Acupuncture needle in situ

Battlefield Acupuncture

Blog, Conditions, Research, Shaftesbury Clinic, , ,

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.

Battlefield acupuncture was developed with the intention to be used in military battlefields as well as in emergency situations, as a protocol for the rapid relief of pain. Consisting of a set of auricular acupuncture points (on the ear), the technique is tailored to the type and location of the pain, making it potentially applicable to many types of pain. 

Case Study and Video for Trauma/PTSD

Acupuncturists (MBAcC) Rachel Peckham and Samina Haider set up an acupuncture NADA group in a Mosque in London in the aftermath of the Grenfell Tower tragedy, using the NADA protocol for trauma application, there is a video about this from the British Acupuncture Council here that may be of interest, and which shows the NADA protocol in action, and patients talking about it and their experiences of it: BAcC auricular (NADA) video Rachel talks about the general uses of this, background and the idea which came from the use of this in the aftermath of 9/11 in America.

Research and Resources on Battlefield Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “battlefield” yields over 3150 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 139 results; of which 48% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used currently in this area, leading to a small body of research being carried out so far (it is a recent development and area of practise). However the pace of research is increasing with nearly 50% of the research ever done, having happened in the last 4 years, showing promise for future studies and systematic reviews regarding examining its potential role.

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:

A 2017 systematic review of 6 trials (Jan et al, 2017; n=458) found that “ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED [emergency department]”, although study numbers were limited at the time more research had since been carried out, so we look forward to more sysyematic reviews as this develops..

This style of acupuncture has been found effective as an adjunct for low back pain in a USA ED setting (Emergency Dept., A&E equivalent, with a statistically significant benefit over usual care alone (Fox et al, 2018; n=30; p=0.04). Tsai et al, (2016) described 4 cases in which emergency physicians with brief training in the protocol treated patients with acute pain when opioid-based painkillers were unsuitable. It has also been examined in the case of chronic neck pain (Guthrie et al, 2016).

Elsewhere, battlefield acupuncture is used the US Department of Defense’s medical facilities for ex-military personnel for trauma related issues including PTSD (Walker et al, 2016);

Recently, a systematic review protocol was put forward (Zhang et al, 2020) for application of battlefield acupuncture protocol to migraine; it will be interesting to see the outcome here.

Regarding Your Individual Condition and Symptoms:

There are many painful conditions for which patients seek out acupuncture to address their symptoms. We have dedicated pages for arthritis, back pain, carpal tunnel, facial (TMJ) pain, shoulder and frozen shoulder, headache, migraine, kidney stones, plantar fasciitis, knee pain, sciatica, neuropathic (nerve) pain, rheumatoid arthritis, tennis and golfer’s elbow, neck pain, and pelvic pain each of which give references and further resources to evidence based factsheets and may be of use.

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

References:

Fox, L.M., Murakami, M., Danesh, H. and Manini, A.F., 2018. Battlefield acupuncture to treat low back pain in the emergency department. The American Journal of Emergency Medicine, 36(6), pp.1045-1048.

Guthrie, R.M. and Chorba, R., 2016. Physical Therapy Treatment Of Chronic Neck Pain A Discussion And Case Study: Using Dry Needling And Battlefield Acupuncture. Journal of special operations medicine: a peer reviewed journal for SOF medical professionals, 16(1), pp.1-5.

Jan, A.L., Aldridge, E.S., Rogers, I.R., Visser, E.J., Bulsara, M.K. and Niemtzow, R.C., 2017. Does ear acupuncture have a role for pain relief in the emergency setting? A systematic review and meta-analysis. Medical acupuncture, 29(5), pp.276-289.

Niemtzow, R.C., 2007. Battlefield acupuncture. Medical Acupuncture, 19(4), pp.225-228.

Tsai, S.L., Fox, L.M., Murakami, M. and Tsung, J.W., 2016. Auricular acupuncture in emergency department treatment of acute pain. Annals of emergency medicine, 68(5), pp.583-585.

