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Rajendran V. Practice recommendations for physiotherapists in Canada managing adverse events associated with acupuncture. Acupunct Med 2024:9645284241248468. [PMID: 38706181 DOI: 10.1177/09645284241248468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
In Canada, acupuncture is a regulated medical practice that involves inserting thin needles at specific points on the body to alleviate pain and other health conditions. Acupuncture is a controlled act in physiotherapy practice. Therefore, physiotherapists who incorporate acupuncture into their practice should have the necessary education and roster this controlled act with the regulatory college in their province. Although acupuncture can be helpful, potential complications can arise, ranging from minor bruising to life-threatening conditions such as pneumothorax and cardiac tamponade. This article provides information on the potential adverse effects of acupuncture and provides recommendations for physiotherapists regarding prevention and management of any incidents that may arise during treatment.
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Affiliation(s)
- Venkadesan Rajendran
- Acute Stroke and Internal Medicine Unit, Health Sciences North, Sudbury, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
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2
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Lin CL, Chern A, Wang MJ, Lin SK. Incidence of nerve injury following acupuncture treatments in Taiwan. Complement Ther Med 2024; 80:103007. [PMID: 38040097 DOI: 10.1016/j.ctim.2023.103007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Acupuncture, a widely employed traditional therapeutic modality known for its efficacy in pain alleviation and diverse condition management, may inadvertently result in mechanical nerve injury due to its invasive nature. This research aimed to ascertain the incidence of nerve injuries post-acupuncture, identify associated risk factors, and map the distribution of nerve injury sites. METHODS A case-control study nested in the National Health Insurance Research Database (NHIRD) 2000-2018 two million cohort was conducted. Patients previously diagnosed with nerve injury, surgery, or degeneration before acupuncture were excluded. Cases were defined as patients receiving acupuncture and seeking medical attention for nerve injury (ICD9-CM code 950-957) within 14 days post-procedure, while control groups comprised patients undergoing acupuncture without subsequent adverse events. Invasive treatments prior to adverse events and adverse events occurring more than 14 days post-acupuncture were excluded. To ensure case-control comparability, factors such as age, gender, socioeconomic status, and medical facility environment were controlled using propensity score matching. RESULTS The study encompassed 14,507,847 acupuncture treatments administered to 886,753 patients, with 8361 instances of post-acupuncture nerve injury identified, representing an incidence rate of approximately 5.76 per 10,000 procedures. Age emerged as a significant risk factor, with the adjusted odds ratios escalating with age. Several comorbidities including diabetes, hypothyroidism, liver cirrhosis, chronic kidney disease, herpes zoster, hepatitis virus, rheumatoid arthritis, systemic lupus erythematosus, dementia, and cerebrovascular accidents were associated with an elevated risk of nerve injury post-acupuncture. CONCLUSION This study underscores the importance of meticulous patient profiling and cautious therapeutic approach in acupuncture, considering the evident influence of various demographic, systemic, and treatment-related factors on the incidence of nerve injuries.
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Affiliation(s)
- Chia-Lin Lin
- Department of Chinese medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
| | - Andy Chern
- Department of Chinese medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Jen Wang
- Department of Chinese medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, ROC; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shun-Ku Lin
- Department of Chinese medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, ROC; Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; University of Taipei, Taipei, Taiwan, ROC
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3
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Kim TH, Lee MS, Birch S, Alræk T, Norheim AJ, Kang JW. Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies. Heliyon 2023; 9:e20577. [PMID: 37842566 PMCID: PMC10569964 DOI: 10.1016/j.heliyon.2023.e20577] [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: 05/09/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Case reports on acupuncture-related adverse events (AEs) have been consistently published in the literature. This review aims to assess the current publication status of case reports on acupuncture-related AEs and evaluate their reporting quality in order to identify areas for improvement. Methods This study is a systematic review (SR) of case reports. Studies describing cases for acupuncture-related AEs between 2010 and 2023 (until July) were searched in PubMed, Embase, and local databases (China and Korea), as well as by hand-searching references included in published relevant SRs. A bibliometric analysis was conducted to examine the publication trends of the included literature. The appropriateness of the acupuncture described in the cases, the causality assessment between AEs and acupuncture treatment, and the presence of necessary items from the CAse REport guidelines (CARE) checklist were narratively analyzed. Results A total of 169 case reports were included in this review. Over the past decade, an average of 12 case reports on acupuncture-related AEs were published annually. However, only 38.2% of the articles provided sufficient information to determine the appropriateness of the acupuncture treatment used in the reported cases, and considerable numbers of the included case reports did not suggest enough information for the assessment of a causal relationship. The majority of cases did not report the timeline (n = 164), patient perspectives (n = 157), and informed consent (n = 121) items from the CARE checklist. Discussion Acupuncture-related AEs persist in being frequently reported in the literature. Nonetheless, the information concerning acupuncture and causality assessment within these publications is still found to be insufficient. The development of reporting guidelines for future case reports on acupuncture-related AEs is anticipated to promote an academic environment conducive to more comprehensive reporting.
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Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Terje Alræk
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Arne Johan Norheim
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Jung Won Kang
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
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4
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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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5
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Nielsen A, Olson J, Quesada M, Zhu C, Raskin E, Vang B, Painovich J, Scott M, Xiong VJ, Dusek JA. Acupuncture intervention for acute pain in the Emergency Department trial: a consensus process. Acupunct Med 2022; 40:339-346. [PMID: 35229658 PMCID: PMC10948001 DOI: 10.1177/09645284221076507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This document describes the consensus process and intervention for a National Institutes of Health (NIH)-funded multi-site feasibility study utilizing acupuncture for ACUte paIn in The EmergencY Department (ACUITY). The acupuncture intervention is designed to be flexible and responsive to the most common Emergency Department (ED) scenarios, including trauma, acute pain of the low back, abdomen and/or musculoskeletal system, renal colic and headache. BACKGROUND Opioids remain a primary treatment for acute ED pain with attendant risk of adverse effects, addiction liability, diversion and death. Effective/safer options for acute pain are needed. Although acupuncture therapy has shown promise for acute pain in the ED alone or in conjunction with usual care, pragmatic trials are needed to obtain definitive and generalizable evidence. METHODS An Acupuncture Advisory Panel was convened that included nine acupuncture experts with 5-44 years of experience in practice and 2-16 years of experience in the acute pain care setting. A modified Delphi process was used with provision of a literature review, surveys of our panel members, three online discussions and email discussion as needed. The STandards for Reporting Interventions in Controlled Trials (STRICTA) checklist was used as a guide. RESULTS A responsive acupuncture intervention was agreed on for ACUITY. Session forms were fashioned in REDCap (Research Electronic Data Capture program to capture essential treatment data, assess fidelity and inform our design for a future pragmatic multi-site randomized controlled trial (RCT) of acupuncture in the ED, and for use by other future researchers. CONCLUSION Development of a responsive manualization intervention provides the appropriate framework for conducting a future, pragmatic, multi-site, definitive RCT of acupuncture in the ED. TRIAL REGISTRATION NUMBER NCT04880733 (ClinicalTrials.gov).
