bluuebunny/crossref_metadata_2025 huggingface dataset:
A Proposed Experimental Model of Myofascial Trigger Points in Human Muscle after Slow Eccentric Exercise
Authors: Itoh Kazunori , Okada Kaoru , Kawakita Kenji
Published: April 2009

Background

The purpose of this study was to develop an experimental model of myofascial trigger points to investigate their pathophysiology.

Methods

Fifteen healthy volunteers who gave informed consent underwent repetitive eccentric exercise of the third finger of one hand (0.1Hz repetitions, three sets at five minute intervals) until exhaustion. Physical examination, pressure pain threshold, and electrical pain threshold of the skin, fascia and muscle were measured immediately afterwards and for seven days. Needle electromyogram (EMG) was also recorded in a subgroup of participants.

Results

Pressure pain thresholds decreased to a minimum on the second day after the exercise, then gradually returned to baseline values by the seventh day. On the second day, a ropy band was palpated in the exercised forearm muscle and the electrical pain threshold of the fascia at the palpable band was the lowest among the measured loci and tissues. Needle EMG activity accompanied with dull pain sensation was recorded only when the electrode was located on or near the fascia of the palpable band on the second day of exercise.

Conclusion

These results suggest that eccentric exercise may yield a useful model for the investigation of the myofascial trigger points and/or acupuncture points. The sensitised nociceptors at the fascia of the palpable band might be a possible candidate for the localised tender region.
Education, Training and Continuing Professional Development in Medical Acupuncture – a Contemporary Overview
Authors: Tait Jo , Cummings Mike
Published: April 2009

Most medical and complementary medicine practitioners will have some awareness of the government-driven requirement to set and maintain explicit standards for education and professional development. For many doctors, revalidation has become a concern because they worry that it will raise the requirements for practice and increase bureaucratic documentation in support of the process. For those who have integrated complementary practices into their work within the National Health System, issues of registration and regulation add a further complication. The publication of the Department of Health consultation document on proposals for statutory regulation of herbal medicine and acupuncture in March 2004 raises issues of particular significance for medically qualified practitioners (such as ‘medical acupuncturists’), and other health professionals whose practice includes complementary skills. This paper focuses on the educational implications of these recent developments and offers an informed perspective that includes a reflection on how education and training (as initial training and as continuing professional development) can best meet the needs of acupuncture practitioners in this fast-changing environment.
An Audit of Acupuncture in General Practice
Authors: Day Anthony , Kingsbury-Smith Rosie
Published: April 2009

An audit was conducted to determine the effects of acupuncture treatment used in a dedicated clinic in primary care by a GP, starting shortly after first learning acupuncture. The outcome measure was MYMOP2 which was developed into the MYMOP pictorial during the course of the audit to improve patient compliance. Out of 62 patients enrolled in the audit, 55 completed both the initial and follow-up questionnaires: they had a mean age of 56 years, and included 43 women. The overall mean improvement in symptom 1 was 2.0 (standard deviation 1.6) scale points, and the improvement was significant in 30 patients (55%). Twenty-eight patients reported significant improvement in activity (58% of those reporting this section), and 23 patients (48% of those reporting) obtained a significant improvement in wellbeing. Adverse events were minor, though one patient fainted and fell to the floor. Although the conclusions of this audit are limited by its small size, nevertheless the results were generally encouraging, and the authors recommend that acupuncture should be considered for use in primary care for a wide range of complaints.
A Survey of the Use of Self-Acupuncture in Pain Clinics - a Safe Way to Meet Increasing Demand?
Authors: Orpen Michele , Harvey Gale , Millard Jeff
Published: April 2009

An acupuncture service is well established within a pain clinic in Nottingham, England, and is now unable to meet the increasing demand for treatment despite recent expansion. Patients used to be offered training in self-acupuncture. This was withdrawn because of safety concerns, but is being considered again as a way of meeting the demand. There is little published research on the topic, so a survey of 42 English hospitals was conducted to establish whether acupuncture services are provided, and to discover whether others were offering training in self-acupuncture to patients. Thirty hospitals replied, 23 of which offer an acupuncture service. The average waiting time for the first acupuncture treatment was 18.5 weeks, and the average waiting time for follow up treatments was nine weeks. One hospital taught patients auricular self-acupuncture, another was planning to teach patients, and a third hospital had previously taught patients but stopped. Discussing these findings, concerns are raised about the safety of self-acupuncture, and issues about patient selection, training, information, supervision and supply of materials are reviewed. A debate on these issues would be valuable.
Trigger Point Acupuncture Treatment of Chronic Low Back Pain in Elderly Patients – a Blinded Rct
Authors: Itoh Kazunori , Katsumi Yasukazu , Kitakoji Hiroshi
Published: April 2009

Objective

There is some evidence for the efficacy of acupuncture in chronic low back pain, but it remains unclear which acupuncture modes are most effective. Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to standard acupuncture treatment.

