bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Programme for the Evaluation of Patient Care with Acupuncture (Pep-Ac) – a Project Sponsored by Ten German Social Health Insurance Funds
Authors: Linde Klaus , Streng Andrea , Hoppe Andrea , Jürgens Susanne , Weidenhammer Wolfgang , Melchart Dieter 
Published: April 2009

Objective The aim of the Programme for the Evaluation of Patient care with Acupuncture (PEP-Ac) was to investigate the efficacy, effectiveness and safety of acupuncture in patients with the following three indications: chronic headache, chronic low back pain and chronic osteoarthritic pain. This article provides an overview of the results of the whole programme. Methods The programme included five randomised trials, a large observational study, a survey of physicians providing acupuncture, and three systematic reviews. Results The results show that, for all three indications, acupuncture, when compared to no treatment, produces a clear benefit that lasts for at least several months. However the effects of point-specific acupuncture only offered a significant advantage over minimal acupuncture in the treatment of OA knee. Conclusions The evidence from these trials – on the one hand, a clear overall effect of acupuncture and on the other hand, the lack of evidence supporting its superiority over sham acupuncture for all indications except osteoarthritis of the knee – leaves a considerable amount of room for interpretation.
Some of the Effects of Acupuncture in Knee Pain May be Due to Activation of the Reward System
Authors: Lundeberg Thomas 
Published: April 2009

Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiologic effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Also, insertion of needles into the body can stimulate effects not dependent on the locations of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and an increased feeling of wellbeing. One area in the brain that is affected by acupuncture stimulation is the limbic system. The limbic system consists of a group of brain structures, including the hippocampus, amygdala, and their interconnections, and connections with the hypothalamus, septal area, and portions of the tegmentum. It contains many of the centres related to emotion and reward. The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered to be part of its antinociceptive effects. It has previously been reported that physical exercise and electroacupuncture in animals result in modulation of the peptidergic content in limbic structures. These results are supported by recent animal studies in Japan that have clearly demonstrated that acupuncture results in the activation of the reward system. These findings are supported by positron emission tomography studies in patients, which showed that the insula ipsilateral to the site of needling was activated, as well as the dorsolateral prefrontal cortex, the anterior cingulate and the midbrain. Taken together, these results suggest that acupuncture, as well as the patient's expectation and belief regarding a potentially beneficial treatment, modulate activity in the reward system.
Acupuncture for Anxiety and Anxiety Disorders – a Systematic Literature Review
Authors: Pilkington Karen , Kirkwood Graham , Rampes Hagen , Cummings Mike , Richardson Janet 
Published: April 2009

Introduction The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research. Methods Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes. Results Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed. Conclusions Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.
Acupuncture as a Potential Treatment for Non-Cardiac Chest Pain – a Survey
Authors: MacPherson Hugh , Dumville Jo C 
Published: April 2009

Objective To establish the level of interest in acupuncture as a treatment option for non-cardiac chest pain and to identify the factors associated with this interest. Background Non-cardiac chest pain is known to be a prevalent condition in the general population. Treatment options are limited. Given that acupuncture has a potential role in the treatment of chronic pain, this study was designed to establish the levels of interest in acupuncture among people with continuing non-cardiac chest pain. Methods This small study formed part of a larger retrospective cohort study, and was conducted with all 235 people who were given a diagnosis of non-cardiac chest pain at the Rapid Access Chest Pain Unit in York within a 14 month period. We collected data on whether people continued to experience chest pain, and if so, whether they had considered, or would consider, acupuncture as a treatment. We used ordinal logistic regression to investigate potential covariates, including sex and age, that might be associated with this interest. Results In total, 161 (69%) participants returned questionnaires, 75 (47%) of whom were experiencing continued chest pain with a median duration of 5.4 months. Of these participants, 42% reported that they would consider acupuncture, 36% reported that they would not, and 22% did not know. In the ordinal regression model, we found no covariates significantly associated with the strength of participants’ interest in acupuncture. Conclusion People with continuing non-cardiac chest pain after attending a Rapid Access Chest Pain Unit have shown considerable interest in acupuncture as a primary care treatment option.
Effectiveness of Acupuncture and Related Techniques in Treating Non-Oncological Pain in Primary Healthcare – An Audit
Authors: Vas Jorge , Aguilar Inmaculada , Perea-Milla Emilio , Méndez Camila 
Published: April 2009