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juli Olson
- Department of Veterans Affairs, Central Iowa, Des Moines, IA, USA
| | - Megan Quesada
- University Hospitals Connor Whole Health, Cleveland Medical Center, Cleveland, OH, USA
| | - Chongbin Zhu
- Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt Health, Nashville, TN, USA
| | - Erin Raskin
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, USA
| | - Bobbee Vang
- Penny George Institute For Health and Healing, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Megan Scott
- Tanya I. Edwards, MD Center for Integrative and Lifestyle Medicine at Cleveland Clinic, Cleveland, OH, USA
| | - Vashir J Xiong
- Integrated Medicine, Advocate Aurora Healthcare, Milwaukee, WI, USA
| | - Jeffery A Dusek
- University Hospitals Connor Whole Health, Cleveland Medical Center, Cleveland, OH, USA
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
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6
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Nielsen A, Dusek J, Taylor-Swanson L, Tick H. Acupuncture therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: the Academic Consortium Pain Task Force White Paper Update. PAIN MEDICINE 2022; 23:1582-1612. [PMID: 35380733 PMCID: PMC9434305 DOI: 10.1093/pm/pnac056] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Background A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department. Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials for “acupuncture” and “acupuncture therapy” and “acute pain,” “surgery,” “peri-operative,” “trauma,” “emergency department,” “urgent care,” “review(s) ,” “systematic review,” “meta-analysis,” with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance. Future multicenter trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the emergency department. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Dusek
- University Hospitals, Connor Whole Health, Cleveland Medical Center; Cleveland, Ohio.,Department of Family Medicine and Community Health; Case Western Reserve University, Cleveland, OH
| | | | - Heather Tick
- Department of Family Medicine, and Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
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7
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Dusek JA, Kallenberg GA, Hughes RM, Storrow AB, Coyne CJ, Vago DR, Nielsen A, Karasz A, Kim RS, Surdam J, Segall T, McKee MD. Acupuncture in the emergency department for pain management: A BraveNet multi-center feasibility study. Medicine (Baltimore) 2022; 101:e28961. [PMID: 35244059 PMCID: PMC8896475 DOI: 10.1097/md.0000000000028961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Pain accounts for up to 78% of emergency department (ED) patient visits and opioids remain a primary method of treatment despite risks of addiction and adverse effects. While prior acupuncture studies are promising as an alternative opioid-sparing approach to pain reduction, successful conduct of a multi-center pilot study is needed to prepare for a future definitive randomized control trial (RCT). METHODS Acupuncture in the Emergency Department for Pain Management (ACUITY) is funded by the National Center for Complementary and Integrative Health. The objectives are to: conduct a multi-center feasibility RCT, examine feasibility of data collection, develop/deploy a manualized acupuncture intervention and assess feasibility/implementation (barrier/facilitators) in 3 EDs affiliated with the BraveNet Practice Based Research Network.Adults presenting to a recruiting ED with acute non-emergent pain (e.g., musculoskeletal, back, pelvic, noncardiac chest, abdominal, flank or head) of ≥4 on a 0-10-point Numeric Rating Scale will be eligible. ED participants (n = 165) will be equally randomized to Acupuncture or Usual Care.At pre-, post-, and discharge time-points, patients will self-assess pain and anxiety using the Numeric Rating Scale. Pain, anxiety, post-ED opioid use and adverse events will be assessed at 1 and 4 weeks. Opioid utilization in the ED and discharge prescriptions will be extracted from patients' electronic medical records.Acupuncture recipients will asked to participate in a brief qualitative interview about 3 weeks after their discharge. ED providers and staff will also be interviewed about their general perspectives/experiences related to acupuncture in the ED and implementation of acupuncture in ACUITY. RESULTS Recruitment began on 5/3/21. As of 12/7/21: 84 patients have enrolled, the responsive acupuncture intervention has been developed and deployed, and 26 qualitative interviews have been conducted. CONCLUSION Successful conduct of ACUITY will provide the necessary framework for conducting a future, multi-center, definitive RCT of acupuncture in the ED. CLINICAL TRIALSGOV NCT04880733 https://clinicaltrials.gov/ct2/show/NCT04880733.
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Affiliation(s)
- Jeffery A. Dusek
- UH Connor Whole Health, University Hospitals, Cleveland, OH
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Gene A. Kallenberg
- Department of Family Medicine, University of California San Diego, La Jolla, CA
| | - Robert M. Hughes
- Department of Emergency Medicine, Case Western Reserve University School of Medicine, Cleveland OH
- Clinical Decision Unit, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher J. Coyne
- Department of Emergency Medicine and Department of Radiation Medicine and Applied Sciences University of California San Diego La Jolla, CA
| | - David R. Vago
- Department of Physical Medicine and Rehabilitation and Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Arya Nielsen
- Department of Family Medicine and Community Health Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Karasz
- Department of Family Medicine and Social Medicine, Albert Einstein College of Medicine/Montefiore, New York, NY
| | - Ryung S. Kim
- Department of Epidemiology and Population Health and Institute of Clinical and Translational Research, Albert Einstein College of Medicine/Montefiore, New York, NY
| | - Jessica Surdam
- UH Connor Whole Health, University Hospitals, Cleveland, OH
| | - Tracy Segall
- UH Connor Whole Health, University Hospitals, Cleveland, OH
| | - M. Diane McKee
- Department of Family Medicine and Community Health, University of Massachusetts School of Medicine, Worcester, MA
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Uehara A, Yoshimoto T, Kaneko Y, Ochiai H, Shirasawa T, Minoura A, Den H, Sakamoto A, Kokaze A. Patient- and Therapist-Related Risk Factors for Adverse Events in Acupuncture and Moxibustion in Japan: Multicenter Survey of Acupuncture and Moxibustion Teaching Clinics. Med Acupunct 2021; 33:435-442. [PMID: 34976277 PMCID: PMC8716478 DOI: 10.1089/acu.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background/Objective: To investigate the patient- and therapist-related factors underlying adverse events (AEs) in acupuncture and moxibustion (A&M). Design: Retrospective study using data from medical records. Subjects: Patients who underwent A&M therapy in 4 clinics providing A&M over a 6-month period and their therapists. Main Outcome Measures: Survey items included the number of patients, age, sex, number of sessions, number and type of AEs, patients' underlying disease, and the therapist's years of clinical experience. The chi-squared test was used for intergroup comparisons. Spearman's rank correlation coefficient was used to analyze the correlations between the number of sessions and AEs. Logistic regression analysis was performed with AEs as the objective variable to investigate the relationships between the various parameters and AEs. Results: The analysis included 615 patients and 113 therapists. A total of 421 AEs occurred in a total of 4,369 sessions (9.6%). The number of sessions and number of AEs were significantly and positively correlated with patients (r = 0.47, P < 0.001) and therapists (r = 0.65, P < 0.001). Logistic analysis identified patient sex (adjusted odds ratio: 1.78, 95% confidence interval: [1.39-2.30]), liver disease (0.40, [0.19-0.84]), and years of clinical experience (to a cutoff of 2 or fewer years, 2-4 years: 0.65, [0.48-0.88], 5-9 years: 0.62, [0.44-0.87], 10 years or more: 0.50, [0.37-0.68]) as significant variables. Conclusions: Female sex and fewer years of clinical experience were factors that increased the risk of AEs, and underlying liver disease was a factor that decreased the risk of AEs.
