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Plaut S. Suggesting a mechanism for acupuncture as a global percutaneous needle fasciotomy that respects tensegrity principles for treating fibromyalgia. Front Med (Lausanne) 2023; 9:952159. [PMID: 36777160 PMCID: PMC9911817 DOI: 10.3389/fmed.2022.952159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/30/2022] [Indexed: 01/28/2023] Open
Abstract
Acupuncture is a minimally invasive therapeutic method that uses small caliber needles while inserting them through the skin into various areas of the body. Some empirical studies find evidence to support the use of acupuncture as a treatment for certain medical conditions, however, this peculiar practice is widely considered as the domain of alternative and non-evidence-based medicine. Several mechanisms have been suggested in an attempt to explain the therapeutic action of acupuncture, but the way in which acupuncture alleviates chronic non-cancer pain or psychosomatic and psychiatric disorders is not fully understood. A recent study suggested a theoretical model (coined "Fascial Armoring") with a cellular pathway to help explain the pathogenesis of myofascial pain/fibromyalgia syndrome and functional psychosomatic syndromes. It proposes that these syndromes are a spectrum of a single medical entity that involves myofibroblasts with contractile activity in fascia and aberrant extracellular matrix (ECM) remodeling, which may lead to widespread mechanical tension and compression. This can help explain diverse psycho-somatic manifestations of fibromyalgia-like syndromes. Fascia is a continuous interconnected tissue network that extends throughout the body and has qualities of bio-tensegrity. Previous studies show that a mechanical action by needling induces soft tissue changes and lowers the shear modulus and stiffness in myofascial tissue. This hypothesis and theory paper offers a new mechanism for acupuncture therapy as a global percutaneous needle fasciotomy that respects tensegrity principles (tensegrity-based needling), in light of the theoretical model of "Fascial Armoring." The translation of this model to other medical conditions carries potential to advance therapies. These days opioid overuse and over-prescription are ubiquitous, as well as chronic pain and suffering.
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Affiliation(s)
- Shiloh Plaut
- *Correspondence: Shiloh Plaut, , ; orcid.org/0000-0001-5823-3390
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2
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Ijaz N, Boon H. Evaluating the international standards gap for the use of acupuncture needles by physiotherapists and chiropractors: A policy analysis. PLoS One 2019; 14:e0226601. [PMID: 31846494 PMCID: PMC6917269 DOI: 10.1371/journal.pone.0226601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/01/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acupuncture needles have become an increasingly-popular treatment tool used by multiple health professions. However, the World Health Organization (WHO)'s 1999 training guidelines for acupuncture address only medical doctors and licensed acupuncturists, leaving a gap as to appropriate training standards for other professions. AIMS AND METHODS With reference to an extensive document analysis, and interviews with seventeen acupuncture educators from across several professions in Ontario, Canada, this work uses a critical qualitative policy analytic approach to: a) present a comprehensive account of statutory training requirements for acupuncture-needling physiotherapists and chiropractors in the United States, Canada, and Australia; and b) evaluate competing stakeholder discourses pertaining to recent related controversies. RESULTS A wide range of educational requirements are evident across the jurisdictions under study (most below the 200-hour WHO guideline for physicians); and there is considerable disagreement among stakeholders as to what constitutes sufficient training in various forms of acupuncture, including 'dry needling'. Organizations defending brief post-graduate training for needling physiotherapists and chiropractors are generally associated with these two professions, and contend that their 'dry needling' practices differ substantially from traditional acupuncture. Characterizing such brief training as insufficient, opportunistic and unsafe, and 'dry needling' as a subset of acupuncture practice, are the voices of all acupuncture educators interviewed, as well as professional organizations representing physicians, licensed acupuncturists, and some physiotherapists and chiropractors. DISCUSSION AND CONCLUSION Critiquing claims on both sides of the debate, this work calls for the development of independent, international safety-geared training guidelines that explicitly address the recent, evidence-informed trend towards biomedicalized acupuncture needling. Findings also suggest a need for additional research regarding the current shift towards overlapping-rather than exclusive-health professional practice scopes in industrialized countries.
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Affiliation(s)
- Nadine Ijaz
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- * E-mail:
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Abstract
Pediatric primary headache disorders are best treated using a comprehensive and integrative approach, due to the complex interactions between psychosocial and biological processes. Although more quality research is needed for treatment approaches to pediatric headaches, current practice management includes both pharmaceutical and nonpharmaceutical management. This article describes the integrative treatments used in a large regional pediatric headache program. Lifestyle approaches, nutraceuticals and dietary supplements, acupuncture, transcutaneous neurostimulation, relaxation, clinical hypnosis, biofeedback, and psychological services are discussed in detail for clinicians who may consider applying to their practice. [Pediatr Ann. 2019;48(6):e231-e235.].
