This week's Acupuncture Abstracts from Medline

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Elden H, Hagberg H, Olsen MF, Ladfors L, Ostgaard HC. Regression of

pelvic girdle pain after delivery: follow-up of a randomised single

blind controlled trial with different treatment modalities. Acta

Obstet Gynecol Scand. 2008;87(2):201-8. Perinatal Center, Dept of

Obstetrics and Gynecology, Sahlgrenska Univ Hospital, Göteborg Univ,

Sweden. helen.elden OBJECTIVE: An earlier publication

showed that acupuncture and stabilising exercises as an adjunct to

standard treatment was effective for pelvic girdle pain during

pregnancy, but the post-pregnancy effects of these treatment

modalities are unknown. The aim of this follow-up study was to

describe regression of pelvic girdle pain after delivery in these

women. DESIGN: A randomised, single blind, controlled trial. SETTING:

East Hospital and 27 maternity care centres in Göteborg, Sweden.

POPULATION: Some 386 pregnant women with pelvic girdle pain. METHODS:

Participants were randomly assigned to standard treatment plus

acupuncture (n=125), standard treatment plus specific stabilising

exercises (n=131) or to standard treatment alone (n=130). MAIN

OUTCOME MEASURES: Primary outcome measures: pain intensity (Visual

Analogue Scale). Secondary outcome measure: assessment of the

severity of pelvic girdle pain by an independent examiner 12 weeks

after delivery. RESULTS: Approximately three-quarters of all the

women were free of pain 3 weeks after delivery. There were no

differences in recovery between the 3 treatment groups. According to

the detailed physical examination, pelvic girdle pain had resolved in

99% of the women 12 weeks after delivery. CONCLUSIONS: This study

shows that irrespective of treatment modality, regression of pelvic

girdle pain occurs in the great majority of women within 12 weeks

after delivery. PMID: 18231889 [PubMed - in process]

 

Itoh K, Kitakoji H. Acupuncture for chronic pain in Japan: a review.

Evid Based Complement Alternat Med. 2007 Dec;4(4):431-8. Dept of

Clinical Acupuncture and Moxibustion, Meiji Univ of Oriental

Medicine, Kyoto, Japan. Many Japanese reports of acupuncture and

moxibustion for chronic pain are not listed in medical databases such

as Medline. Therefore, they are not easily accessible to researchers

outside of Japan. To complement existing reviews of acupuncture and

moxibustion for chronic pain and to provide more detailed discussion

and analysis, we did a literature search using 'Igaku Chuo Zasshi

Wed' (Japana Centra Revuo Medicina) and 'Citation Information by

National Institute of Information' covering the period 1978-2006.

Original articles and case reports of acupuncture and moxibustion

treatment of chronic pain were included. Animal studies, surveys, and

news articles were excluded. Two independent reviewers extracted data

from located articles in a pre-defined structured way, and assessed

the likelihood of causality in each case. We located 57 papers

written in Japanese (20 full papers, 37 case reports). Conditions

examined were headache (12 trials), chronic low back pain (9 trials),

rheumatoid arthritis (8 trials), temporomandibular dysfunction (8

trials), katakori (8 trials) and others (12 trials). While 23 were

described as clinical control trials (CCTs), 11 employed a quasi-

random method. Applying the 5-point Jadad quality assessment scoring

system, the mean score was 1.5 +/- 1.3 (SD). Eleven (52%) of the CCTs

were conducted to determine a more effective procedure for

acupuncture; these compared a certain type of acupuncture with

another type of acupuncture or specific additional points. In

particular, the trigger point acupuncture was widely used to treat

chronic low back pain in Japan. Many reports of chronic pain

treatment by acupuncture and moxibustion are listed in Japanese

databases. From the data, we conclude that there is limited evidence

that acupuncture is more effective than no treatment, and

inconclusive evidence that trigger point acupuncture is more

effective than placebo, sham acupuncture or standard care. PMID:

18227910 [PubMed - in process]

 

Lee MS, Pittler MH, Shin BC, Kong JC, Ernst E. Bee Venom Acupuncture

for Musculoskeletal Pain: A Systematic Review. J Pain. 2008 Jan 26

[Epub ahead of print]. Complementary Medicine, Peninsula Medical

School, Universities of Exeter and Plymouth, Exeter, United Kingdom.

Bee venom (BV) acupuncture (BVA) involves injecting diluted BV into

acupoints and is used for arthritis, pain, and rheumatoid diseases.

