1
|
Song X, Wang J, Bai L, Zou W. Bibliometric Analysis of 100 Most Highly Cited Publications on Acupuncture for Migraine. J Pain Res 2023; 16:725-747. [PMID: 36923648 PMCID: PMC10010187 DOI: 10.2147/jpr.s396909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background Migraine is a serious global health concern that imposed a huge economic burden on social health care. Over the past few decades, the analgesic effects of acupuncture have been widely recognized, and there is a growing body of research on acupuncture for migraine. Citation analysis is a branch of bibliometrics that helps researchers analyze and identify historical or landmark studies within the scientific literature. Currently, there is no analysis of the 100 most highly cited publications on acupuncture for migraine. Methods The 100 most highly cited publications on acupuncture for migraine were screened using the Science Citation Index Expanded of the Web of Science Core Collection database. CiteSpace and VOSviewer programs were used for bibliometric analysis. Results A total of 493 publications on acupuncture for migraine were identified. 100 of the most highly cited publications on acupuncture for migraine were published from 1984-2020. These publications were cited 6142 times with an h-index of 44 and 84% were original articles. The highest frequency of citations was 416. A total of 335 authors were involved in the study with 37 lead authors. 212 institutions from 20 countries contributed to the 100 most highly cited publications. The most published studies came from the United States (n=36), followed by China (n=27) and Germany (n=26). The Technical University of Munich published the largest number of papers (n = 15). Top-cited publications mainly came from the Headache (n=13, citations=582). Neuroimaging is gradually emerging as a hot topic of research. Conclusion This is the first bibliometric analysis to offer a thorough list of the 100 most highly cited papers on acupuncture for migraine, demonstrating significant progress and emerging trends in this field to assist researchers in determining the direction for further research.
Collapse
Affiliation(s)
- Xue Song
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Jiaqi Wang
- The Second Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Lu Bai
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Wei Zou
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People's Republic of China
| |
Collapse
|
2
|
He K, Zhan M, Li X, Wu L, Liang K, Ma R. A Bibliometric of Trends on Acupuncture Research About Migraine: Quantitative and Qualitative Analyses. J Pain Res 2022; 15:1257-1269. [PMID: 35509621 PMCID: PMC9059996 DOI: 10.2147/jpr.s361652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Kelin He
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Mingjie Zhan
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
| | - Xinyun Li
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Lei Wu
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Kang Liang
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
| | - Ruijie Ma
- Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, People’s Republic of China
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, the Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Ruijie Ma, Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), No. 219 Moganshan Road, Xihu District, Hangzhou, Zhejiang, People’s Republic of China, Email
| |
Collapse
|
3
|
Abstract
A group of 201 patients who had received acupuncture for chronic facial pain during the last 10 years was reviewed. Of patients with temporomandibular joint or muscular pain, 46% claimed full recovery after acupuncture and 61% reported benefit. In trigeminal neuralgia there was a 30.8% claim of considerable improvement with a 69.2% overall benefit. It was felt that greater accuracy in interpreting response rates would result from the use of a visual analogue scale to record pain; so this was assessed in a small group, in which 75% showed improvement after acupuncture.
Collapse
Affiliation(s)
- Nazim Merchant
- Consultant Oral & Maxillo-Facial Surgeon, Crosshouse Hospital, Kilmarnock, Scotland
| |
Collapse
|
4
|
Baldry P. The Integration of Acupuncture within Medicine in the UK – the British Medical Acupuncture Society—s 25Th Anniversary. Acupunct Med 2018; 23:2-12. [PMID: 15844434 DOI: 10.1136/aim.23.1.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acupuncture was first used in China, probable about 2000 years ago. When acupuncture first arrived in the West in the 17th century, the principles which the Chinese had used to explain its actions were at variance with current scientific knowledge of the body's structure and function. This led to the rejection of acupuncture by the medical profession in the UK, although individual practitioners adopted it with enthusiasm, usually needling the point of maximal tenderness to treat musculoskeletal pain. Acupuncture was more generally accepted in France and Germany, where the pioneering British physician Felix Mann encountered it in the 1950s. He then taught acupuncture to other medical practitioners and organised regular meetings in London, from which the British Medical Acupuncture Society, BMAS, emerged in 1980. The tradition of biannual scientific meetings has continued since then. The Society has many connections with prominent acupuncturists internationally and is a founder member of the International Council of Medical Acupuncture and Related Techniques (ICMART), and has hosted two world congresses. The Society was involved in standardisation of the meridian nomenclature published in 1990. The Society's scientific journal, Acupuncture in Medicine, was founded in 1981 and has gained international recognition, being indexed on several databases. The Society has established regular teaching courses at different levels, which lead to professional qualifications of Certificate and Diploma. The membership is now open to different health professionals, has grown steadily and now stands at nearly 2500. The Society is administered from offices in Cheshire and London. Many individual members have contributed to the Society's characteristic Western ‘medical’ approach to acupuncture in which needling is seen as a form of neuromuscular stimulation that owes little to traditional meridians or points. The Society has shown a particular interest in acupuncture for myofascial trigger point pain. Members of the Society have contributed to the evidence base of acupuncture with several books, clinical trials and reviews. The Society is optimistic that it will have an increasingly important role in promoting the use and scientific evaluation of acupuncture for the public benefit.
Collapse
|
5
|
Perera SM. Acupuncture: An Alternative Treatment for Post Dural-Puncture Headaches following Obstetric Epidural Or Spinal. Acupunct Med 2018. [DOI: 10.1136/aim.16.2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Six obstetric patients were treated with acupuncture for post dural-puncture headaches. Five had had epidurals for pain relief in labour and one a spinal for an elective lower segment caesarean section; all had developed a post dural-puncture headache, although in the epidural group not all had had an obvious CSF leak. After explaining the options available for treatment of post dural-puncture headache, verbal consent was obtained to perform acupuncture. Minimal needling was done using 0.25 by 30mm sterile disposable needles. The points were chosen from: LR.3, bilateral cervical articular pillar (CAP) as described by Felix Mann, and GB.12,14,20 and 21. The CAP points and LR.3 were needled in all patients; other points were chosen according to the site of headache and the location of tender points. Four patients had complete relief of symptoms from the onset of treatment. They were given a second treatment one or two days later and then discharged home. Two patients had only a transient relief lasting about four hours. They were not given a second acupuncture treatment, but were blood-patched with a successful outcome.