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Vas J, Aguilar I, Perea-Milla E, Méndez C. Effectiveness of Acupuncture and Related Techniques in Treating Non-Oncological Pain in Primary Healthcare – An Audit. Acupunct Med 2018; 25:41-6. [PMID: 17641567 DOI: 10.1136/aim.25.1-2.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Pain is one of the principal symptoms for which the general public seeks medical attention, and it is frequently treated by GPs. Although acupuncture is mainly practised in the private field, it enjoys growing acceptance in the public system too, which helps bring down the high cost of its use. The aim of the present study is to evaluate the effectiveness of acupuncture and related techniques in treating non-oncological pain during nine years of activity at the Pain Treatment Unit (PTU) within the Andalusian Public Health System (Spain) in the field of primary healthcare. Methods Retrospective review of 5981 electronically stored case histories of patients who sought treatment for non-oncological pain and were seen at the PTU between June 1997 and July 2006. We excluded from this review those patients who had on any occasion been recruited for clinical trials at the PTU. The primary result measure applied was the success rate, defined as an improvement of least 50% on the Global Assessment Index, which is made up of five variables: pain intensity, as measured on a numerical scale of 0–10, pain frequency, consumption of analgesics, level of incapacity and sleep disorders caused by pain (the latter four variables were measured on a 5-point Likert scale of 0–4). Results The majority (84.5%) of the patients treated were women, with a mean age of 58.8 years (range 8–93), and they attended the healthcare clinic because of pain present for over three months (88.8%) and mainly affecting the lower back (58.8%). In the 5690 patients who completed treatment, the mean success rate was 79.7%, with highest rates (93%) being achieved in patients with cephalalgia. The mean reduction in pain intensity was 5.5 (SD 2.5) points amounting to 67% fall from the baseline. There was a reduction of ¢7.1 in the mean weekly expenditure on analgesics per patient. From the regression model, we conclude that the patients who suffered acute or sub-acute pain presented higher success rates than did those with chronic pain (OR, 1.94; 95% CI, 1.53–2.48). Conclusions Acupuncture seems to be effective in treating musculoskeletal pain, and presents no severe adverse events. With acupuncture treatment, the consumption of analgesic and anti-inflammatory drugs is considerably reduced.
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Affiliation(s)
- Jorge Vas
- Pain Treatment Unit, Dos Hermanas, Sevilla, Spain.
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Kim YJ. Acupuncture for Management of Type 2 Diabetes Mellitus in a Patient with Myasthenia Gravis: A Case Report. J Acupunct Meridian Stud 2017; 10:290-293. [PMID: 28889846 DOI: 10.1016/j.jams.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 02/01/2023] Open
Abstract
Myasthenia gravis (MG) is an acquired disease of the neuromuscular junctions characterized by muscular weakness and fatigue, with a prevalence of 50-125 cases per million population in western countries. In men, it usually appears after the age of 60 years, while in women, it usually appears before the age of 40 years. Long-term immunosuppression with corticosteroids is the mainstay treatment for patients with MG; however, the use of corticosteroids is a well-documented risk factor for type 2 diabetes mellitus, which has also been reported in steroid-treated patients with MG. Here, a case of type 2 diabetes mellitus in a patient with MG who underwent 105 sessions of acupuncture delivered over 6 months is reported. After acupuncture treatment, the patient's fasting plasma glucose and hemoglobin A1c levels, as well as the score on the Hamilton Depression Rating Scale, were decreased. Furthermore, no adverse effects were observed. The findings in this clinical study are encouraging and provide evidence supporting the effectiveness of acupuncture in reducing type 2 diabetes mellitus in a patient with MG.
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Affiliation(s)
- Yun Jin Kim
- Faculty of Chinese Medicine, Southern University College, Johor, Malaysia.
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Lee SW, Ahn JY, Choi WJ, Kim EJ, Bae SH, Choi YS, Jung HY, Kim JH. A needle penetrating the stomach cavity after acupuncture. Clin Endosc 2014; 47:258-61. [PMID: 24944991 PMCID: PMC4058545 DOI: 10.5946/ce.2014.47.3.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/06/2013] [Indexed: 11/14/2022] Open
Abstract
Although acupuncture is known as a safe procedure that is widely used in many countries, complications including infection, hemorrhage, hematoma, pneumothorax, nerve damage, and cardiac tamponade have been reported. A needle penetrating the stomach after acupuncture, however, is very rare. Here, we report the case of 47-year-old woman who experienced abdominal pain 2 days after receiving acupuncture. Upper gastrointestinal endoscopy identified an approximately 2.5-cm long needle in the posterior wall of the antrum. The needle was removed endoscopically using rat tooth forceps with no complications.