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Affiliation(s)
- Akihito Uehara
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
- Kuretake College of Medical Arts and Sciences, Oriental Medicine Clinical Institute, Shinjuku-ku, Tokyo, Japan
- Address correspondence to: Akihito Uehara, MNR, LAc, Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku 142-8555, Japan
| | - Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Yasuhisa Kaneko
- Kuretake College of Medical Arts and Sciences, Oriental Medicine Clinical Institute, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Ochiai
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Takako Shirasawa
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akira Minoura
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Hiroki Den
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Ayumi Sakamoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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9
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Yamaguchi R, Makino Y, Torimitsu S, Chiba F, Kihara Y, Iwase H. Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review. J Forensic Sci 2021; 67:377-383. [PMID: 34435369 DOI: 10.1111/1556-4029.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Acupuncture is practiced as a complementary medicine worldwide. Although it is considered a safe practice, pneumothorax is one of its most common serious complications. However, there have been few reports of deaths due to pneumothorax after acupuncture treatment, especially focused on electroacupuncture. We report an autopsy case of a man in his 60s who went into cardiopulmonary arrest and died immediately after receiving electroacupuncture. Postmortem computed tomography (PMCT) showed bilateral pneumothoraces, as well as the presence of numerous gold threads embedded subcutaneously. An autopsy revealed two ecchymoses in the right thoracic cavity and a pinhole injury on the lower lobe of the right lung, suggesting that the needles had penetrated the lung. There were marked emphysematous changes in the lung, suggesting that rupture of bullae might also have contributed to bilateral pneumothoraces and fatal outcome. The acupuncture needles may have been drawn deeper into the body than at the time of insertion due to electrical pulses and muscle contraction, indicating the need for careful determination of treatment indications and technical safety measures, such as fail-safe mechanisms. This is the first case report of fatal bilateral pneumothoraces after electroacupuncture reported in the English literature. This case sheds light on the safety of electroacupuncture and the need for special care when administering it to patients with pulmonary disease who may be at a higher risk of pneumothorax. This is also the first report of three-dimensional reconstructed PMCT images showing the whole-body distribution of embedded gold acupuncture threads, which is unusual.
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Affiliation(s)
- Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
| | - Yuko Kihara
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba City, Japan
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10
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Nielsen A, Gereau S, Tick H. Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events. PAIN MEDICINE 2021; 21:1276-1293. [PMID: 32430505 DOI: 10.1093/pm/pnz379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT. METHODS Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy," "auricular acupuncture" or "auricular acupressure," "safety," "adverse events," "chondritis," and "perichondritis," with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT. RESULTS Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included. CONCLUSIONS The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Heather Tick
- Department of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Washington, USA
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11
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Yoon SH, Kim SA, Lee GY, Kim H, Lee JH, Leem J. Using magnetic resonance imaging to measure the depth of acupotomy points in the lumbar spine: A retrospective study. Integr Med Res 2020; 10:100679. [PMID: 33898243 PMCID: PMC8054160 DOI: 10.1016/j.imr.2020.100679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 01/02/2023] Open
Abstract
Background The acupotomy is an acupuncture device recently used to stimulate lumbar vertebrae such as transverse processes (TPs) and facet joints (FJs). However, there are many organs, nerves, and blood vessels, which can lead to side effects if the needle misses the treatment target. Therefore, information regarding appropriate insertion depths, which is currently lacking, could facilitate its safe use. We retrospectively investigated the depth from the skin to the TP and FJ of the lumbar vertebrae, using magnetic resonance imaging (MRI). Methods This retrospective chart review was conducted at a single medical centre in Korea. From 55,129 patient records, 158 subjects were selected. Perpendicular depth from the skin to the left and right TPs and FJs was measured using T1-weighted sagittal plane MRI. Depth differences between the left and right sides were evaluated using the paired t-test and analysis of covariance (body mass index [BMI] as a covariate). The influence of BMI on depth at each location was evaluated by simple linear regression analysis. Results The mean age was 43.2 years and mean BMI was 23.6 kg/m2. The depth from skin to the TPs or FJs was unaffected by age, sex, or side. Mean depths (cm) were as follows: (TPs) L1 = 4.5, L2 = 4.9, L3 = 5.3, L4 = 5.7, L5 = 5.9; (FJs) L12 = 3.8, L23 = 4.0, L34 = 4.4, L45 = 4.6, L5S1 = 4.6. Depth was highly correlated with BMI at each location. Conclusion The depth of TPs and FJs adjusted for BMI can safely and effectively be used for treatment via various invasive interventions, including acupotomy treatment, in the lumbar region.
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Affiliation(s)
- Sang-Hoon Yoon
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Shin-Ae Kim
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Geon-Yeong Lee
- Chung-Yeon Korean Medicine Hospital, Gwangju, Republic of Korea
| | - Hyunho Kim
- Chung-Yeon Central Institute, Gwangju, Republic of Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jungtae Leem
- Chung-Yeon Central Institute, Gwangju, Republic of Korea.,Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Republic of Korea
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12
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Arunkajohnsak S, Thanomkitti K, Kasemsarn P, Pattanaprichakul P, Jiamton S, Eimpunth S. Successful treatment of acupuncture-induced argyria using Q-switched 1064-nm Nd:YAG laser. JAAD Case Rep 2020; 6:984-987. [PMID: 32995425 PMCID: PMC7508910 DOI: 10.1016/j.jdcr.2020.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Kanchalit Thanomkitti
- Correspondence to: Kanchalit Thanomkitti, MD, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Bangkoknoi, Bangkok 10700, Thailand.
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13
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Nielsen A, Wieland LS. Cochrane reviews on acupuncture therapy for pain: A snapshot of the current evidence. Explore (NY) 2019; 15:434-439. [PMID: 31636020 DOI: 10.1016/j.explore.2019.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cochrane is an international non-profit organization established in 1993 to produce and disseminate high quality and unbiased systematic reviews of evidence on health care interventions. At the forefront of systematic review methodology, Cochrane is generally accepted to be among the most carefully prepared and rigorous sources of systematic review evidence. There are numerous Cochrane reviews on nonpharmacologic interventions for pain and multiple Cochrane reviews evaluating acupuncture therapy in pain conditions. But how complete and up to date are those reviews relative to other rigorous systematic reviews with meta-analyses of acupuncture therapy for pain published in the literature? In this 'snapshot' overview, we found 22 relevant Cochrane reviews, some concluding that acupuncture therapy is probably useful for treating specific pain conditions. However, many of the conditions for which acupuncture is most commonly used are either not represented in Cochrane reviews or the existing Cochrane reviews are seriously outdated and do not reflect current evidence. This creates confusion with the risks of adverse effects and addiction liability associated with pain medications, the prevalence of chronic pain, the ongoing opioid epidemic and the need for evidence-based options for pain as part of comprehensive pain care. Clinicians and patients want clarification on safe and effective options to treat pain. Issues involving reviewed trials' inadequate use of sham comparators, of acupuncture as a complex intervention with interactive components and a shift in research focus from efficacy trials to real-world pragmatic trials are discussed in relation to updating Cochrane reviews of acupuncture therapy for pain.
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Affiliation(s)
- Arya Nielsen
- Icahn School of Medicine at Mount Sinai, Department of Family Medicine & Community Health, United States.