The objective of this systematic review was to evaluate the evidence

for the effectiveness of BVA in the treatment of musculoskeletal

pain. Seventeen electronic databases were systematically searched up

to September 2007 with no language restrictions. All randomized

clinical trials (RCTs) of BVA for patients with musculoskeletal pain

were considered for inclusion if they included placebo controls or

were controlled against a comparator intervention. Methodology

quality was assessed and, where possible, statistical pooling of data

was performed. A total of 626 possibly relevant articles were

identified, of which 11 RCTs met our inclusion criteria. Four RCTs

that tested the effects of BVA plus classic acupuncture compared with

saline injection plus classic acupuncture were included in the main

meta-analysis. Pain was significantly lower with BVA plus classic

acupuncture than with saline injection plus classic acupuncture

(weighted mean difference: 100-mm visual analog scale, 14.0 mm, 95%

CI = 9.5-18.6, P < .001, n = 112; heterogeneity: tau(2) = 0, chi(2) =

1.92, P = .59, I(2) = 0%). Our results provide suggestive evidence

for the effectiveness of BVA in treating musculoskeletal pain.

However, the total number of RCTs included in the analysis and the

total sample size were too small to draw definitive conclusions.

Future RCTs should assess larger patient samples for longer treatment

periods and include appropriate controls. PERSPECTIVE: Bee venom

acupuncture involves injecting diluted BV into acupoints and is used

for arthritis, pain, and rheumatoid diseases. A meta-analysis

produced suggestive evidence for the effectiveness of BVA in

musculoskeletal pain management. However, primary data were scarce.

Future RCTs should assess larger patient samples for longer treatment

periods and include appropriate controls. PMID: 18226968 [PubMed - as

supplied by publisher]

 

Martensson L, Stener-Victorin E, Wallin G. Acupuncture versus

subcutaneous injections of sterile water as treatment for labour

pain. Acta Obstet Gynecol Scand. 2008;87(2):171-7. School of Life

Sciences, Univ of Skövde, Skövde, Sweden. lena.martensson

BACKGROUND: Two methods for pain relief and relaxation during labour

are sterile water injections and acupuncture. In several studies,

sterile water injections have been shown to provide good pain relief,

particularly for low back pain during labour. The acupuncture studies

for pain relief during labour are not as concordant. Therefore, the

aim of this study was to explore if there were any differences

between acupuncture and sterile water injections regarding pain

relief and relaxation during labour. METHODS: A randomised controlled

trial. Some 128 pregnant women at term were randomly assigned to

receive acupuncture (n=62) or sterile water injections (n=66). The

primary endpoint was to compare the differences between pre-treatment

pain levels and maximum pain in the 2 groups. RESULTS: The main

results of this study were that sterile water injections yielded

greater pain relief (p<0.001) during childbirth compared to

acupuncture. The secondary outcome showed that women in the sterile

water group had a higher degree of relaxation (p<0.001) compared to

the acupuncture group. The women's own assessment of the effects also

favoured sterile water injections (p<0.001). There were no

significant differences regarding requirements for additional pain

relief after treatment between the 2 groups. CONCLUSIONS: Women given

sterile water injection experience less labour pain compared to women

given acupuncture. PMID: 18231884 [PubMed - in process]

 

Tournaire M, Theau-Yonneau A. Complementary and alternative

approaches to pain relief during labor. Evid Based Complement

Alternat Med. 2007 Dec;4(4):409-17. Obstetrics and Gynecology Dept,

Saint Vincent de Paul Hospital, Univ of Paris, Paris, France. This

review evaluated the effect of complementary and alternative medicine

on pain during labor with conventional scientific methods using

electronic data bases through 2006 were used. Only randomized

controlled trials with outcome measures for labor pain were kept for

the conclusions. Many studies did not meet the scientific inclusion

criteria. According to the randomized control trials, we conclude

that for the decrease of labor pain and/or reduction of the need for

conventional analgesic methods: (i) There is an efficacy found for

acupressure and sterile water blocks. (ii) Most results favored some

efficacy for acupuncture and hydrotherapy. (iii) Studies for other

complementary or alternative therapies for labor pain control have

not shown their effectiveness. PMID: 18227907 [PubMed - in process]

 

Wang SM, Kain ZN, White P. Acupuncture analgesia: 1. The scientific

basis. Anesth Analg. 2008 Feb;106(2):602-10. Dept of Anesthesiology,

Yale School of Medicine, 333 Cedar St., New Haven, CT 06510, USA. shu-

ming.wang Acupuncture has been used in China and other Asian

countries for the past 3000 yr. Recently, this technique has been

gaining increased popularity among physicians and patients in the

United States. Even though acupuncture-induced analgesia is being

used in many pain management programs in the United States, the

mechanism of action remains unclear. Studies suggest that acupuncture

and related techniques trigger a sequence of events that include the

release of neurotransmitters, endogenous opioid-like substances, and

activation of c-fos within the central nervous system. Recent

developments in central nervous system imaging techniques allow

scientists to better evaluate the chain of events that occur after

acupuncture-induced stimulation. In this review article we examine

current biophysiological and imaging studies that explore the

mechanisms of acupuncture analgesia. PMID: 18227322 [PubMed - in

process]

