Acupuncture Reduces Pain, Need For Opioids After Surgery (Oct 18, 07)
Acupuncture Eases Low Back Pain (Sept 24, 07)
Chinese Herbs Ease Menstrual Cramps Better than NSAIDs (OCT 17, 07)
Acupuncture Relieves Pain & Improves Function in Knee Osteoarthritis (Dec 20, 04)
Blood-Pressure Changes With Acupuncture (June 7, 07)

Acupuncture Reduces Pain, Need For Opioids After Surgery

ScienceDaily (Oct. 18, 2007) — Using acupuncture before and during surgery significantly reduces the level of pain and the amount of potent painkillers needed by patients after the surgery is over, according to Duke University Medical Center anesthesiologists who combined data from 15 small randomized acupuncture clinical trials.

"While the amount of opioids needed for patients who received acupuncture was much lower than those who did not have acupuncture, the most important outcome for the patient is the reduction of the side effects associated with opioids," said Tong Joo (T.J.) Gan, M.D., a Duke anesthesiologist who presented the results of the analysis at the annual scientific conference of the American Society for Anesthesiology in San Francisco. "These side effects can negatively impact a patient's recovery from surgery and lengthen the time spent in the hospital."

Based on the results of this analysis, Gan recommends that acupuncture should be considered a viable option for pain control in surgery patients.

Patients who received acupuncture had significantly lower risk of developing most common side effects associated with opioid drugs compared with control: 1.5 times lower rates of nausea, 1.3 times fewer incidences of severe itching, 1.6 times fewer reports of dizziness and 3.5 times fewer cases of urinary retention.

Opioids are a class of medications that act on the body much like morphine. While they are effective in controlling pain, the side effects of the drugs often influence a patient's recovery from, and satisfaction with, their surgery, Gan said.

The results of this study add to the growing body of evidence that acupuncture can play an effective role in improving the quality of the surgical experience, Gan added. Numerous studies, some conducted by Gan, have demonstrated that acupuncture can also be more effective than current medications in lessening the occurrence of post operative nausea and vomiting, the most common side effect experienced by patients after surgery.

"Acupuncture is slowly becoming more accepted by American physicians, but it is still underutilized," Gan said. "Studies like this, which show that there is a benefit to using it, should help give physicians sitting on the fence the data they need to integrate acupuncture into their routine care of surgery patients."

Acupuncture has the added benefits of being inexpensive, with virtually no side effects, when done by properly trained personnel, Gan added.

The Chinese have been using acupuncture for more than 5,000 years for the treatment of a variety of ailments, including headaches, gastrointestinal disorders and arthritis. According to Chinese healing practices, there are about 360 specific points along 14 different lines, or meridians, that course throughout the body just under the skin.

"The Chinese believe that our vital energy, known as chi, flows throughout the body along these meridians," Gan explained. "While healthiness is a state where the chi is in balance, unhealthiness or disease state arises from either too much or too little chi, or a blockage in the flow of the chi."

Different bodily locations or organs have their own distinct acupuncture points that are the targets for the acupuncturist. For example, a point just below the wrist is the common target for women undergoing breast procedures to prevent nausea and vomiting, another point at the back of the hand is effective in reducing pain.

While it is not completely known why or how acupuncture works, recent research seems to point to its ability to stimulate the release of hormones or the body's own painkillers, known as endorphins, Gan said. He is now conducting studies to determine the exact mechanism behind acupuncture's effects.

Other members of the research team included Yanxia Sun, John Dubose and Ashraf Habib. The meta-analysis was supported by Duke's Department of Anesthesiology.

Adapted from materials provided by Duke University Medical Center.

Study: Acupuncture Eases Low Back Pain

Patients Report More Pain Relief From Acupuncture Than Conventional Treatment

By Salynn Boyles
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 24, 2007 -- Acupuncture proved to be more effective than conventional lower back pain treatments in a new study, but it was no more effective than a sham needle procedure.

The German study compared outcomes among 1,162 patients with chronic low back pain treated with traditional Chinese acupuncture; sham acupuncture; or a conventional approach to treating back pain using drugs, physical therapy, and exercise.

The study is the largest investigation of acupuncture vs. conventional nonsurgical treatment for lower back pain ever reported, researchers say.

"Acupuncture represents a highly promising and effective treatment option for chronic back pain," researcher Heinz Endres, MD, tells WebMD. "Patients experienced not only reduced pain intensity, but also reported improvements in the disability that often results from back pain -- and therefore in their quality of life."

Acupuncture for Back Pain

Endres says up to 85% of people will suffer from low back pain at some point in their lives. The pain may last for a few days or continue as chronic low back pain for months and years.

