Researchers in China have been investigating the effect of acupuncture to the sacral vertebrae on the bladder function of rats.The mechanism of how acupuncture, or peripheral nerve stimulation, may affect bladder function has been unclear. This study, using urethane-anesthetized rats, investigated the effects of acupuncture stimulation of the sacral vertebrae on bladder activity and bladder activity-related neurons in and around Barrington’s nucleus. In 95 of 147 trials (64.6%), acupuncture stimulation of the sacral vertebrae for 1min suppressed bladder contraction. Acupuncture-induced suppression of bladder contraction was blocked by intraperitoneal injection of bicuculline.

The researchers report that acupuncture stimulation strongly affected bladder activity-related neurons, including those which fired only prior to the start of contraction, those whose firing was maintained during contraction, and those whose firing was strongly suppressed during contraction. All Type E1 neurons and most Type E2 neurons decreased firing when bladder activity was suppressed by acupuncture stimulation.

The researchers concluded that these findings suggest that acupuncture stimulation of the sacral vertebrae suppresses bladder contraction and changes the firing properties of bladder activity-related neurons in and around Barrington’s nucleus, and that these changes are mediated by GABAergic systems.

Full details here:

http://www.ncbi.nlm.nih.gov/pubmed/22001760

An article in today’s Guardian reports the conclusions of recent research showing that patients with lower back pain who had a 12 week course of yoga experienced greater mobility and pain relief than patients on current standard care. Benefits were also maintained even 9 months after the yoga was stopped, which could see yoga being recommended for patients with lower back pain and integrated into conventional care.

In the study, a group of 156 patients with chronic lower back pain were assigned to have the 75-minute yoga classes over 12 weeks, while a control group of 157 just saw their GPs. Participants filled in a 24-point questionnaire on whether their condition prevented them from doing everyday tasks. Those who did the yoga scored on average 2.17 points lower than those who did not. Three and nine months later, their scores were still 1.48 and 1.57 points lower respectively.

The National Institute of Health and Clinical Excellence (NICE) is the body in the UK which sets the guidelines on the recommendations for best treatment. Acupuncture for lower back pain is already recommended by NICE, and as a result I’m one of the acupuncturists working in conjunction with the NHS to deliver acupuncture to patients with chronic lower back pain through the Milton Keynes primary care trust pain clinic.

Yoga is something I frequently recommend to patients as an excellent practice for health, mental and physical well being, and physical flexibility, so it’s a great thing to see its benefits being more readily recognised through research.

The full story in The Guardian is here:

http://www.guardian.co.uk/science/2011/oct/31/yoga-lower-back-pain-treatments?fb=native&CMP=FBCNETTXT9038

A systematic review and meta analysis of the effect of Tai Chi on Osteoarthritis has concluded the results as “encouraging, and suggest that t’ai chi may be effective in controlling pain and improving physical function in patients with OA in the knee”.

The caveat is as always that due to the low level of RCT’s and risk of bias the evidence is limited, but it seems that since Tai Chi may confer significant other health benefits it could be a worthwhile exploration for patients seeking relief from this painful condition.

The researchers searched eleven databases from their inception to July 2010. Randomised controlled trials testing t’ai chi against any type of controls with OA localised in any joints were considered in the review. The meta-analysis suggested that t’ai chi has favourable effects on pain, physical function and joint stiffness.

Full details:

http://www.ncbi.nlm.nih.gov/pubmed/22021734

A group of researchers at the Institute of Integrated Traditional and Western Medicine at Tongji Hospital in China have conducted a trial to investigate whether obtaining de qi (the dull heavy feeling of adequate nerve stimulation) is a necessary component of the treatment effect in a group of patients receiving acupuncture for period pain.

The patients were randomly assigned to a group of acupuncture with manual manipulation and an acupuncture group without manipulation. Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment. De-qi, the sensations a patient experienced during the acupuncture treatment, was scored on a 4-point scale by the subjects. In addition, the psychological factors, including belief in acupuncture, the level of nervousness, anxiety, and depression, were quantitatively assessed.

Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity and pain duration between the two groups. The number of De-qi acupoints and the average intensity of De-qi  were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy.

The researchers concluded that compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture for period pain. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

Full report here:

http://www.ncbi.nlm.nih.gov/pubmed/21994026

Some of the best research and most knowledgeable insights in the field of acupuncture come from physiologist Thomas Lundeberg. It’s safe to say that he is perhaps the one scientist who has done the most research into the physiological mechanisms and effects of acupuncture, and his work is essential reading for anybody interested in a modern scientific interpretation of acupuncture as a treatment modality. I will be referring to many of his research papers on this blog and the one I’ll refer to today is a brief paper about gender differences among the acupuncture patient population.

It’s probably true that the majority of acupuncture clinics are populated by more women than men, and while there may be many socio psychological explanations for this, there appears to now be an increasing biological explanation too , and put simply it’s because women are in more pain, and possibly more biologically prone to it.

