Thyroid – Condition Information

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About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Resources:

British Acupuncture Council evidence based factsheet about Thyroid including specific research, trials and mechanisms of action for acupuncture in this condition.

References:

Helen
Posted on: Sep-30-2020 20:44 pm
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Chronic Pain

Acupuncture and Chronic Primary Pain: the new NICE guidelines

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You may have seen the recent press stories about acupuncture being one of the suggested treatments by NICE for the management of chronic primary pain.  This is an interesting headline and is in development, so we thought it would be useful to explain a bit more about what this means, and how it has come about.

What is NICE?

NICE is the NHS advisory body, which looks at the scientific evidence, cost and practicalities of treatment options for specific conditions, and produces guidelines for the NHS doctors and clinicians as to what they should prescribe, and/or where they should refer patients – to consultants or surgery for example.

What is chronic primary pain?

This is condition that is ongoing, and which isn’t caused by another diagnosis or condition.  It is difficult to treat, and can have a big impact on the lives of patients and their families, with many of them being unable to work, and half of them being diagnosed with depression. 

What has NICE said about acupuncture?

Chronic Primary Pain: NICE recommends acupuncture in new draft guidelines, Aug 2020

NICE has said that the emphasis needs to be shifted to place the patient at the centre of the care provision, and makes clear that there is a need to reduce the amount of opioid-based painkillers as a front-line treatment, shifting the long-term care focus toward including non-drug interventions, of which acupuncture is an important one.

NICE stated that commonly used painkilling drugs have little evidence to support their use, and that supervised exercise programmes (cardio, mind-body or a combination) and certain types of psychological therapy (CBT or Acceptance and Commitment Therapy), acupuncture, and some types of antidepressants are more suitable approaches.

What was the evidence for acupuncture?

27 studies showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture, and was cost-effective, and the quality of this evidence was considered robust enough by the NICE committee for them to recommend that the NHS should use it.

What sort of acupuncture?

The draft guidelines state that both Traditional acupuncture and western medical acupuncture are suitable for this, and that they wish this to be delivered in a community setting (i.e. not in hospital), and by a health practitioner lower than band 7 (i.e. not by a doctor).

What about other physical therapies?

Other manual therapies were not recommended as there was not enough evidence (e.g. osteopathy, chiropractic), and the researchers recommended further research.

What are the new NICE guidelines?

The formal NICE guidelines are set out in a format where they explain when each approach should be used, dosages or length of treatment for example, so it is likely that after these refinements we will know a bit more. They now, since 2021 include acupuncture, as follows:

1.2.5 Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system,

This is a very encouraging for the following reasons:

High level recognition form an influential health organisation informing NHS policy; the fact that as using a patient-centred approach is beneficial for patients and their families; demonstrates that the increasing, high-quality research evidence for acupuncture is able to support its effectiveness to an extent where the NHS recognise and adopt its usage.

Resources:

British Acupuncture Council Chronic Pain factsheet

References:

UK, N.G.C., 2021: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline [NG193]Published: 07 April 2021

Helen
Posted on: Aug-11-2020 19:57 pm
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Sinusitis – Condition Information

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There is a great deal of information about acupuncture and allergy, and allergic rhinitis, as well as cold and flu on our other pages.

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Reducing Inflammation and Nasal Congestion – Mechanisms of Action

Per MacDonald et al (2015), acupuncture may: reduce inflammation and nasal congestion by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.

Possible mechanisms of action in inflammation reduction

A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines.  The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”. 

Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states. 

Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:

  • Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
  • Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
  • Acupuncture may contribute to analgesia by stimulating the release of β-endorphin, which binds to opioid receptors and inhibits pain signals.
  • Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

McDonald et al (2013) reviewed the pathophysiology of acupuncture, as it had been shown to improve clinical outcomes by modulating immune response and reducing inflammation.  Per the review of RCTs, acupuncture down-regulated Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF); showing some of the means by which the anti-inflammatory effect occurs.

Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines.  They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis.  They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.

Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).

Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function).  Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.

Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Resources:

British Acupuncture Council evidence based factsheet about Sinusitis including specific research, trials and mechanisms of action for acupuncture in this condition.

BAcC evidence based Allergic Rhinitis Factsheet

References:

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007;  6:  251-7.

Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8.

Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.

McDonald, J.L., Cripps, A.W., Smith, P.K., Smith, C.A., Xue, C.C. and Golianu, B., 2013. The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based Complementary and Alternative Medicine, 2013.

McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.

Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.

Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.

Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.