While a recent review of research showed acupuncture to be useful for the treatment of low back pain when given in addition to other therapies, the latest study was designed to determine if acupuncture is an effective treatment on its own.

Acupuncture was delivered in 10, 30-minute sessions conducted over six weeks. Patients who received conventional treatments had a similar number of total treatments, which included exercise, pain medication, and nonsteroidal anti-inflammatory drugs (NSAIDs).

The acupuncture groups were allowed to use medication for acute episodes of back pain only. This consisted of NSAID use no more than two days a week during the treatment period.

Traditional acupuncture involved inserting needles at fixed points and depths on the body and manipulating the needles in accordance with ancient Chinese practice.

With the sham treatment, needles were inserted in the lower back at shallower depths at non-acupuncture points and the needles were not manipulated.

Patients who got the traditional and sham acupuncture treatments were almost twice as likely to report treatment-related responses six months later as patients who did not have acupuncture.

Responses were defined as a 33% improvement in pain or a 12% improvement in functional ability.

"Because acupuncture has a low risk of side effects and few contraindications, it should be added to the catalogue of treatments recommended for acute and chronic back pain, even though -- just as for any other form of treatment -- there will always be some patients who do not respond," Endres says.

Sham Acupuncture Works

Several earlier studies involving patients with chronic pain have shown similar benefits for traditional and sham acupuncture.

A 2005 analysis of 33 back pain studies did show a treatment advantage for traditional acupuncture, but a researcher involved in the analysis says more recent studies challenge this finding.

"The evidence as a whole suggests that the benefits of true acupuncture over sham acupuncture are almost clinically irrelevant," Eric Manheimer, MS, of the University of Maryland Center for Integrative Medicine tells WebMD. "The reasons for this are not really clear. It may be that putting the needles anywhere stimulates some sort of analgesic effect."

Acupuncture is still considered an alternative treatment for low back pain in the U.S., but this is no longer the case in Germany. Based on findings from the newly reported study, it is now covered by state health insurance.

Endres says acupuncture is a clearly useful treatment for low back pain, even if we don't understand why.

"Just because we cannot explain exactly the mechanism by which a treatment works, doesn't mean that it doesn't work," he says.

View Article Sources Sources

Chinese Herbs Ease Menstrual Cramps Better than NSAIDs

By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
October 17, 2007

SYDNEY, Australia, Oct. 17 -- Traditional Chinese remedies may ease painful menstrual cramps better than nonsteroidal anti-inflammatories (NSAIDs) and other drugs, according to a Cochrane systematic review.

Chinese herbal medicine for primary dysmenorrhea roughly doubled pain relief and improvement in overall symptoms compared with conventional Western pharmaceuticals, reported Xiaoshu Zhu, M.Med., of the Chinese Medicine Program at the University of Western Sydney here, and colleagues in the fourth issue for 2007 of The Cochrane Library.

The herbal remedies were also significantly better at relieving painful cramps and other symptoms than acupuncture or a hot water bottle, with overall promising findings, they said.

"However, the small number and the low quality of included studies did not allow for any definite conclusion for their use in clinical practice," Zhu and colleagues wrote.

Herbal medicine has been used for centuries in China and continues to be used in public hospitals there to treat primary dysmenorrhea, whereas Western medicine has relied on pharmaceutical treatment, such as NSAIDs and the contraceptive pill, they said.

But, "more women are looking for non-drug therapies," they added, particularly those women who have a contraindication for or cannot tolerate these drugs.

So, the researchers conducted a systematic review and identified 39 randomized controlled trials of Chinese herbal medicine with a total of 3,475 women treated for self-reported primary dysmenorrhea.

All of the trials were of parallel design. One trial each was conducted in Taiwan, Japan, and the Netherlands, while the rest were done in China.

The majority of trials used complicated herbal formulas with more than five of six herbs, most commonly including Danggui (Chinese angelica root), Chuanxiong (Szechuan lovage root), Chishao (red peony root), and Baishao (white peony root), in a traditional cooked decoction.

These herbs could affect hormones and microcirculation hemorrheology, the researchers said.

Herbal interventions were usually started five to seven days before menstruation and continued for about 10 to 15 days -- until the first or second day of menstruation or throughout menstruation.

Most trials compared one herbal medicine with another (18 trials) or with conventional therapy, such as NSAIDs or oral contraceptives (14 trials).

Three trials compared Chinese herbal medicine with placebo, one compared it with no treatment, two compared it with acupuncture, and one compared it with heat compression.