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Affiliation(s)
- Sin Won Lee
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Jung Choi
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Kim
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Hyeon Bae
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Sik Choi
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Asan Digestive Disease Research Institute, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shen EY, Hsieh CL, Chang YH, Lin JG. Observation of Sympathomimetic Effect of Ear Acupuncture Stimulation for Body Weight Reduction. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 37:1023-30. [DOI: 10.1142/s0192415x09007466] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ear acupuncture stimulation has been used for body weight reduction as early as the 1970s. Several hypotheses have been proposed in literature regarding its mechanism of action, among which are the effects of the stimulation of the hypothalamic satiety center on decreased neuropeptide Y production. Here, we present another possible mechanism to account for the temporary and short-term effects of ear acupuncture stimulation in the treatment of obesity, the sympathetic effects of the autonomic nervous system. 14 female volunteers underwent a randomized clinical trial of the ear acupuncture stimulation. A prospective, sham-point control, crossover study was performed with two sequential four-week stimulation periods separated by a two-week washout interval. The clinical features of and effects on the autonomic nervous system were recorded and analyzed. Decreased body weight was observed in both the experimental and the control groups in the first 4 weeks of stimulation. Sympathomimetic effects were also noted in both groups. Whereas the sympathomimetic effects and body weight reduction were sustained in the experimental group in the second 4 weeks of stimulation, such effects were not observed in the control group. Some sympathomimetic effects were noted in both the experimental and the control groups initially. This effect remained apparent in the experimental group in sequential stimulation but was lost in the control group. Consequently, we believe that sympathomimetic effects may account for the reduction in body weight by temporarily increasing basal metabolic rate and decreasing appetite, but the body may regain weight after the termination of such effects. Accordingly, the combination of an optimal exercise and diet program with repeated acupoint therapy may be necessary to maintain a healthy body weight.
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Affiliation(s)
- Ein-Yiao Shen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
- Department of Pediatrics, China Medical University Hospital, Taipei Branch, Taipei, Taiwan
| | - Ching-Liang Hsieh
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Yung-Hsien Chang
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
| | - Jaung-Geng Lin
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
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8
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Park KH, Baik JK, Yoo TW. What is Evidence-Based Acupuncture? A Comparative Review of Traditional Acupuncture and Korean Hand Acupuncture Therapy. Med Acupunct 2012. [DOI: 10.1089/acu.2011.0817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyu Hyun Park
- Department of Neurology, Pusan National University, Busan, South Korea
| | | | - Tae Woo Yoo
- Korean Hand Acupuncture Therapy Institute, Seoul, South Korea
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Fleckenstein J, Schottdorf J, Kreimeier U, Irnich D. [Acupuncture in emergency medicine : results of a case series]. Anaesthesist 2012; 60:854-62. [PMID: 21918826 DOI: 10.1007/s00101-011-1919-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acupuncture (AP) might be indicated in emergency medicine. This case series was performed to demonstrate the practicability and possible effects of AP in emergency medical services (EMS) as a basis for randomized controlled trials (RCT). SUBJECTS AND METHODS A total of 60 patients (average age 55.4±23.0 years, 57% female) treated by the EMS received AP if applicable. Main outcome parameter was to rate the symptom alleviating effect of acupuncture treatment on a 4-point scale or by VAS. RESULTS Of the 60 patients 35 (58%) reported considerable improvement, 15 patients (25%) reported complete relief and 10 patients (17%) reported no changes in the cardinal symptom. The predominant symptoms alleviated by AP were nausea (n=31) and vomiting (n=21). Pericardium 3 and 6 (27%) and Spleen 6 and 9 were the most commonly used AP points. CONCLUSION This case series demonstrates that AP can alleviate certain symptoms in emergency patients. The results of the study provide data as a basis to perform clinical controlled trials on the effectiveness of AP in emergency medicine.
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Affiliation(s)
- J Fleckenstein
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Universität München, Innenstadt, München, Deutschland
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Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics 2011; 128:e1575-87. [PMID: 22106073 DOI: 10.1542/peds.2011-1091] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Acupuncture is increasingly used in children; however, the safety of pediatric acupuncture has yet to be reported from systematic review. OBJECTIVE To identify adverse events (AEs) associated with needle acupuncture in children. METHODS Eighteen databases were searched, from inception to September 2010, irrespective of language. Inclusion criteria were that the study (1) was original peer-reviewed research, (2) included children from birth to 17 years, inclusively, (3) involved needle acupuncture, and (4) included assessment of AEs in a child. Safety data were extracted from all included studies. RESULTS Of 9537 references identified, 450 were assessed for inclusion. Twenty-eight reports were included, and searches of reference lists identified 9 additional reports (total: 37). A total of 279 AEs were identified, 146 from randomized controlled trials, 95 from cohort studies, and 38 from case reports/series. Of the AEs, 25 were serious (12 cases of thumb deformity, 5 infections, and 1 case each of cardiac rupture, pneumothorax, nerve impairment, subarachnoid hemorrhage, intestinal obstruction, hemoptysis, reversible coma, and overnight hospitalization), 1 was moderate (infection), and 253 were mild. The mild AEs included pain, bruising, bleeding, and worsening of symptoms. We calculated a mild AE incidence per patient of 168 in 1422 patients (11.8% [95% confidence interval: 10.1-13.5]). CONCLUSIONS Of the AEs associated with pediatric needle acupuncture, a majority of them were mild in severity. Many of the serious AEs might have been caused by substandard practice. Our results support those from adult studies, which have found that acupuncture is safe when performed by appropriately trained practitioners.