Collapse
Affiliation(s)
- S Mahendra Perera
- Department of Anaesthetics, Queen Elizabeth II Hospital, Welwyn Garden City, Herts AL7 4HQ (UK)
| |
Collapse
|
6
|
White AR, Eddleston C, Hardie R, Resch KL, Ernst E. A Pilot Study of Acupuncture for Tension Headache, Using a Novel Placebo. Acupunct Med 2018. [DOI: 10.1136/aim.14.1.11] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tension headache is common, and treatment with acupuncture is frequently recommended, although the evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed as a pilot to test procedures in preparation for a multi-centre trial investigating the effect of acupuncture as a treatment for tension headache. Ten volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were randomised to receive either brief needling to tender areas or selected traditional points (Group A), or pressure from a cocktail stick supported within a guide tube to defined, non-tender and non-acupuncture areas (Group B). The patients’ view of the treatment sites was obstructed so that no indication could be gained as to which form of treatment was being given. Throughout the period of the trial, duration, frequency and intensity of headaches were recorded, from which the mean weekly headache index was calculated. There was no difference between the changes in weekly headache index in the two groups, comparing scores before and after treatment. However, Group A experienced a considerably higher number of headache-free weeks than Group B. The credibility of the two procedures was tested using a standard credibility questionnaire and a “final verdict”. One subject in Group B concluded that she had not received genuine acupuncture, but overall there was no statistical difference between the credibility of treatment in the two groups.
Collapse
Affiliation(s)
- AR White
- Department of Complementary Medicine, University of Exeter
| | | | - R Hardie
- Consultant Neurologist, Royal Devon & Exeter Hospital
| | - KL Resch
- Department of Complementary Medicine, University of Exeter
| | - E Ernst
- Department of Complementary Medicine, University of Exeter
| |
Collapse
|
7
|
Abstract
Acupuncture, developed thousands of years ago in the Orient, is increasingly being integrated into modern Western Medicine. Its neurophysiological basis is partly understood, and controlled trials are demonstrating its efficacy and safety.
Collapse
|
8
|
Affiliation(s)
| | - Paul Abbot
- Senior Registrar The Royal Marsden Hospital Sutton, Surrey
| |
Collapse
|
9
|
Lavies NG. Laser Acupuncture for Migraine and Muscle Tension Headache: A Double-Blind Controlled Trial. Acupunct Med 2018. [DOI: 10.1136/aim.16.2.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Twelve patients with chronic migraine recruited from a neurology clinic or a self-help group were randomly allocated to receive either 6 weeks active laser acupuncture or 6 weeks dummy laser acupuncture. Patients completed headache diaries for the 6 weeks prior to treatment and for 6 weeks following. They were then crossed over to receive the alternative treatment for a further 6 weeks. Neither patients nor operator knew which unit was the active one. There was a reduction in mean total headache score (combining duration and severity) of 18% in the active group and 43% in the control group following the first treatment period. This difference was not significant. Following the second treatment period, mean scores increased by 50% in the active group and 5% in the control group but again this difference was not significant due to inconsistent responses by some patients. When active and placebo treatments were computed for all patients, there were still no significant differences. It is concluded that laser acupuncture does not have an important clinical effect in migraine over and above the expected placebo response.
Collapse
Affiliation(s)
- Nicholas G Lavies
- Department of Anaesthesia, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH
| |
Collapse
|
10
|
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Shin B, Vickers A, White AR. Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev 2016; 4:CD007587. [PMID: 27092807 PMCID: PMC4955729 DOI: 10.1002/14651858.cd007587.pub2] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acupuncture is often used for prevention of tension-type headache but its effectiveness is still controversial. This is an update of our Cochrane review originally published in Issue 1, 2009 of The Cochrane Library. OBJECTIVES To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in adults with episodic or chronic tension-type headache. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE and AMED to 19 January 2016. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials. SELECTION CRITERIA We included randomised trials with a post-randomisation observation period of at least eight weeks, which compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another prophylactic intervention in adults with episodic or chronic tension-type headache. DATA COLLECTION AND ANALYSIS Two review authors checked eligibility; extracted information on participants, interventions, methods and results; and assessed study risk of bias and the quality of the acupuncture intervention. The main efficacy outcome measure was response (at least 50% reduction of headache frequency) after completion of treatment (three to four months after randomisation). To assess safety/acceptability we extracted the number of participants dropping out due to adverse effects and the number of participants reporting adverse effects. We assessed the quality of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). MAIN RESULTS Twelve trials (11 included in the previous version and one newly identified) with 2349 participants (median 56, range 10 to 1265) met the inclusion criteria.Acupuncture was compared with routine care or treatment of acute headaches only in two large trials (1265 and 207 participants), but they had quite different baseline headache frequency and management in the control groups. Neither trial was blinded but trial quality was otherwise high (low risk of bias). While effect size estimates of the two trials differed considerably, the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups (moderate quality evidence; trial 1: 302/629 (48%) versus 121/636 (19%); risk ratio (RR) 2.5; 95% confidence interval (CI) 2.1 to 3.0; trial 2: 60/132 (45%) versus 3/75 (4%); RR 11; 95% CI 3.7 to 35). Long-term effects (beyond four months) were not investigated.Acupuncture was compared with sham acupuncture in seven trials of moderate to high quality (low risk of bias); five large studies provided data for one or more meta-analyses. Among participants receiving acupuncture, 205 of 391 (51%) had at least 50% reduction of headache frequency compared to 133 of 312 (43%) in the sham group after treatment (RR 1.3; 95% CI 1.09 to 1.5; four trials; moderate quality evidence). Results six months after randomisation were similar. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects and 0 of 343 receiving sham (six trials; low quality evidence). Three trials reported the number of participants reporting adverse effects: 29 of 174 (17%) with acupuncture versus 12 of 103 with sham (12%; odds ratio (OR) 1.3; 95% CI 0.60 to 2.7; low quality evidence).Acupuncture was compared with physiotherapy, massage or exercise in four trials of low to moderate quality (high risk of bias); study findings were inadequately reported. No trial found a significant superiority of acupuncture and for some outcomes the results slightly favoured the comparison therapy. None of these trials reported the number of participants dropping out due to adverse effects or the number of participants reporting adverse effects.Overall, the quality of the evidence assessed using GRADE was moderate or low, downgraded mainly due to a lack of blinding and variable effect sizes. AUTHORS' CONCLUSIONS The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials - particularly comparing acupuncture with other treatment options - are needed.