Walker, P.H., Pock, A., Ling, C.G., Kwon, K.N. and Vaughan, M., 2016. Battlefield acupuncture: opening the door for acupuncture in Department of Defense/Veteran’s Administration health care. Nursing outlook, 64(5), pp.491-498.

Zhang, F., Shen, Y., Fu, H., Zhou, H. and Wang, C., 2020. Auricular acupuncture for migraine: a systematic review protocol. Medicine, 99(5).

Resources:

BAcC Acupuncture for PTSD Factsheet

Helen
Posted on: Jun-29-2021 12:35 pm
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Shaftesbury Clinic Star of Conditions

Chronic Pain – Condition Resources

Blog, Conditions, Research, Shaftesbury Clinic, , , ,

See also: Our in-depth blog about the NICE guidelines regarding recommendation of acupuncture for Chronic Pain, which is an evidence based piece informing NHS practise.

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

There are many painful conditions for which patients seek acupuncture to address their symptoms. We have dedicated pages for arthritis, back pain, carpal tunnel, facial (TMJ) pain, shoulder and frozen shoulder, headache, migraine, kidney stones, plantar fasciitis, knee pain, sciatica, neuropathic (nerve) pain, rheumatoid arthritis, tennis and golfer’s elbow, neck pain, and pelvic pain each of which give references and further resources to evidence based factsheets and may be of use.

A scholarly search of the available research papers on the terms “acupuncture” + “chronic pain” yields over 52,000 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 7,000 results; of which 36% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research has been carried out, the pace of which is increasing in recent years, therefore indicating that it merits of scientific appraisal and consideration in the field.

“Acupuncture has been widely applied to alleviate several pain diseases and incorporated into guidelines, and it is an effective method of coping with the opioid crisis and is widely respected due to its safety, low price, and low addiction” – Zhang et al, 2022

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.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018; large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

NICE (NHS advisory body) Recommendation:

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

In America, the NIH (National Institutes of Health) has recognised since 1997 that acupuncture alleviates pain (Zhang et al, 2022). Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

Mechanisms of Action on Pain:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).

Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010).

Very specific effects have been seen on a number of neurotransmitters, when acupuncture treatment is given, and to investigate this, a large and growing body of evidence has accumulated from clinical experiments with animal models, where levels of neurotransmitters and their effects are measured objectively; and because the animal is not aware of the intended outcomes, this drastically reduces any influence of placebo effect, as a cause of pain relief. 

Human trials, where measurable in an ethical and objective way, are also employed through fMRI (brain scans showing which areas are stimulated or downregulated in acupuncture treatment), measuring blood levels of neurotransmitters as well as pain ratings for an objective approach.

The role of acupuncture in modulating neurotransmitters involved in pain has been well discussed. Zhang et al (2022) outlined the research on each of the main observed neurotransmitter roles that have been researched in acupuncture for pain: those are opioid peptides; γ-Aminobutyric acid (GABA); Norepinephrine; 5-Hydroxytryptamine (5-HT – aka serotonin); and glutamate.  Overall for these neurotransmitters (in turn), the following are the highlights from the research body per Zhang and colleagues:

  • Endogenous opioid peptides are produced in the body as a direct result of acupuncture, and have a positive effect on analgesia (pain relief).  By name, these are enkephalins, endomorphins, dynorphins, and nociceptin, and these are the body’s own natural painkilling substances, types of neurotransmitters, or chemical messengers of the nervous system
  • γ-Aminobutyric acid (GABA) is an inhibitory neurotransmitter in the central nervous system.  It has a painkilling effect, and it has been demonstrated that acupuncture can upregulate GABA expression; another part of how acupuncture helps with pain
  • Norepinephrine (noradrenalin in the UK), is a neurotransmitter, the release of which is enhances by acupuncture; this influences pain because norepinephrine is also capable of inhibiting pain in the body
  • 5-Hydroxytryptamine (5-HT), or serotonin; is a neurotransmitter that is involved in analgesia (pain relief).  5-HT is secreted in the brain during acupuncture administration, making it another known mechanism of action for acupuncture’s ability to help pain
  • Glutamate is a central nervous system neurotransmitter (chemical messenger), and is involved in the transmission of pain signals in the spinal cord.  Acupuncture downregulates glutamate, as part of how it provides pain relief

Overall, per the research it can be seen that a combination of demonstratable mechanisms is at play; as measured and observed to be the cause of why acupuncture has been shown in so many practical studies to help a number of different types of pain. 