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Affiliation(s)
- Denise Adams
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Insulin resistance (IR) is closely associated with obesity, type 2 diabetes mellitus (T2DM), hypertension, polycystic ovary syndrome (PCOS), non-alcohol fatty liver diseases (NAFLD) and metabolic syndrome and is also a risk factor for serious diseases such as cardiovascular diseases. Pharmacological treatments available for IR are limited by drug adverse effects. Because acupuncture has been practiced for thousands of years in China, it has been increasingly used worldwide for IR-related diseases. This review analyses 234 English publications listed on the PubMed database between 1979 and 2009 on the effectiveness of acupuncture as a treatment for IR. These publications provide clinical evidence, although limited, in support of the effectiveness of acupuncture in IR. At this stage, well-designed, evidence-based clinical randomized controlled trial studies are therefore needed to confirm the effects of acupuncture on IR. Numerous experimental studies have demonstrated that acupuncture can correct various metabolic disorders such as hyperglycemia, overweight, hyperphagia, hyperlipidemia, inflammation, altered activity of the sympathetic nervous system and insulin signal defect, all of which contribute to the development of IR. In addition, acupuncture has the potential to improve insulin sensitivity. The evidence has revealed the mechanisms responsible for the beneficial effects of acupuncture, though further investigations are warranted.
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Affiliation(s)
- F Liang
- Department of Endocrinology & Metabolism, Kanazawa Medical University, Ishikawa, Japan
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12
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Efficacy of acupuncture in management of premenstrual syndrome: a systematic review. Complement Ther Med 2010; 18:104-11. [PMID: 20430293 DOI: 10.1016/j.ctim.2009.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 11/18/2009] [Accepted: 12/08/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The effectiveness of acupuncture in the case of premenstrual syndrome (PMS) is not fully understood. OBJECTIVES To assess the effectiveness and adverse effects of acupuncture for the symptomatic treatment of PMS from randomised controlled trials (RCTs). SEARCH STRATEGY Electronic databases, including English, Korean, Japanese and Chinese, were systematically searched up to January 2009 with no language restrictions. SELECTION CRITERIA RCTs comparing acupuncture with control investigating acupuncture for PMS were considered. DATA COLLECTION AND ANALYSIS Study collection and quality assessment were performed by two reviewers using the criteria described in the Cochrane Handbook. MAIN RESULTS Nine studies were systematically reviewed. Only two of the nine trials reported details regarding sequence generation and allocation concealment. Four studies reported a significant difference in reduction of PMS symptoms for acupuncture treatment compared with pharmacological treatment. Two studies reported the improvements in primary symptoms within the acupuncture and herbal medications groups compared with baseline. Only two RCTs reported information regarding acupuncture-related adverse events, which included one case of a small subcutaneous haematoma. CONCLUSIONS Although the included trials showed that acupuncture may be beneficial to patients with PMS, there is insufficient evidence to support this conclusion due to methodological flaws in the studies, including unknowns in sequence generation, concealment of allocation, blinding and outcome measures.
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Abstract
BACKGROUND Acupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs). METHODS Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. RESULTS Eleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal. CONCLUSIONS The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.
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Affiliation(s)
- Seung-Hun Cho
- Department of Neuropsychiatry, Hospital of Korean Medicine, Kyung Hee University Medical Center, Seoul, Korea.
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Tu B, Johnston M, Hui KK. Elderly patient refractory to multiple pain medications successfully treated with integrative East-West medicine. Int J Gen Med 2008; 1:3-6. [PMID: 20428398 PMCID: PMC2840549 DOI: 10.2147/ijgm.s3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence. Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL). Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.
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Affiliation(s)
- Bill Tu
- UCLA Center for East-West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Miyazaki S, Hagihara A, Mukaino Y. Acupuncture practitioner-patient communication in Japan. Int J Gen Med 2008; 1:83-90. [PMID: 20428411 PMCID: PMC2840548 DOI: 10.2147/ijgm.s4263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We evaluated acupuncture practitioner–patient communication using pairs of
practitioners and patients. Our primary objective was to evaluate the concordance of
practitioner and patient perceptions in terms of explanations regarding consultation,
therapy, and patient satisfaction. The subjects were 250 practitioners and their 1250
patients in Fukuoka, Japan. Answers were obtained from 91 acupuncture practitioners
(36.40%) and 407 patients (32.56%). Of these, responses from 125 pairs without missing
values were used for the analysis. When practitioner–patient communication, as
evaluated by the difference between the patients’ and the
practitioners’ perceptions with respect to the level of practitioner
explanation, was good, patient outcome (ie, satisfaction with therapy, improvement in
health) was also good. Factors related to poor practitioner–patient
communication included age of the practitioner, the number of practitioners at a clinic,
the experience of the practitioner, and the age of the patient. These findings may be
useful in improving practitioner–patient communication.