Methods

Thirty five consecutive out-patients (25 women, 10 men; age range: 65–81 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to one of three groups over 12 weeks. Each group received two phases of acupuncture treatment with an interval between them. Nine patients dropped out during the course of the study. The standard acupuncture group (n=9) received treatment at traditional acupuncture points for low back pain, while the other acupuncture groups received superficial (n=9) or deep (n=9) treatments on trigger points. Outcome measures were VAS pain intensity and Roland Morris Questionnaire.

Results

After treatment, the group that received deep needling to trigger points reported less pain intensity and improved quality of life compared to the standard acupuncture group or the group that received superficial needling to trigger points, but the differences were not statistically significant. There was a significant reduction in pain intensity between the treatment and interval in the group that received deep needling to trigger points (P<0.01), but not in the standard acupuncture group or the group that received superficial needling to trigger points.

Conclusion

These results suggest that deep needling to trigger points may be more effective in the treatment of low back pain in elderly patients than either standard acupuncture therapy, or superficial needling to trigger points.
Biomechanics of Back Pain
Authors: Adams Michael A
Published: April 2009

This paper offers a mechanistic account of back pain which attempts to incorporate all of the most important recent advances in spinal research. Anatomical and pain-provocation studies show that severe and chronic back pain most often originates in the lumbar intervertebral discs, the apophyseal joints, and the sacroiliac joints. Psychosocial factors influence many aspects of back pain behaviour but they are not important determinants of who will experience back pain in the first place. Back pain is closely (but not invariably) associated with structural pathology such as intervertebral disc prolapse and endplate fractures, although age-related biochemical changes such as those revealed by a ‘dark disc’ on MRI have little clinical relevance. All features of structural pathology (including disc prolapse) can be re-created in cadaveric specimens by severe or repetitive mechanical loading, with a combination of bending and compression being particularly harmful to the spine. Structural disruption alters the mechanical environment of disc cells in a manner that leads to cell-mediated degenerative changes, and animal experiments confirm that surgical disruption of a disc is followed by widespread disc degeneration. Some people are more vulnerable to spinal degeneration than others, largely because of their genetic inheritance. Age-related biochemical changes and loading history can also affect tissue vulnerability. Finally the concept of ‘functional pathology’ is introduced, according to which, back pain can arise because postural habits generate painful stress concentrations within innervated tissues, even though the stresses are not high enough to cause physical disruption.
Audit of Conservative Management of Chronic Low Back Pain in a Secondary Care Setting – Part I: Facet Joint and Sacroiliac Joint Interventions
Authors: Chakraverty Robin , Dias Richard
Published: April 2009

The work of a chronic back pain service in secondary care in the West Midlands is reported. The service offers acupuncture, spinal injection procedures, osteopathy and a range of other interventions for patients whose back pain has not responded to conservative management. This section of the report focuses on injection procedures for lumbar facet joint and sacroiliac joint pain, which have been shown to be the cause of chronic low back pain in 16–40% and 13–19% of patients respectively. Diagnosis relies on the use of intra-articular or sensory nerve block injections with local anaesthetic. Possible treatments following diagnosis include intra-articular corticosteroid, radiofrequency denervation (for facet joint pain) or ligament prolotherapy injections (for sacroiliac joint pain). The results of several hospital audits are reported. At six month follow up, 50% of 38 patients undergoing radiofrequency denervation following diagnostic blocks for facet joint pain had improved by more than 50%, compared to 29% of 34 patients treated with intra-articular corticosteroid injection. Sixty three per cent of 19 patients undergoing prolotherapy following diagnostic block injection for sacroiliac joint pain had improved at six months, compared to 33% of 33 who had intra-articular corticosteroid. Both radiofrequency denervation and sacroiliac prolotherapy showed good long-term outcomes at one year.
The Effectiveness of An Acupuncturist Working in General Practice – An Audit
Authors: Harborow Patrick W , Ogden Jane
Published: April 2009

