acupuncture

1. By Marissa Grace
Latin: Acus (needle) Punctura
Values Assessment:
Continuum…….

2. Cognitive Objectives
• List 3 stated benefits of acupuncture.
• Define sham acupuncture.
• Describe what Qi is.
• Identify the most significant adverse effect
related to safety and explain what it was related
to.
• Explain which treatment application (Back pain,
OA of the Knee, or PONV) has the most
evidence of benefits based on results, strengths
and limitations.

3. Origins
• Trace back more than 2000 years in China
• 6th
Century spread to Korea and Japan
• 8th
and 10th
Century trade into Vietnam
• 16th
Century Western France by Jesuit
missionaries
• 1972- Visit to China from President Nixon-
– Member of US Press Corps with emergency
appendectomy received acupuncture.
– Experienced shared with New York Time

4. Stated Benefits
• N/V after
chemotherapy
• Back Pain
• Osteoarthirtis
• Preop surgery pain
• Addiction
• Stroke
• Headache
• Menstrual Cramps
• Tennis elbow
• Fibromyalgia
• Asthma
• Carpal Tunnel

5. Techniques and Practices
• Sham acupuncture
• Okibari - Japanese style
• Moxibustion
• Cupping
• Electroacupuncture (EA)

6. Needles
• Needles made of flint, thorns of plants, bamboo
slivers or bone
• Very fine and flexible about 1/2in (0.6cm) to 1 ½
in (38cm)
• Attract or disburse energy along meridians
• FDA approved needles by use of licensed
practitioners in 1996. Sterile, non toxic, single
use only

7. Tools of the Trade
http://www.lhasaoms.com/

8. Traditional Chinese Medicine
• Qi: Life force, vital energy behind all
physiological processes.
– warms body, pathogen protection, promotes
growth
– Meridian network system
– Disruption of flow results in illness
– Mechanism of Qi still mysterious

9. Traditional Chinese Medicine
• Meridians
– Term for each of 20 pathways through body
for flow of qi, accessed through acupuncture
points
– 12 main and 8 secondary
– Up to 2000 points along meridian complex
– Points regulate different areas of the body

10. Theory
• Stimulation of the nervous system to
release chemicals in the muscles, spinal
cord, and brain.
– Beta-endorphin
• Analgesia.
• Placebo effect.

11. Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
• Method
–202 cases reported (40% from US) from
1965-1999,
–First hand reports included, case reports

12. Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
• Results
– Infection: Hepatitis 80% (94cases/35
years)
• Needles not cleans/ repeated use/ inadequateNeedles not cleans/ repeated use/ inadequate
sterilizationsterilization
–Internal Organ/tissue injury
–Fewer complications after 1988: no further
Hepatitis reports.
– 20% of practitioners with no recognized qualifications

13. Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241
• Methods
– Randomized controlled trials of acupuncture of back
pain in humans
– 377 subjects, mostly with chronic poor prognosis back
pain
– Consulted by 6 experienced acupuncturists
– 12 studies included (9 suitable for meta-analysis)
• Conclusion
– Insufficient evidence to state whether superior to
placebo
– Long term effect of back pain with acupuncture
uncertain

14. Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241

15. Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic
low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al.
Archives of internal medicine. 2001; 161, 8: 1081-1088.
• Design
– Only 17% of invited Washington State Group Health
HMO patients participated (262 patients, age 20-70
years).
– Ten acupuncture or massage visits in a 10 week
period.
– 95% of patients w/ Follow-up after 4, 10, and 52
weeks.
• Symptoms and dysfunctions assessed
• Results
– F/U with 95% of participants
– massage is an effective short-term treatment for
chronic low back pain with benefits to last at least 1
year

16. Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic low
back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of
internal medicine. 2001; 161, 8: 1081-1088.
• Results
– If acupuncture has a positive effect it seems
to be during the first 4 weeks with limited
improvement thereafter.
• Strengths- randomized design, involvement of
therapist with protocol development, and high
compliance rate.
• Limitations -absence of control group, restriction
of single form of acupuncture (TCM), possibility
of atypical therapists, use of protocols that
excluded treatments often used by some TCM
acupuncturist.

17. Osteoarthritis
• OA most prevalent form of arthritis
• Common site is knee joint and a leading
cause of disability in the elderly
• Acupuncture for OA is a therapeutic
approach common in Asian societies

18. A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354
• Design
– 73 patients from the Baltimore area (average
age 65 years).
– Inclusion criteria ≥ 50 older Dx of OA ≥ 6
months, moderate pain in knee most days in
the last month, taking analgesic or anti-
inflammatory agents for pain control at least
one month.
– protocol included TCM treatment for Bi
syndrome which uses local and distal points
on channels that cross the area of pain

19. A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354
– Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC)
– The patient’s scores were determined at 0, 4, 8 and
12 weeks during trial.
• Results
– the acupuncture group with about 34% ↓ on WOMAC
at week 4 and 42% at week 8.
– There were no significant changes in the control
group from baseline to week 12.
– Limitations noted lack of placebo control group.

21. Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial.
Berman BM, Lao L, Langenberg P, et al. Annals of Internal
Medicine. 2004
• Design
– Reduce pain/improve function among patients
with knee OA as compared to both sham
acupuncture and education control groups
– 8 week intense acupuncture treatment,
followed by an 18 week tapering regime
– 570 participants
– Assessments conducted at baseline, 4, 8, 14,
and 26 weeks

22. Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial. Berman
BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004
• Results
– True acupuncture groups improvement from baseline
was significantly greater than the sham control group
at weeks 8 (P=0.01), 14 (P=0.04), 26 (P=0.009)
– Most believe they received true acupuncture at both
times, suggesting the sham acupuncture to be a
credible blinding strategy
• At 4 weeks 67% of the true acupuncture group and 58% of
sham believed they were receiving true acupuncture
(P=0.06) and at 26 weeks 75% in acupuncture group and
58% in sham (P=0.003).

23. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Design
– Stimulation of wrist at pericardium (P6)
– Systemic review 24 randomized controlled
trials (1679 patients)
• Nonphamacologic- acupuncture, electroacupuncture,
transcutaneous electrical nerve stimulation, acupoint stimulation and
acupressure
– Measured incidence of nausea, vomiting or
both after surgery 0-6h (early) or 0-48h (late)

24. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Results
– Pediatric studies failed to show significant
benefit.
– Antiemetic use in preventing early or late
PONV in adults was comparable to the non-
pharmacologic techniques.
– Significant reduction of early vomiting in
nonpharm. group compared with placebo w/in
6h of surgery for adults.

25. The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.
• Limitations
– Combining different non-pharmacologic techniques.
• May have different effects to prevent PONV
– Optimal methods of applying techniques unknown.
– Length of treatment (5min- 7days)
– No statistical heterogeneity
• Conclusions
– Further RCT with better study methodology needed in
adults.
– Mechanism for prevention of PONV not established.

27. Values Assessment:
Continuum……./ Questions????