. . . you can get rid of that pain in the neck. There is nothing like a large sample size to support a point (no pun intended)!
Yes, acupuncture really does have a point, study reveals
By Hannah Devlin from The Times Online
A study has found that acupuncture not only helps to relieve pain but is a cost-effective way of doing so.
More than 3,400 patients suffering from neck pain were studied over a three-month period by scientists based at the Berlin Institute of Social Medicine. About half received acupuncture in addition to routine care.
The researchers, whose study is reported in the journal Pain, found that the extra cost of the acupuncture treatment resulted in health benefits that were great enough to make the treatment cost-effective.
“Acupuncture isn’t controversial any more,” said Claudia Witt, who led the project. “We’ve shown that it works.” She added that it was in no way comparable to other alternative therapies. ”
One in five people in Britain suffers from long-term pain and about half of these have taken time off work because of it. While acupuncture is provided in the majority of pain clinics in Britain, access to the treatment is limited.
Sunday, August 27, 2006
Wednesday, August 16, 2006
The Woes of Research Grant Money
If one were to believe the bevy of solicitous e-mails, one would surmise that to get a grant, you just need to fill out a few pieces of paperwork and send it off to various organizations that some internet company provides you for the low cost of $59.99. For the past two years, we have been trying to get funding though the government to continue the research started by Dr. Hollifield and Nityamo Lian concerning an acupuncture treatment protocol for PTSD, and the going is rough and frustrating.
We have applied for grants to "further research in several sites with several practitioners of each discipline is needed to confirm these results," but when the concerns on the part of the grant investigators are addressed and answered by our team, the investigators come up with additional concerns. The latest: To sham, or not to sham - that is the question.
A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert.
J Altern Complement Med. 2006 Apr;12(3):303-10.
Birch S.Stichting (Foundation) for the Study of Traditional East Asian Medicine (STEAM), Amsterdam, The Netherlands. sjbirch@gmail.com
Researchers examining the efficacy of medical procedures make assumptions about the nature of placebo. From these assumptions they select the sham interventions to be used in their trials. However, placebo is not well defined. A number of definitions are contradictory and sometimes misleading. This leads to problems in sham-controlled studies of medical procedures and difficulties interpreting their results. The author explores some of the contradictory definitions of placebo and assumptions and consequences of these. Principal among these is the assumption that the placebo is inert when it is not, which introduces bias against the tested medical procedures and devices. To illustrate the problem, the author examines the use of sham procedures in clinical trials of the medical procedures surgery and acupuncture in which the sham was assumed to be inert but was not. Trials of surgery and acupuncture should be re-examined in light of this.
More to come on this in the future. In the meantime, here is the abstract from the Journal of Alternative and Complementary Medicine on the protocol that was used in New Mexico (you need sign-on to access the full article - it has the specifics on the treatment points). If you would like to see some JAMA abstracts of acupuncture research fortunate enough to get funding, check out http://jama.ama-assn.org/cgi/search?fulltext=acupuncture or the Society for Acupuncture research http://www.acupunctureresearch.org/
Journal of Alternative and Complementary Medicine
Developing a Traditional Chinese Medicine Diagnostic Structure for Post-Traumatic Stress Disorder
Jan 2006, Vol. 12, No. 1: 45-57
Nityamo Sinclair-Lian, D.O.M. (N.M.)
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Behavioral Health Research Center of the Southwest, Albuquerque, NM.
Michael Hollifield, M.D.
University of Louisville, Department of Psychiatry and Behavioral Sciences, Louisville, KY.
Margaret Menache, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Teddy Warner, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Jenna Viscaya, D.O.M. (N.M.)
International Institute of Chinese Medicine, Sante Fe, NM.
Richard Hammerschlag, Ph.D.
Oregon College of Oriental Medicine, Portland, OR.
Background: Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.
Methods: Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.
Results: The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation—Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire—and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.
Conclusions: The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.
We have applied for grants to "further research in several sites with several practitioners of each discipline is needed to confirm these results," but when the concerns on the part of the grant investigators are addressed and answered by our team, the investigators come up with additional concerns. The latest: To sham, or not to sham - that is the question.
A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert.
J Altern Complement Med. 2006 Apr;12(3):303-10.
Birch S.Stichting (Foundation) for the Study of Traditional East Asian Medicine (STEAM), Amsterdam, The Netherlands. sjbirch@gmail.com
Researchers examining the efficacy of medical procedures make assumptions about the nature of placebo. From these assumptions they select the sham interventions to be used in their trials. However, placebo is not well defined. A number of definitions are contradictory and sometimes misleading. This leads to problems in sham-controlled studies of medical procedures and difficulties interpreting their results. The author explores some of the contradictory definitions of placebo and assumptions and consequences of these. Principal among these is the assumption that the placebo is inert when it is not, which introduces bias against the tested medical procedures and devices. To illustrate the problem, the author examines the use of sham procedures in clinical trials of the medical procedures surgery and acupuncture in which the sham was assumed to be inert but was not. Trials of surgery and acupuncture should be re-examined in light of this.