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

NICE Guidelines (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

Evidence Based Acupuncture Osteoarthritis Factsheet

Evidence Based Acupuncture Pain Factsheet

Evidence Based Acupuncture Cancer Pain Factsheet

BAcC Back Pain Factsheet

BAcC Facial Pain Factsheet

BAcC Frozen Shoulder Factsheet

BAcC Headache Factsheet

BACC Neck Pain Factsheet

BAcC Osteoarthritis of the Knee Factsheet

References:

Chronic Pain in General, References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Mechanism of Action References:

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.

Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.

Zhang, M., Shi, L., Deng, S., Sang, B., Chen, J., Zhuo, B., Qin, C., Lyu, Y., Liu, C., Zhang, J. and Meng, Z., 2022. Effective oriental magic for analgesia: acupuncture. Evidence-Based Complementary and Alternative Medicine, 2022.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)

Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

Helen
Posted on: Jun-19-2021 8:19 am
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Shaftesbury Clinic Star of Conditions

Pregnancy, Breech baby, and Childbirth – Condition Resources

Blog, Conditions, Research, Shaftesbury Clinic, , , , , , , ,

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.

Acupuncture is a safe and popular choice during pregnancy, our practitioners have worked with very many pregnant women at all stages of pregnancy over the years. It is important that your midwife/obstetrician is happy with this approach, and we have had many direct recommendations to us, from local midwives over the years.

There is an interesting video from the British Acupuncture Council with a patient regarding hyperemesis gravidarum (severe morning sickness) and her use of acupuncture, showing a treatment and discussion with her acupuncturist: you can see it here

The BAcC has a factsheet on the research and use of acupuncture in Obstetrics, as well as one on Childbirth, and on Puerperium (post natal period) 

Acupuncture is safe in pregnancy with a qualified acupuncturist.

Research and Resources on Pregnancy and Acupuncture:

A scholarly search of the available research studies mentioning “acupuncture and pregnancy” reveals over 45,00 papers from journals, of these “RCT” narrows down to 5,280 papers. Of the RCT’s ever published in this area, 38% have been published in the last 4 years (since 2017). A number of systematic reviews have been done for acupuncture in particular issues of pregnancy (see below).  From this abundance of research, we can deduce that acupuncture is employed, traditionally and currently in this area; widely scientifically researched, and that the pace at which the research is being carried is increasing – leading us to understand this is an area that has been deemed worthy of scientific appraisal and consideration.  

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.

Breech Presentation

A common request and referral from midwives is regarding the use of moxibustion to the point Bl67, which is a traditional indication for the Breech presentation of a baby. There have been over 600 number of scientific papers in this area as seen in a scholarly search, and a number of systematic reviews in a scholarly search, showing this as an area of frequent use, as well as scientific interest. Systematic reviews that have been carried out on this are: Liao et al, (2021); Vas et al, (2009); Li et al, (2009); Van den Berg et al, (2008); Mailan et al (2009); Lee at al, (2010); Zhang et al, (2013). Full references are below, to enable to you find and access the original articles.

The most recent of these systematic reviews, carried out by Taiwanese researchers (Liao et al, 2021) looked at 16 RCT’s and n=2555, appraised the studies in terms of bias risk as well as outcome, excluding studies that were not of sufficient quality, 8 studies from China were included, and the rest from European countries. Overall they found that moxibustion had merit in this field, but that more RCT’s are needed to establish the magnitude of the effect. A systematic review found moxibustion as used in this field to be safe when carried out by a trained professional (Xu et al, 2014;

It is vital that your obstetrician and midwife are aware before you undertake acupuncture (or any complementary therapy) in pregnancy.

Induction of Labour

This is an area for which pregnant women sometimes look to information about acupuncture when they are overdue their expected deliver date, usually because they have heard mention of it from a midwife, or had a personal recommendation for someone they know.

