COMBINE acupuncture with western medicine?

[Guest guest]

Hi All,

 

Do you COMBINE acupuncture with western medicine (especially steroid-

or NSAID- therapy)?

 

Some teachers and practitioners say that AP is less effective in

people or animals currently on steroid therapy, especially high-dose

steroids. In theory, exogenous steroids can inhibit adrenal release

of endogenous steroids. But some practitioners are not so sure that

steroids inhibit the clinical effects of AP.

 

Below are some recent abstracts that suggest a BENEFIT from combining

AP with steroids / NSAIDS.

 

What do you think?

 

Miller E, Maimon Y, Rosenblatt Y, Mendler A, Hasner A, Barad A, Amir

H, Dekel S, Lev-Ari S. Delayed Effect of AP Treatment in OA of the

Knee: A Blinded, Randomized, Controlled Trial. Evid Based Complement

Alternat Med. 2009 Jan 5. [Epub ahead of print] Unit of Complementary

Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv

64239, Israel. compmed To assess the efficacy in

providing improved function and pain relief by administering 8 weeks

of AP as adjunctive therapy to standard care in elderly patients with

OA of the knee. This randomized, controlled, blinded trial was

conducted on 55 patients with OA of the knee. Forty-one patients

completed the study (26 females, 15 males, mean age +/- SD 71.7 +/-

8.6 years). Patients were randomly divided into an intervention group

that received biweekly AP treatment (n = 28) and a control group that

received sham AP (n = 27), both in addition to standard therapy

[NSAIDS, cyclooxygenase-2 inhibitors, acetaminophen, intra-articular

hyaluronic acid and steroid injections]. Primary outcomes measures

were changes in the Knee Society Score (KSS) knee score and in KSS

function and pain ratings at therapy onset, at 8 weeks (closure of

study) and at 12 weeks (1 month after last treatment). Secondary

outcomes were patient satisfaction and validity of sham AP. There was

significant improvement in all three scores in both groups after 8

and 12 weeks compared with baseline (P<0.05). Significant differences

between the intervention and control groups in the KSS knee score (P

= 0.036) was apparent only after 12 weeks. Patient satisfaction was

higher in the intervention group. Adjunctive AP treatment seems to

provide added improvement to standard care in elderly patients with

OA of the knee. Future research should determine the optimal duration

of AP treatment in the context of OA. PMID: 19124552 [PubMed - as

supplied by publisher]

 

Qin XY, Li XX, Berghea F, Suteanu S. [Comparative study on Chinese

medicine and western medicine for treatment of osteoarthritis of the

knee in Caucasian patients] [Article in Chinese] Zhongguo Zhen Jiu.

2008 Jun;28(6):459-62. Xuanwu Hospital, Capital Medical University,

Beijing 100053, China. OBJECTIVE: To compare the efficacy, safety and

tolerability of different therapies in Caucasian patients with

osteoarthritis (QA) of the knee. METHODS: Seventy-five cases (90 knee

joints) of osteoarthritis were randomly divided into 3 groups,

western medicine (WM) group, TCM group, integrated TCM + WM group.

The WM group was treated with oral administration of Glucosamine

Sulfate, oral administration and external application of NSAID,

ultrasound physiotherapy, etc. The TCM group was treated with oral

administration of Juanbi Decoction, AP and moxibustion, cupping,

massage of acupoint and ear AP. The integrated TCM + WM group was

treated with oral administration of Glucosamine Sulfate, oral

administration and external application of non-steroid anti-

inflammatory agent, AP and moxibustion, cupping, massage of acupoint

and ear AP. The intensity of knee joint pain on walking, resting and

standing, the nocturnal pain, stiffness, the maximum walking distance

and the daily living ability were monitored after 30 days, 60 days

and 90 days of treatment. RESULTS: After 90 days of treatment, the

integrated TCM + WM group was better than other two groups in

improvement of percentages in self pain assessment with visual analog

scale (VAS), pain and stiffness measured by WOMAC scale, pain and

maximum walking distance measured by Lequesne scale (p <.05 or

p<.01). There were no significant differences in the therapeutic

effects between the TCM group and the WM group. All of these three

treatments were well tolerated, and no severe adverse events were

found. Combined TCM + WM treatment has rapid and definite therapeutic

effect in reducing pain and improving mobility of knee joints and

daily living ability in Caucasian patients of knee osteoarthritis.

PMID: 18630549 [PubMed - indexed for MEDLINE]

 

Wehling P, Reinecke J. [AP together with cytokine depressing herbs in

comparison to injection therapy with steroids in sciatic pain]

[Article in German] Schmerz. 1997 Jun 13;11(3):180-4. Praxis und

Klinik für Orthopädie und Neurochirurgie, Düsseldorf. Because of

their frequency and consequences sciatica remains a demanding

clinical entity with significant social and economical impact. There

is a high demand on therapeutic modalities, using folk medicine

methods in the treatment of orthopaedic diseases. No data is

available on the usefulness of methods like natural herbs in

combination with AP. Aim of our study was to present data on the

effect of AP and cytokine-inhibiting natural herbs in sciatic pain.