 

Wang SM, Kain ZN, White PF. Acupuncture analgesia: 2. Clinical

considerations. Anesth Analg. 2008 Feb;106(2):611-21, table of

contents. Center for Advancement of Perioperative Health, Dept of

Anesthesiology, Yale School of Medicine, 333 Cedar St., New Haven, CT

06510, USA. shu-ming.wang BACKGROUND: Acupuncture and

related percutaneous neuromodulation therapies can be used to treat

patients with both acute and chronic pain. In this review, we

critically examined peer-reviewed clinical studies evaluating the

analgesic properties of acupuncture modalities. METHODS: Using Ovid

and published medical databases, we examined prospective, randomized,

sham-controlled clinical investigations involving the use of

acupuncture and related forms of acustimulation for the management of

pain. Case reports, case series, and cohort studies were not included

in this analysis. RESULTS: Peer-reviewed literature suggests that

acupuncture and other forms of acustimulation are effective in the

short-term management of low back pain, neck pain, and osteoarthritis

involving the knee. However, the literature also suggests that short-

term treatment with acupuncture does not result in long-term

benefits. Data regarding the efficacy of acupuncture for dental pain,

colonoscopy pain, and intraoperative analgesia are inconclusive.

Studies describing the use of acupuncture during labor suggest that

it may be useful during the early stages, but not throughout the

entire course of labor. Finally, the effects of acupuncture on

postoperative pain are inconclusive and are dependent on the timing

of the intervention and the patient's level of consciousness.

CONCLUSIONS: Current data regarding the clinical efficacy of

acupuncture and related techniques suggest that the benefits are

short-lasting. There remains a need for well designed, sham-

controlled clinical trials to evaluate the effect of these modalities

on clinically relevant outcome measures such as resumption of daily

normal activities when used in the management of acute and chronic

pain syndromes. PMID: 18227323 [PubMed - in process]

 

Weiss HR, Bohr S, Jahnke A, Pleines S. Acupuncture in the treatment

of scoliosis - a single blind controlled pilot study. Scoliosis. 2008

Jan 28;3(1):4 [Epub ahead of print]. Today, acupuncture therapy is

commonly used for pain control throughout the world, although the

putative mechanisms behind acupuncture are still unclear. A Pub Med

search for the key words " Acupuncture " and " Scoliosis " reveals 3

papers only, not containing any results of studies designed for the

treatment of scoliosis with the help of acupuncture. Because of this

lack of trials especially designed for the treatment of scoliosis

this pilot study has been performed. METHODS: 24 girls undergoing in-

patient rehabilitation, 14 - 16 years of age (at average 15,1 years,

SD 0,74) with the diagnosis of an Adolescent Idiopathic Scoliosis

(AIS) have agreed to take part in this controlled single blind

crossover study. Average Cobb angle was 33 degrees (SD 9,2) ranging

from 16 to 49 degrees. 10 of the girls had a thoracic, one a lumbar,

7 a double major and 6 a thoracolumbar curve pattern. The patients

have been scanned with the Formetric® surface topography

measurement system before and after lying on the left side [L],

before and after sham acupuncture and before and after real

acupuncture [R]. RESULTS: For the whole group of patients no

significant changes have been found during lying, sham acupuncture or

real acupuncture. There were no differences between the patient

groups with different curve pattern. In the explorative subgroup

analysis of patients with curvatures from 16 to 35 degrees, however

significant changes in surface rotation have been found after R

intervention as well as a strong difference in lateral deviation

while in the L or S intervention no real changes have been achieved.

CONCLUSIONS: One session with real (verum) acupuncture seems to have

an influence on the deformity of scoliosis patients with no more than

35 degrees. The findings during verum acupuncture clearly are

different to sham acupuncture or just lying, while in the whole group

of patients also including patients with curvatures of more than 35

degrees no obvious changes have been found. The results of this study

justify further investigation of the effect of acupuncture in the

treatment of patients with scoliosis. PMID: 18226193 [PubMed - as

supplied by publisher]

Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN.

