By Marissa Grace Latin: Acus (needle) Punctura Values Assessment: Continuum……. - PowerPoint PPT Presentation

Latin: Acus (needle) Punctura

Values Assessment: Continuum…….

• 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.

• 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

Back Pain

Osteoarthirtis

Preop surgery pain

Addiction

Stroke

Headache

Menstrual Cramps

Tennis elbow

Fibromyalgia

Asthma

Carpal Tunnel

• Sham acupuncture
• Okibari - Japanese style
• Moxibustion
• Cupping
• Electroacupuncture (EA)

• 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

• 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

• 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

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

• Method
• 202 cases reported (40% from US) from 1965-1999,
• First hand reports included, case reports

• 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

• 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

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

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.

• 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

• 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

• 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.

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

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).

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)

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.

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.