bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupuncture as an Alternative to Diazepam Sedation for Diagnostic Gastrointestinal Endoscopy
Authors: Stellon Anthony , Palmer Terence
Published: April 2009

A study was undertaken to compare the differences in ease of intubation, emotional distress and physical discomfort during oesophago-gastro-duodenoscopy in 3 groups of patients: sedated with intravenous diazepam, receiving acupuncture, or being part of a control group having neither treatment. Patients were given the option of sedation. Those that declined were randomly divided into two groups, either receiving acupuncture or acting as a control.

Patient distress was measured by two independent methods: direct observation by the attending nurse and a self-report questionnaire. The observed and self-reported physical discomfort were significantly reduced in the sedation group compared to controls, but there was no significant difference in any measurement between the acupuncture and the control groups. Respiratory complications were least in the acupuncture group and there was some evidence of benefit from acupuncture in relieving emotional distress.
Physical Exercise, Acupuncture and Immune Function
Authors: Jonsdottir Ingibjörg H
Published: April 2009

Experimental evidence suggests that the immune system is influenced by various types of psychological and physiological stressors, including physical activity. Natural immunity, representing a first line of defence in viral infections and cytotoxicity to a variety of tumour cells, is strongly influenced by frequent exercise. This regulation includes interaction between the nervous, endocrine and immune systems and central mechanisms including the endogenous opioids are of great interest here. Chronic activation of endogenous opioid systems augments natural cytotoxicity, and the possible involvement of opioids in the exercise-induced enhancement of natural immunity is discussed. Few reports are available on acupuncture and its effect on immune function but, interestingly, the effects of acupuncture and physical exercise are somewhat similar. The physiological significance as well as the underlying mechanisms of the reported changes in natural cytotoxicity after exercise training and acupuncture is as yet unclear. However, moderate exercise training has been associated with elevated natural immune function and reduced upper respiratory tract infections and available epidemiological and experimental studies suggest that moderate physical exercise may protect against several forms of cancer.
Acupuncture Treatment of Osteoarthritis
Authors: Tukmachi Emad S
Published: April 2009

Two cases of drug resistant osteoarthritis were effectively treated using acupuncture. Sessions of up to 40min twice a week for 3 to 5 weeks were required to induce remission of pain, joint swelling and stiffness. Benefits were still seen at the six month follow-up.
The Limbic System and Emotion in Relation to Acupuncture
Authors: Campbell Anthony
Published: April 2009

Patients receiving acupuncture sometimes manifest phenomena such as laughter or crying; varying degrees of relaxation or euphoria are quite common. Rarely, epileptic fits occur. Patients vary considerably in their responsiveness to acupuncture: some fail to respond at all while others (strong reactors) experience marked effects. It is widely recognised that fear of acupuncture generally precludes a therapeutic response, whereas belief in the efficacy of the treatment is irrelevant. All these phenomena must presumably have a neurophysiological explanation. This paper proposes that they may, at least in part, be caused by processes occurring in those brain structures that are classified as forming the limbic system. The paper briefly reviews the history and status of the limbic system idea, discusses how limbic system structures may contribute to the phenomena in question, and offers a number of predictions which would allow these hypotheses to be tested.
A Study of the Comparative Accuracy of Two Methods of Locating Acupuncture Points
Authors: Aird Mark , Coyle Meaghan , Cobbin DM , Zaslawski C
Published: April 2009

The ability to locate an acupuncture point accurately is an essential component of both effective treatment and meaningful acupuncture research. This study examined the comparative accuracy of two commonly used mechanical methods of acupuncture point location: directional and proportional. Twenty final-year acupuncture students attempted to locate the points LI.10 (Shousanli) and ST.40 (Fenglong) using each method contralaterally on a volunteer. Both methods are appropriate for use in the locating of these points. Analysis of the results found no significant difference in accuracy between the two methods for either LI.10 (t=1.05, p=0.31) or ST.40 (t=0.59, p=0.57), both methods being found to be similarly inaccurate. The findings of this study demonstrate the serious limitations of both methods for accurate point location. Implications for acupuncture research and treatment are discussed.
Somatosensory Evoked Potentials in the Investigation of Auricular Acupuncture Points
Authors: Volf Nadia
Published: April 2009

A preliminary study correlating the wrist and gall bladder body areas with their auricular acupuncture points, through recording the somatosensory evoked potentials (SEP) at the corresponding brain localisation, showed that stimulation of the “Wrist” auricular point activates the primary cortical somatosensory area of the upper extremity on the contralateral hemisphere in a similar way to direct median nerve stimulation. A “placebo” point 5 to 8mm from the “Wrist” auricular point was used as a control: no activation in the brain area was observed.