Background Pain is one of the principal symptoms for which the general public seeks medical attention, and it is frequently treated by GPs. Although acupuncture is mainly practised in the private field, it enjoys growing acceptance in the public system too, which helps bring down the high cost of its use. The aim of the present study is to evaluate the effectiveness of acupuncture and related techniques in treating non-oncological pain during nine years of activity at the Pain Treatment Unit (PTU) within the Andalusian Public Health System (Spain) in the field of primary healthcare. Methods Retrospective review of 5981 electronically stored case histories of patients who sought treatment for non-oncological pain and were seen at the PTU between June 1997 and July 2006. We excluded from this review those patients who had on any occasion been recruited for clinical trials at the PTU. The primary result measure applied was the success rate, defined as an improvement of least 50% on the Global Assessment Index, which is made up of five variables: pain intensity, as measured on a numerical scale of 0–10, pain frequency, consumption of analgesics, level of incapacity and sleep disorders caused by pain (the latter four variables were measured on a 5-point Likert scale of 0–4). Results The majority (84.5%) of the patients treated were women, with a mean age of 58.8 years (range 8–93), and they attended the healthcare clinic because of pain present for over three months (88.8%) and mainly affecting the lower back (58.8%). In the 5690 patients who completed treatment, the mean success rate was 79.7%, with highest rates (93%) being achieved in patients with cephalalgia. The mean reduction in pain intensity was 5.5 (SD 2.5) points amounting to 67% fall from the baseline. There was a reduction of ¢7.1 in the mean weekly expenditure on analgesics per patient. From the regression model, we conclude that the patients who suffered acute or sub-acute pain presented higher success rates than did those with chronic pain (OR, 1.94; 95% CI, 1.53–2.48). Conclusions Acupuncture seems to be effective in treating musculoskeletal pain, and presents no severe adverse events. With acupuncture treatment, the consumption of analgesic and anti-inflammatory drugs is considerably reduced.
Acupuncture in the Treatment of Fibromyalgia in Tertiary Care – a Case Series
Authors: Duncan Barbara , White Adrian , Rahman Anisur 
Published: April 2009

Aims Fibromyalgia is a common cause of chronic widespread pain. The benefit of medication is often limited by its side effects, and the improvements obtained with exercise and education are inconsistent. Many patients seek acupuncture treatment, which is reported to be helpful in some cases. This study aimed to explore the acceptability and benefits of acupuncture offered in the setting of a tertiary referral clinic. Methods An open, uncontrolled observational study was conducted among patients who met the usual fibromyalgia criteria and who had a pain score of at least 30 on a 100mm Visual Analogue Scale (VAS). Patients were allowed to continue other treatments but not to introduce new ones. Acupuncture was given using a Western approach according to a protocol developed by consensus. Patients were offered eight treatments in eight weeks. Outcome measures included VAS of pain intensity and Fibromyalgia Impact Questionnaire (range 0 – 100), and were taken before and after treatment, and at 14, 20 and 34 weeks from enrolment. Results Twenty four eligible patients were enrolled in a 12 month period. Baseline mean pain VAS score for these 24 patients was 74 (SD 18) and mean Fibromyalgia Impact Questionnaire score 78 (SD 12.4). Only 14 patients completed the course of treatment within about 10 weeks. Compliance was poor in the remaining patients because of difficulty attending clinic, and in two cases because of exacerbation of pain. Completion of outcome measures was variable and therefore the analysis of data is limited. Five patients scored at least 20% reduction in Fibromyalgia Impact Questionnaire score which is a clinically relevant improvement. Two of these scored at least 50% reduction. Conclusion Acupuncture appears to offer symptomatic improvement to some patients with fibromyalgia in a tertiary clinic who have failed to respond to other treatments. In view of its safety, further acupuncture research is justified in this population.
De Qi: Chinese Acupuncture Patients' Experiences and Beliefs regarding Acupuncture Needling Sensation – An Exploratory Survey
Authors: Mao Jun J , Farrar John T , Armstrong Katrina , Donahue Alethea , Ngo Jessica , Bowman Marjorie A 
Published: April 2009