This audit was based in general practice and examined 49 consecutive referrals to a UK trained traditional Chinese acupuncturist. It aimed to assess the type of patients referred to an acupuncturist, subsequent changes in health status, whether the effectiveness of acupuncture was related to the type of presenting problem and to examine which factors were predictive of the success of acupuncture. The referred patients had a wide variety of conditions which were categorised as to whether or not there was empirical evidence from trials of responsiveness to acupuncture (evidence based vs non evidence based). Patients completed measures of their health status prior to treatment and at two and six month follow ups. In addition, the referring GP's beliefs about the prognosis of the problem and the therapist's and patient's expectations of success were measured at baseline. The results showed that referred patients reported poorer health status than a historical sample of general practice patients and that they showed significant improvements in all aspects of health status following acupuncture. In particular, patients showed improved energy, pain, emotional reactions, sleep and reduced social isolation at two months which were maintained at six months. Physical mobility was improved at six months. In addition, the results indicated that the best predictors of effectiveness were the therapist's and patient's expectations of success at baseline. Effectiveness was not related to the category of condition (evidence based or not) nor to the GP's expectations about the prognosis of the condition. The results are discussed in terms of implications for the role of acupuncture in General Practice and selectively targeting patients who would be responsive to such an approach.
The Effects of Laser Acupuncture on Chronic Tension Headache – a Randomised Controlled Trial
Authors: Ebneshahidi Narges Sadat , Heshmatipour Mojtaba , Moghaddami Alireza , Eghtesadi-Araghi Payam
Published: April 2009

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 (~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.
The Integration of Acupuncture within Medicine in the UK – the British Medical Acupuncture Society—s 25Th Anniversary
Authors: Baldry Peter
Published: April 2009

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.
Electroacupuncture Direct to Spinal Nerves as an Alternative to Selective Spinal Nerve Block in Patients with Radicular Sciatica – a Cohort Study
Authors: Inoue Motohiro , Hojo Tatsuya , Yano Tadashi , Katsumi Yasukazu
Published: April 2009

We applied electroacupuncture to the spinal nerve root by inserting needles under x ray imaging in three cases with radicular sciatica, as a non-pharmacological substitute for lumbar spinal nerve block. In all three cases, symptoms were markedly reduced immediately after electroacupuncture to the spinal nerve root. The sustained effect was noticeably longer than that of spinal nerve blocks previously performed, in two out of the three cases. We suggest that descending inhibitory control, inhibitory control at the spinal level, inhibition of potential activity by hyperpolarisation of nerve endings, or changes in nerve blood flow may be involved in the mechanism of the effect of electroacupuncture to the spinal nerve root. These results suggest that electroacupuncture to the spinal nerve root may be superior to lumbar spinal nerve block when it is applied appropriately in certain cases of radicular sciatica, taking into consideration patient age, severity of symptoms and duration of the disorder.
The Use of Laser Acupuncture for the Treatment of Neurogenic Pruritus in a Child – a Case History
Authors: Stellon Anthony
Published: April 2009

This report describes the successful treatment using laser acupuncture of a six year old girl with neurogenic pruritus of the abdomen. It is the first case report of neurogenic pruritus treated by laser acupuncture. The main advantage of using low energy laser, as opposed to acupuncture needles, to stimulate points, is that low energy laser causes little or no sensation, which is particularly useful when treating children.
The Effectiveness of Acupuncture for Depression – a Systematic Review of Randomised Controlled Trials
Authors: Mukaino Yoshito , Park Jongbae , White Adrian , Ernst Edzard
Published: April 2009

Objective

To summarise the existing evidence on acupuncture as a therapy for depression.

Methods

RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted independently by two authors. The methodological quality was assessed. Pre and post means and SDs for depression specific measures were extracted, when available, for meta-analysis.

Results

Seven randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication, weighted mean difference −0.43(95% CI −5.61 to 4.76). There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs.