In patients with post-stroke hemiplegia, SEP traces obtained both by direct median nerve stimulation at the wrist, and by stimulation of the “wrist” auricular point, were altered in a similar manner and only on the damaged side. Similarly, “gall bladder” auricular point stimulation activates the corresponding cortical somatosensory area in the same way as direct stimulation of the T7 intercostal nerve. Again, a “placebo” point, 5 to 8mm away from the “Gall bladder” auricular point, was used as a control, and activation in the brain area was not observed. Also, in patients with cholelithiasis, both the SEP traces evoked by T7 direct intercostal nerve stimulation and those evoked by “Gall bladder” auricular point stimulation were altered in the same manner.

These results demonstrate that there is correlation between the activation of specific areas of brain cortex and stimulation of their corresponding auricular acupuncture points, and indicate a convergence into the same cortical somatosensory area of nerve impulses coming from the body organ itself and from the auricular point corresponding to that organ. This might be taken as suggesting neurological support for a functional somatic relationship of auricular points.
Myofascial Trigger Points: Pathophysiology and Correlation with Acupuncture Points
Authors: Hong Chang-Zern
Published: April 2009

A review is made of recent studies on myofascial trigger points (MTrP) and their mechanism is discussed. Clinical and basic science studies have shown that there are multiple MTrP loci in a MTrP region. A MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is a point from which tenderness or pain, referred pain, and local twitch response can be elicited by mechanical stimulation. Sensitive loci (probably sensitised nociceptors) are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is a site from which spontaneous electrical activity can be recorded. Active loci appear to be dysfunctional endplates since spontaneous electrical activity is essentially the same as the electrical activity reported by neurophysiologists as that recorded from an abnormal endplate. A MTrP is always found in a taut band which is histologically related to contraction knots caused by excessive release of acetylcholine in abnormal endplates. Both referred pain and local twitch response are mediated through spinal cord mechanisms, as demonstrated in both human and animal studies.

The pathogenesis of MTrPs appears to be related to integration in the spinal cord of response to the disturbance of nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. There are many similarities between MTrPs and acupuncture points including their location and distribution, pain and referred pain patterns, local twitch responses (de qi), and possible spinal cord mechanism.
The Treatment of Persistent Yawning with Acupuncture
Authors: Wong Raimond KW , Sagar Stephen MS
Published: April 2009

Persistent and excessive yawning (greater than 1 to 4 yawns/minute) is a pathological process associated with a variety of conditions including central nervous system disorders, opiate withdrawal and drug side effects. This report describes a patient with a brain tumour who presented with persistent excessive yawning. She was successfully treated with medical acupuncture. A possible mechanism involving the autonomic nervous system is discussed.
Percutaneous Electrical Nerve Stimulation – Electroacupuncture by Another Name? A Comparative Review
Authors: Cummings Mike
Published: April 2009

Percutaneous electrical nerve stimulation (PENS) is a technique that has been described as a ‘novel analgesic therapy’. A review was performed of the published literature in order to compare PENS with the author's knowledge and experience of the use of EA, specifically with regard to the stimulation parameters, the selection of points, and the reported efficacy. The conclusion of the review is that PENS is neither different in principle nor in practice from EA, and whilst the term accurately reflects the nature of the treatment, there is no substantial justification for referring to PENS as a novel therapy.
Skin Disinfection and Acupuncture
Authors: Hoffman Peter
Published: April 2009

The need for skin disinfection before insertion of an acupuncture needle is controversial and there is no specific research on this topic. However research and observations on the effect of, and the need for, skin disinfection before injections forms a good analogy of acupuncture. Whilst micro-organisms present on the surface of the skin are accessible to disinfection, those located under the surface in ducts, glands and follicles are out of reach and can be inoculated into the sterile tissues below by needle insertion. Fortunately, the bacteria resident on the skin have a low potential to cause infection if host immunity is not severely impaired or compromised by the long-term presence of foreign material, such as a surgical stitch. Disinfection of clean skin before injection is not generally considered necessary and observations of lack of infection following injections without prior skin disinfection support this; however, contamination by micro-organisms not normally resident on skin can pose a higher risk of infection. If skin is visibly soiled, it should be washed and if needle insertion is near an infected or contaminated site, it should be disinfected with alcohol.

Practitioner hand hygiene between patients is important, even if gloves are worn. Hands should be washed with soap or detergent and water, or an alcohol handrub can be used if hands are physically clean.
Safety Aspects of Acupuncture in Palliative Care
Authors: Filshie Jacqueline
Published: April 2009

Acupuncture can mask symptoms of cancer and tumour progression. It is not safe to use such a therapy without full knowledge of the clinical stage of the disease, and the current status of orthodox therapy. Contraindications to acupuncture needling include an unstable spine, severe clotting disorder, neutropenia and lymphoedema. Whilst semi-permanent needles are used increasingly in symptom control and pain management they should not be used in patients with valvular heart disease or in vulnerable neutropenic patients. Acupuncture has an increasing role in support for pain and symptom management, but patients should not be advised to abandon conventional treatments in favour of complementary or alternative therapies alone, and should not have their hopes raised inappropriately, or have any guilt projected on to them for the cause of their cancer.
Informed Consent for Acupuncture - An Information Leaflet Developed by Consensus
Authors: White Adrian , Cummings Mike , Hopwood Val , MacPherson Hugh
Published: April 2009