More to come on this in the future. In the meantime, here is the abstract from the Journal of Alternative and Complementary Medicine on the protocol that was used in New Mexico (you need sign-on to access the full article - it has the specifics on the treatment points). If you would like to see some JAMA abstracts of acupuncture research fortunate enough to get funding, check out http://jama.ama-assn.org/cgi/search?fulltext=acupuncture or the Society for Acupuncture research http://www.acupunctureresearch.org/
Journal of Alternative and Complementary Medicine
Developing a Traditional Chinese Medicine Diagnostic Structure for Post-Traumatic Stress Disorder
Jan 2006, Vol. 12, No. 1: 45-57
Nityamo Sinclair-Lian, D.O.M. (N.M.)
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Behavioral Health Research Center of the Southwest, Albuquerque, NM.
Michael Hollifield, M.D.
University of Louisville, Department of Psychiatry and Behavioral Sciences, Louisville, KY.
Margaret Menache, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Teddy Warner, Ph.D.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM.
Jenna Viscaya, D.O.M. (N.M.)
International Institute of Chinese Medicine, Sante Fe, NM.
Richard Hammerschlag, Ph.D.
Oregon College of Oriental Medicine, Portland, OR.
Background: Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.
Methods: Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.
Results: The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation—Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire—and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.
Conclusions: The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.
Monday, August 07, 2006
German Survey
Our Teutonic friends have been busy lately in collecting research covering a wide range of acupuncture effects and techniques. From one side of the pond to the other, a lot of great investigation is being done and I have included links to some of my favorites.
Measurement of acupuncture needle grasp at acupuncture points and control points
http://www.akupunktur-aktuell.de/fb0112_1.htm
One of the most controversial aspects of acupuncture is whether the location of acupuncture needling sites is important, ie: does the needling of classically defined acupuncture points have an enhanced therapeutic effect as compared with the needling of any other set of points on the body. Resolving this issue is of fundamental importance, since the specificity of acupuncture points is implied in some of the most basic principles underlying the traditional practice of acupuncture.
These results provide objective evidence that acupuncture points have different biomechanical behavior than control points. Whether this is due to anatomical and/or physiological differences between acupuncture points and surrounding tissues, and what these differences are, remains unknown. Our results also show that needle manipulation strongly influences needle grasp, and does so at control points as well as at acupuncture points. We are planning to use the results of this study as a first step to understand the mechanisms underlying needle grasp, and the therapeutic significance of both de qi and acupuncture points.
As someone trained in TCM, I have always believed if there is no Qi, there is no treatment. Perhaps it is Western programming to believe “no pain, no gain,” but I see better results with patients who report feeling sensation over ones that feel nothing. In my experience, I find the patient will have the Qi sensation a moment after I feel the needle “grab.” For those patients that I know are sensitive, I try to keep the needle positioned at that threshold between the grab and the sensation so that they can reap the maximum benefit with the minimum discomfort. Of course, there are those others that can’t get enough Qi either, or as one of my patients says, “Give me the ju-ju!”
DESCRIPTION AND VALIDATION OF A NON-INVASIVE PLACEBO ACUPUNCTURE PROCEDURE
http://www.akupunktur-aktuell.de/fb0202_1.htm
Objective: To evaluate a simulated acupuncture technique for use in randomized controlled trials assessing the efficacy of acupuncture for low back pain.
Experimental Design: In the first experiment, subjects received six insertions of real needles and six pokes with a toothpick in a guidetube in a two-period crossover design. In the second experiment, subjects were randomized to receive either a complete treatment with real acupuncture needles or a simulated treatment using a toothpick in a guidetube.
Conclusions: The simulated acupuncture procedure evaluated in this study represents a reasonable control treatment for acupuncture-naïve individuals in randomized controlled trials assessing the efficacy of acupuncture for low back pain.
Having sat in on some design planning for a few different research projects, I know the use of sham acupuncture is a controversy. A placebo pill in a drug trial is not analogous to random needling. This sounds like a promising (an somewhat humerous) alternative for those who have research aspirations.
