneous electrical nerve stimulation, acupoint stimulation and
acupressure
– Measured incidence of nausea, vomiting or
both after surgery 0-6h (early) or 0-48h (late)
24. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Results
– Pediatric studies failed to show significant
benefit.
– Antiemetic use in preventing early or late
PONV in adults was comparable to the non-
pharmacologic techniques.
– Significant reduction of early vomiting in
nonpharm. group compared with placebo w/in
6h of surgery for adults.
25. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Limitations
– Combining different non-pharmacologic techniques.
• May have different effects to prevent PONV
– Optimal methods of applying techniques unknown.
– Length of treatment (5min- 7days)
– No statistical heterogeneity
• Conclusions
– Further RCT with better study methodology needed in
adults.
– Mechanism for prevention of PONV not established.
Back Pain, arthirtis, Addiction, Headache – daily discomforts that may be remedied by acupuncture. I would not be willing to try acupuncture…… unsure…….I would be wiling to try (or have tried) acupuncture……………..
One of the oldest and most commonly used medical procedure in the world (4)
is no intention to stimulate acupuncture points, Okibari, is a Japanese style technique where the needles are left in the points for some time. , Moxibustion is the combustion of plant material to warm specific points at or near the surface of the body and cupping involves placing a small heated cup on the body to create a vacuum and can be used along withacupuncture (13). In Moxibustion, burned dried and aged mugwort (a medicinal plant) on the meridian point may be used (16). Electroacupuncture (EA) is the stimulation of acupuncture point with electrical current and is thought to be more effective for pain relief than manual stimulation (9).
Our signature brand is SEIRIN, providing painless acupuncture for over 25 years.
Federal Law (USA) restricts TENS, EMS and MicroCurrent devices to sale by or on the order of a licensed physician. Electro-therapy devices are sold only to qualified practitioners. Effectiveness is dependent on patient selection. Keep out of reach of children.
Discrepancies in number of points.
Painkiller, type of Chemicals??
Average 6 cases/ year among 22 countries
A pneumothorax is collection of air or gas in the space surrounding the lungs. Pneumothorax 26 cases
Okibari: Needles inserted permanently, r/t spinal injuries
Recognized Qualifications……….
The trials included were heterogeneous in terms of study population, type of acupuncture used, outcome measure used, and length of follow up; heavy biases towards positive results where negative trials may not have been published.
Details about Quality rating scores- adequacy of acupuncture, randomizes, blinding, drop-outs. What is odds ratio?
Other treatment herbs, oriental massage.
Electrical stimulation for 20 minutes used
WOMAC- which is a validated, multidimensional self-report scale to assess pain, stiffness and physical function of OA of the knee
9 points 5 local, 4 distal
Electrical stimulation was provided at knee points at a low frequency for 20 minutes.
For the sham control the treatment was modified with a combination on insertion and noninsertion procedures without electrical stimulation as well as use of a shield to participants could not observe procedure. This study was improved from the 1999 trial related to use of credible sham acupuncture group and inclusion of nonpharmacologic education as a second control and suggests an important role in the adjunctive therapy for treating OA of the knee
Placebo considered sham point or no tx
I would not be willing to try acupuncture…… unsure…….I would be wiling to try (or have tried) acupuncture……………..
