Acupuncture Reduces Pain, Need For
Opioids After Surgery (Oct 18, 07)
Acupuncture Eases Low Back
Pain (Sept 24, 07)
Chinese Herbs Ease Menstrual
Cramps Better than NSAIDs (OCT 17, 07)
Acupuncture Relieves Pain &
Improves Function in Knee Osteoarthritis (Dec 20, 04)
Blood-Pressure Changes With Acupuncture (June 7, 07)
Acupuncture Reduces Pain, Need For
Opioids After Surgery
ScienceDaily (Oct. 18, 2007) — Using acupuncture
before and during surgery significantly reduces the level of
pain and the amount of potent painkillers needed by patients
after the surgery is over, according to Duke University
Medical Center anesthesiologists who combined data from 15
small randomized acupuncture clinical trials.
"While the amount of opioids needed
for patients who received acupuncture was much lower than
those who did not have acupuncture, the most important
outcome for the patient is the reduction of the side effects
associated with opioids," said Tong Joo (T.J.) Gan, M.D., a
Duke anesthesiologist who presented the results of the
analysis at the annual scientific conference of the American
Society for Anesthesiology in San Francisco. "These side
effects can negatively impact a patient's recovery from
surgery and lengthen the time spent in the hospital."
Based on the results of this
analysis, Gan recommends that acupuncture should be
considered a viable option for pain control in surgery
Patients who received acupuncture
had significantly lower risk of developing most common side
effects associated with opioid drugs compared with control:
1.5 times lower rates of nausea, 1.3 times fewer incidences
of severe itching, 1.6 times fewer reports of dizziness and
3.5 times fewer cases of urinary retention.
Opioids are a class of medications
that act on the body much like morphine. While they are
effective in controlling pain, the side effects of the drugs
often influence a patient's recovery from, and satisfaction
with, their surgery, Gan said.
The results of this study add to the
growing body of evidence that acupuncture can play an
effective role in improving the quality of the surgical
experience, Gan added. Numerous studies, some conducted by
Gan, have demonstrated that acupuncture can also be more
effective than current medications in lessening the
occurrence of post operative nausea and vomiting, the most
common side effect experienced by patients after surgery.
"Acupuncture is slowly becoming more
accepted by American physicians, but it is still
underutilized," Gan said. "Studies like this, which show
that there is a benefit to using it, should help give
physicians sitting on the fence the data they need to
integrate acupuncture into their routine care of surgery
Acupuncture has the added benefits
of being inexpensive, with virtually no side effects, when
done by properly trained personnel, Gan added.
The Chinese have been using
acupuncture for more than 5,000 years for the treatment of a
variety of ailments, including headaches, gastrointestinal
disorders and arthritis. According to Chinese healing
practices, there are about 360 specific points along 14
different lines, or meridians, that course throughout the
body just under the skin.
"The Chinese believe that our vital
energy, known as chi, flows throughout the body along these
meridians," Gan explained. "While healthiness is a state
where the chi is in balance, unhealthiness or disease state
arises from either too much or too little chi, or a blockage
in the flow of the chi."
Different bodily locations or organs
have their own distinct acupuncture points that are the
targets for the acupuncturist. For example, a point just
below the wrist is the common target for women undergoing
breast procedures to prevent nausea and vomiting, another
point at the back of the hand is effective in reducing pain.
While it is not completely known why
or how acupuncture works, recent research seems to point to
its ability to stimulate the release of hormones or the
body's own painkillers, known as endorphins, Gan said. He is
now conducting studies to determine the exact mechanism
behind acupuncture's effects.
Other members of the research team
included Yanxia Sun, John Dubose and Ashraf Habib. The
meta-analysis was supported by Duke's Department of
Adapted from materials provided
Duke University Medical Center.
Study: Acupuncture Eases Low
Patients Report More Pain
Relief From Acupuncture Than Conventional Treatment
Sept. 24, 2007 -- Acupuncture
proved to be more effective than conventional lower back
pain treatments in a new study, but it was no more
effective than a sham needle procedure.
The German study compared outcomes among 1,162 patients
with chronic low back pain treated with traditional
Chinese acupuncture; sham acupuncture; or a conventional
approach to treating back pain using drugs, physical
therapy, and exercise.