We compared these results with nerve root infiltration by local

anaesthetics and corticosteroids in our orthopaedic outpatient

clinic. MATERIALS AND RESULTS: 278 patients with chronic pain for at

least 3 months were observed. All three therapeutical modalities

showed improvement of pain scores. Best results were gained with

steroid injection ( n=26; 66% pain reduction), AP in combination with

herbs improved the pain in average of 62% ( n=230), whereas injection

with local anaesthetic had a pain reduction of 48% ( n=22). Sole

Mepivacain-HCl treatment had significant less pain reduction compared

to the other treatment modalities. AP in combination with herbs and

steroid nerve blocks appear to be an effective and thus recommendable

conservative therapy in cases of sciatic pain. Taking into account

that patients increasingly prefer ethnomedical modalities of

treatment our study gains importance for practising orthopaedists.

PMID: 12799820 [PubMed]

 

Yang JW, Jeong SM, Seo KM, Nam TC. Effects of corticosteroid and

Electro-AP on experimental spinal cord injury in dogs. J Vet Sci.

2003 Apr;4(1):97-101. College of Vet Med, Seoul National Univ, San 56-

1 Shillim 9-dong, Kwanak-gu, Seoul 151-742, Korea. The aim of this

study is to investigate the effects of Electro-AP (EAP),

corticosteroid and combination of two treatments on ambulatory

paresis due to spinal cord injury in dogs by comparing therapeutic

effects of EAP and corticosteroid. Spinal cord injury was induced in

20 healthy dogs (2.5-7 kg and 2-4 years) by foreign body insertion

which compressed about 25% of spinal cord. There was no conscious

proprioception, no extensor postural thrust and ambulatory. Dogs were

divided into four groups according to the treatment; corticosteroid

(Group A), EAP (Group B), corticosteroid and EAP (Group AB) and

control (Group C). Neurological examination was performed everyday to

evaluate the spinal cord dysfunction until motor functions were

returned to normal. Somatosensory evoked potentials (SEPs) were

measured for Aim and accurate evaluations. The latency in measured

potentials was converted into the velocity for the evaluation of

spinal cord dysfunctions. Pain perceptions were normal from pre-

operation to 5 weeks after operation. Recovery days of conscious

proprioception in groups A, B, AB and C were 21.2+/-8.5 days, 19.8+/-

4.3 days, 8.2+/-2.6 days and 46.6+/-3.7 days, respectively. Recovery

days of extensor postural thrust in Group A, Group B, Group AB and

Group C were 12.8+/-6.8 days, 13.8+/-4.8 days, 5.4+/-1.8 days and

38.2+/-4.2 days, respectively. There were no significant differences

between Group A and Group B. However, recovery days of Group AB was

significantly shorter than that of other groups and that of Group C

was significantly delayed (p<0.05). Conduction velocities of each

Group were significantly decreased after induction of spinal cord

injury on SEPs (p<0.05) and they showed a tendency to return to

normal when motor functions were recovered. Combination of

corticosteroid and EAP was the most therapeutically effective for

ambulatory paresis due to spinal cord injury in dogs. PMID: 12819372

[PubMed - indexed for MEDLINE]

 

Zhang RX, Lao L, Wang X, Ren K, Berman BB. Electro-AP combined with

indomethacin enhances antihyperalgesia in inflammatory rats.

Pharmacol Biochem Behav. 2004 Aug;78(4):793-7. Center for Integrative

Medicine, School of Medicine, Univ of Maryland, Baltimore, MD 21201,

USA. Our previous study showed that Electro-AP (EAP) significantly

attenuated hyperalgesia and inflammation. The present study is an

evaluation of the potential synergism of EAP and a subeffective

dosage of indomethacin (INDO) in a rat model. Inflammation and

hyperalgesia, manifesting as edema and decreased paw withdrawal

latency (PWL) to a noxious stimulus, were induced by injecting

complete Freund's adjuvant (CFA) subcutaneously into the plantar

surface of one hind paw of the rat. EAP treatments were given at GB30

immediately and 2 h post-CFA. INDO at 2 mg/kg was given

(intraperitoneally) 40 min before the second EAP. PWL and edema were

measured prior to CFA and 2.5 and 5 h post-CFA. EAP at 10 and 100 Hz

significantly inhibited CFA-induced hind paw hyperalgesia. Both low-

and high-frequency EAP combined with INDO enhanced antihyperalgesia

compared to each component alone, and 10 Hz but not 100 Hz EAP

significantly reduced CFA-induced hind paw edema. A combination of

low-frequency EAP and INDO did not show synergistic inhibitory

effects on edema. EAP combined with INDO synergistically inhibited

hyperalgesia and may be an improved treatment strategy for

inflammatory pain. Copyright 2004 Elsevier Inc. PMID: 15301937

[PubMed - indexed for MEDLINE]

 

 

 

Best regards,

 

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