Collapse
Affiliation(s)
- Klaus Linde
- Klinikum rechts der Isar, Technical University MunichInstitute of General PracticeOrleansstrasse 47MünchenGermany81667
| | - Gianni Allais
- University of TorinoWomen's Headache Center and Service for Acupuncture in Gynecology and Obstetrics, Department of Surgical SciencesVia Ventimiglia 3TorinoItaly10126
| | - Benno Brinkhaus
- Charité ‐ Universitätsmedizin BerlinInstitute for Social Medicine, Epidemiology and Health EconomicsLuisenstrasse 57BerlinGermany10117
| | - Yutong Fei
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Michael Mehring
- Klinikum rechts der Isar, Technical University MunichInstitute of General PracticeOrleansstrasse 47MünchenGermany81667
| | - Byung‐Cheul Shin
- School of Korean Medicine, Pusan National UniversityRehabilitation MedicineBeom‐eu, MeulgeumYangsanKyungnamKorea, South626‐870
| | - Andrew Vickers
- Memorial Sloan‐Kettering Cancer CenterDepartment of Epidemiology and Biostatistics1275 York AvenueNew YorkUSA10021
| | - Adrian R White
- Plymouth University Peninsula Schools of Medicine and DentistryPrimary Care25 Room N32, ITTC BuildingTamar Science ParkPlymouthUKPL6 8BX
| | | |
Collapse
|
11
|
Nikkhah K, Ghandehari K, Jouybari AG, Mirzaei MM, Ghandehari K. Clinical Trial of Subcutaneous Steroid Injection in Patients with Migraine Disorder. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:9-12. [PMID: 26722139 PMCID: PMC4691277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients. METHODS Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area (exactly at retromastoid cervicocranial junction) and the other two injections in the lower medial frontal area (exactly at medial right and left eyebrows). A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis. RESULTS 504 patients (378 females, 126 males) with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection. CONCLUSION Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache.
Collapse
Affiliation(s)
- Karim Nikkhah
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kavian Ghandehari
- Neurocognitive Research Center, Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence: Kavian Ghandehari, MD; Department of Neurology, Ghaem Hospital, Ahmadabad Street, P.O. Box: 91766-99199, Mashhad, Iran Tel: +98 51 38012398 Fax: +98 51 38429828
| | | | | | - Kosar Ghandehari
- Neurocognitive Research Center, Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
12
|
A. Linde M, Y. Carlsson J, GH. Dahlöf C. Impact of acupuncture as add-on therapy to pharmacological treatment of migraine: A pilot study. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856900750232605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics 2011; 128:e1575-87. [PMID: 22106073 DOI: 10.1542/peds.2011-1091] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
CONTEXT Acupuncture is increasingly used in children; however, the safety of pediatric acupuncture has yet to be reported from systematic review. OBJECTIVE To identify adverse events (AEs) associated with needle acupuncture in children. METHODS Eighteen databases were searched, from inception to September 2010, irrespective of language. Inclusion criteria were that the study (1) was original peer-reviewed research, (2) included children from birth to 17 years, inclusively, (3) involved needle acupuncture, and (4) included assessment of AEs in a child. Safety data were extracted from all included studies. RESULTS Of 9537 references identified, 450 were assessed for inclusion. Twenty-eight reports were included, and searches of reference lists identified 9 additional reports (total: 37). A total of 279 AEs were identified, 146 from randomized controlled trials, 95 from cohort studies, and 38 from case reports/series. Of the AEs, 25 were serious (12 cases of thumb deformity, 5 infections, and 1 case each of cardiac rupture, pneumothorax, nerve impairment, subarachnoid hemorrhage, intestinal obstruction, hemoptysis, reversible coma, and overnight hospitalization), 1 was moderate (infection), and 253 were mild. The mild AEs included pain, bruising, bleeding, and worsening of symptoms. We calculated a mild AE incidence per patient of 168 in 1422 patients (11.8% [95% confidence interval: 10.1-13.5]). CONCLUSIONS Of the AEs associated with pediatric needle acupuncture, a majority of them were mild in severity. Many of the serious AEs might have been caused by substandard practice. Our results support those from adult studies, which have found that acupuncture is safe when performed by appropriately trained practitioners.
Collapse
Affiliation(s)
- Denise Adams
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | |
Collapse
|
14
|
A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus. Complement Ther Med 2010; 18:249-55. [DOI: 10.1016/j.ctim.2010.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 08/15/2010] [Accepted: 09/08/2010] [Indexed: 11/23/2022] Open
|
15
|
Hsieh LLC, Liou HH, Lee LH, Chen THH, Yen AMF. Effect of acupressure and trigger points in treating headache: a randomized controlled trial. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2010; 38:1-14. [PMID: 20128040 DOI: 10.1142/s0192415x10007634] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The efficacy of acupressure in relieving pain has been documented; however, its effectiveness for chronic headache compared to the muscle relaxant medication has not yet been elucidated. To address this, a randomized, controlled clinical trial was conducted in a medical center in Southern Taiwan in 2003. Twenty-eight patients suffering chronic headache were randomly assigned to the acupressure group (n = 14) or the muscle relaxant medication group (n = 14). Outcome measures regarding self-appraised pain scores (measured on a visual analogue scale; VAS) and ratings of how headaches affected life quality were recorded at baseline, 1 month after treatment, and at a 6-month follow-up. Pain areas were recorded in order to establish trigger points. Results showed that mean scores on the VAS at post-treatment assessment were significantly lower in the acupressure group (32.9+/-26.0) than in the muscle relaxant medication group (55.7+/-28.7) (p = 0.047). The superiority of acupressure over muscle relaxant medication remained at 6-month follow-up assessments (p = 0.002). The quality of life ratings related to headache showed similar differences between the two groups in the post treatment and at six-month assessments. Trigger points BL2, GV20, GB20, TH21, and GB5 were used most commonly for etiological assessment. In conclusion, our study suggests that 1 month of acupressure treatment is more effective in reducing chronic headache than 1 month of muscle relaxant treatment, and that the effect remains 6 months after treatment. Trigger points help demonstrate the treatment technique recommended if a larger-scale study is conducted in the future.