The study is the largest
investigation of acupuncture vs. conventional
nonsurgical treatment for lower back pain ever reported,
"Acupuncture represents a highly
promising and effective treatment option for chronic
back pain," researcher Heinz Endres, MD, tells WebMD.
"Patients experienced not only reduced pain intensity,
but also reported improvements in the disability that
often results from back pain -- and therefore in their
quality of life."
Endres says up to 85% of people
will suffer from low back pain at some point in their
lives. The pain may last for a few days or continue as
chronic low back pain for months and years.
While a recent review of
research showed acupuncture to be useful for the
treatment of low back pain when given in addition to
other therapies, the latest study was designed to
determine if acupuncture is an effective treatment on
Acupuncture was delivered in 10,
30-minute sessions conducted over six weeks. Patients
who received conventional treatments had a similar
number of total treatments, which included exercise,
pain medication, and nonsteroidal anti-inflammatory
The acupuncture groups were
allowed to use medication for acute episodes of back
pain only. This consisted of NSAID use no more than two
days a week during the treatment period.
Traditional acupuncture involved
inserting needles at fixed points and depths on the body
and manipulating the needles in accordance with ancient
With the sham treatment, needles
were inserted in the lower back at shallower depths at
non-acupuncture points and the needles were not
Patients who got the traditional
and sham acupuncture treatments were almost twice as
likely to report treatment-related responses six months
later as patients who did not have acupuncture.
Responses were defined as a 33%
improvement in pain or a 12% improvement in functional
"Because acupuncture has a low
risk of side effects and few contraindications, it
should be added to the catalogue of treatments
recommended for acute and chronic back pain, even though
-- just as for any other form of treatment -- there will
always be some patients who do not respond," Endres
Several earlier studies
involving patients with chronic pain have shown similar
benefits for traditional and sham acupuncture.
A 2005 analysis of 33 back pain
studies did show a treatment advantage for traditional
acupuncture, but a researcher involved in the analysis
says more recent studies challenge this finding.
"The evidence as a whole
suggests that the benefits of true acupuncture over sham
acupuncture are almost clinically irrelevant," Eric
Manheimer, MS, of the University of Maryland Center for
Integrative Medicine tells WebMD. "The reasons for this
are not really clear. It may be that putting the needles
anywhere stimulates some sort of analgesic effect."
Acupuncture is still considered
an alternative treatment for low back pain in the U.S.,
but this is no longer the case in Germany. Based on
findings from the newly reported study, it is now
covered by state health insurance.
Endres says acupuncture is a
clearly useful treatment for low back pain, even if we
don't understand why.
"Just because we cannot explain
exactly the mechanism by which a treatment works,
doesn't mean that it doesn't work," he says.
SOURCES: Haake, M.
Archives of Internal Medicine, Sept. 24, 2007;
vol 167: pp 1892-1899. Heinz G. Endres, MD, Eric
Manheimer, MS, research associate, Center for
Integrative Medicine, University of Maryland School
of Medicine, College Park.
© 2007 WebMD, Inc. All rights
Chinese Herbs Ease
Menstrual Cramps Better than NSAIDs
SYDNEY, Australia, Oct. 17
-- Traditional Chinese remedies may ease painful
menstrual cramps better than nonsteroidal anti-inflammatories
(NSAIDs) and other drugs, according to a Cochrane
Chinese herbal medicine for
primary dysmenorrhea roughly doubled pain relief and
improvement in overall symptoms compared with
conventional Western pharmaceuticals, reported
Xiaoshu Zhu, M.Med., of the Chinese Medicine Program
at the University of Western Sydney here, and
colleagues in the fourth issue for 2007 of The
The herbal remedies were
also significantly better at relieving painful
cramps and other symptoms than acupuncture or a hot
water bottle, with overall promising findings, they
"However, the small number
and the low quality of included studies did not
allow for any definite conclusion for their use in
clinical practice," Zhu and colleagues wrote.
Herbal medicine has been
used for centuries in China and continues to be used
in public hospitals there to treat primary
dysmenorrhea, whereas Western medicine has relied on
pharmaceutical treatment, such as NSAIDs and the
contraceptive pill, they said.