It is vital that your obstetrician and midwife are aware before you undertake acupuncture (or any complementary therapy) in pregnancy.

Studies have been done regarding traditional acupuncture protocols for this, (a scholarly search reveals over 930 articles mentioning “acupuncture” + “labour induction” OR “labor induction”, 30% of these have been carried out since 2017.

A Cochrane systematic review of 22 trials (Smith et al, 2017), concluded that acupuncture showed some benefit in improving cervical maturity, but insufficient evidence as to whether it reduced caesarean rate, meaning more high-quality RCT trials are needed. In a more recent systematic review, Siregar et al (2020, 9 articles, n=1656) reached a similar conclusion.

Hyperemesis Gravidarum (Morning Sickness)

Studies have been done regarding traditional acupuncture protocols for this, (a scholarly search reveals over 2,200 articles mentioning “acupuncture” + “hyperemesis gravidarum”, 207 show as “RCT” and 24% of these have been carried out since 2017.

In 1996, researcher Andrew Vickers had published a review article entitled “Can Acupuncture have Specific Effects on Health? A Systematic Review of Acupuncture Antiemesis Trials” (Vickers, 1996), because the traditional anti-sickness point in acupuncture theory was PC6, he examined 33 trials of the effect of this in nausea caused by pregnancy as well as chemotherapy and post-surgery, with the research pointing to PC6 having an anti nausea effect. Of interest to note is that the car sickness wristbands that have been available to buy in chemists for a couple of decades, are intended to press upon this exact acupuncture /acupressure points, their idea being drawn from traditional acupuncture.

Systematic reviews in this area include Sridharan and Sivaramakrishnan (2020; 20 studies) which saw some benefit for the acupuncture intervention, albeit that the quality of the studies was low and warranted more trials in future; Van den Heuvel et al ‘s systematic review (2015, 29 trials, n=3519) had reached a similar conclusion. Li et al, 2017 (11 studies) also concurred, noting in addition the possible publication bias (i.e. researchers having carried out a successful study may be more likely to publish it/have it accepted for publication than are those whose study shows no effects in some spheres).

EA is a safe and effective form of therapy and was found effective for hyperemesis gravidarum (severe “morning sickness” of pregnancy) (Ezzo et al, 2006). Yan et al recently (2020) put forward a protocol for a systematic review in this area, so this is currently awaited.

Mechanism of action in nausea and vomiting: an animal model: Scallan et al (2016) investigated point PC6 on 81 healthy dogs who had drug-induces nausea and vomiting, finding that use of the point reduces vomiting. Notably in animals the placebo effect is somewhat overcome by a lack of the animal anticipating an acupuncture intervention to be of assistance.

Dyspepsia (Indigestion, Heartburn)

We have a separate page for this condition – Dyspepsia – which is common in pregnancy

Low Back Pain

We have a separate page for this condition – Low Back Pain – which is common in pregnancy

Post Caesarean Pain

We have a separate page for this condition – Post Operative Pain – which is common in pregnancy

Mental Health, Anxiety, Depression

We have separate pages for these conditions – Anxiety – Depression – Mental Health – Stress and a blog about mental health

Gestational Diabetes

The British Acupuncture’s Diabetes Factsheet also covers the research that has been done into Gestational Diabetes.

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

See our Fertility and Pregnancy page for full details on the studies and mechanisms of the above.

Resources:

The British Acupuncture Council has several relevant evidence based factsheets about Women’s Health, including specific research, trials and mechanisms of action for acupuncture in these conditions.

BAcC Childbirth and acupuncture factsheet

BAcC Obstetrics (pregnancy and childbirth) and acupuncture factsheet

BAcC Puerperium (postnatal / postpartum) acupuncture factsheet

Our own page on Fertility, Pregnancy and Acupuncture

The British Acupuncture Council also has a review paper on Gynaecology and acupuncture: The evidence for effectiveness

Bibliography:

Ezzo, J., Streitberger, K. and Schneider, A., 2006. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. Journal of Alternative & Complementary Medicine, 12(5), pp.489-495.