Collapse
|
16
|
Abstract
BACKGROUND Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for migraine prophylaxis') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. OBJECTIVES To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. SEARCH STRATEGY The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. SELECTION CRITERIA We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another intervention in patients with episodic or chronic tension-type headache. DATA COLLECTION AND ANALYSIS Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (at least 50% reduction of headache frequency; outcome of primary interest), headache days, pain intensity and analgesic use. MAIN RESULTS Eleven trials with 2317 participants (median 62, range 10 to 1265) met the inclusion criteria. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Long-term effects (beyond 3 months) were not investigated. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes in the control groups. AUTHORS' CONCLUSIONS In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.
Collapse
Affiliation(s)
- Klaus Linde
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitaet Muenchen, Wolfgangstr. 8, Munich, Germany, 81667.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. OBJECTIVES To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine. SEARCH STRATEGY The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. SELECTION CRITERIA We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine. DATA COLLECTION AND ANALYSIS Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model. MAIN RESULTS Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably. AUTHORS' CONCLUSIONS In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Collapse
Affiliation(s)
- Klaus Linde
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitaet Muenchen, Wolfgangstr. 8, Munich, Germany, 81667.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE The objective of this review was to evaluate the efficacy of acupuncture for treatment of chronic headache. METHODS We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials investigating the use of acupuncture for chronic headache. Studies were included in which adults with chronic headache, including migraine, tension-type headache or both, were randomized to receive needling acupuncture treatment or control consisting of sham acupuncture, medication therapy, and other nonpharmacological treatments. We extracted the data on headache intensity, headache frequency, and response rate assessed at early and late follow-up periods. RESULTS Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio [RR]: 1.19, 95% confidence interval [CI]: 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17). CONCLUSION Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate.
Collapse
|
19
|
Niemtzow RC, Burns SM, Cooper J, Libretto S, Walter JA, Baxter J. Acupuncture Clinical Pain Trial in a Military Medical Center: Outcomes. Med Acupunct 2008. [DOI: 10.1089/acu.2008.0594] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - John Baxter
- Pentagon Flight Medicine Clinic (779th MDG), Pentagon, Washington, DC
| |
Collapse
|
20
|
Acupuncture for Tension-Type Headache: A Meta-Analysis of Randomized, Controlled Trials. THE JOURNAL OF PAIN 2008; 9:667-77. [DOI: 10.1016/j.jpain.2008.03.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 03/24/2008] [Accepted: 03/28/2008] [Indexed: 11/20/2022]
|
21
|
Laser acupuncture in children with headache: A double-blind, randomized, bicenter, placebo-controlled trial. Pain 2008; 137:405-412. [DOI: 10.1016/j.pain.2007.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/06/2007] [Accepted: 10/01/2007] [Indexed: 11/22/2022]
|
22
|
Zhao CH, Stillman MJ, Rozen TD. Traditional and Evidence‐Based Acupuncture in Headache Management: Theory, Mechanism, and Practice. Headache 2008; 45:716-30. [PMID: 15953304 DOI: 10.1111/j.1526-4610.2005.05139.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acupuncture, traditional Chinese needle therapy, has become widely used for the relief of headache. The history of the practice of acupuncture in the United States and the theoretical framework for acupuncture in Chinese medicine are reviewed. The basic scientific background and clinical application of acupuncture in the headache management are discussed.
Collapse
Affiliation(s)
- Chong-Hao Zhao
- Division of Orofacial Pain Medicine, School of Dentistry, University of California-Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
23
|
Acupuncture in migraine prevention: a randomized sham controlled study with 6-months posttreatment follow-up. Clin J Pain 2008; 24:98-105. [PMID: 18209514 DOI: 10.1097/ajp.0b013e3181590d66] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of acupuncture in migraine prophylaxis. METHODS Thirty-seven patients with migraine were enrolled in a randomized control trial at the Headache clinic located in a University Hospital. Real and sham acupuncture groups received 16 acupuncture sessions over 3 months. Treatment was individualized in the real acupuncture group and minimal acupuncture was used in the sham group. The primary end point was the percentage of patients with a >or=50% reduction in their migraine attack frequency in the second, third, fourth, fifth, and sixth (months) compared with the first one (baseline period). Primary and secondary end points were measured comparing headache diaries. RESULTS Real acupuncture group showed improvement with significant differences compared with the sham acupuncture group in the primary efficacy end point (P=0.021) at the second month of the treatment. Differences also appeared in 2 secondary end points: number of days with migraine per month (P=0.007) in the second month and the percentage of patients with >or=40% reduction in migraine attack frequency in the first (P=0.044) and second months (P=0.004) of the treatment. These differences disappeared in the third (last) month of the treatment as a consequence of the high improvement of the sham acupuncture group. Comparisons within each group showed that several migraine parameters evaluated improved significantly in both groups. CONCLUSIONS Individualized treatment based on traditional Chinese medicine plays a role in preventing migraine attacks. Nevertheless, sham acupuncture had similar effects. Major conclusions were limited by the small sample sizes however the observed trends may contribute to design future trials.
Collapse
|
24
|
|
25
|
Wang K, Svensson P, Arendt-Nielsen L. Effect of acupuncture-like electrical stimulation on chronic tension-type headache: a randomized, double-blinded, placebo-controlled trial. Clin J Pain 2007; 23:316-22. [PMID: 17449992 DOI: 10.1097/ajp.0b013e318030c904] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of acupuncture-like electrical stimulation on chronic tension-type headache (TTH) in a randomized, double-blinded, placebo-controlled study. METHODS Thirty-six patients (18 men, 18 women) with chronic TTH in accordance with the criteria of International Headache Society were investigated. The patients were randomly assigned into 2 groups: a treatment group and a placebo group. Pain duration, pain intensity on a 0 to 10 cm visual analog scale, number of headache attacks, and use of medication were recorded in a diary for 2 weeks before treatment (baseline), early stage of treatment (Treat-1; 2 wk), late stage of treatment (Treat-2; 4 wk), and after the end of treatment (Post-1, Post-2, Post-3 corresponding to 2, 4, and 6-wk follow-up). The patients also provided an overall evaluation of the treatment effect at each stage. Patients were taught how to use either an acupuncture-like electrical stimulator or a sham stimulator (identical but incapable of delivering an electric current) and then instructed to use the device at home. Six acupoints, bilateral EX-HN5, GB 20, LI 4, were selected to be stimulated 3 minutes for each point, twice a day. Friedman repeated measure analysis of variance on rank was used to test the data. RESULTS The pain duration was shortened at Treat-1 and pain intensity was decreased at Treat-1 and Treat-2 compared with baseline. The overall evaluation of the 2 treatments indicated improvements in both the treatment and the placebo groups, but with no significant difference between the groups (P>0.061). Despite the apparent improvement in both the treatment and placebo groups, a decrease in analgesic use was only observed in the treatment group. There was also a significant positive correlation between the reported intensity of the stimulus-evoked sensation and the evaluation of the effect of either active or placebo treatments (P=0.039). CONCLUSIONS The use of acupuncture-like electrical stimulation was not associated with significant adverse effects. These results indicate that acupuncture-like electrical stimulation is a safe and potentially analgesic-sparing therapy that may be considered as an adjunctive treatment for patients with chronic TTH although the clinical effect on pain seems to be marginal in the present set-up.