Patients have the right to be fully informed about the likely benefits and risks of any proposed examination or treatment, and practitioners are obliged to obtain informed consent beforehand. Accurate information about the risks of acupuncture is available following publication of the results of two prospective surveys. At a joint meeting on the safety of acupuncture, members of the three largest UK professional bodies expressed a need to establish what information on risks patients should be given. A standard Information Leaflet was developed by consensus between these organisations, and is intended to be used as a stimulus for discussion of standard risks as well as any particular risks that might apply to individual patients. Additionally, it may be used as a form for written consent when this is required. To provide the context for using the Leaflet, the legal and ethical bases of informed consent for medical procedures are discussed.
Survey of Adverse Events following Acupuncture (Safa): A Prospective Study of 32,000 Consultations
Authors: White Adrian , Hayhoe Simon , Hart Anna , Ernst Edzard ,   Volunteers from BMAS and AACP
Published: April 2009

Acupuncture is increasingly used, so it is important to establish whether its benefits outweigh its risks. Numerous case reports of adverse events show that acupuncture is not free of risk, but accurate data from prospective investigations is scarce. A prospective survey was undertaken using intensive event monitoring. Forms were developed for reporting minor events each month and significant events as they occurred. The sample size was calculated to identify any adverse events that occurred more frequently than once in 10,000 consultations. Acupuncturists were recruited from two professional organisations in the UK. Seventy-eight acupuncturists, all doctors or physiotherapists, reported a total of 2178 events occurring in 31,822 consultations, an incidence of 684 per 10,000 consultations. The most common minor adverse events were bleeding, needling pain, and aggravation of symptoms; aggravation was followed by resolution of symptoms in 70% of cases. There were 43 significant minor adverse events reported, a rate of 14 per 10,000, of which 13 (30%) interfered with daily activities. One patient suffered a seizure (probably reflex anoxic) during acupuncture, but no adverse event was classified as serious. Avoidable events included forgotten patients, needles left in patients, cellulitis and moxa burns. In conclusion, the incidence of adverse events following acupuncture performed by doctors and physiotherapists can be classified as minimal; some avoidable events do occur. Acupuncture seems, in skilled hands, one of the safer forms of medical intervention.
A Prospective Survey of Adverse Events and Treatment Reactions following 34,000 Consultations with Professional Acupuncturists
Authors: MacPherson Hugh , Thomas Kate , Walters Stephen , Fitter Mike
Published: April 2009

The paper describes the type and frequency of adverse events and transient reactions following consultations with professional acupuncturists. In a postal survey, involving 1848 professional acupuncturists, all of whom were members of the British Acupuncture Council and practising in the UK, details of adverse events and transient reactions following treatment were recorded on standardised self-report forms. A sample size of 30,000 treatments was sought, and piloting indicated that a four-week period was required. Practitioners also provided information on themselves, including age, sex, length of training and years of practice.

A total of 574 practitioners responded, 31% of the total population. These practitioners reported on adverse events and transient reactions associated with 34,407 treatments. No serious adverse events were reported, where these were defined as requiring hospital admission, prolonging hospital stays, permanently disabling, or resulting in death (95% CI: 0 to 1.1 per 10,000 treatments). A total of 43 significant minor adverse events were reported, a rate of 1.3 per 1,000 treatments (95% CI: 0.9 to 1.7). These included severe nausea and actual fainting (12), unexpected, severe and prolonged aggravation of symptoms (7), prolonged and unacceptable pain and bruising (5) and psychological and emotional reactions (4). There were three avoidable events: two patients had needles left in by mistake, and one patient had moxa burns to the skin, also caused by practitioner error. The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments, 15% (95% CI: 14.6 to 15.3) of the 34,407 total. In terms of local reactions, there were reports of mild bruising (1.7%), pain (1.2%) and bleeding (0.4%). Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8% of treatments. The most common mild transient reactions to treatment were feeling relaxed (11.9%) and feeling energised (6.6%).