Khorram, N.M.; S. Horton, V. Sahakian The Effect of Acupuncture on Outcome of in Vitro Fertilization Fertility and Sterility, Vol. 84, S364 Published in issue: September 2005

Li, Xun, Jun Hu, Xiaoyi Wang, Huirui Zhang, and Jianping Liu. Moxibustion and other acupuncture point stimulation methods to treat breech presentation: a systematic review of clinical trials. Chin Med 2009;4:4.

LI, Y., WANG, Y., LI, C. and ZHANG, Z., 2017. A Systematic Review and Meta-analysis of Domestic Acupuncture for Treatment of Hyperemesis Gravidarum. Journal of Liaoning University of Traditional Chinese Medicine, p.09.

Lee, M.S., Kang, J.W. and Ernst, E., 2010. Does moxibustion work? An overview of systematic reviews. BMC Research Notes, 3(1), pp.1-5.

Liao, J.A., Shao, S.C., Chang, C.T., Chai, P.Y.C., Owang, K.L., Huang, T.H., Yang, C.H., Lee, T.J. and Chen, Y.C., 2021, June. Correction of Breech Presentation with Moxibustion and Acupuncture: A Systematic Review and Meta-Analysis. In Healthcare (Vol. 9, No. 6, p. 619). Multidisciplinary Digital Publishing Institute.

Lim, Chi Eung Danforn; Jenny Wilkinson, WS Felix Wong, Nga Chong Lisa Cheng Effect of Acupuncture on Induction of Labor Journal of alternative and complementary medicine (New York, N.Y.)  11/2009; 15(11):1209-14.

Mailan, L.I.U., Lei, L.A.N., Yong, T.A.N.G. and Fanrong, L.I.A.N.G., 2009. Acupuncture and moxibustion for breech presentation: a systematic review. Chinese Journal of Evidence-Based Medicine, 9(8), pp.840-843.

Manber, Rachel PhD; Schnyer, Rosa N. DAOM, LAc; Lyell, Deirdre MD; Chambers, Andrea S. PhD; Caughey, Aaron B. MD, PhD; Druzin, Maurice MD; Carlyle, Erin MS; Celio, Christine MS; Gress, Jenna L. BA; Huang, Mary I. MS; Kalista, Tasha MA; Martin-Okada, Robin BS; Allen, John J. B. PhD Acupuncture for depression during pregnancy: a randomized controlled trial. ObstetGynecol 2010;115:511-20

Mozurkewich, E.L., Chilimigras, J.L., Berman, D.R., Perni, U.C., Romero, V.C., King, V.J. and Keeton, K.L., 2011. Methods of induction of labour: a systematic review. BMC pregnancy and childbirth, 11(1), pp.1-19.

Scallan, E.M. and Simon, B.T., 2016. The effects of acupuncture point Pericardium 6 on hydromorphone-induced nausea and vomiting in healthy dogs. Veterinary anaesthesia and analgesia, 43(5), pp.495-501.

Siregar, E., Herawati, L., Runjati, R. and Erisna, M., 2020. The Effects of Acupressure and Acupuncture as Natural Induction Methods for Spontaneous Labor: A Systematic Review. International Journal of Nursing and Health Services (IJNHS), 3(6), pp.743-753.

Smith, C; Crowther, C and Beilby, J (2002) Acupuncture To Treat Nausea and Vomiting in Early Pregnancy: A Randomized Controlled Trial Birth Volume 29 Issue 1, Pages 1-9

Smith, C.A., Armour, M. and Dahlen, H.G., 2017. Acupuncture or acupressure for induction of labour. Cochrane Database of Systematic Reviews, (10).

Sridharan, K. and Sivaramakrishnan, G., 2020. Interventions for treating hyperemesis gravidarum: a network meta-analysis of randomized clinical trials. The Journal of Maternal-Fetal & Neonatal Medicine, 33(8), pp.1405-1411.

van den Berg I, Bosch JL, Jacobs B, Bouman I, Duvekot JJ, Hunink MG. Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review. Complement Ther Med 2008;16:92-100.) 