Conclusion

The evidence from controlled trials is insufficient to conclude whether acupuncture is an effective treatment for depression, but justifies further trials of electroacupuncture.
Laser Acupuncture for Mild to Moderate Depression in a Primary Care Setting – a Randomised Controlled Trial
Authors: Quah-Smith Joo Im , Tang Wai Mun , Russell Janice
Published: April 2009

Objective

Depression is a major public health problem. There is some evidence supporting the effectiveness of needle acupuncture in its treatment. Laser stimulation, regarded here as a modality of acupuncture, is non-invasive and therefore free of infection risk; and it is acceptable to patients with needle phobia. The technique is relatively easily learned by community-based general practitioners. It is also amenable to sham control and therefore double-blinding in clinical trials. A double-blind randomised controlled trial was conducted to test the efficacy of low level laser acupuncture in mild to moderate depression.

Methods

Thirty patients with depression were randomised to receive either active or inactive laser treatment. The laser unit could be switched to one of two settings. One switch position delivered active laser acupuncture and the other was inactive (sham). In the active mode, 0.5J was delivered to each of six to eight individually tailored acupuncture sites per visit. All patients were treated twice weekly for four weeks then weekly for a further four weeks. The patients and the acupuncturist were both blinded to conditions. Outcome was assessed using the Beck Depression Inventory at baseline, weeks four and eight during treatment, and at 4 and 12 weeks following the treatment.

Results

At the end of the treatment period, Beck Depression Inventory scores fell from baseline by 16.1 points in the intervention group and by 6.8 points in the sham control group (P<0.001). The difference showed only a trend four weeks later, but was again significant after 12 weeks (P=0.007). Laser acupuncture was well tolerated with transient fatigue as the most common adverse effect.

Conclusion

Laser acupuncture may be worth further investigation as a treatment for mild to moderate depression in primary care.
Short Term Reactions to Acupuncture – a Cross-Sectional Survey of Patient Reports
Authors: MacPherson Hugh , Thomas Kate
Published: April 2009

Objective

To explore the type and frequency of short term reactions associated with a single acupuncture treatment.

Methods

As part of recruitment to a large-scale prospective survey of the safety of acupuncture, 9408 consecutive patients each completed one survey form soon after receiving treatment with acupuncture, and returned it directly to the research centre. On this form, patients were asked to report on a range of possible short term reactions relating to their most recent acupuncture treatment using a checklist of options.

Results

At least one short term reaction to acupuncture during or immediately after treatment was reported by 94.6% (CI 94.2 to 95.1) of patients, an average of 1.8 reactions per patient. The most common experiences reported were feeling ‘relaxed’ (79.1%) followed by feeling ‘energised’ (32.7%). A total of 24.4% of patients reported ‘tiredness’ or ‘drowsiness’, with obvious implications for safety if the patient intended to drive after treatment. ‘Negative’ reactions, such as pain and bruising at the site of needling, were reported by 29.7% of patients who were more likely to be female patients (OR 1.58), patients under the age of 40 (OR 1.62), patients who had consulted their GP or hospital specialist beforehand (OR 1.30), patients consulting their acupuncturist for the first time (OR 1.24), and patients treated by an acupuncturist with less than two years’ experience since qualification (OR 1.24). Only 13 patients were unwilling to have acupuncture again as a result of these short term reactions.

Conclusion

In this large cross-sectional study, extensive patient reports showed that ‘positive’ reactions to acupuncture treatment were very common. Tiredness, drowsiness and a range of ‘negative’ reactions were also frequently reported. Almost all patients were willing to experience these reactions again.
A Model for Acupuncture Training in Primary Care
Authors: Richardson Marion , Freedman Jonathan
Published: April 2009

A recent innovation in acupuncture training at a clinic in a primary care practice is reported. The trainer is a General Practitioner within the practice and the trainee an academic nurse. The semi-structured training programme is outlined and benefits and challenges to both trainer and trainee are discussed. The patients generally welcomed the scheme. We consider that the programme could provide a model for similar training initiatives in the future.
Acupuncture in the Treatment of Post Viral Fatigue Syndrome – a Case Report
Authors: Mears Tim
Published: April 2009

This case report concerns the treatment of post viral fatigue (chronic fatigue syndrome) with electroacupuncture. This condition is particularly difficult to treat whether using conventional or complementary therapy. Whilst the treatment did not cure the patient, it appears to have facilitated her return to work and markedly improved her symptoms. There are few publications on acupuncture treatment of this condition and the approach used here has not been reported previously.
The Acupuncture Randomised Trial (Art) for Tension-Type Headache - Details of the Treatment
Authors: Melchart Dieter , Streng Andrea , Hoppe Andrea , Brinkhaus Benno , Becker-Witt Claudia , Hammes Michael , Irnich Dominic , Hummelsberger Josef , Willich Stefan N , Linde Klaus
Published: April 2009

Objective

The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ARTTTH, in order to enable acupuncturists to assess the study interventions.