In this prospective survey of 34,407 treatments, practitioners reported no serious adverse events. This conclusion was based on data collected from one in three members of the British Acupuncture Council. Given that the whole membership delivers between one and a half and two million treatments a year, this is important evidence on public health and safety. When compared with medication routinely prescribed in primary care, the results suggest that acupuncture is a relatively safe treatment modality.
Single-Use Acupuncture Needles: Scanning Electron-Microscopy of Needle-Tips
Authors: Hayhoe Simon , McCrossan Maria , Smith Aden , Ellis David , Croft Simon , Mei Man Fong
Published: April 2009

Unselected, disposable acupuncture needles from various manufacturers and retail suppliers were taken from a pool of donated and bought samples. Three needles of each type were prepared for electron-microscopy. The needle tips were inspected at two magnifications (x39.37 and x612.5): 52 electron-micrographs were taken of 31 individual needles from 11 different types. No needle-tip looked perfect and significant faults were seen in most; some appeared seriously deformed. The faults noted were: scratch marks along or across the needle, metallic scuff, lumps and irregularities in the needle surface, needle-tip stubbed or malformed, and needle point off-centre. An additional test made was to wipe a number of needles firmly on white paper tissue. Some left grey lines, and these were regarded as evidence of metallic or oily residue from the needle surface which could have been deposited in the patient. These unexpected findings, in a variety of popularly used needles from well-respected suppliers, suggest that most manufacturers need to reassess their quality control procedures.
Standards for Reporting Interventions in Controlled Trials of Acupuncture: The Stricta Recommendations
Authors: MacPherson Hugh , White Adrian , Cummings Mike , Jobst Kim , Rose Ken , Niemtzow Richard ,   for the STRICTA Group. Members of the STRICTA group are listed at the end of this paper
Published: April 2009

Acupuncture treatment and control group interventions in parallel-group randomised trials of acupuncture are not always precisely reported. In an attempt to improve standards, an international group of experienced acupuncturists and researchers devised a set of recommendations, designating them STRICTA: STandards for Reporting Interventions in Controlled Trials of Acupuncture. In a further consensus-building round, the editors of several journals helped redraft the recommendations. These follow the Consolidated Standards for Reporting Trials (CONSORT) format, acting as an extension of the CONSORT guidelines for the specific requirements of acupuncture studies. Participating journal editors are publishing the STRICTA recommendations and requesting prospective authors to adhere to them when preparing reports for publication. Other journals are invited to adopt these recommendations. The intended outcome is that interventions in controlled trials of acupuncture will be more adequately reported, thereby facilitating an improvement in critical appraisal, analysis and replication of trials.
An Audit of 500 Acupuncture Patients in General Practice
Authors: Freedman Jonathan
Published: April 2009

This is an audit of 500 patients treated in a general practice setting. Acupuncture clinics are provided on two evenings each week and are funded by the practice. Short treatment times are favoured but this varies according to condition and response. A wide variety of conditions have been treated the commonest being neck pain, low back pain, shoulder problems, hayfever, knee osteoarthritis, and migraine. An overall improvement of 73% was obtained with 61% classified as ‘significant improvement’ or ‘cure’. Amongst the adverse effects recorded, retained needles and forgotten patients have been the most concerning and have led to changes in practice following ‘critical incident’ meetings.
The Reliable Measurement of Radial Pulse Characteristics
Authors: King Emma , Cobbin Deirdre M , Walsh Sean , Ryan Damien
Published: April 2009

The use of the radial pulse as a diagnostic tool is an integral part of the Traditional Chinese Medicine (TCM) patient evaluation. In spite of its long history of use, there is little systematic information available to support the many claims about the relationship between pulse qualities and physiological condition contained in the ancient Chinese texts and echoed in modern pulse terminology. This study reports the development of a reliable means of measuring and recording pulse characteristics. This was achieved by reporting on the physical sensations that are detected under the fingertips when the radial pulse is palpated, rather than attempting to translate these into the complex and typically ambiguously defined TCM pulse qualities. The study involved development of a standardised pulse taking procedure and development of concrete operational definitions for each of the characteristics of the pulse being measured. The inter-rater reliability of the pulse taking procedure and operational definitions was assessed by determining agreement levels between two independent pulse assessors for each characteristic. Inter-rater agreement averaged 80% between the two assessors in both the initial data collection (66 subjects) and in a replication collection (30 subjects) completed two months later. Demonstrating reliability of the procedure represents an essential first step for examining the validity of TCM pulse diagnosis assumptions.
Acupuncture for Tennis Elbow: An E-Mail Consensus Study to Define a Standardised Treatment in a Gps— Surgery
Authors: Webster-Harrison Philip , White Adrian , Rae Jonny
Published: April 2009

Acupuncture is a possible alternative treatment for tennis elbow in general practice. Rigorous investigation of its effectiveness is needed by means of a randomised controlled trial. Before undertaking a trial, a consensus is required on the best treatment protocol. Therefore, a modified Delphi Process was undertaken by email, consisting in three iterative rounds. Fourteen acupuncture trainers initially reported details of their normal treatment that were then incorporated into a treatment plan. This was circulated once for further suggestions and finally for agreement. Consensus was achieved from all 14 participants who responded to the third round.
Acupuncture Treatment of Pain Dysfunction Syndrome after Dental Extraction
Authors: Rosted Palle , Jørgensen Viggo
Published: April 2009