But, "more women are looking
for non-drug therapies," they added, particularly
those women who have a contraindication for or
cannot tolerate these drugs.
So, the researchers
conducted a systematic review and identified 39
randomized controlled trials of Chinese herbal
medicine with a total of 3,475 women treated for
self-reported primary dysmenorrhea.
All of the trials were of
parallel design. One trial each was conducted in
Taiwan, Japan, and the Netherlands, while the rest
were done in China.
The majority of trials used
complicated herbal formulas with more than five of
six herbs, most commonly including Danggui (Chinese
angelica root), Chuanxiong (Szechuan lovage root),
Chishao (red peony root), and Baishao (white peony
root), in a traditional cooked decoction.
These herbs could affect
hormones and microcirculation hemorrheology, the
Herbal interventions were
usually started five to seven days before
menstruation and continued for about 10 to 15 days
-- until the first or second day of menstruation or
Most trials compared one
herbal medicine with another (18 trials) or with
conventional therapy, such as NSAIDs or oral
contraceptives (14 trials).
Three trials compared
Chinese herbal medicine with placebo, one compared
it with no treatment, two compared it with
acupuncture, and one compared it with heat
For reduction in pain, the
Chinese herbs overall,
whether standardized or tailored, yielded better
pain relief than conventional pharmaceutical
therapies (RR 1.99, 95% CI 1.52 to 2.60)
typically for up to three months of follow-up.
Chinese herbal medicine
relieved pain significantly better than
over-the-counter herbal health products (RR
2.06, 95% CI 1.80 to 2.36).
Chinese herbal medicine
improved pain significantly better than
acupuncture (RR 1.75, 95% CI 1.09 to 2.82).
No consistent advantage
was seen for acupuncture in the
placebo-controlled trials, which could not be
Chinese herbs beat heat
compression using a hot water bottle (RR 32.08,
95% CI 2.06 to 499.18).
For symptom reduction, the
findings were similar and included:
Chinese herbal medicine
was significantly better than placebo in the one
trial that reported this outcome (RR 5.59, 95%
CI 0.32 to 97.87).
improved more with Chinese herbal medicine than
with conventional pharmaceutical therapy, which
was sustained through three months of follow-up
(RR 2.17, 95% CI 1.73 to 2.73).
Chinese herbal medicine
was significantly better than over-the-counter
herbal medicine through up to three months of
follow-up (RR 1.99, 95% CI 1.65 to 2.40).
Chinese herbal medications
were also associated with less frequent need of
additional medication compared with Western
pharmaceutical therapy (RR 1.58, 95% CI 1.30 to
tailored Chinese herbal formulations were
significantly better than commonly used
over-the-counter herbal health products on several
measures, Zhu and colleagues said their review could
not explicitly answer if one was more beneficial.
No significant adverse
effects were identified in the studies, but "the
safety of Chinese herbal medicine in clinical
practice was not addressed adequately in the
reviewed trials," they said. Measurement and
reporting of adverse effects was poor, and only two
trials had adequate overall methodological quality.
"An attempt towards
evidence-based Chinese medicine practice has been
made," the investigators concluded. "However, more
research trials with high quality design --
especially in terms of laboratory tests -- are
The review was
supported by the University of Western
Sydney and the Cochrane Menstrual Disorders
and Subfertility Group. Zhu reported having
recently completed a trial of Chinese herbal
medicine to treat primary dysmenorrhea.