Collapse
Affiliation(s)
- Kelun Wang
- Center for Sensory-Motor Interaction, Orofacial Pain Laboratory, Aalborg University, Aalborg, Denmark.
| | | | | |
Collapse
|
26
|
Wink S, Cartana MDHF. Promovendo o autocuidado a pacientes com cefaléia por meio da perspectiva oriental de saúde. Rev Bras Enferm 2007; 60:225-8. [PMID: 17585533 DOI: 10.1590/s0034-71672007000200019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este é um relato de experiência que teve por objetivo elaborar, implementar e avaliar um projeto de prática de cuidado de enfermagem a alunos de um curso de graduação em Enfermagem portadores de dor de cabeça. Construído a partir de uma disciplina do Curso de Mestrado em Enfermagem da UFSC, o projeto fundamentou-se no conceito de competência para o autocuidado de Orem, compreendido na perspectiva oriental de saúde. Foram aplicadas três estratégias de cuidado: o diário da dor, a focalização e a crânio-acupuntura, em encontros semanais mensais e em encontros individuais, por um período de dois meses. Os participantes relataram resultados de alívio da dor, descoberta de causas não-físicas para a dor e aumento do bem-estar. Foi possível constatar que as estratégias selecionadas são adequadas ao cuidado.
Collapse
Affiliation(s)
- Solange Wink
- Universidade Federal de Santa Catarina, Florianópolis, SC
| | | |
Collapse
|
27
|
Abstract
AIM The aim of this paper is to evaluate previous research studies on acupuncture for migraine with reference to the Standards for Reporting Interventions in Controlled Trials of Acupuncture guidelines. BACKGROUND It is estimated that around 2-15% of the world's population are affected by migraine headaches. Thirteen per cent of adults in the United Kingdom suffer with chronic pain, migraine headaches accounting for 7% of cases. Migraine pain relief is grounded in pharmacology. Acupuncture for migraine has been widely researched. However, inconsistent and low quality results have been produced. Recently, published Standards for Reporting Interventions in Controlled Randomized Trials of Acupuncture guidelines recommend important information that must be included in research in order to be valid and reliable. METHODS Searches were conducted between September 2003 and May 2004 using the Ovid Medline 1966-2004, British Medical Journal, Blackwell Synergy, Science Direct, The Lancet and Cochrane Library Issue 1 databases. Searches were limited to the previous 20 years and to publications in the English language only. FINDINGS Thirteen randomized controlled trials met the inclusion criteria and were critically reviewed for methodological quality, reporting of acupuncture needling details, practitioner background, control interventions and use of a diagnostic criterion. Findings agreed with previous literature reviews that the majority of studies of acupuncture for migraine research are of poor quality, with conflicting results. Few studies met the criteria of the Standards for Reporting Interventions in Controlled Trials of Acupuncture recommendations. Overall, the quality of research in this area must be questioned. CONCLUSIONS In the light of these findings, practitioners may face a dilemma when considering the use of acupuncture for migraine. Therefore, large, high quality randomized controlled trials of acupuncture for migraine are needed. Until better quality research is published, with verification of the benefits of acupuncture for migraine, provision of this alternative therapy should not be expanded or withdrawn.
Collapse
|
28
|
Coeytaux RR, Chen W, Lindemuth CE, Tan Y, Reilly AC. Variability in the Diagnosis and Point Selection for Persons with Frequent Headache by Traditional Chinese Medicine Acupuncturists. J Altern Complement Med 2006; 12:863-72. [PMID: 17109577 DOI: 10.1089/acm.2006.12.863] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare Traditional Chinese Medicine (TCM) pattern diagnosis and acupuncture point selection for persons with frequent headache, as ascribed by three highly trained, licensed acupuncturists. METHODS Thirty-seven (37) study participants with frequent headaches were independently evaluated by three licensed acupuncturists trained in TCM. The acupuncturists identified the meridians and type of dysfunction they believed were contributing to study participants' symptoms. Study acupuncturists also ascribed one or more TCM diagnoses to each participant and selected eight acupuncture points for needling. RESULTS Some variation in TCM pattern diagnosis and point selection was observed for all subjects. Liver Yang and Qi dysfunction were diagnosed in more than two thirds of subjects. Acupuncture points Liver 3, Large Intestine 4, and Governing Vessel (DU) 20 were the most commonly selected points for treatment. CONCLUSIONS Headache is a heterogeneous condition represented by a wide variety of TCM diagnoses. There is variability among acupuncturists in the diagnosis of TCM patterns and the selection of acupuncture points for needling. These data suggest, however, that most persons with frequent headache appear to have liver Yang and Qi disharmonies for which needling of Liver 3, Large Intestine 4, and/or Governing Vessel 20 may be appropriate. Further research is needed to determine the extent to which variability in the diagnosis or acupuncture point selection among acupuncturists affects clinical outcomes.