Methods

Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. A total of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined ‘basic’ points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial.

Results

The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (<1 to 25) years acupuncture experience. The three ‘basic’ points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture.

Conclusions

In general, trial physicians complied well with the predefined interventions. A relevant minority of participating trial physicians stated that they would have treated patients differently outside the trial.
Effects of Lumbar Acupuncture Stimulation on Blood Flow to the Sciatic Nerve Trunk - An Exploratory Study
Authors: Inoue Motohiro , Hojo Tatsuya , Yano Tadashi , Katsumi Yasukazu
Published: April 2009

Introduction

Acupuncture may have a role in the treatment of intermittent claudication of the cauda equina due to lumbar spinal canal stenosis. The aim of this study was to explore the possible physiological mechanisms.

Methods

In a laboratory experiment, manual acupuncture was performed at a point adjacent to the sixth lumbar vertebra of 13 animals and its effect on sciatic nerve blood flow was measured using a laser Doppler flowmetry. Simultaneously, changes in blood pressure and cardiac rate were observed. Each animal was stimulated four to eight times, making a total of 58 experiments.

Results

Acupuncture stimulation did not produce consistent changes in sciatic nerve blood flow, with increased and decreased blood flow as well as no change in blood flow observed. Among the 58 individual experiments, sciatic nerve blood flow was increased in 33, reduced in 12, and unchanged in 13. Approximately half of the stimulations showed a correlation between blood flow and blood pressure change.

Conclusion

Our results indicate that lumbar acupuncture stimulation can have an influence on sciatic nerve blood flow. The effect is dependent not only on blood pressure but also other factors, for example vasodilator and vasoconstrictor nerve activity. This mechanism may contribute to a clinical effect on intermittent claudication of the cauda equina.
Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm
Authors: Filshie Jacqueline , Bolton Tara , Browne Doreen , Ashley Sue
Published: April 2009

Introduction

Since hormone replacement therapy given for long periods is now recognised to produce serious side effects, patients with troublesome vasomotor symptoms are increasingly using non-hormonal treatment including acupuncture. Several randomised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric. It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus. Vasomotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy. The safety of some herbal medicines and phytoestrogens has been questioned, as they could potentially interfere adversely with the bioavailability of tumouricidal drugs. A previous study reports short term benefit from acupuncture, and the aim of this report is to describe our approach to long term treatment.

Acupuncture Approach

After piloting several approaches, six weekly treatments were given initially at LI4, TE5, LR3 and SP6 and two upper sternal points, but avoiding any limb with existing lymphoedema or prone to developing it. If there were no contraindications, patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6, weekly for up to six years, for long term maintenance.

Audit Methods and Results

A retrospective audit of electronic records was carried out by a doctor not involved in treatment. A total of 194 patients were treated, predominantly with breast and prostate cancer. One hundred and eighty two patients were female. The number of pre-treatment hot flushes per day was estimated by the patient: in the 159 cases providing adequate records, the mean was 16 flushes per day. Following treatment, 114 (79%) gained a 50% or greater reduction in hot flushes and 30 (21%) a less than 50% reduction. Treatment was abandoned in those who responded poorly or not at all. The duration of treatment varied from one month to over six years with a mean duration of nine months. Seventeen patients (9%) experienced minor side effects over the six year period, mostly minor rashes; one patient described leg swelling but this was likely to be due to a concurrent fracture.

