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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
By Marissa Grace

Latin: Acus (needle) Punctura

Values Assessment: Continuum…….

cognitive objectives
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.
origins
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
stated benefits
N/V after chemotherapy

Back Pain

Osteoarthirtis

Preop surgery pain

Addiction

Stroke

Headache

Menstrual Cramps

Tennis elbow

Fibromyalgia

Asthma

Carpal Tunnel

Stated Benefits
techniques and practices
Techniques and Practices
  • Sham acupuncture
  • Okibari - Japanese style
  • Moxibustion
  • Cupping
  • Electroacupuncture (EA)
needles
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
traditional chinese medicine
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
traditional chinese medicine9
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
theory
Theory
  • Stimulation of the nervous system to release chemicals in the muscles, spinal cord, and brain.
    • Beta-endorphin
  • Analgesia.
  • Placebo effect.
slide11
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
slide12
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
slide13
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
slide14
Acupuncture for back pain: A meta-analysis of randomized controlled trials.Ernst, Arch of internal Med. 1998;158:20:2235-2241
slide15

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
slide16

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.
osteoarthritis
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
slide18
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
slide19
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.
slide21

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
slide22

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).
slide23

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)
slide24

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.
slide25

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.