In this paper, Lundeberg et al refers to the fact that women are more likely to suffer from many painful syndromes such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. While folk wisdom often posits women have better pain tolerance levels than men due to the frequency of menstrual pain and childbirth, it seems research is proving that women have lower pain tolerance levels not higher. In the paper there are references as to how women frequently score lower than men in pain tolerance scores, and how this is also borne out in animal studies too which show female rats being more sensitive to noxious stimulation than their male counterparts. There is also the fascinating observation that due to the hormonal fluctuations of the menstrual cycle, many clinical trials for medications don’t use as many women as it’s simpler to study men. Trials using animals will also frequently use only male rats for the same reasons. The natural and startling conclusion of this is that many women may be using medicine’s that are actually not fully studied for their own gender. Some rather complex biological differences in what could account for the difference in pain processing between the sexes are discussed, and overall the paper is an interesting reminder that clinical trials have many individual variances to consider if their conclusions are to be reliable – Individuality being something clinical trials have great difficulty in being inclusive of. As I’ll comment frequently, it simply isn’t possible to study optimal, individualised acupuncture in the context of a randomised controlled trial, but understanding how we might get as close to it as possible, or at least perceiving the barriers to it  is a useful approach in understanding the virtues and limitations of how we gather information about acupuncture.

You can find Lundberg’s paper here:

http://thomaslundeberg.com/uploaded/dokument/publicerade_dokument/Lund%2008%20Is%20it%20all%20about%20sex.pdf

A new Cochrane review of acupuncture and acupressure for pain management in labour has come to the tentative conclusion that ‘acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management’ ; however they note as is so often the case, that there is a need for further research to confirm these findings.

In the review, 13 trials with data reporting on 1986 women were used. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention, one trial showed increased satisfaction with pain relief compared with placebo control; and reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (and compared with standard care).

Fewer instrumental deliveries from acupuncture were found compared with standard care, however there was significant heterogeneity. Pain intensity was reduced in the acupressure group compared with a placebo control and a combined control.

While the reviewers note there are potential areas of bias (quite possibly because acupuncture cannot be delivered ‘blind’) the preliminary evidence is encouraging.

Full details here:

http://www.ncbi.nlm.nih.gov/pubmed/21735441

In an interesting article published online in the New Scientist, writer Jo Marchant explores the evidence for looking at how our mental and emotional activity affects our physical health. While in Chinese medicine the mind body connection has been long established for thousands of years, it’s only relatively recently that western biomedicine has begun to escape the shackles of Descartes’ mistaken assertion that the two are separate, non interacting entities. Modern disciplines such as psychoneuroimmunology are showing us how our emotional life has distinct physiological correlates that  impact not only the quality of our lives, but also their length.

In this brief video, and in the associated article, Jo quotes evidence that shows that optimism and positivity reduces circulating levels of stress hormones like cortisol, and that optimists not only recover better from medical procedures such as coronary bypass surgery but also live longer when suffering from conditions such as cancer, heart disease and kidney failure. In general they are noted to have significantly healthier immune systems.

You’ll also find some interesting facts that people who see themselves in a positive light have lower cardiovascular responses to stress and recover faster as well as having lower baseline cortisol levels. There are also references to some fascinating research that showed that students suffering from exam anxiety showed lower levels of adrenaline in their urine on exam day when they were given creative writing tasks before hand that focussed on their own positive qualities…All fascinating stuff, so read, watch, and perhaps consider for yourself what one thing could you do, that would  positively impact how you view yourself and your life. Your organs will thank you for it.

Video: The healing power of the mind

Article: http://www.newscientist.com/article/mg21128271.700-heal-thyself-think-positive.html

As the saying in Chinese medicine goes, treating disease when it’s already begun is like rooting for water in a well when one is already thirsty, so where possible prevention of disease is always preferable to treating it when it’s arrived. In a similar vein, an interesting report in todays guardian shows that the conclusions from a 2 year study show that supplementation of vitamins B6, B12 and folic acid in medicinal quantities reduced the overall shrinkage of a persons brain by 30%, or at least in elderly patients with already existing cognitive impairment.

In the study 270 men and 70 women with mild cognitive impairment (a diagnosis of which leads 50% of patients to go on to develop Alzheimer’s) were studied. They were given higher than the recommended dosage of vitamins B6, B12 and folic acid which are thought to control levels of the amino acid homocysteine which is known to damage blood vessels and contribute to brain atrophy. A 30% reduction in brain shrinkage was observed but in patients who had the highest levels of homocysteine at the beginning of the study, a 50% reduction in shrinkage of the brain was observed.

It’s thought as we age we are less able to absorb B vitamins, and levels of homocysteine levels are also thought to rise with excessive alcohol consumption and poor dietary habits.

While the evidence is encouraging, the researchers warn the elderly against over consumption of supplements since folic acid has some potential to re-activate cancer cells, and to use vitamin supplementation after consultation with a doctor.

Full story here:

http://www.guardian.co.uk/science/2011/sep/13/b-vitamins-alzheimers

An interesting study has just been published through the Department of Economics at Tilburg University in The Netherlands about the cost effectiveness of complementary approaches to healthcare and the impact of their use on mortality rates.

Data was collected from the years 2006–2009 and 1913 conventional GP’s were compared with data from 79 GP’s using complementary approaches in addition to conventional healthcare. According to the researchers, patients whose GP had additional CAM training have 0-30% lower healthcare costs and mortality rates, depending on age groups and type of complementary medicine used. The lower costs resulted from fewer hospital stays and fewer prescription drugs.

As my previous blog entries have stated, I highlight complementary approaches as being just that – complementary and secondary rather than a primary means of dealing with healthcare, and so studies like this provide interesting reading in highlighting the potential inherent in using a number of different ideological approaches to dealing with patient care.

Full details here: http://www.ncbi.nlm.nih.gov/pubmed/21695547