Introduction While de qi, the acupuncture needling sensation, has been considered as an important component of acupuncture, little is known of the acupuncture patient's experience and beliefs about de qi in clinical settings. The aim of this study was to describe Chinese acupuncture patients’ perceived sensations of, and beliefs about, acupuncture needling. Methods We developed a questionnaire and conducted a survey study at two time periods among 200 subjects at six outpatient acupuncture clinics in Beijing, China. Results Respondents were 55% female and had a mean age of 41 years. The most common types of needling sensations reported by subjects were the terms ‘distended’(94%), ‘sore’(81%), ‘electric’(81%) and ‘numb’ (78%). Eighty-nine percent of subjects reported that the needling sensation travelled away from the puncturing points or travelled among the needling points. Eighty-two percent of subjects believed that the needling sensation was very important for acupuncture treatment, and 68% further indicated that the stronger the needling sensation, the more effective the therapy. Eighty-one percent of subjects found the acupuncture process to be very comfortable and relaxing. Conclusion Chinese acupuncture patients described the common characteristics of de qi and its migratory nature. The sensations were believed to be important in producing clinical efficacy by most patients. Measuring the sensations described as de qi in future prospective studies will help us understand the degree to which this phenomenon has an effect on the physiological outcome and clinical response to acupuncture. There appears to be a limit to the number of sensations that can be discriminated by each individual patient, and further development of the questionnaire is planned.
Analgesic Effects of Indirect Moxibustion on An Experimental Rat Model of Osteoarthritis in the Knee
Authors: Uryu Noriko , Okada Kaoru , Kawakita Kenji 
Published: April 2009

Aims The analgesic effects of moxibustion on an experimental model of osteoarthritis of the knee were investigated. Methods Male Wistar rats (n= 36,296–421g) were used. Intra-articular injection of mono-iodoacetic acid (MIA) was performed to induce knee osteoarthritis. Indirect moxibustion was applied to the lateral aspect of the knee joint every other day for 28 days (14 treatments). Weight bearing of the hind legs was measured directly by the downward pressure applied to footplates, using an Incapacitance Tester. Morphine was injected for testing the validity of weight bearing as a pain measure, and naloxone was used to examine the participation of endogenous opioids in the mechanism of moxibustion analgesia. Data were analysed by calculating the area under the curve. Results Injection of MIA significantly reduced weight bearing. No analgesic effects of moxibustion were observed during the initial 7 days (unpaired t test, P=0.83). Continued moxibustion treatments increased weight bearing at the 14th day significantly, and this effect continued until the end of the experiment on the 28th day (P<0.05). A single moxibustion treatment had no immediate effect on weight bearing. The analgesia due to the cumulative effect of moxibustion was antagonised by naloxone injection. Morphine injection in control MIA injected rats increased weight bearing to the normal range, confirming the validity of the measurements. Conclusion These results highlight the importance of repeated moxibustion treatments for pain relief in experimental knee osteoarthritis and suggest the existence of sustained inhibitory modulation by endogenous opioids in the moxibustion group.
Did ‘the Princess on the Pea— Suffer from Fibromyalgia Syndrome?
Authors: Lundeberg Thomas , Lund Iréne 
Published: April 2009

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterised by central sensitisation resulting in hypersentivity of the skin and deeper tissues as well as fatigue. Possibly the princess in Hans Christian Andersen's ‘The Princess and the Pea’ suffered from FMS since chronic sleep disturbances are typical in FMS. These sleep disturbances have been attributed to a dysfunction in the systems regulating sleep and wakefulness resulting in loss of deep sleep. In addition, many patients with FMS experience cognitive dysfunction, characterised by impaired concentration and short term memory consolidation, a complaint also commonly reported in other sleep disorders. In recent reviews evaluating the efficacy of acupuncture in FMS it has been concluded that acupuncture has no specific effect. A prerequisite for this conclusion is that all the major symptoms in the syndrome have been assessed. However, previous studies have generally focused on the pain alleviating effect of acupuncture in FMS. We have observed that not only pain but also sleep and cognitive dysfunction may be ameliorated in response to acupuncture, suggesting that these variables should be taken into account when evaluating the effects of acupuncture in FMS. Furthermore, the results demonstrated great individual variability apart from the systematic effects related to the group, indicating that individually performed treatment strategies are required. Our suggestion is supported by experimental and clinical studies showing that acupuncture may affect in somnia and alertness, and that there may be neurophysiologic bases for these specific effects.
Surface Electrostimulation of Acupuncture Points for Sedation of Critically Ill Patients in the Intensive Care Unit – a Pilot Study
Authors: Nayak Sandeep , Wenstone Richard , Jones Andy , Nolan Jill , Strong Ann , Carson Jeff 
Published: April 2009

