Acupuncture Studies on Pain

Effect of Acupuncture Treatment on Heel Pain Due to Plantar Fasciitis

Eighteen patients attending an orthopaedic outpatient clinic with a year or more's history of heel pain due to plantar fasciitis were studied. All had had conservative treatment of physiotherapy and shoe-support without significant pain relief before acupuncture was offered, and thus acted as their own controls for the purposes of the study. The following traditional points were needled: Taixi (KI.3), Kunlun (BL.60) and Sanyinjiao (SP.6). Pain was assessed by a 100mm visual analogue scale (VAS) before treatment was started and after four, weekly sessions of acupuncture treatment. If complete pain relief was not obtained by the initial four-week treatment, a further two, weekly sessions of the above mentioned acupoints, with the addition of trigger point acupuncture in the gastro-soleus and plantar fascia, was carried out and pain assessed.

Patients were also assessed with a verbal rating score to indicate the percentage improvement after acupuncture compared to before treatment. The mean duration of heel pain was 25.11 months (SD 10.68). The VAS data obtained at 4 and 6 weeks of acupuncture treatment showed a statistically highly significant improvement compared to the VAS before acupuncture (p < 0.0009 and p < 0.0001 respectively). Using the Mann-Whitney test, there was a statistically significant difference in VAS obtained at 6 weeks, after trigger point acupuncture had been added for poor responders, compared to that obtained after the first 4 weeks of acupuncture treatment (p < 0.047). Our study demonstrates that acupuncture is effective in treating patients with chronic heel pain due to plantar fasciitis and that the addition of trigger point acupuncture in poor or non-responders may be useful.

Acupuncture as an Alternative to Diazepam Sedation for Diagnostic Gastrointestinal Endoscopy

A study was undertaken to compare the differences in ease of intubation, emotional distress and physical discomfort during oesophago-gastro-duodenoscopy in 3 groups of patients: sedated with intravenous diazepam, receiving acupuncture, or being part of a control group having neither treatment. Patients were given the option of sedation. Those that declined were randomly divided into two groups, either receiving acupuncture or acting as a control.

Patient distress was measured by two independent methods: direct observation by the attending nurse and a self-report questionnaire. The observed and self-reported physical discomfort were significantly reduced in the sedation group compared to controls, but there was no significant difference in any measurement between the acupuncture and the control groups. Respiratory complications were least in the acupuncture group and there was some evidence of benefit from acupuncture in relieving emotional distress.

Did ‘the Princess on the Pea— Suffer from Fibromyalgia Syndrome?

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterised by central sensitisation resulting in hypersentivity of the skin and deeper tissues as well as fatigue. Possibly the princess in Hans Christian Andersen's ‘The Princess and the Pea’ suffered from FMS since chronic sleep disturbances are typical in FMS. These sleep disturbances have been attributed to a dysfunction in the systems regulating sleep and wakefulness resulting in loss of deep sleep. In addition, many patients with FMS experience cognitive dysfunction, characterised by impaired concentration and short term memory consolidation, a complaint also commonly reported in other sleep disorders.

In recent reviews evaluating the efficacy of acupuncture in FMS it has been concluded that acupuncture has no specific effect. A prerequisite for this conclusion is that all the major symptoms in the syndrome have been assessed. However, previous studies have generally focused on the pain alleviating effect of acupuncture in FMS. We have observed that not only pain but also sleep and cognitive dysfunction may be ameliorated in response to acupuncture, suggesting that these variables should be taken into account when evaluating the effects of acupuncture in FMS. Furthermore, the results demonstrated great individual variability apart from the systematic effects related to the group, indicating that individually performed treatment strategies are required. Our suggestion is supported by experimental and clinical studies showing that acupuncture may affect in somnia and alertness, and that there may be neurophysiologic bases for these specific effects.

Methodological concerns when designing trials for the efficacy of acupuncture for the treatment of pain

The aim of all clinical research must surely be to assess an intervention or process or relationship between variables, ultimately in order to be able to improve clinical practice and healthcare for patients/consumers. As such, evidence gathered must have external validity (generalisability) and it must be relevant to clinical practice. It can be seen therefore that research into acupuncture for pain relief is an inherently difficult task, which requires much sensitivity and careful planning in order to minimise error when drawing conclusions. The researcher needs to adequately address problems such as sample size, blinding, randomisation and appropriate use of control and treatment. It is also most important to be able to clarify that the placebo (if used) is credible to the patient. The field of acupuncture has been overwhelmed with hundreds of sub-standard trials and much doubt still surrounds the issue of efficacy. Few good quality rigorous trials exist to support the use of acupuncture for pain relief in general. It has also been noted that the question of long-term efficacy has not been assessed by the many trials and this needs to be addressed prior to its acceptance. Further well conducted rigorous trials are therefore needed, utilising the lessons learnt through the substantial number of previous trials, in order to adequately assess the efficacy of acupuncture for painful conditions. Such trials must therefore: Utilise a placebo control. Be randomised and stratified. Ensure patient blinding. Use self completed outcome measures and blinded assessors. Have sufficient and well validated outcome measures. Check credibility of treatment. Have a well defined entry criteria which includes a single condition only. Have a long term follow up. Enrol sufficient subjects, the number to be determined by a power calculation. Provide adequate acupuncture treatment as would be found in clinical practice. Be group comparative so as to negate any carry-over effects. In this way good quality trials can be undertaken which will yield reliable results and therefore add meaningful data to the body of knowledge appertaining to the effectiveness of acupuncture.

An audit of acupuncture in a single-handed general practice over one year

An audit was performed over one year on all patients undergoing acupuncture for a variety of conditions in a single-handed GP practice. The patients were observed for a further year to assess the effectiveness and duration of the treatment effect. Using the 'measure yourself medical outcome profile' (MYMOP) questionnaire, the effectiveness of acupuncture treatment was measured, and patients were categorised into no effect, improved or much improved. A total of 140 patients were audited over the one-year period. No effect was seen in 31% of patients, a further 31% were improved, and 38% were much improved. Those with a shorter duration of symptoms appeared to show the most benefit. During the one-year post-treatment observation period 50% of patients required further treatment. In conclusion, acupuncture appears to have been an effective treatment in the author's General Practice population. In this audit acupuncture seems to have had a short duration of effect. It is believed that this has lead to an increase in workload, not only as a result of patient demand, but also due to recurrence of symptoms following the initial success of treatment.