Acupuncture in patients with dysmenorrhea: a randomized study on

clinical effectiveness and cost-effectiveness in usual care. Am J

Obstet Gynecol. 2008 Feb;198(2):166.e1-8. Institute for Social

Medicine, Epidemiology, and Health Economics, Charité Univ Medical

Center, Berlin, Germany. claudia.witt OBJECTIVE: To

investigate the clinical effectiveness and cost-effectiveness of

acupuncture in patients with dysmenorrhea. STUDY DESIGN: In a

randomized controlled trial plus non-randomized cohort, patients with

dysmenorrhea were randomized to acupuncture (15 sessions over three

months) or to a control group (no acupuncture). Patients who declined

randomization received acupuncture treatment. All subjects were

allowed to receive usual medical care. RESULTS: Of 649 women (mean

age 36.1 +/- 7.1 years), 201 were randomized. After three months, the

average pain intensity (NRS 0-10) was lower in the acupuncture

compared to the control group: 3.1 (95% CI 2.7; 3.6) vs. 5.4 (4.9;

5.9), difference -2.3 (-2.9; -1.6); P<.001. The acupuncture group had

better quality of life and higher costs. (overall ICER 3,011 euros

per QALY). CONCLUSION: Additional acupuncture in patients with

dysmenorrhea was associated with improvements in pain and quality of

life as compared to treatment with usual care alone and was cost-

effective within usual thresholds. PMID: 18226614 [PubMed - in

process]

Zhang RX, Li A, Liu B, Wang L, Xin J, Ren K, Qiao JT, Berman BM, Lao

L. Electroacupuncture attenuates bone cancer-induced hyperalgesia and

inhibits spinal preprodynorphin expression in a rat model. Eur J

Pain. 2008 Jan 21 [Epub ahead of print]. Center For Integrative

Medicine, School of Medicine, Univ of Maryland, HSF-2, Room S209, 20

Penn Street, Baltimore, MD 21201, USA. Cancer pain impairs the

quality of life of cancer patients, but opioid intervention can cause

significant side effects that further decrease quality of life.

Although electroacupuncture (EA) has been used to treat cancer pain,

its mechanisms are largely unknown. To examine its effects and

underlying mechanisms on cancer pain, we injected AT-3.1 prostate

cancer cells into the tibia to induce bone cancer in the male

Copenhagen rat. The resulting pain was treated with 10Hz/2mA/0.4ms

pulse EA for 30min daily at the point equivalent to the human

acupoint GB30 (Huantiao) between days 14 and 18 after the injection.

For sham control, EA needles were inserted into GB30 without

stimulation. Thermal hyperalgesia, a decrease in paw withdrawal

latency (PWL) to a noxious thermal stimulus, and mechanical

hyperalgesia, a decrease in paw withdrawal pressure threshold (PWPT),

was measured at baseline and 20min after the EA treatment.

Preprodynorphin mRNA and dynorphin were determined by RT-PCR and

immunohistochemistry, respectively. Thermal and mechanical

hyperalgesia developed ipsilaterally between days 12 and 18 after

cancer cell inoculation. EA significantly (P<0.05) attenuated this

hyperalgesia, as shown by increased PWL and PWPT, and inhibited up-

regulation of preprodynorphin mRNA and dynorphin compared to sham

control. Intrathecal injection of antiserum against dynorphin A (1-

17) also significantly inhibited the cancer-induced hyperalgesia.

These results suggest that EA alleviates bone cancer pain at least in

part by suppressing dynorphin expression, and they support the

clinical use of EA in the treatment of cancer pain. PMID: 18221900

[PubMed - as supplied by publisher]

Zheng LH, Sun H, Wang GN, Liang J, Wu HX. Effect of transcutaneous

electrical acupoint stimulation on nausea and vomiting induced by

patient controlled intravenous analgesia with Tramadol. Chin J Integr

Med. 2008 Jan 25 [Epub ahead of print]. Dept of Analgesia, the Tumor

Hospital Affiliated to Harbin Medical Univ, Harbin, (150081), China,

sjj1216zlh Objective: To observe the effect of transcutaneous

electrical acupoint stimulation (TEAS) on nausea and vomiting (N & V)

induced by patient controlled intravenous analgesia (PCIA) with

Tramadol. Methods: Sixty patients who were ready to receive scheduled

operation for tumor in the head-neck region and post-operation PCIA,

aged 9-65 years, with the physique grades I-II of ASA, were

randomized into two groups, A and B, 30 in each group. The pre-

operation medication, induction of analgesia and continuous

anesthesia used in the two groups were the same. TEAS on bilateral

Hegu (LI4) and Neiguan (PC6) points was intermittently applied to the

patients in group A starting from 0 min before analgesia induction to

h after operation, and the incidence and score of nausea and

vomiting, antiemetic used, visual analogue scores (VAS), and PCIA

pressing times in time segments (0-4, 4-8, 8-12 and 12-24 h after the

operation was finished) were determined. The same management was

applied to patients in Group B, with sham TEAS for control. Results:

The incidence and degree of N & V, as well as the number of patients

who needed remedial antiemetic in Group A were less than those in

Group B. The VAS score and PCIA pressing time were lower in Group A

than those in Group B in the corresponding time segments

respectively. Conclusion: TEAS could prevent N & V induced by PCIA with

Tramadol. PMID: 18219451 [PubMed - as supplied by publisher]

Best regards,