Collapse
Affiliation(s)
- Remy R Coeytaux
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA.
| | | | | | | | | |
Collapse
|
29
|
|
30
|
Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P. The effects of laser acupuncture on chronic tension headache--a randomised controlled trial. Acupunct Med 2005; 23:13-8. [PMID: 15844435 DOI: 10.1136/aim.23.1.13] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Headache affects the quality of life for many people throughout the world. Tension headache is among the commonest forms. Acupuncture is the most widely practised non-medicinal treatment for headaches. The purpose of this study was to explore the effects of laser acupuncture in this type of headache. METHODS Fifty patients with chronic tension-type headache were randomly allocated to treatment or placebo groups. Patients in the treatment group received low energy laser acupuncture to LU7, LI4, GB14, and GB20 bilaterally. Points were irradiated for 43 seconds, and the intensity was 1.3J (approximately 13J/cm2). Ten sessions were given, three per week. The placebo group was treated in a similar way except that the output power of the equipment was set to zero. The outcome variables were headache intensity (VAS), duration of attacks, and number of days with a headache per month, by daily diary, assessed monthly to three months after treatment. RESULTS There were significant differences between groups (P<0.001) in changes from baseline in months one, two and three, in median score for headache intensity (treatment group -5, -3 and -2, placebo group -1, 0 and 0), median duration of attacks (treatment group -6, -4 and -4, placebo group -1, 0 and 0 hours), and median number of days with headache per month (treatment group -15, -10 and -8, placebo group -2, 0 and 0). CONCLUSION This study suggests that laser acupuncture may be an effective treatment for chronic tension-type headache, but the results should be confirmed in larger and more rigorous trials.
Collapse
|
31
|
Overview of models used in controlled acupuncture studies and thoughts about questions answerable by each. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1461-1449(02)00044-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
32
|
Linde K, Scholz M, Melchart D, Willich SN. Should systematic reviews include non-randomized and uncontrolled studies? The case of acupuncture for chronic headache. J Clin Epidemiol 2002; 55:77-85. [PMID: 11781125 DOI: 10.1016/s0895-4356(01)00422-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We aimed to investigate: (1) whether patient and intervention characteristics, design-independent quality aspects, and response rates differ between randomized and non-randomized trials of acupuncture for chronic headache; (2) whether non-randomized studies provide useful additional information (regarding long-term effects, prognostic factors, adverse effects, and generalizability); (3) reasons for potential differences in response rates. Studies including at least five patients and reporting clinical outcome data were identified through searches in Medline, Embase, the Cochrane Controlled Trials Register, other databases and checking of bibliographies. Twenty-four randomized trials and 35 non-randomized studies (five non-randomized controlled cohort studies, 10 prospective uncontrolled studies, 10 case series, and 10 cross-sectional surveys) met the inclusion criteria. Studies were heterogeneous regarding patients, interventions, outcome measurements and results. On average, randomized trials had smaller sample sizes, met more quality criteria, and had lower response rates (0.59 [95% confidence interval 0.48-0.69] vs. 0.78 [0.72-0.83]). Whether randomized or not, studies meeting more quality criteria had lower response rates. Non-randomized studies did not have significantly longer follow-up periods, three included an analysis of prognostic variables, only one reported on adverse effects, and the degree of generalizability was unclear. In the case of acupuncture for chronic headache, non-randomized studies confirmed the finding of a systematic review of randomized trials that the treatment is likely to be effective but provided little relevant additional information on long-term effects, prognostic factors, and adverse effects.
Collapse
Affiliation(s)
- Klaus Linde
- Institute for Social Medicine & Epidemiology, Charité Hospital, Humboldt-Universität, 10098, Berlin, Germany.
| | | | | | | |
Collapse
|
33
|
Karst M, Reinhard M, Thum P, Wiese B, Rollnik J, Fink M. Needle acupuncture in tension-type headache: a randomized, placebo-controlled study. Cephalalgia 2001; 21:637-42. [PMID: 11531895 DOI: 10.1046/j.1468-2982.2001.00198.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture METHOD Sixty-nine patients (mean age 48.1 years, SD = 14.1) fulfilling the International Headache Society criteria for tension-type headache were randomly assigned to verum or placebo condition. No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately, 6 weeks and 5 months after the end of treatment. There was a significant but weak improvement in quality of life parameters (clinical global impressions, Nottingham Health Profile) after verum treatment. In decision tree analyses, the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month. High values in the von Zerssen Depression Score resulted in high mean visual analogue scale values.
Collapse
Affiliation(s)
- M Karst
- Department of Anaesthesiology, Medical School of Hannover, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Boutouyrie P, Corvisier R, Azizi M, Lemoine D, Laloux B, Hallouin M, Laurent S. Effects of acupuncture on radial artery hemodynamics: controlled trials in sensitized and naive subjects. Am J Physiol Heart Circ Physiol 2001; 280:H628-33. [PMID: 11158960 DOI: 10.1152/ajpheart.2001.280.2.h628] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Palpation of the radial pulses is an important technique in traditional Chinese medicine. Two double-blind randomized trials of the effects of real and sham acupuncture on radial artery hemodynamics were conducted in 19 patients regularly exposed to acupuncture (sensitized subjects) and in 8 healthy subjects devoid of previous exposure (naive subjects), respectively. Radial artery diameter and pulse waveform were measured with a high-resolution echotracking system and aplanation tonometry, respectively, before and during a 20-min acupuncture period. In sensitized patients, arterial diameter significantly increased during real acupuncture, compared with the sham group (+7.5 +/- 2.8 vs. -2.9 +/- 2.7%, respectively; P < 0.01). By contrast, in naive subjects, arterial diameter did not change during real or sham acupuncture. In both populations, no significant difference was observed between real and sham acupuncture, concerning the time course of blood pressure, radial artery distensibility, and pressure waveform. Our results demonstrate that real acupuncture is associated with an objective vasodilatation of the radial artery in patients regularly exposed to acupuncture, but not in naive subjects.