Van den Heuvel, E., Goossens, M., Vanderhaegen, H., Sun, H.X. and Buntinx, F., 2015. Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature. BMC complementary and alternative medicine, 16(1), pp.1-18.

Vas J, Aranda JM, Nishishinya B, Mendez C, Martin MA, Pons J, Liu JP, Wang CY, Perea-Milla E. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol.2009 Sep;201(3):241-59.

Vickers, A.J., 1996. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine, 89(6), pp.303-311.

Xu, Jin; MacKenzie, Ian Z.The current use of acupuncture during pregnancy and childbirth Current Opinion in Obstetrics &Gynecology. 24(2):65-71, March 2012. 

Xu, J., Deng, H. and Shen, X., 2014. Safety of moxibustion: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine, 2014.

Yan, R., Zhan, J., Liu, G., Li, C., Cai, P., Chen, Y. and Cao, H., 2020. A comparison of the efficacy and safety of traditional Chinese medicine external treatment for the hyperemesis gravidarum: A protocol for systematic review and network meta-analysis. Medicine, 99(45).

Zhang, Q.H., Yue, J.H., Liu, M., Sun, Z.R., Sun, Q., Han, C. and Wang, D., 2013. Moxibustion for the correction of nonvertex presentation: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2013.

Helen
Posted on: Jun-15-2021 13:56 pm
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Shaftesbury Clinic Star of Conditions

Arthritis – Condition Resources

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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.

Acupuncture has been shown to modulate inflammatory responses in the body, as well as to reduce the activity in the areas of the brain associated with pain and stress (as seen on functional MRI brain scans in research settings).

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:

Osteoarthritis: Since 2005, there have been over than 50 NHS publications recommending acupuncture for osteoarthritis (largely knee or hip) and many more worldwide (Birch et al 2018).

A large (n=20827) meta-analysis of 39 studies showed acupuncture to be significantly superior to usual care and to sham (non-specific acupuncture point usage), for patients with osteoarthritis and other painful conditions (all p <.001; Vickers et al, 2018).  Additionally, clear evidence was found in this meta-study that that the effects of acupuncture persisted over time.

For patients with osteoarthritis pain, acupuncture improved pain relief compared to sham at short-term and at six-month follow up. When compared to wait list controls, acupuncture showed a clinically significant improvement in short term pain relief.  A randomised controlled trail in patients with osteoarthritis of the knee or hip, showed a significant difference at three months between acupuncture and routine care (Reinhold et al, 2008; Manheimer et al, 2010).

Knee Pain: Osteoarthritis of the knee is a chronic degenerative disease, with symptoms of pain, stiffness, swelling and dysfunction.  OA of the knee is the most prevalent pain- and disability inducing condition in adults over 50 years old (Araya-Quintanilla et al. 2022)

A systematic review and meta-analysis of 17 trials, showed significant benefits whereby in patients in study groups having received acupuncture, this was associated with significantly reduced chronic knee pain 12 weeks (Zhang et al, 2017).  Specifically comparing treatments including acupuncture in osteoarthritic knee pain, Corbett et al’s (2013, n=9709) systematic review and network meta-analysis found that acupuncture could be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term: Acupuncture was ranked second out of 21 physical treatments in this study.  The team also clarified that further research is also warranted in this area, due to the quality of the research available in some treatment areas across the studies.

Acupuncture can be cost effective, according to an RCT (n=60); acupuncture was offered to patients with knee osteoarthritis who were going to be referred for orthopaedic surgery by their GP, with acupuncture a third were able to avoid surgery which also represented a cost-saving of £100,000 per year [to the NHS]” (White et al, 2016). Acupuncture has been found to improve improve pain and improve function and quality of life in knee osteoarthritis, particularly where chronic (Tian et al, 2022).

An overview of 15 systematic reviews of pain relief in patients with osteoarthritis knee by Araya-Quintanilla et al. (2022) found that in the short term, acupuncture had a moderate positive impact on both pain intensity; and knee function, compared to the control groups. The evidence was rated as low to very low quality according to GRADE ratings.