CLINICAL STUDY OF HERPES ZOSTER TREATMENT USING ACUPUNCTURE OF THUMB-JOINT ACUPOINT AND FIRE-TWINKLING METHOD
http://www.akupunktur-aktuell.de/fb0224_1.htm
This paper is the summary of clinical results of using Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling for 27 cases of Herpes Zoster, a virulent skin disease called "Yao Chan Huo Dan" and "She Du Cang" in traditional Chinese medicine. The condition usually results from decreased immune function, emotional depression, dietary disorder, malfunctional spleen and liver, or virus infection. The course of the illness lasts from two to fifteen days. The purpose of using Acupuncture of Thumb-joint Acupoint locally is to stimulate the infected region, improve the overall body immune system, and thus kill the virus using the body’s own immune functionality. Additionally, the Fire-Twinkling method utilizes the flame’s radiating and heating effect to enlarge local blood vessels, accelerate blood circulation and energize body cells.
The outcome of the treatment and observation study showed that Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling was a very effective treatment method for Herpes Zoster: among the 27 cases studied, 24 (88.8%) were completely cured, 2 cases (7.4%) showed evident improvement, and only one case (3.8%) showed no sign of improvement. The overall efficiency of the treatment was 96.8%.
“Fire-Twinkling” - I have always been a sucker for TCM technique descriptions!
Measurement of acupuncture needle grasp at acupuncture points and control points
http://www.akupunktur-aktuell.de/fb0112_1.htm
One of the most controversial aspects of acupuncture is whether the location of acupuncture needling sites is important, ie: does the needling of classically defined acupuncture points have an enhanced therapeutic effect as compared with the needling of any other set of points on the body. Resolving this issue is of fundamental importance, since the specificity of acupuncture points is implied in some of the most basic principles underlying the traditional practice of acupuncture.
These results provide objective evidence that acupuncture points have different biomechanical behavior than control points. Whether this is due to anatomical and/or physiological differences between acupuncture points and surrounding tissues, and what these differences are, remains unknown. Our results also show that needle manipulation strongly influences needle grasp, and does so at control points as well as at acupuncture points. We are planning to use the results of this study as a first step to understand the mechanisms underlying needle grasp, and the therapeutic significance of both de qi and acupuncture points.
As someone trained in TCM, I have always believed if there is no Qi, there is no treatment. Perhaps it is Western programming to believe “no pain, no gain,” but I see better results with patients who report feeling sensation over ones that feel nothing. In my experience, I find the patient will have the Qi sensation a moment after I feel the needle “grab.” For those patients that I know are sensitive, I try to keep the needle positioned at that threshold between the grab and the sensation so that they can reap the maximum benefit with the minimum discomfort. Of course, there are those others that can’t get enough Qi either, or as one of my patients says, “Give me the ju-ju!”
DESCRIPTION AND VALIDATION OF A NON-INVASIVE PLACEBO ACUPUNCTURE PROCEDURE
http://www.akupunktur-aktuell.de/fb0202_1.htm
Objective: To evaluate a simulated acupuncture technique for use in randomized controlled trials assessing the efficacy of acupuncture for low back pain.
Experimental Design: In the first experiment, subjects received six insertions of real needles and six pokes with a toothpick in a guidetube in a two-period crossover design. In the second experiment, subjects were randomized to receive either a complete treatment with real acupuncture needles or a simulated treatment using a toothpick in a guidetube.
Conclusions: The simulated acupuncture procedure evaluated in this study represents a reasonable control treatment for acupuncture-naïve individuals in randomized controlled trials assessing the efficacy of acupuncture for low back pain.
Having sat in on some design planning for a few different research projects, I know the use of sham acupuncture is a controversy. A placebo pill in a drug trial is not analogous to random needling. This sounds like a promising (an somewhat humerous) alternative for those who have research aspirations.
CLINICAL STUDY OF HERPES ZOSTER TREATMENT USING ACUPUNCTURE OF THUMB-JOINT ACUPOINT AND FIRE-TWINKLING METHOD
http://www.akupunktur-aktuell.de/fb0224_1.htm
This paper is the summary of clinical results of using Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling for 27 cases of Herpes Zoster, a virulent skin disease called "Yao Chan Huo Dan" and "She Du Cang" in traditional Chinese medicine. The condition usually results from decreased immune function, emotional depression, dietary disorder, malfunctional spleen and liver, or virus infection. The course of the illness lasts from two to fifteen days. The purpose of using Acupuncture of Thumb-joint Acupoint locally is to stimulate the infected region, improve the overall body immune system, and thus kill the virus using the body’s own immune functionality. Additionally, the Fire-Twinkling method utilizes the flame’s radiating and heating effect to enlarge local blood vessels, accelerate blood circulation and energize body cells.
The outcome of the treatment and observation study showed that Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling was a very effective treatment method for Herpes Zoster: among the 27 cases studied, 24 (88.8%) were completely cured, 2 cases (7.4%) showed evident improvement, and only one case (3.8%) showed no sign of improvement. The overall efficiency of the treatment was 96.8%.
“Fire-Twinkling” - I have always been a sucker for TCM technique descriptions!
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