Background This is a pilot study to investigate the effects of electrostimulation of acupuncture points on sedation and the dose of sedatives in the Intensive Care Unit. Methods Electrostimulation of acupuncture points was performed on 12 critically ill patients requiring sedation for mechanical ventilation. Electrostimulation was applied by point surface electrodes at LI4, ST36, HT7 and LR3 points for 20 minutes every hour for 12 hours using dense dispersed mode with a current frequency of 10–100Hz and maximum intensity of 10mA. All patients were sedated with propofol and alfentanil as required. The dose of propofol was reduced by 10mg/hour provided the patient remained sedated according to our guidelines. Sedation and analgesia scores, dose of sedative and analgesics drugs, respiratory rate, heart rate, mean arterial blood pressure and compliance with the ventilator were recorded before electrostimulation of acupuncture points, and hourly thereafter for 12 hours. Results There was significant reduction in the median propofol consumption from 145mg/hour (range 30–250) to 15mg/hour (range 0–250) (P<0.05), without any significant change in sedation scores or analgesia scores. The haemodynamic and respiratory variables remained stable. All patients were compliant with the ventilator. Conclusion This pilot study showed significant reduction in the dose of propofol required for sedation in critically ill patients following surface electrostimulation of acupuncture points, without any adverse effects. A randomised controlled trial is warranted.
Acupuncture in the Rehabilitation of Women after Breast Cancer Surgery – a Case Series
Authors: Alem Michele , Gurgel Maria Salete Costa 
Published: April 2009

Objective To evaluate the effect of acupuncture on rehabilitation of motor function, reduction in lymphoedema and improvement in perceived heaviness and tightness in the arms of women who had undergone breast cancer surgery. Subjects and Methods Twenty nine women who had had mastectomy or segmentectomy with axillary dissection, presenting with lymphoedema and/or a decrease in movement amplitude of the upper limb ipsilateral to surgery were studied. The patients underwent 24 acupuncture sessions once a week from February to December 2004. The movement amplitude of shoulder flexion and abduction and circumferential measurements of the arm, forearm and wrist were evaluated before and after one, three and six months of treatment. Statistical analysis was performed by Friedman's test. Results Significant improvements in range of movement of shoulder flexion and abduction (P<0.001), degree of lymphoedema (P=0.016), and sense of heaviness and tightening (P<0.001) in the affected limb after six months of therapy were observed. For circumferential measurements of the arm, forearm and wrist, no significant improvement between the different periods of treatment was observed. Conclusions Acupuncture in rehabilitation after breast cancer surgery was shown to be associated with improvements in movement amplitude of the shoulder, symptoms of heaviness and tightness in the arm, and the degree of lymphoedema. However, controlled trials should be performed to ascertain whether the results were due to the natural history of the complaint or the acupuncture treatment.
A Placebo Acupuncture Needle with Potential for Double Blinding – a Validation Study
Authors: Takakura Nobuari , Yajima Hiroyoshi 
Published: April 2009

Background The double blind, non-penetrating placebo needle is effective in masking patients who are not informed that they may receive a placebo needle. In this study, we aimed to examine whether such needles are effective in masking subjects who have been so informed. Methods One hundred and fourteen informed, consenting, healthy volunteers were recruited. An experienced acupuncturist applied one of the following needle pairs – penetrating/non-penetrating, non-penetrating/non-penetrating, penetrating/penetrating – randomly at bilateral TE5 points in subjects who were informed that they would receive either a non-penetrating or a penetrating needle. After the application of a pair of needles, the subjects reported for each arm on whether they identified the needle as non-penetrating or penetrating. The patients also rated skin penetration/penetration-like pain and the deep dull pain ( de qi) associated with the needle application on a visual analogue scale (VAS). The chi squared goodness of fit test was used to determine the probability of the number of correctly and incorrectly identified needles. Statistical comparisons for VAS scores for skin penetration pain and de qi were made using Mann-Whitney's U test. Results Of the 114 non-penetrating needle applications, the subjects identified 64 incorrectly and 50 correctly, fitting a probability of 0.5 (χ2=1.72, P=0.19). Most interestingly, the subjects identified 36 (32%) of 114 penetrating needle applications incorrectly. Skin penetration/penetration-like pain and de qi scores did not differ significantly (P=0.87 and P=0.17, respectively) between the 114 non-penetrating and 114 penetrating needles. Conclusions The non-penetrating placebo needle was effective in masking fully informed subjects. When used together with the matched penetrating needle, it has potential for use in double blind (patient and practitioner blind) studies.