For reduction in pain, the findings included:

Chinese herbs overall, whether standardized or tailored, yielded better pain relief than conventional pharmaceutical therapies (RR 1.99, 95% CI 1.52 to 2.60) typically for up to three months of follow-up.
Chinese herbal medicine relieved pain significantly better than over-the-counter herbal health products (RR 2.06, 95% CI 1.80 to 2.36).
Chinese herbal medicine improved pain significantly better than acupuncture (RR 1.75, 95% CI 1.09 to 2.82).
No consistent advantage was seen for acupuncture in the placebo-controlled trials, which could not be combined.
Chinese herbs beat heat compression using a hot water bottle (RR 32.08, 95% CI 2.06 to 499.18).

For symptom reduction, the findings were similar and included:

Chinese herbal medicine was significantly better than placebo in the one trial that reported this outcome (RR 5.59, 95% CI 0.32 to 97.87).
Overall symptoms improved more with Chinese herbal medicine than with conventional pharmaceutical therapy, which was sustained through three months of follow-up (RR 2.17, 95% CI 1.73 to 2.73).
Chinese herbal medicine was significantly better than over-the-counter herbal medicine through up to three months of follow-up (RR 1.99, 95% CI 1.65 to 2.40).

Chinese herbal medications were also associated with less frequent need of additional medication compared with Western pharmaceutical therapy (RR 1.58, 95% CI 1.30 to 1.93).

Although individually tailored Chinese herbal formulations were significantly better than commonly used over-the-counter herbal health products on several measures, Zhu and colleagues said their review could not explicitly answer if one was more beneficial.

No significant adverse effects were identified in the studies, but "the safety of Chinese herbal medicine in clinical practice was not addressed adequately in the reviewed trials," they said. Measurement and reporting of adverse effects was poor, and only two trials had adequate overall methodological quality.

"An attempt towards evidence-based Chinese medicine practice has been made," the investigators concluded. "However, more research trials with high quality design -- especially in terms of laboratory tests -- are needed."

The review was supported by the University of Western Sydney and the Cochrane Menstrual Disorders and Subfertility Group. Zhu reported having recently completed a trial of Chinese herbal medicine to treat primary dysmenorrhea.

Additional Alternative Medicine Coverage

Primary source: Cochrane Database of Systematic Reviews
Source reference:
Zhu X, et al "Chinese herbal medicine for primary dysmenorrhoea" Cochrane Database of Systematic Reviews 2007;3: CD005288.

Acupuncture Relieves Pain and Improves Function in Knee Osteoarthritis

NIH News Advisory (Dec 20, 2004)

Acupuncture provides pain relief and improves function for people with osteoarthritis of the knee and serves as an effective complement to standard care. This landmark study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health. The findings of the study--the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted--were published in the December 21, 2004, issue of the Annals of Internal Medicine.¹

The multi-site study team, including rheumatologists and licensed acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis of the knee. Participants had significant pain in their knee the month before joining the study, but had never experienced acupuncture, had not had knee surgery in the previous 6 months, and had not used steroid or similar injections. Participants were randomly assigned to receive one of three treatments: acupuncture, sham acupuncture, or participation in a control group that followed the Arthritis Foundation's self-help course for managing their condition. Patients continued to receive standard medical care from their primary physicians, including anti-inflammatory medications, such as COX-2 selective inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain relievers.

"For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D., NCCAM Director. "These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."

"More than 20 million Americans have osteoarthritis. This disease is one of the most frequent causes of physical disability among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "Thus, seeking an effective means of decreasing osteoarthritis pain and increasing function is of critical importance."

During the course of the study, led by Brian M. Berman, M.D., Director of the Center for Integrative Medicine and Professor of Family Medicine at the University of Maryland School of Medicine, Baltimore, Maryland, 190 patients received true acupuncture and 191 patients received sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture is a procedure designed to prevent patients from being able to detect if needles are actually inserted at treatment points. In both the sham and true acupuncture procedures, a screen prevented patients from seeing the knee treatment area and learning which treatment they received. In the education control group, 189 participants attended six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation's Arthritis Self-Help Course, a proven, effective model.

On joining the study, patients' pain and knee function were assessed using standard arthritis research survey instruments and measurement tools, such as the Western Ontario McMasters Osteoarthritis Index (WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks. By week 8, participants receiving acupuncture were showing a significant increase in function and by week 14 a significant decrease in pain, compared with the sham and control groups. These results, shown by declining scores on the WOMAC index, held through week 26. Overall, those who received acupuncture had a 40 percent decrease in pain and a nearly 40 percent improvement in function compared to baseline assessments.