| | - L Susan Wieland
- University of Maryland School of Medicine, Center for Integrative Medicine, United States
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14
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Kong DZ, Liang N, Yang GL, Zhang Z, Liu Y, Yang Y, Liu YX, Wang QG, Zhang F, Zhang HY, Nikolova D, Jakobsen JC, Gluud C, Liu JP. Acupuncture for chronic hepatitis B. Cochrane Database Syst Rev 2019; 8:CD013107. [PMID: 31436846 PMCID: PMC6705348 DOI: 10.1002/14651858.cd013107.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic hepatitis B is a liver disease associated with high morbidity and mortality. Chronic hepatitis B requires long-term management aiming to reduce the risks of hepatocellular inflammatory necrosis, liver fibrosis, decompensated liver cirrhosis, liver failure, and liver cancer, as well as to improve health-related quality of life. Acupuncture is being used to decrease discomfort and improve immune function in people with chronic hepatitis B. However, the benefits and harms of acupuncture still need to be established in a rigorous way. OBJECTIVES To assess the benefits and harms of acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. SEARCH METHODS We undertook electronic searches of the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and SinoMed to 1 March 2019. We also searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp), ClinicalTrials.gov (www.clinicaltrials.gov/), and the Chinese Clinical Trial Registry (ChiCTR) for ongoing or unpublished trials until 1 March 2019. SELECTION CRITERIA We included randomised clinical trials, irrespective of publication status, language, and blinding, comparing acupuncture versus no intervention or sham acupuncture in people with chronic hepatitis B. We included participants of any sex and age, diagnosed with chronic hepatitis B as defined by the trialists or according to guidelines. We allowed co-interventions when the co-interventions were administered equally to all intervention groups. DATA COLLECTION AND ANALYSIS Review authors in pairs individually retrieved data from reports and through correspondence with investigators. Primary outcomes were all-cause mortality, proportion of participants with one or more serious adverse events, and health-related quality of life. Secondary outcomes were hepatitis B-related mortality, hepatitis B-related morbidity, and adverse events considered not to be serious. We presented the pooled results as risk ratios (RRs) with 95% confidence intervals (CIs). We assessed the risks of bias using risk of bias domains with predefined definitions. We put more weight on the estimate closest to zero effect when results with fixed-effect and random-effects models differed. We evaluated the certainty of evidence using GRADE. MAIN RESULTS We included eight randomised clinical trials with 555 randomised participants. All included trials compared acupuncture versus no intervention. These trials assessed heterogeneous acupuncture interventions. All trials used heterogeneous co-interventions applied equally in the compared groups. Seven trials included participants with chronic hepatitis B, and one trial included participants with chronic hepatitis B with comorbid tuberculosis. All trials were assessed at overall high risk of bias, and the certainty of evidence for all outcomes was very low due to high risk of bias for each outcome, imprecision of results (the confidence intervals were wide), and publication bias (small sample size of the trials, and all trials were conducted in China). Additionally, 79 trials lacked the necessary methodological information to ensure their inclusion in our review.None of the included trials aim to assess all-cause mortality, serious adverse events, health-related quality of life, hepatitis B-related mortality, and hepatitis B-related morbidity. We are uncertain whether acupuncture, compared with no intervention, has an effect regarding adverse events considered not to be serious (RR 0.67, 95% CI 0.43 to 1.06; I² = 0%; 3 trials; 203 participants; very low-certainty evidence) or detectable hepatitis B e-antigen (HBeAg) (RR 0.64, 95% CI 0.11 to 3.68; I² = 98%; 2 trials; 158 participants; very low-certainty evidence). Acupuncture showed a reduction in detectable hepatitis B virus (HBV) DNA (a non-validated surrogate outcome; RR 0.45, 95% CI 0.27 to 0.74; 1 trial, 58 participants; very low-certainty evidence). We are uncertain whether acupuncture has an effect regarding the remaining separately reported adverse events considered not to be serious.Three of the eight included trials received academic funding from government or hospital. None of the remaining five trials reported information on funding. AUTHORS' CONCLUSIONS The clinical effects of acupuncture for chronic hepatitis B remain unknown. The included trials lacked data on all-cause mortality, health-related quality of life, serious adverse events, hepatitis-B related mortality, and hepatitis-B related morbidity. The vast number of excluded trials lacked clear descriptions of their design and conduct. Whether acupuncture influences adverse events considered not to be serious is uncertain. It remains unclear if acupuncture affects HBeAg, and if it is associated with reduction in detectable HBV DNA. Based on available data from only one or two small trials on adverse events considered not to be serious and on the surrogate outcomes HBeAg and HBV DNA, the certainty of evidence is very low. In view of the wide usage of acupuncture, any conclusion that one might try to draw in the future should be based on data on patient and clinically relevant outcomes, assessed in large, high-quality randomised sham-controlled trials with homogeneous groups of participants and transparent funding.
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Affiliation(s)
- De Zhao Kong
- Liaoning University of Traditional Chinese MedicineChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
- The Affiliated Hospital of Liaoning University of Traditional Chinese MedicineDepartment of CardiologyBeiling Street 33ShenyangLiaoning ProvinceChina110032
- Liaoning University of Traditional Chinese MedicineCo‐construct Key Laboratory of Theory of Visceral Manifestations and ApplicationsChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupCopenhagenDenmark
| | - Ning Liang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupCopenhagenDenmark
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese MedicineBei San Huan Dong Lu 11, Chaoyang DistrictBeijingChina100029
| | - Guan Lin Yang
- Liaoning University of Traditional Chinese MedicineChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
| | - Zhe Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese MedicineChong Shan East Street 79ShenyangLiaoning ProvinceChina110032
| | - Yue Liu
- Liaoning University of Traditional Chinese MedicineCo‐construct Key Laboratory of Theory of Visceral Manifestations and ApplicationsChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
| | - Ye Yang
- Liaoning University of Traditional Chinese MedicineChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
| | - Yu Xi Liu
- Liaoning University of Traditional Chinese MedicineChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
| | - Qi Ge Wang
- Liaoning University of Traditional Chinese MedicineChong Shan East Road 79ShenyangLiaoning ProvinceChina110032
| | - Fan Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese MedicineChong Shan East Street 79ShenyangLiaoning ProvinceChina110032
| | - Hui Yong Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese MedicineChong Shan East Street 79ShenyangLiaoning ProvinceChina110032
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupCopenhagenDenmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupCopenhagenDenmark
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupCopenhagenDenmark
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese MedicineBei San Huan Dong Lu 11, Chaoyang DistrictBeijingChina100029
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15
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Tick H, Nielsen A. Academic Consortium for Integrative Medicine & Health Commentary to Health and Human Services (HHS) on Inter-agency Task Force Pain Management Best Practices Draft Report. Glob Adv Health Med 2019; 8:2164956119857656. [PMID: 31360615 PMCID: PMC6637830 DOI: 10.1177/2164956119857656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Heather Tick
- Department of Family Medicine and Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Extensive pyomyositis of prevertebral muscles after acupuncture: Case report. Turk J Emerg Med 2019; 19:113-114. [PMID: 31321345 PMCID: PMC6612627 DOI: 10.1016/j.tjem.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Severe infectious diseases that require surgery after acupuncture therapy are quite rare. There are only a few cases of pyomyositis following acupuncture reported in the literature. This paper presents a case of cervical pyomyositis developed after such treatment. Case presentation A 36-year-old man presented with swelling and pain in the posterior cervical region as well as high fever and torticollis, after having received three sessions of acupuncture therapy during the preceding weeks aimed to treat his neck stiffness. Ultrasound guided fine needle aspiration (FNA) and contrast-enhanced Computed Tomography (CT) were performed, which showed a large abscess along the paraspinal muscles. The symptoms were resolved after surgical treatment and antibiotherapy. Conclusion Although highly infrequent, pyomyositis is a probable complication of acupuncture. In order to minimise the risk of complications, strict hygenic precautions and knowledge of the human anatomy are mandatory to decrease the rate of complications of acupuncture.