Conclusion

Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients. Treatment is safe and costs appear to be low. An algorithm is presented to guide clinical use. We recommend the use of self acupuncture with needles at SP6 in preference to semi-permanent needles in the first instance, but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles. Point location may be of less importance than the overall ‘dose’, and an appropriate minimum dose may be required to initiate the effect.
Conducting and Reporting Case Series and Audits - Author Guidelines for Acupuncture in Medicine
Authors: White Adrian
Published: April 2009

This article aims to give guidance on the conduct and reporting of case series and audits of acupuncture, based on common problems that have arisen in the past. This type of project, and particularly the prospective case series or pre- post-intervention study, may give valuable evidence of the overall effectiveness of acupuncture for example in different situations and in different conditions and provides one step in the research pathway before generating an hypothesis. The project should be designed with the aim of reducing bias as much as possible. Careful and detailed planning is essential for the project to produce worthwhile results that readers can evaluate and replicate. Ethical issues should be considered and formal approval may be necessary. The patient group should be recruited systematically and baseline data obtained. The treatment given should be systematic and decisions to change or end treatment made explicit. The outcome should be measured in ways that are known to be reliable and valid. Musculoskeletal problems can be evaluated with scales for pain and confirmed by measuring one other symptom such as stiffness or one other aspect such as bothersomeness. Global change scores also provide supporting information, and the MYMOP (Measure Yourself Medical Outcome Profile) measure is popular when patients with different conditions are included. The design of questionnaires for beliefs and attitudes is a specialised area that should not be attempted without expert help. Adverse events should also be recorded. Analysis of the data and the best way of summarising and presenting the results are also discussed.
Electroacupuncture in the Treatment of a Ganglion of the Wrist – a Case Report
Authors: Tekeoğlu İbrahim , Doğan Ali
Published: April 2009

A ganglion is a cystic swelling that occurs most commonly in women. Recurrence is possible after conservative or surgical treatment. A novel method of therapy, electroacupuncture stimulation, was performed in a 53 year old woman with a large, recurrent dorsal wrist ganglion. After treatment it rapidly disappeared and there was no recurrence during the one year follow-up period. Although the mechanism is obscure, it is our impression that electroacupuncture may have a local action on such cysts in addition to needle drainage.
Nystagmus following Acupuncture – a Case Report
Authors: Bradbury Angela , Botancor Jose , White Adrian
Published: April 2009

A 50 year old woman experienced an episode of vertigo and nystagmus about 10 minutes after receiving her first treatment with acupuncture for shoulder pain. The nystagmus was confirmed by several health professionals. She had no previous history of nystagmus, and the symptom was not associated with feelings of faintness. Her blood pressure was 90/50 at the onset of symptoms but returned to normal while the symptoms continued. She recovered spontaneously after about five hours. Nystagmus after acupuncture has not been unequivocally reported before, though dizziness associated with hypotension is common. In this case the association may be coincidental, or a focal neurological response to needling; if the latter, then it should be regarded as an unavoidable idiosyncratic reaction.
A Review of Acupuncture Clinical Trials Indexed during 2005
Authors: White Adrian , Tough Elizabeth , Cummings Mike
Published: April 2009

Background

Clinical trials in acupuncture are published in a variety of journals, and it is useful to summarise them in one place.

Methods

We conducted a search of PubMed and Embase for clinical trials of acupuncture with date of entry 2005, and selected randomised controlled trials with clinical outcomes for review. Where possible, the original report was read for full details.

Results

Thirty-eight RCTs were found from databases, and one more during the process of the study. Ten of the trials included about 100 patients or more. Five showed acupuncture to be superior to usual care in back pain, knee pain and headache. Acupuncture was superior to placebo for chronic knee pain, but not for fibromyalgia, or post-stroke rehabilitation. Acupuncture was not as good as conventional analgesia for oocyte collection.

Conclusion

The role of acupuncture is becoming more precisely established in treatment of chronic knee pain, back pain and headache. Acupuncture for chronic back pain is more cost-effective than many other medical interventions.
Effects of Trigger Point Acupuncture on Chronic Low Back Pain in Elderly Patients – a Sham-Controlled Randomised Trial
Authors: Itoh Kazunori , Katsumi Yasukazu , Hirota Satoko , Kitakoji Hiroshi
Published: April 2009

Introduction

There is some evidence for the efficacy of acupuncture, but it remains unclear whether trigger point acupuncture is effective. Our objective was to evaluate the effects of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared with sham acupuncture.