Helen
Posted on: Jul-31-2020 20:23 pm
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Coronavirus Update

Coronavirus Update

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We’re open for practise with COVID-19 secure gudelines

We are now open for all treatments, in line with the British Acupuncture Council COVID-19 Secure Guidelines

Risk Assessment

We have undertaken a risk assessment on the premises and practise, and have made the necessary changes to mitigate and minimise all identified risks, as per BAcC and HSE and government guidelines.  The important aspects you need to be aware of, are as below.

The acupuncturist carries out a risk assessment regarding each patient, to ensure that attending in person is appropriate, as for example if you are shielding or in a high risk group, this still will not be possible for the time being.

Telephone triage/screening before you attend

Please also note that your practitioner will contact you on the day of treatment to check that you are not symptomatic of Covid-19, and other related checks to ensure it’s safe for you to attend.

The acupuncturist will do as much of the verbal consultation on the telephone prior to the appointment to minimise the amount of time exposure in the treatment room.  They will discuss your symptoms and circumstances with you.

All this is in line with the guidelines for safe practise of our regulatory body, the British Acupuncture Council (BAcC), and national government guidance.

Consent

You will need to complete a specific consent form in order to undertake  treatment at this time, your acupuncturist will advise on the specifics of this.

Changes to the rooms and equipment

In accordance with government guidelines and those of the BAcC British Acupuncture Council we have made changes to the rooms in which we practise, and the way in which we work in order to do so safely in this unprecedented time.  You will notice less chairs, no waiting area (a chair is provided for emergencies) and you are encouraged not to use the toilet onsite unless in an emergency.  You’ll notice more posters and safety equipment, as well as the use of PPE for you and the practitioner in the treatment room.

You’ll be asked to wash your hands or use alcohol gel on entering the premises, and you’ll see more in the way of cleaning equipment occurring.  You’ll be reminded to keep 2 metres away from anyone from outside your household, including the practitioner; with the exception of the treatment itself where PPE is used due to unavoidable proximity.  Your treatment may be shorter than usual, as we will have completed the talking element of the treatment by phone, prior to the treatment. We intend to minimise the time we spend in the 2-metre zone, to less than 15mins,- minimising both our risk.  We will leave larger gaps between patients so that cleaning can take place between patients.

Useful to know on the day

If you are attending for urgent care the following is a useful reminder (although not exhaustive and you will have discussed with your acupuncturist):

  • Check your symptoms and those of your household – your acupuncturist will make a pre-appointment phone call to screen for this
  • Use the toilet before you leave home as we need to keep the numbers of users to a minimum as cleaning is needed between users (you can of course use it in an emergency but must let your practitioner know so that they can arrange cleaning)
  • Be on time, and not early as there is no waiting facility. We recommend travelling by car, walking or cycling.  If you must use public transport, there are specific government guidelines on this here including mandatory masks on public transport, for example
  • Do not wait outside the front door, or use the buzzers, instead text your practitioner from your car, or text from the car park or pavement outside whilst keeping socially distant from anyone else who is waiting
  • Bring the minimum of items with you, so no shopping or large bags, and please bring the items your practitioner requests, e.g. face mask, towel, bottle of water

Further information

Specific government advice for this sector, should you wish to read it first-hand is here: Close contact working

Bear in mind that guidance changes, sometimes daily as a result of the R number and the government’s 5 tests, and therefore and we will keep this up to date as this happens, but the primary source of what can and cannot be safely done remains government guidelines here: https://www.gov.uk/coronavirus – which over-arches all of the above.

Information correct per government websites at 14/07/2020

Helen
Posted on: Jun-7-2020 12:50 pm
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Tinnitus – Condition Information

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About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Resources:

British Acupuncture Council evidence based factsheet about Tinnitus including specific research, trials and mechanisms of action for acupuncture in this condition.

References:

Helen
Posted on: May-31-2020 20:46 pm
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Obesity – Condition Information

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Resources:

British Acupuncture Council evidence based factsheet about Obesity including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
Posted on: May-31-2020 19:21 pm
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Palliative Care – Condition Information

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

References: British Acupuncture Council evidence based factsheet about Palliative Care including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
Posted on: Mar-31-2020 19:56 pm
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Dementia – Condition Information

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Zhi et al (2021; n=60) compared a vascular dementia group (VD) with a healthy control group to see if acupuncture can change the number and type of immune cells and molecules in the blood of patients with VD.  This wasn’t an RCT, as they did not have a VD control group, so the findings can be interpreted with caution.  They used blood tests to measure immune markers; Flow cytometry was used to count different types of immune cells, e.g. T cells, B cells, and natural killer (NK) cells. And ELISA was used to measure different inflammation markers, such as interleukins (IL), tumour necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ).