"This trial, which builds upon our previous NCCAM-funded research, establishes that acupuncture is an effective complement to conventional arthritis treatment and can be successfully employed as part of a multidisciplinary approach to treating the symptoms of osteoarthritis," said Dr. Berman.

Acupuncture--the practice of inserting thin needles into specific body points to improve health and well-being--originated in China more than 2,000 years ago. In 2002, acupuncture was used by an estimated 2.1 million U.S. adults, according to the Centers for Disease Control and Prevention's 2002 National Health Interview Survey.² The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. In recent years, scientific inquiry has begun to shed more light on acupuncture's possible mechanisms and potential benefits, especially in treating painful conditions such as arthritis.

¹Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Annals of Internal Medicine. 2004; 141(12):901-910.

²Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

The National Center for Complementary and Alternative Medicine (NCCAM) is dedicated to exploring complementary and alternative medical (CAM) practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For additional information, call NIAMS's Clearinghouse toll free at 1-877-22-NIAMS, or visit the NIAMS Web site at www.niams.nih.gov.

Blood-Pressure Changes With Acupuncture Comparable to ACE-Inhibitor Monotherapy

from Heartwire — a professional news service of WebMD

Shelley Wood

June 7, 2007 (Erlangen, Germany) - A study billed as the first rigorous, randomized trial in the West to test acupuncture against a sham needle technique to treat hypertension suggests that, performed properly, acupuncture may produce blood-pressure changes on a par with monotherapy in mild to moderate hypertension [1].

"It's certainly not like a wonder drug; it's not a massive effect, but it's a clear effect," lead investigator Dr Frank A Flachskampf (Universitätsklinikum Erlangen, Germany) told heartwire.

Smaller randomized trials have been performed in China, with mixed results, while one randomized study in the West found no difference in blood-pressure lowering between traditional Chinese acupuncture, standardized acupuncture, and a sham procedure, the authors note. This earlier study did not use ambulatory blood-pressure measurements, believed to be superior to office-based measurements.

Results of their study are published online June 4, 2007 in Circulation.

Needlework

For the study, 160 outpatients with uncomplicated, mild to moderate hypertension were randomized to six weeks of acupuncture performed by Chinese medicine practitioners, trained in China, or to a sham procedure. In both arms, patients underwent 22 sessions, each 30 minutes in length. By the end of the six weeks, 24-hour ambulatory systolic and diastolic blood pressures were significantly reduced from baseline in the acupuncture-treated patients (5.4 mm Hg and 3.0 mm Hg, respectively), and this change was also significantly different from values in the sham-treated patients, in whom no meaningful changes were seen.

After three and six months, however, the blood-pressure reductions disappeared, leading investigators to conclude that ongoing acupuncture treatments would be required to maintain the blood-pressure reductions.

"The main finding is that for the first time in a reasonably sized but still relatively small randomized study, this establishes beyond a reasonable doubt that acupuncture lowers blood pressure," Flachskampf commented. "It's a modest but undeniable effect on both systolic and diastolic blood pressure."

The extent of the blood-pressure reductions are comparable to those seen with ACE-inhibitor monotherapy or aggressive lifestyle changes, including radical salt restrictions, he added.

A "demanding" alternative to drugs

Flachskampf had some caveats, acknowledging that the regular acupuncture sessions used in the study represent a significant time investment: each acupuncture session lasted 30 minutes--not including transportation and administrative time--and took place several times a week. The study subjects were also reasonably healthy, with no other major risk factors and with only mild to moderate hypertension.

"This is clearly something that would probably not work as well with very sick people or people with blood pressure at dangerous levels," he said. "We cannot easily extrapolate to people, for example, with complicated hypertension who have had a myocardial infarction."

Flachskampf believes, however, that acupuncture likely represents an attractive option in specific patients, particularly those averse to taking medical therapy who are open to so-called "alternative" medicine.

"This is probably only for people who somehow relate to this spiritually, who say I am profoundly against taking drugs and I'm very fond of Oriental wisdom or things like that," Flachskampf told heartwire. "I don't want to make a joke about this, but this certainly needs more compliance than taking two or three pills a day. It's much more demanding."

Unlike drugs, acupuncture appeared to have few or no side effects, although two people complained that the needles were painful. "Clearly, many millions of Chinese get acupuncture without any major problems so I think this is really a minor point," Flachskampf observed.

Flachskampf FA, Gallasch J, Gefeller O, et al. Randomized trial of acupuncture to lower blood pressure. Circulation 2007; DOI: 10.1161/CIRCULATIONAHA.106.661140. Available at: http://www.circulationaha.org.

The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.