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Affiliation(s)
- Shougo Miyazaki
- Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Japan
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16
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Shah SH, Engelhardt R, Ovbiagele B. Patterns of complementary and alternative medicine use among United States stroke survivors. J Neurol Sci 2008; 271:180-5. [DOI: 10.1016/j.jns.2008.04.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 03/28/2008] [Accepted: 04/10/2008] [Indexed: 11/28/2022]
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Nayak S, Wenstone R, Jones A, Nolan J, Strong A, Carson J. Surface electrostimulation of acupuncture points for sedation of critically ill patients in the intensive care unit--a pilot study. Acupunct Med 2008; 26:1-7. [PMID: 18356793 DOI: 10.1136/aim.26.1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This is a pilot study to investigate the effects of electrostimulation of acupuncture points on sedation and the dose of sedatives in the Intensive Care Unit. METHODS Electrostimulation of acupuncture points was performed on 12 critically ill patients requiring sedation for mechanical ventilation. Electrostimulation was applied by point surface electrodes at LI4, ST36, HT7 and LR3 points for 20 minutes every hour for 12 hours using dense dispersed mode with a current frequency of 10-100 Hz and maximum intensity of 10 mA. All patients were sedated with propofol and alfentanil as required. The dose of propofol was reduced by 10mg/hour provided the patient remained sedated according to our guidelines. Sedation and analgesia scores, dose of sedative and analgesics drugs, respiratory rate, heart rate, mean arterial blood pressure and compliance with the ventilator were recorded before electrostimulation of acupuncture points, and hourly thereafter for 12 hours. RESULTS There was significant reduction in the median propofol consumption from 145 mg/hour (range 30-250) to 15 mg/hour (range 0-250) (P<0.05), without any significant change in sedation scores or analgesia scores. The haemodynamic and respiratory variables remained stable. All patients were compliant with the ventilator. CONCLUSIONS This pilot study showed significant reduction in the dose of propofol required for sedation in critically ill patients following surface electrostimulation of acupuncture points, without any adverse effects. A randomised controlled trial is warranted.
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Affiliation(s)
- Sandeep Nayak
- Intensive Care Unit, Royal Liverpool University Hospital, Liverpool, UK.
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18
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Lam YC, Kum WF, Durairajan SSK, Lu JH, Man SC, Xu M, Zhang XF, Huang XZ, Li M. Efficacy and Safety of Acupuncture for Idiopathic Parkinson's Disease: A Systematic Review. J Altern Complement Med 2008; 14:663-71. [PMID: 18684073 DOI: 10.1089/acm.2007.0011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuen Chi Lam
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Wan Fung Kum
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | | | - Jia Hong Lu
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Sui Cheung Man
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Min Xu
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Xiao Fei Zhang
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Xian Zhang Huang
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Min Li
- School of Chinese Medicine, Hong Kong Baptist University, Kowloon Tong, Hong Kong
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Systematic reviews of clinical trials of acupuncture as treatment for depression: how systematic and accurate are they? CNS Spectr 2008; 13:293-4, 299-300. [PMID: 18408648 DOI: 10.1017/s1092852900016400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Complementary and alternative medicine (CAM) is very popular in the United States, Canada and other Western societies, and the number of patients seeking treatment by CAM practitioners is increasing. This trend also affects treatment-seeking patients with affective disorders. Many patients and mental health providers update their information and formulate opinions and decisions based on second-hand digested summaries and scientific reviews of the literature. This results in the proliferation of review articles and journals that are exclusively dedicated to reviews. Since most medical schools do not teach CAM and most continuing medical education programs still ignore these subjects, it is of interest to examine the reliability of reviews that claim to be “systematic” and not to take their procedures and conclusions for granted.