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17
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Nielsen A, Tick H, Mao JJ, Hecht F. Academic Consortium for Integrative Medicine & Health Commentary to CMS; RE: National Coverage Analysis (NCA) Tracking Sheet for Acupuncture for Chronic Low Back Pain (CAG-00452N). Glob Adv Health Med 2019; 8:2164956119857648. [PMID: 31321149 PMCID: PMC6624915 DOI: 10.1177/2164956119857648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Arya Nielsen
- Department of Family Medicine & Community Health, Icahn
School of Medicine at Mount Sinai, New York, New York
| | - Heather Tick
- Department of Family Medicine, and Anesthesiology & Pain
Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Frederick Hecht
- Osher Center for Integrative Medicine, San Francisco,
California
| | - the Consortium Pain Task Force
- Department of Family Medicine & Community Health, Icahn
School of Medicine at Mount Sinai, New York, New York
- Department of Family Medicine, and Anesthesiology & Pain
Medicine, University of Washington School of Medicine, Seattle, Washington
- Memorial Sloan Kettering Cancer Center, New York, New York
- Osher Center for Integrative Medicine, San Francisco,
California
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18
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Eggenschwiler CD, Dummer R, Imhof L. Iatrogenic tattoos after acupuncture: successful outcome after treatment with QS Ruby Laser: A case report and review of literature. Laser Ther 2019; 28:139-144. [PMID: 32921913 DOI: 10.5978/islsm.19-cr-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and Aims Acupuncture has become a substantial part of medical practice in Switzerland. So far, only few cases of accidental tattoo after acupuncture have been reported, which were all caused by acupuncture needles that had been left in the skin and led to local argyrosis. Case We report the case of a 31-year-old female who developed gray-brown macules after acupuncture. Over 5 months, she had received acupuncture on the same spots one to two times per week and the macules had gradually become darker and had increased in size. The needles used were disposable, contained nickel and were not left in the skin for over 30 minutes. The patient was of Fitzpatrick skin phototype II and showed several grayish-brown macules with an average diameter of around 5mm in the region of glabella, nucha and dorsum pedis. We treated the lesions with a quality-switched ruby laser (694 nm) with a fluence between 3 and 5.5 J/cm2, a spot size of 4 or 6 mm and in intervals of 8 to 23 weeks up to a complete elimination of the hyperpigmentation within 11 laser sessions. Conclusion In synopsis with the anamnesis, the clinical aspect and the therapeutic course, we interpreted the hyperpigmentary spots as a combination of iatrogenic tattooing with nickel and deposition of hemosiderin as well as melanin due to repeated mechanical manipulation and UV exposure of the skin. Furthermore, we hereby show the validity of the quality-switched ruby laser in the removal of accidental hyperpigmentation in skin phototype II.
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Affiliation(s)
- Corinne Dc Eggenschwiler
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
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19
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Abstract
Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.
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Affiliation(s)
- Sofia Costa Corado
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | | | - Luísa Quaresma
- Serviço de Cirurgia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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20
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Priola SM, Moghaddamjou A, Ku JC, Taslimi S, Yang VXD. Acupuncture-Induced Cranial Epidural Abscess: Case Report and Review of the Literature. World Neurosurg 2019; 125:519-526.e1. [PMID: 30743042 DOI: 10.1016/j.wneu.2019.01.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acupuncture is a common form of alternative medicine that is used for pain control among other modalities of treatment. It is a relatively safe procedure, but complications, including those of infectious etiology, may still occur. CASE DESCRIPTION A 47-year-old immunosuppressed woman presented with fever, altered level of consciousness, dysphasia, and a left occipital subgaleal fluctuant mass after acupuncture for headaches in the same area. Imaging demonstrated subgaleal and epidural collection localized in the left occipital region. She underwent urgent surgical evacuation of both collections. Cultures from intraoperative specimens grew Streptococcus anginosus. The patient started targeted antibiotic treatment leading to complete recovery. CONCLUSIONS To our knowledge, this is the first report of intracranial abscess after acupuncture. Given the worldwide application of this alternative treatment, physicians, acupuncturists, and the general public should be aware of the possibility of this rare but serious complication.
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Affiliation(s)
- Stefano Maria Priola
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
| | - Ali Moghaddamjou
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Jerry C Ku
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Shervin Taslimi
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Sunnybrook Health Sciences Centre, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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21
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Eggenschwiler CDC, Dummer R, Imhof L. Iatrogenic tattoos after acupuncture: successful outcome after treatment with QS Ruby Laser: A case report and review of literature. Laser Ther 2019. [DOI: 10.5978/islsm.28_19-cr-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Corinne DC Eggenschwiler
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
| | - Laurence Imhof
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzisrasse 3, 8091 Zurich, Switzerland
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22
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Chia KL, Haberberger RV. Needling Depth at Bl52 in 13 Cadavers. Acupunct Med 2018; 35:155-156. [DOI: 10.1136/acupmed-2016-011233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Kwan Leung Chia
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Rainer Viktor Haberberger
- Department of Anatomy and Histology, School of Medicine, Flinders University, Bedford Park, South Australia, Australia
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23
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White A. A Cumulative Review of the Range and Incidence of Significant Adverse Events Associated with Acupuncture. Acupunct Med 2018; 22:122-33. [PMID: 15551936 DOI: 10.1136/aim.22.3.122] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice. Methods Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events. Results A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients. Conclusions The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.
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24
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Kong DZ, Liang N, Yang GL, Zhang Z, Liu Y, Yang Y, Liu YX, Wang QG, Zhang F, Zhang HY, Nikolova D, Jakobsen JC, Gluud C, Liu JP. Acupuncture for chronic hepatitis B. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- De Zhao Kong
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Department of Cardiology; Beiling Street 33 Shenyang Liaoning Province China 110032
- Liaoning University of Traditional Chinese Medicine; Co-construct Key Laboratory of Theory of Visceral Manifestations and Applications; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Ning Liang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
- Beijing University of Chinese Medicine; Centre for Evidence-Based Chinese Medicine; Bei San Huan Dong Lu 11, Chaoyang District Beijing China 100029
| | - Guan Lin Yang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Zhe Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Yue Liu
- Liaoning University of Traditional Chinese Medicine; Co-construct Key Laboratory of Theory of Visceral Manifestations and Applications; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Ye Yang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Yu Xi Liu
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Qi Ge Wang
- Liaoning University of Traditional Chinese Medicine; Chong Shan East Road 79 Shenyang Liaoning Province China 110032
| | - Fan Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Hui Yong Zhang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine; Chong Shan East Street 79 Shenyang Liaoning Province China 110032
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
- Holbaek Hospital; Department of Cardiology; Holbaek Denmark 4300
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Copenhagen Denmark
| | - Jian Ping Liu
- Beijing University of Chinese Medicine; Centre for Evidence-Based Chinese Medicine; Bei San Huan Dong Lu 11, Chaoyang District Beijing China 100029
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Chen HN, Chang CY, Chen LZ, Chang YJ, Lin JG. Using Ultrasonography Measurements to Determine the Depth of the GB 21 Acupoint to Prevent Pneumothorax. J Acupunct Meridian Stud 2018; 11:355-360. [PMID: 29936338 DOI: 10.1016/j.jams.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTIONS Pneumothorax is the most frequent severe acupuncture-related adverse event occurring at the GB 21 acupoint. This study used ultrasonography (US) to measure the depth of the GB 21 acupoint in adults and assessed its applicability for ensuring safe acupuncture practices. MATERIALS AND METHODS A US probe was used to measure the vertical depth from the skin to the pleural line of the apex of the lungs at the right and left GB 21 acupoints. The sex, age, body weight, height, and body mass index of each person were recorded. Student t test and generalized estimating equations were used for statistical analysis. RESULTS Sixty women and 41 men with a median age of 29 years were included in this study. The depth of GB 21 increased with body weight, height, and body mass index (p < 0.001). The mean depth of GB 21 in men (17.4 mm) was greater than that in women (14.6 mm; p < 0.001). The depth difference between the right and left shoulders was significant in men (p < 0.001) but not in women. CONCLUSIONS US can be used to measure GB 21 acupoint depth. Further control studies on its use to ensure safe clinical practices, including preventing acupuncture-related pneumothorax, are warranted.
