Saturday, September 26, 2009

Acupuncture Use in the United States

I have often joked that it takes 18 months for someone who says they are interested in trying acupuncture to actually go through with it. Unfortunately this is often after an occasional stiffness and twinge in the back has tuned into a chronic and severe pain both limiting mobility and requiring hydrocodone four times a day. The following was published a couple of years ago but I find the data relevant in my practice. I am certainly getting more physician referrals as they hear their patients tell them about success with musculoskeletal pain. Natural seems to be in. With the surge of natural prescription medications like Loveza (omega-3s) and Florastore (probiotic), I am waiting for shan zha and chuan xiong to be marketed by Pfizer!

Acupuncture use in the United States: findings from the National Health Interview Survey.

Institute for Holistic Healing Studies, San Francisco State University, San Francisco, CA 94132, USA.

OBJECTIVE: Acupuncture has become an important provider-based complementary and alternative medicine (CAM) treatment. To improve understanding of its role in personal health care, an analysis of national data was conducted to examine user sociodemographics, conditions treated, and the relationship of use with conventional Western medical care.

DESIGN: A nationally representative cross-sectional survey.

SETTING: The 2002 National Health Interview Survey (NHIS), conducted in all 50 states and the District of Columbia.

PARTICIPANTS: Thirty-one-thousand and forty-four (31,044) adults who completed the NHIS Sample Adult Core.

OUTCOME MEASURES: The primary outcome measure was recent use of acupuncture, defined as use within the previous 12 months.

RESULTS: In the 2002 NHIS sample, 4.1% of the respondents reported lifetime use, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture. Recent use (n = 327) was positively associated with being an Asian female, living in the West or Northeast, having poorer self-reported health status, a higher level of education, and being an ex-smoker. Among recent users, the most typical treatment regimen was two to four treatments (34.5%), with musculoskeletal complaints being the most frequently reported conditions, led by back pain (34.0%). Reports of perceived benefit were generally high. Respondents indicated that acupuncture was used both as an alternative and as a complementary therapy. A reasonable number also reported being referred to acupuncture by a conventional medical professional (25.3%). The cross-sectional nature of the data precluded analysis of transitions in health care use (between conventional and CAM treatments) over time.

CONCLUSIONS: Utilization of acupuncture was somewhat lower than expected given its significant national and international recognition and its visibility in the media. This may in part be a function of provider availability and cultural factors.

Sunday, September 13, 2009

Fibromyalgia: Traditional vs Sham Acupuncture Success

In the past year there have been several studies that confirm acupuncture is more effective for back pain than the typical lortab, physical therapy, epidural, and surgery regimen touted by western pain management specialists. The studies included a fake or "sham" acupuncture treatment group along with a real or "traditional" acupuncture treatment group. The problem with these designs was the lack of studies comparing traditional and sham acupuncture. When the results of the studies showed statistically insignificant difference in effectiveness, the conclusions make the reader think all you have to do is stick some needles randomly in your back, not necessarily by a qualified acupuncturist, and the placebo effect will take over from there. The following abstract was pulled from Pub Med and discusses the short and long term effects of traditional acupuncture on pain receptors in the brain for fibromyalgia.

Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).

Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of 4 weeks. Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.