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Cohen AJ, Menter A, Hale L. Acupuncture: role in comprehensive cancer care--a primer for the oncologist and review of the literature. Integr Cancer Ther 2005; 4:131-43. [PMID: 15911926 DOI: 10.1177/1534735405276419] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In recent studies, patients have reported an increased use of complementary and alternative medicine (CAM). Acupuncture is a popular complementary therapy for patients with cancer. This article will provide current cancer treatment providers with information on acupuncture as well as the research conducted on cancer symptoms and side effects of cancer treatments. Antiemetic studies are the most prevalent and contain the most promising results. Several studies have found that acupuncture significantly reduces the number of emesis (vomiting) episodes for patients receiving chemotherapy. While studies on pain control vary due to the heterogeneity of pain, there are few studies investigating pain caused from cancer and the removal of cancerous tumors. These studies, while promising, provide basic results that need further investigation for more definitive results. Although relatively few studies have been done on anxiety and depression, several researchers have found acupuncture to be just as effective as or more effective than antidepressants for patients without cancer. Studies on breathlessness, while small, have shown acupuncture to have a significant positive effect on chronic obstructive pulmonary disease, breathlessness associated with end-stage cancer, and asthma. Researchers studying xerostomic individuals who have received salivary gland irradiation found significant positive results in salivary flow rates compared to baseline. Patients with hot flashes due to hormonal imbalance may benefit from the use of acupuncture. A recent pilot study showed improvement of chronic postchemotherapy fatigue following acupuncture treatments. Many individuals with cancer have turned to acupuncture because their symptoms persisted with conventional treatments or as an alternative or complement to their ongoing treatments. Despite the immense popularity in the community, few large randomized trials have been conducted to determine the effects acupuncture has on cancer symptoms and side effects of treatments. A majority of the current studies have shown beneficial effects that warrant further investigation with large trial sizes.
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Affiliation(s)
- Andrea J Cohen
- Division of Pulmonary Sciences and Critical Care Medicine, Division of Medical Oncology, University of Colorado Health Sciences Center, University of Colorado Cancer Center, Denver, CO 80262, USA.
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21
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Rosted P, Warnakulasuriya S. A survey on the uses of acupuncture by a group of UK dentists. Br Dent J 2005; 198:139-43. [PMID: 15706375 DOI: 10.1038/sj.bdj.4812039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 01/21/2004] [Indexed: 11/08/2022]
Abstract
A small number of fully trained Chinese doctors practise Traditional Chinese Medicine (TCM) in western cities. Use of these services by British citizens is extremely limited, mostly due to lack of any knowledge on the effectiveness of acupuncture or exposure to complementary medicine in this country. Common situations where British patients seek the help of TCM are when medical therapy has failed; in relapsing chronic diseases like asthma, rheumatoid arthritis; and in pain management (mostly headache, migraine and back pain). Patients often appreciate that only limited interventions are available for treatment of these conditions in western medicine. At least one in 10 UK specialist physicians are actively involved in complementary and alternative medicine treatments.(1) A large number of westerners offer acupuncture therapy but lack basic medical training. It is likely that people are reluctant to use these services largely because of hygiene and safety reasons. Moreover, it has been demonstrated that the serious side effects reported are five times more frequent when treatments are provided by non-medically trained therapists compared with professionally registered health care providers.(2).
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Affiliation(s)
- P Rosted
- Pain clinic, Western Park Hospital and Department of Oncology, University of Sheffield, Whitham Road, Sheffield.
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22
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Birch S, Hesselink JK, Jonkman FAM, Hekker TAM, Bos A. Clinical research on acupuncture. Part 1. What have reviews of the efficacy and safety of acupuncture told us so far? J Altern Complement Med 2004; 10:468-80. [PMID: 15253851 DOI: 10.1089/1075553041323894] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED OVERVIEW AND METHODS: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture. RESULTS AND CONCLUSIONS General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.
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Affiliation(s)
- Stephen Birch
- Foundation for the Study of Traditional East Asian Medicine, Amsterdam, The Netherlands.
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Kalish LA, Buczynski B, Connell P, Gemmel A, Goertz C, Macklin EA, Pian-Smith M, Stevens S, Thompson J, Valaskatgis P, Wayne PM, Zusman RM. Stop Hypertension with the Acupuncture Research Program (SHARP): clinical trial design and screening results. ACTA ACUST UNITED AC 2004; 25:76-103. [PMID: 14980754 DOI: 10.1016/j.cct.2003.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Accepted: 08/08/2003] [Indexed: 01/22/2023]
Abstract
Hypertension is a major public health problem with serious medical and financial consequences. Barriers to successful conventional pharmacological treatment include side effects, out-of-pocket expenses, patient noncompliance and insufficient dosages. Acupuncture has been studied as an alternative therapy for controlling blood pressure (BP) but previous studies have serious methodological limitations. This paper describes the design of the Stop Hypertension with the Acupuncture Research Program (SHARP) trial, a pilot randomized clinical trial designed to gather preliminary data regarding the efficacy of traditional Chinese medicine (TCM)-based acupuncture for control of essential hypertension. The design of the SHARP trial balanced rigorous clinical trial methodology with principles of TCM. Eligible participants had systolic BP (SBP) 140-179 mm Hg and diastolic BP (DBP) 90-109 mm Hg in the absence of antihypertensive therapy. Following screening, participants were randomized to one of three groups: individualized, standardized or control acupuncture. Treatments were designed according to principles of TCM; nonspecific effects associated with the interventions were standardized across the randomized groups. For individualized acupuncture, points were tailored to each participant. Standardized acupuncture used a prespecified set of points. The invasive sham control acupuncture regimen was designed to be non-active. Each participant received a "prescription" for individualized acupuncture from an acupuncturist who was masked to treatment assignment, and was subsequently treated by an independent acupuncturist. Patients and those assessing BP were masked to treatment group. Acupuncture was delivered twice a week for 6 weeks. Follow-up visits were every 2 weeks to week 10 and then at months 4, 6, 9 and 12. The primary endpoint will be change in SBP from baseline to 10 weeks. DBP, BP trajectories over the 12-month follow-up and antihypertensive medication requirements will also be examined. Initial contact was documented for 1442 prospective participants from March 2001 to April 2002; 424 provided informed consent and 192 were ultimately randomized.