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Affiliation(s)
- Hsiao-Neng Chen
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chau-Yi Chang
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
| | - Lian-Zen Chen
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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The Biocompatibility of Nanoporous Acupuncture Needles. J Acupunct Meridian Stud 2018; 11:107-115. [PMID: 29635041 DOI: 10.1016/j.jams.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022] Open
Abstract
We investigate the biocompatibility of a new class of acupuncture needles that possess a hierarchical nano/microscale porous surface topology, referred to as porous acupuncture needles (PAN). The PAN is synthesized via a facile electrochemical anodization technique by which a surface area approximately 20 times greater than a conventional acupuncture needle, of approximately the same diameter, is obtained. PAN biocompatibility is evaluated using a variety of standard tests, with results indicating that the PAN can safely be used within therapeutic practice.
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Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (NY) 2018; 14:177-211. [PMID: 29735382 DOI: 10.1016/j.explore.2018.02.001] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
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Affiliation(s)
- Heather Tick
- Departments of Family Medicine, Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kenneth R Pelletier
- Department of Medicine, University of California School of Medicine, San Francisco, CA
| | - Robert Bonakdar
- Department of Pain Management, Scripps Center for Integrative Medicine, La Jolla, CA
| | | | - Ronald Glick
- Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Emily Ratner
- MedStar Health, Institute for Innovation, Integrative Medicine Initiatives, MedStar Montgomery Medical Center, Washington, DC
| | - Russell L Lemmon
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Veronica Zador
- Beaumont Hospital Integrative Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI
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Shim JM. The coordination of plural logics of action and its consequences: Evidence from plural medical systems. PLoS One 2017; 12:e0189841. [PMID: 29253867 PMCID: PMC5734740 DOI: 10.1371/journal.pone.0189841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/04/2017] [Indexed: 01/26/2023] Open
Abstract
Drawing on the theory of social action in organizational and institutional sociology, this paper examines the behavioral consequences of plural logics of action. It addresses the question based on the empirical case of plural medical systems that are composed of both biomedicine and alternative medicine. Applying mixed methods of a cross-national panel data analysis and a content analysis of medical journal articles, it finds that plural systems affect health outcomes negatively when tensions between biomedicine and alternative medicine are unaddressed. In contrast, plural systems produce tangible health benefits when biomedicine and alternative medicine are coordinated through government policies or by health care organizations/professionals. This paper proposes plurality coordination as an important mechanism that modifies the behavioral consequences of plural logics. This proposition contributes to providing theoretical answers to the sociological puzzle that plural logics of action produce inconsistent behavioral consequences.
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Affiliation(s)
- Jae-Mahn Shim
- Department of Sociology, Korea University, Seoul, Korea
- * E-mail:
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29
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Hong S, Park Y, Lee CN. Lateral Medullary Infarction Caused by Oriental Acupuncture. Eur Neurol 2017; 79:63. [PMID: 29241209 DOI: 10.1159/000479963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
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Lee HJ, Kim YJ, Kim WY. Safety Concerns with Thoracoabdominal Acupuncture: Experience at a Tertiary-Care Emergency Department. PAIN MEDICINE 2017; 18:2504-2508. [DOI: 10.1093/pm/pnx068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
Acupuncture is increasingly used worldwide. It is becoming more accepted by both patients and healthcare providers. However, the current understanding of its adverse events (AEs) is fragmented. We conducted this overview to collect all systematic reviews (SRs) on the AEs of acupuncture and related therapies. MEDLINE and EMBASE were searched from inception to December 2015. Methodological quality of included reviews was assessed with a validated instrument. Evidence was narratively reported. Seventeen SRs covering various types of acupuncture were included. Methodological quality of the reviews was overall mediocre. Four major categories of AEs were identified, which are organ or tissue injuries (13 reviews, median: 36 cases, median deaths: 4), infections (11 reviews, median: 17 cases, median deaths: 0.5), local AEs or reactions (12 reviews, median: 8.5 cases, no deaths were reported), and other complications such as dizziness or syncope (11 reviews, median: 21 cases, no deaths were reported). Minor and serious AEs can occur during the use of acupuncture and related modalities, contrary to the common impression that acupuncture is harmless. Serious AEs are rare, but need significant attention as mortality can be associated with them. Referrals should consider acupuncturists’ training credibility, and patient safety should be a core part of acupuncture education.
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Furuse N, Shinbara H, Uehara A, Sugawara M, Yamazaki T, Hosaka M, Yamashita H. A Multicenter Prospective Survey of Adverse Events Associated with Acupuncture and Moxibustion in Japan. Med Acupunct 2017; 29:155-162. [PMID: 28736592 PMCID: PMC5512321 DOI: 10.1089/acu.2017.1230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There have been only a few prospective surveys on adverse events (AEs) in Japanese-style acupuncture practice, and these surveys were conducted only in a single college acupuncture clinic. Objective: The goal of this research was to assess the safety of acupuncture and moxibustion performed in educational facilities in Japan. Materials and Methods: This was a multicenter prospective survey, using paper reporting forms. It was conducted in eight acupuncture clinics affiliated with educational institutions. The subjects were outpatients attending the clinics. The main outcome measure was the number of reported adverse events. The study was conducted for 5-7 months at each facility between October 2014 and June 2015. Participating acupuncture practitioners were instructed to self-report AEs observed during and after treatment; patients were interviewed upon treatment completion. For returning patients, treatment was preceded by an interview survey regarding the AEs identified after the previous treatment session. A specialized 4-sheet questionnaire was used. Results: Two hundred and thirty-two acupuncture practitioners participated, 2180 patients received treatment, and there were 14,039 sessions, overall. In total, 847 (6.03%) AEs were reported. The most common AEs included subcutaneous bleeding and hematomas (370, 2.64%), followed by discomfort (109, 0.78%) and residual pain at insertion points (94, 0.67%). No infections or serious AEs were reported. Conclusions: Acupuncture and moxibustion performed in educational facilities in Japan were safe because most of the AEs reported were mild and transient. However, the risk cannot be defined definitely because the survey sample size was too small.
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Affiliation(s)
- Nobutatsu Furuse
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Osaka Minami Prefectural Special Needs Education School for the Visually Impaired, Osaka, Japan
- Morinomiya University of Medical Sciences Acupuncture Information Center, Osaka, Japan
| | - Hisashi Shinbara
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Department of Acupuncture and Moxibustion Therapy, Faculty of Health Promotional Sciences, Tokoha University, Shizuoka, Japan
| | - Akihito Uehara
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Oriental Medicine Clinical Laboratory, Kuretake College of Medical Arts & Sciences, Tokyo, Japan
| | - Masaaki Sugawara
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
| | - Toshiya Yamazaki
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Department of Health Sciences, Kansai University of Health Sciences, Osaka, Japan
| | - Masayoshi Hosaka
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Morinomiya University of Medical Sciences Acupuncture Information Center, Osaka, Japan
| | - Hitoshi Yamashita
- Committee for Safe Acupuncture, Academic & Research Department, Japan Society of Acupuncture and Moxibustion, Tokyo, Japan
- Morinomiya University of Medical Sciences Acupuncture Information Center, Osaka, Japan
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Leow MQH, Cao T, Wong YR, Tay SC. Needle breakage in acupuncture: a biomechanical study. Acupunct Med 2016; 35:78-79. [PMID: 27932569 DOI: 10.1136/acupmed-2016-011259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Mabel Qi He Leow
- Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore
| | - Taige Cao
- Medical Department, National Skin Centre, Singapore, Singapore.,Singapore College of Traditional Chinese Medicine, Singapore, Singapore
| | - Yoke Rung Wong
- Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore
| | - Shian Chao Tay
- Biomechanics Laboratory, Singapore General Hospital, Singapore, Singapore.,Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore
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Wen Y, Zhang C, Zhao XF, Deng SZ, He S, Huang LH, Tian G, Meng ZH. Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo. Neural Regen Res 2016; 11:1267-73. [PMID: 27651774 PMCID: PMC5020825 DOI: 10.4103/1673-5374.189191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3–4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.