Additional Alternative Medicine Coverage
Primary source: Cochrane
Database of Systematic Reviews
Zhu X, et al
"Chinese herbal medicine for primary dysmenorrhoea"
Cochrane Database of Systematic Reviews 2007;3:
Acupuncture Relieves Pain and
Improves Function in Knee Osteoarthritis
Advisory (Dec 20, 2004)
Acupuncture provides pain relief
and improves function for people with osteoarthritis of
the knee and serves as an effective complement to
standard care. This landmark study was funded by the
National Center for Complementary and Alternative
Medicine (NCCAM) and the National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), both
components of the National Institutes of Health. The
findings of the study--the longest and largest
randomized, controlled phase III clinical trial of
acupuncture ever conducted--were published in the
December 21, 2004, issue of the Annals of Internal
The multi-site study team,
including rheumatologists and licensed acupuncturists,
enrolled 570 patients, aged 50 or older with
osteoarthritis of the knee. Participants had significant
pain in their knee the month before joining the study,
but had never experienced acupuncture, had not had knee
surgery in the previous 6 months, and had not used
steroid or similar injections. Participants were
randomly assigned to receive one of three treatments:
acupuncture, sham acupuncture, or participation in a
control group that followed the Arthritis Foundation's
self-help course for managing their condition. Patients
continued to receive standard medical care from their
primary physicians, including anti-inflammatory
medications, such as COX-2 selective inhibitors,
non-steroidal anti-inflammatory drugs, and opioid pain
"For the first time, a clinical
trial with sufficient rigor, size, and duration has
shown that acupuncture reduces the pain and functional
impairment of osteoarthritis of the knee," said Stephen
E. Straus, M.D., NCCAM Director. "These results also
indicate that acupuncture can serve as an effective
addition to a standard regimen of care and improve
quality of life for knee osteoarthritis sufferers. NCCAM
has been building a portfolio of basic and clinical
research that is now revealing the power and promise of
applying stringent research methods to ancient practices
"More than 20 million Americans
have osteoarthritis. This disease is one of the most
frequent causes of physical disability among adults,"
said Stephen I. Katz, M.D., Ph.D., NIAMS Director.
"Thus, seeking an effective means of decreasing
osteoarthritis pain and increasing function is of
During the course of the study,
led by Brian M. Berman, M.D., Director of the Center for
Integrative Medicine and Professor of Family Medicine at
the University of Maryland School of Medicine,
Baltimore, Maryland, 190 patients received true
acupuncture and 191 patients received sham acupuncture
for 24 treatment sessions over 26 weeks. Sham
acupuncture is a procedure designed to prevent patients
from being able to detect if needles are actually
inserted at treatment points. In both the sham and true
acupuncture procedures, a screen prevented patients from
seeing the knee treatment area and learning which
treatment they received. In the education control group,
189 participants attended six, 2-hour group sessions
over 12 weeks based on the Arthritis Foundation's
Arthritis Self-Help Course, a proven, effective model.
On joining the study, patients'
pain and knee function were assessed using standard
arthritis research survey instruments and measurement
tools, such as the Western Ontario McMasters
Osteoarthritis Index (WOMAC). Patients' progress was
assessed at 4, 8, 14, and 26 weeks. By week 8,
participants receiving acupuncture were showing a
significant increase in function and by week 14 a
significant decrease in pain, compared with the sham and
control groups. These results, shown by declining scores
on the WOMAC index, held through week 26. Overall, those
who received acupuncture had a 40 percent decrease in
pain and a nearly 40 percent improvement in function
compared to baseline assessments.
"This trial, which builds upon
our previous NCCAM-funded research, establishes that
acupuncture is an effective complement to conventional
arthritis treatment and can be successfully employed as
part of a multidisciplinary approach to treating the
symptoms of osteoarthritis," said Dr. Berman.
Acupuncture--the practice of
inserting thin needles into specific body points to
improve health and well-being--originated in China more
than 2,000 years ago. In 2002, acupuncture was used by
an estimated 2.1 million U.S. adults, according to the
Centers for Disease Control and Prevention's 2002
National Health Interview Survey.2
The acupuncture technique that has been most studied
scientifically involves penetrating the skin with thin,
solid, metallic needles that are manipulated by the
hands or by electrical stimulation. In recent years,
scientific inquiry has begun to shed more light on
acupuncture's possible mechanisms and potential
benefits, especially in treating painful conditions such
Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC.
Effectiveness of Acupuncture as Adjunctive Therapy in
Osteoarthritis of the Knee: A Randomized, Controlled
Trial. Annals of Internal Medicine. 2004;
Powell-Griner E, McFann K, Nahin R. CDC Advance Data
Report #343. Complementary and Alternative Medicine
Use Among Adults: United States, 2002. May 27, 2004.