Methods

Twenty-six consecutive out-patients (17 women, 9 men; age range: 65–91 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to two groups. Each group received one phase of trigger point acupuncture and one of sham acupuncture with a three week washout period between them, over 12 weeks. Group A (n=13) received trigger point acupuncture in the first phase and sham acupuncture in the second. Group B (n=13) received the same interventions in the reverse order. Outcome measures were pain intensity (visual analogue scale, VAS) and Roland Morris Questionnaire.

Results

Nineteen patients were included in the analysis. At the end of the first treatment phase, group A receiving trigger point acupuncture scored significantly lower VAS (P<0.001) and Roland Morris Questionnaire scores (P<0.01) than the sham control group. There were significant within-group reductions in pain in both groups during the trigger point acupuncture phase but not in the sham treatment phase. However, the beneficial effects were not sustained.

Conclusion

These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture.
Lack of Effect of Acupuncture on Electromyo-Graphic (Emg) Activity – a Randomised Controlled Trial in Healthy Volunteers
Authors: Tough Liz
Published: April 2009

Background

Acupuncture is used clinically to treat muscle spasticity and flaccidity. Claims have been made that acupuncture can affect muscle EMG activity, though there is some doubt about the reliability of these studies. This study's aim was to examine the immediate effects of acupuncture on the EMG activity of the common wrist extensor muscles.

Methods

Thirty five right-handed healthy volunteers, 17 male and 18 female, aged 18-70 years were recruited from a convenience sample. Five subjects provided reliability data, and the remaining 30 took part in the main study. The study was a crossover, within-subject design, with the interventions counterbalanced. The three conditions were genuine acupuncture to LI4 ( Hegu) and LI10 ( Shousanli) for 20 minutes, with de qi; inappropriate acupuncture to PC3 ( Quze) and PC6 ( Neiguan) for 20 minutes; and 20 minutes of a no intervention control. All participants received each condition in random order. The outcome measure was surface EMG activity recorded over the common wrist extensor muscles during a 10 second, sub-maximal, isometric contraction. The average of three readings was used. The reliability of the outcome measurement was assessed in five volunteers selected at random who received repeated EMG recordings without acupuncture.

Results

The reliability tests showed the EMG procedure was highly reliable, with an intraclass correlation coefficient (ICC 2,1) of 0.9996 and a standard error of measurement of 0.014mV. In the main study, paired t tests for the effect of the order of the first two interventions showed no detectable carry-over effect. Freidman analysis of variance found no difference between the three conditions (P=0.573).

Conclusion

No meaningful change was detected in EMG activity following acupuncture interventions, but this study provides a sound protocol and normative values on which to plan future research.
Needle Electromyographic Activity of Myofascial Trigger Points and Control Sites in Equine Cleido-Brachialis Muscle – An Observational Study
Authors: Macgregor Joanne , von Schweinitz Dietrich Graf
Published: April 2009

Background

Myofascial trigger points are commonly described in humans, and many studies have shown abnormal spontaneous electrical activity, spike activity and local twitch responses at these sites. Myofascial trigger points have only rarely been described in horses, and studies of their electrophysiological characteristics have not previously been published. The objective of this study was to explore the electromyographic (EMG) and other characteristics of myofascial trigger points in equine muscle, and to compare them with normal muscle tissue.

Methods

Four horses with chronic pain signs and impaired performance were examined. They had previously been examined at the second author's practice, and showed signs compatible with the diagnosis of myofascial trigger points in their cleidobrachialis (brachiocephalic) muscle, ie localised tender spots in a taut band of skeletal muscle which produced a local twitch response on snapping palpation. They had therefore been selected for treatment with acupuncture. Needle EMG activity and twitch responses were recorded at 25 positions at the trigger point and at a nearby control point during the course of each horse's acupuncture treatment.

Results

All subjects demonstrated objective signs of spontaneous electrical activity, spike activity and local twitch responses at the myofascial trigger point sites within taut bands. The frequency of these signs was significantly greater at myofascial trigger points than at control sites (P<0.05).