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Affiliation(s)
- Leslie A Kalish
- New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA.
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Moyad MA, Barada JH, Lue TF, Mulhall JP, Goldstein I, Fawzy A. Prevention and treatment of erectile dysfunction using lifestyle changes and dietary supplements: what works and what is worthless, part I. Urol Clin North Am 2004; 31:249-57. [PMID: 15123405 DOI: 10.1016/j.ucl.2004.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinicians working in urology should adhere to the same guidelines that are observed in cardiovascular medicine when dealing with a patient with ED. A golden opportunity exists to discuss lifestyle changes with any man with or concerned about ED. Providing heart-healthy recommendations to men with minimal to extensive ED may produce a twofold impact: (1) patients may be able to affect the future extent of their disease, and (2) patients may become healthier overall. Patients following a heart-healthy lifestyle after a diagnosis of ED or to prevent ED should enjoy increased quality or quantity of life. The time is more than ripe for patients to understand that heart health is tantamount to erectile health.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Abstract
Although acupuncture is being utilized to treat a variety of important health problems, its usefulness in obesity management has not yet been fully evaluated. The aim of this review paper was to survey and critically evaluate the descriptive and controlled trials of acupuncture for enhancing weight loss. The underlying principles of acupoint stimulation are described, with an emphasis on auricular (ear) acupuncture, the method most often chosen for obesity studies. The difficulties of selecting suitable placebo controls are highlighted. To date, most trials have been descriptive in nature, of short duration (< or = 12 weeks), and designed using nonstandard treatment protocols. Despite the unique challenges involved, further careful study of acupuncture's potential usefulness as an adjunct in weight management is recommended. An agenda for future research in this area is provided.
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Affiliation(s)
- J M Lacey
- West Chester University, Sturzebecker Health Sciences Center, PA 19383, USA
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The role of acupuncture schools and individual practitioners in acupuncture research. ACTA ACUST UNITED AC 2002. [DOI: 10.1054/caom.2001.0120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Moyad MA. Dietary supplements and other alternative medicines for erectile dysfunction. What do I tell my patients? Urol Clin North Am 2002; 29:11-22, vii. [PMID: 12109338 DOI: 10.1016/s0094-0143(02)00012-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dietary supplements and other alternative medicines have enjoyed a tremendous amount of popularity and use over the past decade. Although, the prevalence of these therapies for erectile dysfunction (ED) is unknown at this time, numerous media outlets and alternative medicine publications seem to support the utilization of these therapies for ED. The placebo effect is approximately 25% (1 out of 4 benefit) from past randomized trials of FDA approved medications for ED. Adequate clinical trials are needed for dietary supplements for ED to access whether or not a benefit beyond a placebo effect exists. Clinicians should become aware of these supplements and the current research espousing or discouraging their use, and they should understand the adverse effects associated with them in order to effectively discuss these products with any patient inquiring about them.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Yamashita H, Tsukayama H, White AR, Tanno Y, Sugishita C, Ernst E. Systematic review of adverse events following acupuncture: the Japanese literature. Complement Ther Med 2001; 9:98-104. [PMID: 11444889 DOI: 10.1054/ctim.2001.0446] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Many Japanese cases of adverse events after acupuncture are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside Japan. OBJECTIVE To complement existing reviews of adverse events after acupuncture in the West and to provide more detailed discussion and analysis. DATA SOURCES Literature search using 'Igaku Chuo Zasshi (Japana Centra Revuo Medicina) CD-ROM version' covering the period of 1987-1999. STUDY SELECTION Case reports of adverse events, which were suspected to be due to acupuncture treatment, were included. Experimental studies, surveys, and news articles were excluded. DATA EXTRACTION Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed likelihood of causality in each individual case. DATA SYNTHESIS 89 articles which reported 124 cases were located. The most frequent adverse events were: pneumothorax (25 cases), spinal cord injury (18 cases), acute hepatitis B (11 cases), and localized argyria (10 cases). There were two fatalities from infections. Forty-eight events were caused by needle breakage including 26 cases of intentionally embedded needle and 16 cases of accidental breakage. There were also 10 cases of injury from self-treatment. CONCLUSION Although it has already been demonstrated that severe adverse events seem to be uncommon in standard practice, many serious cases of negligence have been found in the present review, suggesting that training system for acupuncturists (including medical doctors) should be improved and that unsupervised self-treatment should be discouraged.