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Affiliation(s)
- Yan Wen
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chao Zhang
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiao-Feng Zhao
- Institute of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shi-Zhe Deng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Si He
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ling-Hui Huang
- Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| | - Guang Tian
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhi-Hong Meng
- Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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35
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Kim JS, Kim KH, Kim WW. 17 Cases of Acupuncture Related Pneumothorax and Factors Influencing Pneumothorax. ACUPUNCTURE ELECTRO 2016; 41:95-105. [PMID: 29897686 DOI: 10.3727/036012916x14666839504596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Acupuncture is increasing in popularity as a complementary and alternative medicine. Pneumothorax is the most common and potentially serious adverse effect after acupuncture. This complication can cause fatality in the absence of rapid treatment. Here, we analyze the clinical presentation and discuss prevention of post-acupuncture pneumothorax and an approach to reducing this complication. METHODS Patients presenting with post-acupuncture pneumothorax in our hospital center during 2011-2015 were retrospectively analyzed. Body mass index (BMI), patient's pre-acupuncture chief complaint and disease, and the characteristics associated with pneumothorax were assessed. The diagnosis of pneumothorax was based on clinical presentation and chest radiography. Conservative treatment or thoracostomy was performed. RESULTS Seventeen patients (15 women and 2 men) with a mean age of 42 years (range: 18-73 years) were included; three were underweight (BMI < 18.5kg/m2), 11 patients had a healthy weight (BMI= 18.5-22.95kg/m2), one was overweight (BMI = 23- 24.95kg/m2), and two were obese (BMI ≥ 25 kg/m2). All but one case of bilateral pneumothorax had unilateral pneumothorax (right side: 6; left side: 10). Chest pain or dyspnea, or both. were the initial symptoms in all patients. Twelve patients underwent immediate thoracostomy. The patient with bilateral pneumothorax underwent right-side thoracostomy, and subsequently left-side thoracostomy, due to progression of the left-side pneumothorax. Five patients were successfully managed conservatively. All patients had an excellent outcome; all were asymptomatic and exhibited a normal chest X-ray at follow-up. CONCLUSION Acupuncturists must be aware that delayed diagnosis and management of pneumothorax are life-threatening, and when symptoms of possible pneumothorax arise, patients should be advised to undergo an appropriate evaluation and intervention, particularly so in those with abnormal BMI.
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Acupuncture as a Treatment for Substance Abuse in Pediatric Patients. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Nielsen A, MacPherson H, Alraek T. Acupuncture for Military Personnel Health and Performance. J Altern Complement Med 2014; 20:417-8. [DOI: 10.1089/acm.2013.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arya Nielsen
- Department of Integrative Medicine, Beth Israel Medical Center, New York, NY
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, United Kingdom
| | - Terje Alraek
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), The Arctic University of Norway, Tromsø, Norway
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Affiliation(s)
- Kenneth Qiao Wei Tan
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
| | - Atasha Asmat
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
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Xie YM, Xu S, Zhang CS, Xue CC. Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles. Acupunct Med 2014; 32:146-54. [PMID: 24522003 PMCID: PMC3995252 DOI: 10.1136/acupmed-2013-010472] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The present work examined the surface conditions and various other physical properties of sterilised single-use stainless steel acupuncture needles from two of the most popular brands widely used in many countries. METHODS Scanning electron microscope (SEM) images were taken for 10 randomly chosen needles from each brand. Further SEM images were taken after each of these needles underwent a standard manipulation with an acupuncture needling practice gel. A comparison of forces and torques during the needling process was also carried out. RESULTS The SEM images revealed significant surface irregularities and inconsistencies at the needle tips, especially for needles from one of the two brands. Metallic lumps and small, loosely attached pieces of material were observed on the surfaces of some needles. Some of the lumps and pieces of material seen on the needle surfaces disappeared after the acupuncture manipulation. If these needles had been used on patients, the metallic lumps and small pieces of material could have been deposited in human tissues, which could have caused adverse events such as dermatitis. Malformed needle tips might also cause other adverse effects including bleeding, haematoma/bruising, or strong pain during needling. An off-centre needle tip could result in the needle altering its direction during insertion and consequently failing to reach the intended acupuncture point or damaging adjacent tissues. CONCLUSIONS These findings highlight the need for improved quality control of acupuncture needles, with a view to further enhancing the safety and comfort of acupuncture users.
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Affiliation(s)
- Yi Min Xie
- Centre for Innovative Structures and Materials, School of Civil, Environmental and Chemical Engineering, RMIT University, , Melbourne, Victoria, Australia
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40
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Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg 2014; 149:S1-27. [PMID: 24189771 DOI: 10.1177/0194599813505967] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. PURPOSE The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell's palsy. The target population is inclusive of both adults and children presenting with Bell's palsy. ACTION STATEMENTS: The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell's palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell's palsy, and (d) clinicians should implement eye protection for Bell's palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell's palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell's palsy, (c) clinicians should not perform electrodiagnostic testing in Bell's palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell's palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell's palsy, and (b) clinicians may offer electrodiagnostic testing to Bell's palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell's palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell's palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell's palsy.
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Dyer L, Venton K, Forrester M. Home Electroacupuncture for Persistent Postsurgical Pain: A Patient's Report. Acupunct Med 2013; 31:425-9. [DOI: 10.1136/acupmed-2013-010421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 30-year-woman presented with iatrogenic myofascial facial pain of 12 months’ duration after surgical treatment for bilateral temporomandibular joint dysfunction. Limited response to manual acupuncture was followed by a trial of electroacupuncture. Response to electroacupuncture was limited in duration and one option was to teach her partner to perform electroacupuncture at home. The patient and partner, trained in beauty therapy, embraced this idea and it proved equally effective as therapist-provided acupuncture. We describe this case report from the perspective of the patient, caregiver or acupuncture partner and therapist. Home electroacupuncture seems to be safe, acceptable and practicable as a maintenance treatment for patients with persistent postsurgical pain of myofascial origin.
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Affiliation(s)
| | | | - Max Forrester
- Department of Orthopaedics, Musgrove Park Hospital, Taunton, Somerset, UK
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42
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McCutcheon L, Yelland M. Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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43
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Verilhac KN, Dobersen MJ, Lear-Kaul KC. Permanent Needle Acupuncture. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Michael J. Dobersen
- University of Colorado Anschutz Medical Campus - Department of Pathology, Aurora, CO (KV)
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Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Greenlee H, Pietanza MC, Cassileth BR. Complementary therapies and integrative medicine in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e420S-e436S. [PMID: 23649450 DOI: 10.1378/chest.12-2364] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Physicians are often asked about complementary therapies by patients with cancer, and data show that the interest in and use of these therapies among patients with cancer is common. Therefore, it is important to assess the current evidence base on the benefits and risks of complementary therapies (modalities not historically used in modern Western medicine). METHODS A systematic literature review was carried out and recommendations were made according to the American College of Chest Physicians Evidence-Based Clinical Practice Guidelines development methodology. RESULTS A large number of randomized controlled trials, systematic reviews, and meta-analyses, as well as a number of prospective cohort studies, met the predetermined inclusion criteria. These trials addressed many different issues pertaining to patients with lung cancer, such as symptoms of anxiety, mood disturbance, pain, quality of life, and treatment-related side effects. The available data cover a variety of interventions, including acupuncture, nutrition, mind-body therapies, exercise, and massage. The body of evidence supports a series of recommendations. An evidenced-based approach to modern cancer care should integrate complementary therapies with standard cancer therapies such as surgery, radiation, chemotherapy, and best supportive care measures. CONCLUSIONS Several complementary therapy modalities can be helpful in improving the overall care of patients with lung cancer.