A successful treatment with acupuncture of a patient with Pain Dysfunction Syndrome is presented. The patient developed restricted mouth opening after removal of a third molar in the lower jaw. Despite orthodox treatment no improvement was noticed after three months, and his general practitioner was contacted. After two acupuncture sessions the patient felt normal and the jaw movement was within the normal range. A follow-up four weeks after the first treatment showed a further increase in the jaw movement. If restricted movement in the temporomandibular joint occurs after operative procedures in the mouth, acupuncture should be considered at an early stage.
Acupuncture for Soft Tissue Shoulder Disorders: A Series of 201 Cases
Authors: Guerra Juan , Bassas Elena , Andres Maria , Verdugo Francisco , Gonzalez Maria
Published: April 2009

A retrospective observational study was performed on shoulder pain cases seen in a community general practice. Two hundred and one patients were treated with acupuncture (on distant points plus local shoulder points), moxibustion and auriculotherapy. Data was retrieved from records over a three-year period to assess the effect of acupuncture and moxibustion on pain, mobility and disability, and to compare perceived efficacy rates with published reports from Chinese acupuncturists. Using a four-point outcome scale in this series of 201 patients the study found: one patient (0.5%) reported no improvement, 12 (6%) simple improvement, 68 (33.8%) remarkable improvement, and 120 (59.7%) clinical resolution. Only two patients left the programme. In conclusion, treatment of soft tissue shoulder disorders with acupuncture and moxibustion in this series seems to have good clinical results in diminishing symptoms, shortening disease duration time and improving functional ability, even in long-lasting disease (up to 10 years). A combination of distant points plus local points, moxibustion and auriculotherapy seems to increase effectiveness, reduce the number of sessions per patient, and increase the time between sessions, suiting the needs of patients and those of a busy National Health Service clinic. The authors report results similar to those reported by Chinese acupuncturists when using similar diagnostic procedures, techniques, outcome measures and patients. This case series is the first step towards conducting a randomised controlled trial (RCT) of acupuncture efficacy in shoulder pain. Such trials are needed to confirm the perceived efficacy of acupuncture from observational studies.
Preparing a Poster
Authors: White Adrian , White Leon
Published: April 2009

Well prepared posters are an effective means to communicate a simple message and stimulate discussion. A good poster requires considerable effort in identifying the vital ingredients and rejecting any superfluous material. The conventional structure for papers and abstracts is a suitable basis for posters on many subjects, with modification if necessary. Suitable topics include clinical trials, surveys, qualitative studies and case reports. Suggestions are made for contents that should be considered for each section. Careful planning of size, shape, flow and content will save time in preparation, and several technical graphical points are made, which may improve the attractiveness and readability of the poster.
The Effects of Electroacupuncture on Peripheral Nerve Regeneration in Rats
Authors: Inoue Motohiro , Hojo Tatsuya , Yano Tadashi , Katsumi Yasukazu
Published: April 2009

This study was designed to examine the effects of electroacupuncture with direct current (DC) on peripheral nerve regeneration. The left sciatic nerve of 55 7-month-old rats was crushed at the thigh. They were ramdomly allocated to four groups: distal cathode DC group (n=15), distal anode DC group (n=14), sham operated group (n=13), and control group (n=13). In the distal cathode DC group, a cathode electrode was connected to an insulated acupuncture needle inserted at 1 cm distal to the injured site, while an anode electrode was connected to a needle inserted at 1 cm proximal to the lesion. In the distal anode DC group, the anode and the cathode electrode were connected to the needle at 1cm distal and proximal to the lesion respectively. In the sham operated group, no electrical stimulation was given to the insulated needle inserted at the same site, and in the control group, no treatment was given. Regeneration of the sciatic nerve was evaluated by the number of evoked EMGs recorded at 12 sites in the plantar region, by their latency, and by the weight ratio of the tibialis anterior at four weeks after the crush injury. Regeneration of the peripheral nerve was faster and more accelerated in the distal cathode DC group than in the other groups, while in the distal anode DC group the regeneration was delayed. This result suggested electroacupuncture with cathode distal orientation might be a useful treatment having the advantage of enabling deeper insertion with minimal tissue damage.
Superficial Dry Needling and Active Stretching in the Treatment of Myofascial Pain – a Randomised Controlled Trial
Authors: Edwards Janet , Knowles Nicola
Published: April 2009

A pragmatic, single blind, randomised, controlled trial was conducted to test the hypothesis that superficial dry needling (SDN) together with active stretching is more effective than stretching alone, or no treatment, in deactivating trigger points (TrPs) and reducing myofascial pain.

Forty patients with musculoskeletal pain, referred by GPs for physiotherapy, fulfilled inclusion / exclusion criteria for active TrPs. Subjects were randomised into three groups: group 1 (n=14) received superficial dry needling (SDN) and active stretching exercises (G1); group 2 (n=13) received stretching exercises alone (G2); and group 3 (n=13) were no treatment controls (G3). During the three-week intervention period for G1 and G2, the number of treatments varied according to the severity of the condition and subject/clinician availability. Assessment was carried out pre-intervention (M1), post-intervention (M2), and at a three-week follow up (M3). Outcome measures were the Short Form McGill Pain Questionnaire (SFMPQ) and Pressure Pain Threshold (PPT) of the primary TrP, using a Fischer algometer. Ninety-one per cent of assessments were blind to grouping.