Collapse
Affiliation(s)
- P Boutouyrie
- Department of Pharmacology and Unité, Institut National de la Santé et de la Recherche Médicale U 337, Paris, France
| | | | | | | | | | | | | |
Collapse
|
35
|
Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G. Acupuncture for idiopathic headache. Cochrane Database Syst Rev 2001:CD001218. [PMID: 11279710 DOI: 10.1002/14651858.cd001218] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acupuncture is widely used for the treatment of headache, but its effectiveness is controversial. OBJECTIVES To determine whether acupuncture is: - more effective than no treatment - more effective than 'sham' (placebo) acupuncture - as effective as other interventions used to treat idiopathic (primary) headaches. SEARCH STRATEGY Electronic searches were performed in MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the database of the Cochrane Field for Complementary Medicine. We also contacted researchers in the field and checked the bibliographies of all articles obtained. SELECTION CRITERIA Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of idiopathic (primary) headaches were included. DATA COLLECTION AND ANALYSIS Information on patients, interventions, methods, and results was extracted by at least two independent reviewers using a pre-tested standard form. Results on headache frequency and intensity were summarized descriptively. Responder rate ratios (responder rate in treatment group/responder rate in control group) were calculated as a crude indicator of results for sham-acupuncture-controlled trials. Quantitative meta-analysis was not possible due to trial heterogeneity and insufficient reporting. MAIN RESULTS Twenty-six trials including a total of 1151 patients (median, 37; range, 10-150) met the inclusion criteria. Sixteen trials were conducted among patients with migraine, six among patients with tension-type headache, and four among patients with various types of headaches. The majority of trials had methodological and/or reporting shortcomings. In eight of the 16 trials comparing true and sham (placebo) acupuncture in migraine and tension-type headache patients, true acupuncture was reported to be significantly superior; in four trials there was a trend in favor of true acupuncture; and in two trials there was no difference between the two interventions. (Two trials were uninterpretable.) The 10 trials comparing acupuncture with other forms of treatment yielded contradictory results. REVIEWER'S CONCLUSIONS Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.
Collapse
Affiliation(s)
- D Melchart
- Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität, Kaiserstr. 9, Munich, Germany, 80801.
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Twenty-seven clinical trials that evaluated the efficacy of acupuncture in the treat ment of primary headaches (migraine headache, tension-type headache, and mixed forms) were reviewed. In the majority of the trials (23 of the 27 trials), it was concluded that acupuncture offers benefits in the treatment of headaches. Conversely, the evaluation of physical forms of treatment, including acupuncture, has special difficulties, and certain parameters in the study design need consideration. Acupuncture methods need individualization, a carefully selected placebo ("minimal acupuncture" seems to be best), and the crossover design must have adequate time between the two treatment periods. Clinical trials that evaluate acupuncture frequently are characterized by several inadequacies (including some from these evaluating headaches), but it seems that additional clinical research is necessary to confirm its efficacy and to clarify its indications.
Collapse
Affiliation(s)
- P Manias
- Athens Headache and Chronic Pain Center, Greece.
| | | | | |
Collapse
|
37
|
Erratum. Cephalalgia 2000; 20:762-763. [PMID: 11167907 DOI: 10.1046/j.1468-2982.2000.00136.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
38
|
White AR, Resch KL, Chan JC, Norris CD, Modi SK, Patel JN, Ernst E. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia 2000; 20:632-7. [PMID: 11128820 DOI: 10.1111/j.1468-2982.2000.00097.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A multicentre, randomized clinical trial was undertaken to test the hypothesis that acupuncture is more efficacious than sham control procedure in the prevention of episodic tension-type headache. Fifty subjects were randomized to receive a course of treatment with either brief acupuncture or a sham procedure. Subjects were followed up for 3 months. Changes in headache were assessed by daily diary, the primary outcome measure being the number of days with headache. No significant differences were found between the changes in the two groups for any measure at any time point. Results also show that patient blinding was successful. In conclusion, this study does not provide evidence that this form of acupuncture is effective in the prevention of episodic tension-type headache.
Collapse
Affiliation(s)
- A R White
- Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK.
| | | | | | | | | | | | | |
Collapse
|
39
|
White AR, Resch KL, Chan JCK, Norris CD, Modi SK, Patel JN, Ernst E. Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial. Cephalalgia 2000. [DOI: 10.1046/j.1468-2982.2000.00097.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
40
|
Melchart D, Linde K, Fischer P, White A, Allais G, Vickers A, Berman B. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia 1999; 19:779-86; discussion 765. [PMID: 10595286 DOI: 10.1046/j.1468-2982.1999.1909779.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess whether there is evidence that acupuncture is effective in the treatment of recurrent headaches. DESIGN Systematic review. STUDY SELECTION Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of recurrent headaches. DATA SOURCES Electronic databases (Medline, Embase, Cochrane Field for Complementary Medicine, Cochrane Controlled Trials Register), personal communications and bibliographies. DATA COLLECTION AND ANALYSIS Information on patients, interventions, methods, and results were extracted by at least two independent reviewers using a pretested form. A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group) was calculated as a crude indicator of trial results as meta-analysis of more specific outcome data was impossible due to heterogeneity and insufficient reporting. RESULTS Twenty-two trials, including a total of 1042 patients (median 36, range 10-150), met the inclusion criteria. Fifteen trials were in migraine patients, six in tension-headache patients, and in one trial patients with various headaches were included. The majority of the 14 trials comparing true and sham acupuncture showed at least a trend in favor of true acupuncture. The pooled responder rate ratio was 1.53 (95% confidence interval 1.11 to 2.11). The eight trials comparing acupuncture and other treatment forms had contradictory results. CONCLUSIONS Overall, the existing evidence suggests that acupuncture has a role in the treatment of recurrent headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of acupuncture under real life conditions.
Collapse
Affiliation(s)
- D Melchart
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität, Germany
| | | | | | | | | | | | | |
Collapse
|
41
|
Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999; 7:142-55. [PMID: 10581824 DOI: 10.1016/s0965-2299(99)80122-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To conduct a systematic review of the randomized controlled clinical trials (RCTs) of complementary/alternative (CAM) therapies in the treatment of non-migrainous headache (i.e. excluding migraine, cluster and organic headaches). DESIGN Systematic review with quality scoring and evidence tables. MAIN OUTCOME MEASURES Number of RCTs per therapy, quality scores, evidence tables. RESULTS Twenty-four RCTs were identified in the categories of acupuncture, spinal manipulation, electrotherapy, physiotherapy, homeopathy and other therapies. Headache categories included tension-type (under various names pre-1988), cervicogenic and post-traumatic. Quality scores for the RCT reports ranged from approximately 30 to 80 on a 100 point scale. CONCLUSION RCTs for CAM therapies of the treatment of non-migrainous headache exist in the literature and demonstrate that clinical experimental studies of these forms of headache can be conducted. Evidence from a sub-set of high quality studies indicates that some CAM therapies may be useful in the treatment of these common forms of headache.