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Affiliation(s)
- Gary E Deng
- Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Sarah M Rausch
- University of Florida College of Medicine, Jacksonville, FL
| | | | | | - Nagi B Kumar
- Moffitt Cancer Center and Research Institute, Tampa, FL
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Wang SM, Harris RE, Lin YC, Gan TJ. Acupuncture in 21st century anesthesia: is there a needle in the haystack? Anesth Analg 2013; 116:1356-9. [PMID: 23709075 DOI: 10.1213/ane.0b013e31828f5efa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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An exploration of the needling depth in acupuncture: the safe needling depth and the needling depth of clinical efficacy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:740508. [PMID: 23935678 PMCID: PMC3722841 DOI: 10.1155/2013/740508] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 05/23/2013] [Indexed: 02/05/2023]
Abstract
Objective. To explore the existing scientific information regarding safe needling depth of acupuncture points and the needling depth of clinical efficacy. Methods. We searched the PubMed, EMBASE, Cochrane, Allied and Complementary Medicine (AMED), The National Center for Complementary and Alternative Medicine (NCCAM), and China National Knowledge Infrastructure (CNKI) databases to identify relevant monographs and related references from 1991 to 2013. Chinese journals and theses/dissertations were hand searched. Results. 47 studies were recruited and divided into 6 groups by measuring tools, that is, MRI, in vivo evaluation, CT, ultrasound, dissected specimen of cadavers, and another group with clinical efficacy. Each research was analyzed for study design, definition of safe depth, and factors that would affect the measured depths. Depths of clinical efficacy were discussed from the perspective of de-qi and other clinical observations. Conclusions. Great inconsistency in depth of each point measured from different subject groups and tools exists. The definition of safe depth should be established through standardization. There is also lack of researches to compare the clinical efficacy. A well-designed clinical trial selecting proper measuring tools to decide the actual and advisable needling depth for each point, to avoid adverse effects or complications and promote optimal clinical efficacy, is a top priority.
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Her AY, Kim YH, Ryu SM, Cho JH. Cardiac tamponade complicated by acupuncture: hemopericardium due to shredded coronary artery injury. Yonsei Med J 2013; 54:788-90. [PMID: 23549831 PMCID: PMC3635632 DOI: 10.3349/ymj.2013.54.3.788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest, we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Se-Min Ryu
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
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de Paula Machado DFG, Martins T, Trevisol DJ, Vieira e Silva RA, Narciso-Schiavon JL, Schuelter Trevisol F, Schiavon LDL. Prevalence and factors associated with hepatitis B virus infection among senior citizens in a southern brazilian city. HEPATITIS MONTHLY 2013; 13:e7874. [PMID: 23922561 PMCID: PMC3734895 DOI: 10.5812/hepatmon.7874] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 01/04/2013] [Accepted: 12/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Given the long term exposure to risk factors, it is likely that older adults exhibit the highest proportions of HBV serological markers. Nevertheless, there are few methodologically adequate studies in Brazil evaluating the prevalence and risk factors for HBV infection in individuals aged 60 years or more. OBJECTIVES To estimate the prevalence and factors associated with HBV infection in elderly residents in the city of Tubarão/SC. PATIENTS AND METHODS This cross-sectional study included 820 individuals (≥ 60 years) selected by simple random sampling. The variables were compared by chi-square test or Fisher's exact test and those with P < 0.200 were included in the regression model. RESULTS The mean age of patients was 68.6 ± 7.0 years, 39% were men and 92% Caucasian. Five subjects (0.6%) presented with positive HBsAg and 124 (15.1%) were anti-HBc reactive. Bivariate analysis showed that the presence of anti-HBc was associated with age ≥ 67 years, ≤ 4 years of schooling, acupuncture therapy and lower proportion of subjects exposed to invasive procedures. In multivariate analysis, the following variables remained independently associated with HBV infection: male gender, marital status, ≤ 4 years of schooling and acupuncture. CONCLUSIONS The prevalence of anti-HBc among the elderly in the city of Tubarão was higher than in previous studies evaluating blood donors in the same region. Despite the association of previous HBV infection and factors indirectly related to sexual risk behaviors, the results suggest the involvement of invasive therapeutic procedures in the HBV transmission chain.
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Affiliation(s)
| | - Tatiana Martins
- Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Daisson José Trevisol
- Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | | | - Janaína Luz Narciso-Schiavon
- Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
- Division of Gastroenterology, Federal University of Santa Catarina, Santa Catarina, Brazil
| | - Fabiana Schuelter Trevisol
- Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
| | - Leonardo de Lucca Schiavon
- Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Tubarão, Santa Catarina, Brazil
- Division of Gastroenterology, Federal University of Santa Catarina, Santa Catarina, Brazil
- Corresponding author: Leonardo de Lucca Schiavon, Division of Gastroenterology, Federal University of Santa Catarina, Santa Catarina, Brazil. Tel: +55-4832086854, Fax: +55-4832086854, E-mail:
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Ding M, Qiu Y, Jiang Z, Tang L, Jin C. Acupuncture-associated pneumothorax. J Altern Complement Med 2013; 19:564-8. [PMID: 23317392 DOI: 10.1089/acm.2011.0495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This article reports on a case and reviews some articles on acupuncture- induced pneumothorax published in Chinese and English medical journals since 1980. CASE A 35-year-old man presented with left chest pain and dyspnea after receiving acupuncture. The patient was later diagnosed with a 12% pneumothorax of the left lung. He was observed in an emergency room for 24 hours while being treated with oxygen, a painkiller, antibiotics, and bedrest. A follow-up computed tomography scan of his chest 1 week later showed complete resolution of the pneumothorax. CASE ANALYSIS AND DISCUSSION: Details of the case are analyzed. A general review of the incidence, causes, symptoms, and outcomes of acupuncture induced pneumothorax is presented. In addition, improved needling methods including needling depth and angle, together with corresponding precautions are also discussed. CONCLUSIONS Pneumothorax caused by acupuncture therapy uncommon, but the consequences can be serious. It is important for practitioners to have adequate knowledge so they can implement better prevention of acupuncture-induced pneumothorax.
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Affiliation(s)
- Min Ding
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, Jiangsu, People's Republic of China.
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He W, Zhao X, Li Y, Xi Q, Guo Y. Adverse events following acupuncture: a systematic review of the Chinese literature for the years 1956-2010. J Altern Complement Med 2012; 18:892-901. [PMID: 22967282 DOI: 10.1089/acm.2011.0825] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to make non-Chinese readers better informed about the current safety situation of acupuncture in China. METHODS Four (4) major Chinese comprehensive databases were searched: Chinese Journal Full-text Database (1949-2010), China Biomedical Literature Database (1978-2010), Chinese Technology Journal Database (1989-2010), and Wanfang (1998-2010). Case reports of adverse events related to acupuncture therapy were included. Literature reviews, case-control study, translations, duplicate literatures in various databases, and duplicate published articles with duplicate data were excluded. RESULTS One hundred and sixty-seven (167) articles were included with 1038 cases, among which 35 patients died. The most frequent adverse events were syncope (468 cases), pneumothorax (307 cases), and subarachnoid hemorrhage (64 cases). CONCLUSIONS Acupuncture-related adverse events were mainly caused by mental tension of the patient, improper operation by the doctor, and incompleteness of sterilization. Most of them can be avoided by standardizing teaching and clinical practices. Making the corresponding safety standards can greatly lower the risk of adverse events and protect patient safety to the greatest extent.
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Affiliation(s)
- Wenju He
- Acupuncture and Moxibustion College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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