At M2 there were no significant inter-group differences, but at M3, G1 demonstrated significantly improved SFMPQ versus G3 (p=0.043) and significantly improved PPT versus G2 (p=0.011). There were no differences between G2 and G3. The mean PPT and SFMPQ scores correlated significantly in G1 only, though no significant inter-group differences were demonstrated. Numbers of patients requiring further treatment following the trial were: 6 (G1); 12 (G2); 9 (G3). Conclusion: SDN followed by active stretching is more effective than stretching alone in deactivating TrPs (reducing their sensitivity to pressure), and more effective than no treatment in reducing subjective pain. Stretching without prior deactivation may increase TrP sensitivity.
Anatomy for the Acupuncturist – Facts & Fiction 3: Upper & Lower Extremity
Authors: Peuker Elmar , Cummings Mike
Published: April 2009

Anatomy knowledge, and the skill to apply it, is arguably the most important facet of safe and competent acupuncture practice. The authors believe that an acupuncturist should always know where the tip of their needle lies with respect to the relevant anatomy so that vital structures can be avoided and so that the intended target for stimulation can be reached. This article describes the anatomy of the upper limb and shoulder girdle, and lower limb and pelvis, relevant to safe needling practice.
Acupuncture for Chronic Venous Ulceration
Authors: Mears Tim
Published: April 2009

Acupuncture was used to treat a 69-year-old man for bilateral ankle pain related to his rheumatoid arthritis. This led to a dramatic improvement in one of his chronic venous leg ulcers. There is very little recent literature on such cases, where acupuncture may be a useful additional treatment.
The Development of the Mymop Pictorial Version
Authors: Day Anthony
Published: April 2009

The MYMOP is a well accepted quality of life instrument that is particularly suitable for assessing the effect of complementary therapies; however, some groups of patients find it difficult to use. A pictorial version was developed using faces instead of the numerical rating scale – it is called MYMOP pictorial. This version appears to be more acceptable to patients but has not been formally validated.
The Use of Acupuncture and Attitudes to Regulation among Doctors in the Uk – a Survey
Authors: Price Julian , White Adrian
Published: April 2009

Objective

To assess the usage of acupuncture by members of British Medical Acupuncture Society (BMAS) in their daily work, in the course of a survey of attitudes to regulation of the acupuncture profession.

Methods

A brief questionnaire survey of all members was conducted in December 2002.

Results

After a single mailing, 1112 members responded (a response rate of 48%). Seventy-five percent of these were general practitioners. The majority were in support of a regulatory process. Ninety percent of respondents indicated that they use acupuncture in their practice, giving an average of about eight treatments per week. Sixty-one percent of these treatments are given within the National Health Service (NHS) at no cost to the patient.

Conclusion

It is estimated that BMAS members provide a total of about one million acupuncture treatments each year, of which well over half a million are given within the NHS.
Writing Case Reports – Author Guidelines for Acupuncture in Medicine
Authors: White Adrian
Published: April 2009

Case reports are particularly valuable in specialist clinical areas such as acupuncture to report new adverse events and to suggest possible new hypotheses. They can also be used to report events that have been reported previously but are rare or serious, in order to illustrate their frequency. They may illuminate the wider side of clinical practice by describing personal experiences of one practitioner. Constraints to writing case reports include finding time, working in isolation, and not having enough experience at the task. This article reproduces and develops a set of guidelines that were previously published, in an attempt to help authors to write thorough but succinct reports in a structured manner. The format for case reports includes an abstract, description of the case, literature search, discussion and summary or conclusions. Recommendations are made for the material to be included in each section. The policy of Acupuncture in Medicine is to require patient consent before accepting a report for publication.
Low Back Pain Assessment for the Medical Acupuncturist
Authors: Cummings Mike
Published: April 2009

Low back pain frequently presents to medical acupuncturists, many of whom are general practitioners working in the public sector. Under these circumstances there is often limited time to devote to an initial assessment of a patient's presenting complaint. This paper presents an assessment process that is aimed at informing management decisions for medical acupuncturists, although much of the process may be useful to a wider range of practitioners. The assessment is divided into an initial screening procedure, and a further more detailed assessment. The initial screening procedure can usefully be applied in a brief consultation. Using this assessment tool, practitioners with medical acupuncture training will be able to select the cases most likely to be helped by their acupuncture skills.
Back Pain – An Integrated Approach in Primary Care
Authors: Watkin Hywel
Published: April 2009

