Traditional Acupuncturist (BSc hons, LicAc, MBAcC, Dip Tui na)
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Archive for the ‘Research’ Category
CGRP (Calcitonin gene related peptide) is a vasodilating peptide which when released by a nerve ending increases blood flow into tissues. The physiologist and acupuncturist Thomas Lundeberg has demonstrated previously that the sensory stimulation of acupuncture increases the levels of CGRP in the saliva of patients with xerostomia (dry mouth) and could be one of the factors that contribute to the effect of acupuncture.
In this recent piece, Swedish researchers have been investigating the effect of acupuncture for hot flushes and postulate that the heat loss experienced by some patients may be once again mediated by release of CGRP which is also a sweat gland activator as well as a potent vasodilator. It’s also known that CGRP is influenced by the body’s opioid system which acupuncture has been shown to affect. The research could be a further useful step in piecing together the complex physiological cascade that follows acupuncture stimulation, and more evidence of the ongoing efforts to reconceptualise acupuncture’s effects in terms of modern scientific theory. More details of the study can be found here
Incidentally this week also saw further positive research looking at acupuncture for relieving the side effects of radiation induced dry mouth in patients with cancer.
Researchers in China have been investigating the potential of acupuncture in relieving xerostomia (dry mouth) induced by head and neck radiation in cancer patients with nasopharyngeal carcinoma. Current standard care often offers little in relieving this simple but distressing symptom and this randomized controlled trial compared acupuncture with current treatment options.
The researchers note that xerostermia questionnaire scores for the acupuncture patients were statistically significantly lower than controls starting at 3 weeks through to 6 months. Regarding salivary flow, group differences emerged as early as 3 weeks and salivary flow rates were improved even at 6 months post treatment.
The researchers concluded acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life.
Full details of the research can be found here:
http://www.ncbi.nlm.nih.gov/pubmed/22072272
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:
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
In the August 2011 edition of Acupuncture in Medicine, the British Medical Journals’s title devoted to western medical acupuncture, a study carried out in Korea has demonstrated the differing effects of acupuncture on patients in different states of health.
Previous research has demonstrated that the effect of acupuncture is different in healthy volunteers than in patients who are symptomatic. In a study carried out at the department of Oriental Internal Medicine at Daejeon Hospital, researchers have demonstrated that although there is no difference between sham acupuncture and true acupuncture in healthy volunteers, when patients gastrointestinal function is impeded by administration of loperamide, true acupuncture has significant benefits of over sham on affecting intestinal function. The study provides further support to the idea that acupuncture stimulates homeostatic mechanisms via the autonomic nervous system. Among other things the study demonstrates the importance of understanding that the health of patients in acupuncture trials determines the results of the effects generated, and should always be a consideration in attempting to determine the effects of acupuncture in the setting of a clinical trial.