In Zhi et al’s study (2023), acupuncture was found to increase CD3+ T cells, CD4+ T cells, and regulatory T cells (Tregs) in the blood of patients with VD. These are types of immune cells that help regulate immune responses and prevent excessive inflammation.  Acupuncture treatment also decreased the level of TNF-α in the blood of patients with VD. TNF-α is a molecule that causes inflammation and can damage brain cells. The study concluded that acupuncture treatment may improve the immune system of patients with VD by changing the number and type of immune cells and molecules in the blood, the theory being that mediating neuroinflammation would be beneficial to VD patients.

References:

Zhi, H., Wang, Y., Chang, S., Pan, P., Ling, Z., Zhang, Z., Ma, Z., Wang, R. and Zhang, X., 2021. Acupuncture can regulate the distribution of lymphocyte subsets and the levels of inflammatory cytokines in patients with mild to moderate vascular dementia. Frontiers in Aging Neuroscience, 13, p.747673.

Resources:

British Acupuncture Council evidence based factsheet about Dementia including specific research, trials and mechanisms of action for acupuncture in this condition.

Helen
Posted on: Mar-10-2020 18:38 pm
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Parkinson’s Disease – Condition Information

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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Effectiveness of Acupuncture for Anxiety Among Patients With Parkinson Disease – A Randomized Clinical Trial

Around a third of Parkinson’s patients report anxiety symptoms, which impacts upon their quality of life. Fan and colleagues (2022) looked at n=64 patients with Parkinson’s disease (PD) using a double-blind randomised controlled trial. They compared real acupuncture (RA) with sham (SA) as a control group. Their scores on a number of scales measuring anxiety, Parkinson’s disease rating scale and questionnaires were compared before and after the treatment course, plus at 8 weeks post treatment (HAM-A; UPDRS; PDQ-39. Measures of blood levels of cortisol (stress hormone) and adrenocorticotropic hormone (the hormone that stimulates the adrenal glands to release cortisol) were also taken before and after the treatment course, and again 8 weeks after the end of the treatment course.

Whereas both groups showed clinical improvements in anxiety at the end of treatment, only the real acupuncture group maintained an improvement after the 8 weeks. The researchers recommend a larger, multi centre study to gain a bigger perspective.

For blood levels of the stress/anxiety related hormones, per the researchers: “The serum ACTH levels in the RA group were lower than in the SA group. It may be preliminarily confirmed that acupuncture can reduce the level of ACTH in serum, a finding that is in line with previous results, where the authors have proved that acupuncture can alleviate increased stress hormone levels and mitigate anxiety“. They reference Seo and colleagues, (2021), an animal model study of effects acupuncture has on specific neurotransmitters and hormones in a stress model.

Systematic Review and Meta-Analysis for PD Motor Symptoms

Lei et al, (2023) examined acupuncture’s effects on the motor function of Parkinson’s disease (PD) patients: a systematic review and meta-analysis (16 RCT’s, n=462) compared acupuncture with sham acupuncture or antiparkinsonian drugs. 

They found that acupuncture had a better effect on UPDRS-III scores (measure of PD motor symptoms severity) than the control group. Lei and colleagues suggested future studies could use larger sample sizes and more standardised protocols to overcome limitations, and concluded that acupuncture may be a beneficial adjuvant therapy for PD patients with motor issues. 

References: British Acupuncture Council evidence based factsheet about Parkinson’s Disease including specific research, trials and mechanisms of action for acupuncture in this condition.

Fan, J.Q., Lu, W.J., Tan, W.Q., Liu, X., Wang, Y.T., Wang, N.B. and Zhuang, L.X., 2022. Effectiveness of acupuncture for anxiety among patients with Parkinson disease: a randomized clinical trial. JAMA Network Open, 5(9), pp.e2232133-e2232133.

Lei, S., Fan, J., Liu, X., Xv, X., Zhang, J., Zhou, Z. and Zhuang, L., 2023. Qualitative and quantitative meta-analysis of acupuncture effects on the motor function of Parkinson’s disease patients. Frontiers in Neuroscience, 17.

Seo, S.Y., Bang, S.K., Kang, S.Y., Cho, S.J., Choi, K.H. and Ryu, Y.H., 2021. Acupuncture Alleviates Anxiety and 22-kHz Ultrasonic Vocalizations in Rats Subjected to Repeated Alcohol Administration by Modulating the Brain-Derived Neurotrophic Factor/Corticotropin-Releasing Hormone Signaling Pathway. International Journal of Molecular Sciences, 22(8), p.4037

Helen
Posted on: Jan-31-2020 19:58 pm
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