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

By Marissa Grace Latin: Acus (needle) Punctura Values Assessment: Continuum……. Cognitive Objectives. List 3 stated benefits of acupuncture. Define sham acupuncture. Describe what Qi is. Identify the most significant adverse effect related to safety and explain what it was related to.

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

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

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

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

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

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

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

  7. Tools of the Tradehttp://www.lhasaoms.com/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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