Back pain is common, and although many cases remit quickly, a significant number also continue a relapsing course over many months and years. Psychosocial factors have a significant influence on the condition. The evidence from clinical trials of the effectiveness of various therapies is available in summarised form in several resources, though is often inconclusive. There is good evidence that acute back pain should be managed by staying active and using non-steroidal anti-inflammatory and analgesic drugs, adding cognitive behaviour therapy for subacute pain. For chronic back pain, exercise, pain management programmes, non-steroidal anti-inflammatory and analgesic drugs, and trigger point and ligament injections are also recommended. There appears to be increasing evidence in favour of the use of acupuncture. Acupuncture appears to be useful to treat back pain, but patients should probably be advised to take advantage of any pain relief obtained to maintain or increase their activity. Acupuncturists must be aware of the psychosocial dimensions of back pain, as well as the physical ones, and should be careful to educate their patients about the condition and not make them become dependent on acupuncture to treat every acute episode.
A Case Report of Postulated ‘barré LiéOu Syndrome—
Authors: Longbottom Jennie
Published: April 2009

The case history presented is of a 32 year old woman suffering with severe occipital and bilateral temporal pain together with autonomic disturbances affecting her vision, balance and breathing, symptoms which have been postulated as ‘Barré Liéou syndrome’. She complained of pain referred to the left arm and associated circulatory and sensory disturbance in keeping with the diagnosis of complex regional pain syndrome type I. Traditional Chinese and Western trigger point acupuncture techniques were used in order to treat her pain and autonomic dysfunction. Acupuncture was successful in reducing, but not totally alleviating, her pain, and was particularly effective in reducing the majority of autonomic symptoms.
A Review of Myofascial Pain and Fibromyalgia – Factors that Promote Their Persistence
Authors: Gerwin Robert D
Published: April 2009

Chronic muscle pain (myalgia) is a common problem throughout the world. Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain. The two common muscle pain conditions are fibromyalgia and myofascial pain syndrome. Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis. Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle. The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying cause(s) of persistent or chronic muscle pain in order to develop a specific treatment plan. Chronic myalgia may not improve until the underlying precipitating or perpetuating factor(s) are themselves managed. Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypomobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency. Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition.
Acupuncture for Treatment of the Yips? - a Case Report
Authors: Rosted Palle
Published: April 2009

A 65 year old golfer with the yips was treated with acupuncture at GV20, EX-HN-1 ( Si Shen Cong) and TE5. The symptoms disappeared after one treatment and no relapse has occurred in the 24 months’ follow up. Although it cannot be determined whether the effect in this case occurred from neurological stimulation or was the result of expectation, acupuncture may be worth trying in patients with the yips since this condition is otherwise difficult to treat.
The Use of Acupuncture in the Treatment of Temporomandibular Dysfunction – An Audit
Authors: Rosted Palle , Bundgaard Mads , Pedersen Anne Marie Lynge
Published: April 2009

Objective

Temporomandibular dysfunction often represents a major therapeutic problem in a dental practice. Evidence from clinical studies suggests that acupuncture may be useful in the treatment of temporomandibular dysfunction. However, most studies have been performed in university settings. The aims of this study were to determine if the results of acupuncture treatment of temporomandibular dysfunction in general dental practice are comparable to the results obtained in previous studies in university clinics, and whether the treatment approach differs from that used in previous studies.

Methods

The case reports submitted by 15 dentists applying for the diploma of the British Dental Acupuncture Society were combined into one audit. All dentists were informed before submitting the forms that the data might be used for scientific purposes. The criteria for Pain Syndrome Dysfunction were used as inclusion criteria. A visual analogue scale (VAS) was used to assess the pain intensity before and after acupuncture treatment. The acupuncture points and technique used were recorded for each treatment.

Results

A total number of 70 case reports were received. Ten patients were excluded, as they did not fulfil the criteria. The remaining 60 patients (50 female) fulfilled an average of 3.2 of the Pain Syndrome Dysfunction criteria, out of a possible five. Their mean age was 40.6 years (range 14–68). The average duration of temporomandibular dysfunction was 32 months (range 1–180). The patients received a mean of 3.4 treatments, each treatment lasting on average 12 minutes. The dentists used only manual stimulation, and mainly acupuncture points over the temporomandibular joint and in the masticatory muscles, points on the neck, and additional relaxing points. The mean pain scores were 7.35 (SD 1.52) before treatment and 2.67 (SD 0.58) after treatment (P<0.001). A beneficial effect was observed in 85% with an average reduction in the pain intensity of 75%.