Conclusion

Equine myofascial trigger points can be identified, and have similar objective signs and electrophysiological properties to those documented in human and rabbit skeletal muscle tissue. The important differences from findings in human studies are that referred pain patterns and the reproduction of pain profile cannot be determined in animals.
Aspects of Pain, Its Assessment and Evaluation from An Acupuncture Perspective
Authors: Lund Iréne , Lundeberg Thomas
Published: April 2009

Pain is a major clinical problem that causes great suffering for the individual and incurs costs for society. Accurate assessment and evaluation of perceived pain is necessary for diagnosis, for choice of treatment, and for the evaluation of treatment efficacy. The assessment of an individual's pain is a challenge since pain is a subjective, multidimensional experience, and assessment is based on the person's own self-report. The results are often varied, possibly due to inter-individual variation, but also in relation to gender and aetiology.

A gold standard for pain assessment is still lacking, but rating scales, questionnaires, and methods derived from psychophysical concepts, such as threshold assessments and perceptual matching, are used. In the evaluation of pain and associated variables, both systematic and individual variation should be taken into account, as should pain-associated symptoms.

Recommendations for pain treatment should be based on the patient's specific needs. Therefore, it is important to assess the level of perceived pain taking individual variation into account. The methods used should preferably have proved to be useful in randomised controlled trials, and analysis of pain assessment should consider its non-metric properties. In the future, the use of studies with a naturalistic protocol together with individual assessment of individual pain responses could increase the internal and external validity.
Pedicle Torsion of Ovarian Cyst and Acupuncture – a Case Report
Authors: Qu Fan , Zhou Jue
Published: April 2009

A case history is reported of a patient who presented with acute pedicle torsion in a left ovarian cyst, which had been diagnosed seven months previously. The diagnosis was established by sonography. She declined surgery for personal reasons, and was treated with acupuncture. Her pain was successfully relieved, and she continued to be observed. The acupuncture was repeated daily for 15 days, after which time repeat sonography showed reduction in size of the cyst, and no torsion of the pedicle. No relapse had occurred at 16 months follow up.
Role of C Tactile Fibres in Touch and Emotion – Clinical and Research Relevance to Acupuncture
Authors: Campbell Anthony
Published: April 2009

Acupuncture is generally thought to rely on Aδ fibre stimulation for its effects and the role of C fibres has been largely discounted. Recent research, however, shows that there are C tactile fibres in humans that respond to light touch and project to the limbic system. They are thought to be responsible for feelings of calm and wellbeing that are elicited by gentle manual stimulation, as in stroking. These findings are likely to be relevant to acupuncture as regards both clinical practice and research. They may explain why even superficial acupuncture with brief needle insertion can have a clinical effect and why light touch may not be an adequate control procedure for use in clinical trials.
Acupuncture Vs Streitberger Needle in Knee Osteoarthritis – An Rct
Authors: Vas Jorge , Méndez Camila , Perea-Milla Emilio
Published: April 2009

Aims

To determine the effectiveness of acupuncture as a therapy complementary to the pharmacological treatment of osteoarthritis of the knee.

Methods

Randomised, single blind, placebo controlled trial. Patients with osteoarthritis of the knee were randomly assigned to either 12 sessions of true acupuncture or 12 sessions of placebo acupuncture (Streitberger needle), these sessions taking place once a week. A baseline measurement was carried out, followed by further observations at 4, 8, 12 and 16 weeks. The clinical variables were the WOMAC (Western Ontario and McMaster Universities Osteoarthritis) index, knee pain measured by a visual analogue scale (pain VAS), the weekly consumption of diclofenac and the Profile of the Quality of Life of the Chronically Ill (PQLC). The two groups were compared for each of the clinical variables per protocol and by intention to treat. A multiple linear regression model for the dependent variables was constructed.

Results

Ninety seven outpatients were selected, with 88 remaining for the per protocol analysis; the analysis of homogeneity concluded that the lost subjects were not significantly different from those that completed the study. The multivariate per protocol model for the relative pain VAS variable showed a difference in improvement of 43.7% (95% CI 29.4% to 58.0%) for acupuncture, compared with the control group. In an intention to treat analysis, the relative improvement was 32.4% (20.3% to 44.4%). In a per protocol analysis, the total WOMAC showed a relative decrease of 52.0% (34.3% to 69.6%) in favour of the acupuncture group, or 37.6% (22.4% to 52.8%) in an intention to treat analysis.

Conclusions

The group treated with acupuncture showed significantly better effects, both clinically and statistically, in the reduction of pain intensity as measured by pain VAS, on the WOMAC index and in decreased consumption of diclofenac.