National Center for Complementary and Alternative
Medicine (NCCAM) is dedicated to exploring complementary
and alternative medical (CAM) practices in the context
of rigorous science, training CAM researchers, and
disseminating authoritative information to the public
and professionals. For additional information, call
NCCAM's Clearinghouse toll free at 1-888-644-6226, or
visit the NCCAM Web site at
mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) is to support
research into the causes, treatment, and prevention of
arthritis and musculoskeletal and skin diseases, the
training of basic and clinical scientists to carry out
this research, and the dissemination of information on
research progress in these diseases. For additional
information, call NIAMS's Clearinghouse toll free at
1-877-22-NIAMS, or visit the NIAMS Web site at
Blood-Pressure Changes With Acupuncture Comparable to
Heartwire — a professional news service of WebMD
June 7, 2007 (Erlangen, Germany)
- A study billed as the first rigorous, randomized trial in the
West to test acupuncture against a sham needle technique to
treat hypertension suggests that, performed properly,
acupuncture may produce blood-pressure changes on a par with
monotherapy in mild to moderate hypertension .
"It's certainly not like a wonder drug;
it's not a massive effect, but it's a clear effect," lead
investigator Dr Frank A Flachskampf (Universitätsklinikum
Erlangen, Germany) told heartwire.
Smaller randomized trials have been
performed in China, with mixed results, while one randomized
study in the West found no difference in blood-pressure lowering
between traditional Chinese acupuncture, standardized
acupuncture, and a sham procedure, the authors note. This
earlier study did not use ambulatory blood-pressure
measurements, believed to be superior to office-based
Results of their study are published
online June 4, 2007 in Circulation.
For the study, 160 outpatients with
uncomplicated, mild to moderate hypertension were randomized to
six weeks of acupuncture performed by Chinese medicine
practitioners, trained in China, or to a sham procedure. In both
arms, patients underwent 22 sessions, each 30 minutes in length.
By the end of the six weeks, 24-hour ambulatory systolic and
diastolic blood pressures were significantly reduced from
baseline in the acupuncture-treated patients (5.4 mm Hg and 3.0
mm Hg, respectively), and this change was also significantly
different from values in the sham-treated patients, in whom no
meaningful changes were seen.
After three and six months, however, the
blood-pressure reductions disappeared, leading investigators to
conclude that ongoing acupuncture treatments would be required
to maintain the blood-pressure reductions.
"The main finding is that for the first
time in a reasonably sized but still relatively small randomized
study, this establishes beyond a reasonable doubt that
acupuncture lowers blood pressure," Flachskampf commented. "It's
a modest but undeniable effect on both systolic and diastolic
The extent of the blood-pressure
reductions are comparable to those seen with ACE-inhibitor
monotherapy or aggressive lifestyle changes, including radical
salt restrictions, he added.
A "demanding" alternative to drugs
Flachskampf had some caveats,
acknowledging that the regular acupuncture sessions used in the
study represent a significant time investment: each acupuncture
session lasted 30 minutes--not including transportation and
administrative time--and took place several times a week. The
study subjects were also reasonably healthy, with no other major
risk factors and with only mild to moderate hypertension.
"This is clearly something that would
probably not work as well with very sick people or people with
blood pressure at dangerous levels," he said. "We cannot easily
extrapolate to people, for example, with complicated
hypertension who have had a myocardial infarction."
Flachskampf believes, however, that
acupuncture likely represents an attractive option in specific
patients, particularly those averse to taking medical therapy
who are open to so-called "alternative" medicine.
"This is probably only for people who
somehow relate to this spiritually, who say I am profoundly
against taking drugs and I'm very fond of Oriental wisdom or
things like that," Flachskampf told heartwire. "I
don't want to make a joke about this, but this certainly needs
more compliance than taking two or three pills a day. It's much
Unlike drugs, acupuncture appeared to
have few or no side effects, although two people complained that
the needles were painful. "Clearly, many millions of Chinese get
acupuncture without any major problems so I think this is really
a minor point," Flachskampf observed.
Gallasch J, Gefeller O, et al. Randomized trial of
acupuncture to lower blood pressure. Circulation
2007; DOI: 10.1161/CIRCULATIONAHA.106.661140. Available at:
complete contents of
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can be found at
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