Conclusion

This audit shows that the results of using acupuncture in the treatment of temporomandibular dysfunction in a general dental practice are comparable to those obtained in clinical studies in university settings. Also the therapeutic approach of using acupuncture is similar. Thus, acupuncture is a simple, relatively safe and potentially efficacious and useful technique in the management of temporomandibular dysfunction in a general dental practice.
Acupuncture Treatment for Chemotherapy-Induced Peripheral Neuropathy – a Case Series
Authors: Wong Raimond , Sagar Stephen
Published: April 2009

Chemotherapy induced peripheral neuropathy (CIPN) occurs in 10 to 20% of cancer patients treated with neurotoxic chemotherapy. A mixture of sensory, sensorimotor and autonomic nervous system dysfunction can occur, resulting in deterioration in function and worsened quality of life. A major feature is discomfort and pain. Early termination of treatment and dose reduction of chemotherapy may be necessary. The clinical course is variable and depends on the chemotherapy agents and their cumulative dose. Although symptoms can resolve completely, in most patients CIPN is either only partially reversible or completely irreversible. Current management for CIPN is symptomatic using membrane stabilising medications and antidepressants. The use of nerve growth factors is still experimental.

Dysaesthesia and pain involving the feet and hands are described in both traditional Chinese medicine (TCM) and Western biomedicine. In TCM, the pathogenesis is related to the inability to direct Qi and Blood to the extremities, and is associated with Qi, Blood, Yang and Kidney deficiencies. Acupuncture is moderately effective in treating diabetic neuropathy. However, to date, there is no report of the usefulness of acupuncture for CIPN.

We report the result of a pilot prospective case series of five patients treated with an acupuncture protocol that aims to correct Qi, Blood and Yang deficiencies and directs Qi and Blood to the extremities, with the goal of improving the symptoms of CIPN. The responses were encouraging, and cannot be easily explained by the known neurophysiological mechanisms of acupuncture.
Point Specificity of Acupuncture in the Light of Recent Clinical and Imaging Studies
Authors: Campbell Anthony
Published: April 2009

One fundamental question that is still not resolved is whether acupuncture needles must be inserted in specific points to have their greatest effects. In the majority of large RCTs recently conducted in Germany, acupuncture was significantly more effective than doing nothing but not than sham acupuncture. Only for one study of chronic knee pain was acupuncture superior to sham. Brain imaging with functional magnetic resonance (fMRI) and positron emission tomography (PET) may be helpful but is still in its early stages. Several studies have shown differences between the way the deep central areas of the brain respond to genuine acupuncture compared with sham. Acupuncture can clearly produce complex changes that are relevant to pain transmission and perception, though it is still uncertain how specific these are. Similar changes have been seen after the application of placebo cream and after hypnosis. A previous paper discussed the likely central role of the limbic system in acupuncture, evidenced by euphoria and out of body experiences. There may be a good deal of common ground between acupuncture, placebo treatments, hypnosis, and even manipulative treatments. This understanding could offer a way out of the sterile debate about whether acupuncture is merely a placebo: acupuncture could be one effective way of stimulating responses within these deep areas of the brain, though not the only way.
Acupuncture for Central Pain Affecting the Ribcage following Traumatic Brain Injury and Rib Fractures – a Case Report
Authors: Donnellan Clare P
Published: April 2009

This case report describes the use of acupuncture in the management of chronic central pain in a 51 year old man following severe traumatic brain injury and multiple injuries including rib fractures. The patient reported rapid and significant improvements in pain and mood during a course of acupuncture treatment. Chronic pain following traumatic brain injury is a significant problem. Chronic pain after rib fractures is also commonly reported. Acupuncture is widely used in the management of pain but its use has been reported rarely in the traumatic brain injury literature. This case report suggests that acupuncture may be a useful option to consider in these patients. Outcome was assessed formally using a 0 10 verbal numerical rating scale for pain, and the Hospital Anxiety and Depression Scale (HADS) for psychological status before and after the course of treatment. These scales are widely used in clinical practice as well as in research involving patients with traumatic brain injury, although they have not been validated in this population. The changes in this patient's outcome scores were not consistent with the benefits he reported. Treatment of this patient highlighted the difficulties of using standardised self rating scales for patients with cognitive impairment. The report also discusses the effects of acupuncture on this patient's mood.
Safety of Acupuncture for Osteoarthritis of the Knee – a Review of Randomised Controlled Trials, Focusing on Specific Reactions to Acupuncture
Authors: Yamashita Hitoshi , Masuyama Shoko , Otsuki Kuniharu , Tsukayama Hitoshi
Published: April 2009

In order to assess how many reported adverse reactions to acupuncture are truly associated with the physiological mechanisms of acupuncture, we performed a literature review of published RCTs of acupuncture for osteoarthritis of the knee. We searched for reports of RCTs using two data sources: PubMed and Japana Centra Revuo Medicina (Igaku Chuo Zasshi). Of the twelve RCTs located, seven included information on adverse events. No serious adverse events were reported. Joint swelling, local inflammation, haematoma and back pain occurred more frequently in the dummy electroacupuncture or minimal acupuncture group. We confirmed the possibility that many adverse reactions to acupuncture treatment reported in RCTs, at least for the knee OA, are non-specific, and that not all reported events should be attributed to the mechanism of action of acupuncture. It is likely this is also true for RCTs of acupuncture in other conditions, and for prospective surveys on adverse events of acupuncture.