Collapse
Affiliation(s)
- H Vernon
- Canadian Memorial Chiropractic College, Toronto, Canada
| | | | | |
Collapse
|
42
|
Lee AC, Highfield ES, Berde CB, Kemper KJ. Survey of acupuncturists: practice characteristics and pediatric care. West J Med 1999; 171:153-7. [PMID: 10560285 PMCID: PMC1305795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To describe the practice characteristics and pediatric care provided by licensed acupuncturists. DESIGN Cross-sectional survey. SETTING Boston metropolitan area. SUBJECTS 227 licensed acupuncturists were surveyed; 140 (62%) responded. MAIN OUTCOME MEASURES (1) DEMOGRAPHICS, (2) practice characteristics, (3) pediatric care, (4) recommendations of peers recognized as experts in pediatric acupuncture. RESULTS (1) DEMOGRAPHICS: 70% Caucasian, 61% female; (2) practice characteristics: average of 39 visits weekly with an average charge of $54 for a 57-minute visit; patients were typically scheduled for follow-up once or twice weekly; only 5% of fees were covered by insurance; 80% recommended herbal remedies and 66% dispensed herbs in the office; (3) few acupuncturists treated more than one child per week; most used non-needle techniques or Japanese-style acupuncture to stimulate points in children; 85% would refer a febrile two-week-old infant immediately to a physician; (4) only 17 acupuncturists were recommended by three or more peers and saw three or more patients weekly; their practices were all in wealthy suburban areas. CONCLUSIONS Most acupuncturists in the Boston area are Caucasian and female. Compared with physicians, they schedule patients for more frequent follow-up, allocate more time, are less likely to be reimbursed by insurance, and treat fewer children. Additional studies are needed to assess effectiveness, quality, and access to acupuncture services for adults and children.
Collapse
Affiliation(s)
- A C Lee
- Harvard Medical School, Boston, MA, USA
| | | | | | | |
Collapse
|
43
|
Abstract
Reasons are advanced for believing that migraine and tension-type headaches are a continuum and that whether migraine or tension-type headache develops at any particular time is dependent on the relative vascular nociceptive, myofascial nociceptive and supraspinal (emotional) inputs that converge on and are integrated by the subnucleus caudalis (medullary dorsal horn). The prophylaxis of both these two types of headache involves reducing each of these various inputs and therefore a polytherapeutic approach is essential. The measures required include pharmacotherapy, psychotherapy and acupuncture. The aetiology and treatment of primary myofascial trigger point cephalaigia is also discussed.
Collapse
Affiliation(s)
- Peter Baldry
- Millstream House, Old Rectory Green, Fladbury, Pershore, Worcs WR10 2QX (UK)
| |
Collapse
|
44
|
Vickers A, Rees R, Zollman C, Smith C, Ellis N. Acupuncture for migraine and headache in primary care: a protocol for a pragmatic, randomized trial. Complement Ther Med 1999; 7:3-18. [PMID: 10361566 DOI: 10.1016/s0965-2299(99)80053-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This paper presents the protocol for a randomized trial of acupuncture for migraine and headache. SUBJECTS Four hundred patients with migraine or headache will be recruited from GP practices. INCLUSION CRITERIA Eighteen to 65 years old, contractable by telephone, onset at least 1 year prior at age less than 50, two headaches per month in the previous 6 months, adequate data completion and headache severity during pre-randomization baseline. EXCLUSION CRITERIA Pregnancy or malignancy, cluster headache, serious pathological aetiology, cranial neuralgia, acupuncture treatment in the past year. DESIGN Following a 4-week baseline, patients will be allocated to acupuncture or control by minimized randomization. Up to 12 acupuncture treatments will be provided by advanced members of the Acupuncture Association of Chartered Physiotherapists. The type of acupuncture given will be recorded. STUDY MEASURES: Outcome will be assessed by headache diary, medication diary and SF36 at 3 months and 1 year. Resource use and days off sick will be assessed by quarterly questionnaire. Adverse events will be monitored by self-report. The primary outcome measure will be the change in mean daily headache score between baseline and the 1 year follow-up. An economic evaluation will also be undertaken.
Collapse
Affiliation(s)
- A Vickers
- Research Council for Complementary Medicine, London, UK.
| | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- S Birch
- Society for Acupuncture Research, Guilford, CT, USA
| | | | | |
Collapse
|
46
|
Affiliation(s)
- L Lao
- University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
47
|
Hammerschlag R, Morris M. Clinical trials comparing acupuncture with biomedical standard care: a criteria-based evaluation of research design and reporting. Complement Ther Med 1997. [DOI: 10.1016/s0965-2299(97)80055-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
48
|
Abstract
Acupuncture is now being increasingly used in the treatment of headache. Acupuncture is a technique originating in Asia, from countries that have a cultural background with a fundamentally different concept of disease and therapy. Up to now, sustained application of acupuncture in Western medicine has been impeded by the lack of a scientifically convincing explanation of the mechanisms of action in terms of neurobiological criteria. Acupuncture is being used empirically in the treatment of migraine; clinical studies have been published. A definitive evaluation of acupuncture based on well-founded clinical experimental studies has yet to be made. The investigation was carried out in migraine patients who were divided into two subgroups in a control group design with two different stimulation techniques. The verum group was treated with the correct point location, normal prick depth and elicitation of a needle sensation. The control group received treatment at points that are far away from the acupuncture points, using a superficial prick technique and without eliciting a needle sensation. The effect of therapy was appraised by means of headache diaries with subsequent interference statistical and individual case analysis. In the present study comprising 81 patients, the incidence of the attacks was significantly reduced in both subgroups. The effect of acupuncture treatment was of comparable magnitude to that of the beta-blocker metoprolol. The advantage of acupuncture treatment consists in the lack of side effects such as gastrointestinal symptoms or an increase in weight. A minor side effect was only reported in one case. In the data analysis with the interference statistical method, verum acupuncture was superior to the control in only one subgroup. The possibility that the addition of further points (distant points) can explain this effect on the basis of the hypothesis of a central modulation of the migraine process is discussed. Acupuncture shows a sufficiently pronounced and sustained therapeutic effect for its use to be considered in a possible interval treatment of migraine.
Collapse
Affiliation(s)
- T Weinschütz
- Klinik für Neurologie, Christian-Albrechts-Universität, Niemannsweg 147, D-24105 Kiel
| |
Collapse
|
49
|
|
50
|
|