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Affiliation(s)
- H Yamashita
- Tsukuba College of Technology Clinic, 4-12-7 Kasuga, Tsukuba, 305-0821, Japan.
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Abstract
Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders. These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments. This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mind-body therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes. Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up. However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.
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Affiliation(s)
- L J Crofford
- University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109-0680, USA.
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Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage 2000; 20:374-87. [PMID: 11068159 DOI: 10.1016/s0885-3924(00)00190-1] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
To review the evidence for efficacy of complementary and alternative medicine (CAM) modalities in treating pain, dyspnea, and nausea and vomiting in patients near the end of life, original articles were evaluated following a search through MEDLINE, CancerLIT, AIDSLINE, PsycLIT, CINAHL, and Social Work Abstracts databases. Search terms included alternative medicine, palliative care, pain, dyspnea, and nausea. Two independent reviewers extracted data, including study design, subjects, sample size, age, response rate, CAM modality, and outcomes. The efficacy of a CAM modality was evaluated in 21 studies of symptomatic adult patients with incurable conditions. Of these, only 12 were directly accessed via literature searching. Eleven were randomized controlled trials, two were non-randomized controlled trials, and eight were case series. Acupuncture, transcutaneous electrical nerve stimulation, supportive group therapy, self-hypnosis, and massage therapy may provide pain relief in cancer pain or in dying patients. Relaxation/imagery can improve oral mucositis pain. Patients with severe chronic obstructive pulmonary disease may benefit from the use of acupuncture, acupressure, and muscle relaxation with breathing retraining to relieve dyspnea. Because of publication bias, trials on CAM modalities may not be found on routine literature searches. Despite the paucity of controlled trials, there are data to support the use of some CAM modalities in terminally ill patients. This review generated evidence-based recommendations and identified areas for future research.
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Affiliation(s)
- C X Pan
- Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y. Incidence of adverse reactions associated with acupuncture. J Altern Complement Med 2000; 6:345-50. [PMID: 10976981 DOI: 10.1089/10755530050120718] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the type, severity, and incidence of acupuncture adverse reactions that are observed in standard practice. DESIGN A survey based on observation and interview by the therapists. SETTING Tsukuba College of Technology Clinic in Japan. SUBJECTS All patients who underwent acupuncture treatment during a period of 4 months from April to July 1998. OUTCOME MEASURES Type, severity, and incidence of acupuncture adverse reactions. RESULTS A total of 391 patients were treated in 1,441 sessions, involving a total of 30,338 needle insertions. The incidence of recorded systemic reactions in individual patients was: tiredness (8.2%); drowsiness (2.8%); aggravation of preexisting symptoms (2.8%); itching in the punctured regions (1.0%); dizziness or vertigo (0.8%); feeling of faintness or nausea during treatment (0.8%); headache (0.5%); and chest pain (0.3%). The incidence of recorded local reactions, expressed as a percentage of needle insertions, was: minor bleeding on withdrawal of the needle (2.6%); pain on insertion of the needle (0.7%); petechia or ecchymosis (0.3%); pain or ache in the punctured region after the treatment (0.1%); subcutaneous haematoma (0.1%); and pain or discomfort in the punctured region during the needle retention (0.03%). CONCLUSION Although some adverse reactions associated with acupuncture were common even in standard practice, they were transient and mild compared to cases such as pneumothorax, cardiac injury, infection, or spinal lesions reported in other studies.
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Affiliation(s)
- H Yamashita
- Tsukuba College of Technology Clinic, Tsukuba City, Japan.
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Abstract
Although the placebo in a clinical trial is often considered simply a baseline against which to evaluate the efficacy of a clinical intervention, there is evidence that the magnitude of placebo effect may be a critical factor in determining the results of a trial. This article examines the question of whether devices have enhanced placebo effects and, if so, what the implications may be. While the evidence of an enhanced placebo effect remains rudimentary, it is provocative and therefore worthy of further study. Suggestions are made, therefore, for how such an effect can be investigated without violating the principles of informed consent.
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Affiliation(s)
- T J Kaptchuk
- Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Treatments used in complementary medicine. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0378-6080(00)80054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Alternative medicine use in the general population has continued to dramatically increase in this decade. The research supporting the use of acupuncture treatment in other areas of medicine is compelling. In addition, herbal therapies, such as PC-SPES and St. John's Wort, may play important roles in this disease. Clinicians dealing with advanced prostate cancer need to be introduced to some of these newer treatments so they can be discussed objectively with patients.
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Affiliation(s)
- M A Moyad
- Department of Surgery, University of Michigan, Ann Arbor, USA
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