The systematic review of eleven RCTs with meta-analysis by Tian et al. (2021) found that acupuncture had a positive effect on reducing pain and improving functional activities in patients with knee osteoarthritis. However, there was no significant effect on relieving stiffness or improving the quality of life (mental or physical health) compared to sham acupuncture. The findings suggest that acupuncture can be recommended as a beneficial alternative therapy for patients with chronic pain and knee OA, but further studies are needed to verify the effectiveness in function improvement.

Liu, J., et al, 2022; In this multicentre RCT (n=625), patients were randomly assigned to receive acupuncture at acupoints with Lower Pain Threshold (LPT); acupuncture at acupoints with Higher Pain Threshold (HPT); and no acupuncture (waiting-list group).  Measures of pain and symptoms (WOMAC) from baseline to 16 weeks; outcome measures of daily life impact of condition (SF-12 score); and active knee range of motion (ROM) were used as comparators. From baseline to 16 weeks, the effects of acupuncture at acupoints with lower versus higher PT were similar, as both were effective for patients with OA of the knee, “results confirmed the positive effects of acupuncture on pain, stiffness, physical function and quality of life of in patients” compared to the waiting list group.

A further systematic review and meta-analysis is due as per the recent protocol in the BMJ (Lui, C.Y., et al; 2022).

Hip osteoarthritis: There is less research in this area, although it is growing, a systematic review (Manheimer et al, 2018; n=413, for 6 trials) found Acupuncture beneficial as an add-on to usual GP care, with a small but significant benefit for physical quality of life.

Mechanisms of Action:

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. 

Many mechanisms of action have been investigated in animal models as well as in humans to measure brain activity associated with pain and the levels of biomarkers associated with inflammation.

You may also find this useful: our Rheumatoid Arthritis page

Resources

BAcC Osteoarthritis of the Knee Factsheet

Evidence Based Acupuncture Foundation Osteoarthritis Evidence Summary

References:

Araya-Quintanilla, F., Cuyúl-Vásquez, I. and Gutiérrez-Espinoza, H., 2022. Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. Journal of Bodywork and Movement Therapies, 29, pp.117-126.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

Corbett, M.S., Rice, S.J.C., Madurasinghe, V., Slack, R., Fayter, D.A., Harden, M., Sutton, A.J., Macpherson, H. and Woolacott, N.F., 2013. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and cartilage, 21(9), pp.1290-1298.

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

Liu, J., Li, Y., Li, L., Luo, X., Li, N., Yang, X., Zhang, H., Liu, Z., Kang, D., Luo, Y. and Liu, Y., 2022. Effects of acupuncture at acupoints with lower versus higher pain threshold for knee osteoarthritis: a multicenter randomized controlled trial. Chinese Medicine, 17(1), pp.1-12.

Liu, C.Y., Tu, J.F., Lee, M.S., Qi, L.Y., Yu, F.T., Yan, S.Y., Li, J.L., Lin, L.L., Hao, X.W., Su, X.T. and Yang, J.W., 2022. Is acupuncture effective for knee osteoarthritis? A protocol for a systematic review and meta-analysis. BMJ open, 12(1), p.e052270.

Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews 2010, Issue 1.

Manheimer, E., Cheng, K., Wieland, L.S., Shen, X., Lao, L., Guo, M. and Berman, B.M., 2018. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews, (5).

Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich SN. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ 2008;9(3):209-19.

Tian, H., Huang, L., Sun, M., Xu, G., He, J., Zhou, Z., Huang, F., Liu, Y. and Liang, F., 2022. Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. BioMed Research International, 2022.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

White, A., Tough, L., Eyre, V., Vickery, J., Asprey, A., Quinn, C., Warren, F., Pritchard, C., Foster, N.E., Taylor, R.S. and Underwood, M., 2016. Western medical acupuncture in a group setting for knee osteoarthritis: results of a pilot randomised controlled trial. Pilot and feasibility studies, 2(1), pp.1-8.

Zhang, Q., Yue, J., Golianu, B., Sun, Z. and Lu, Y., 2017. Updated systematic review and meta-analysis of acupuncture for chronic knee pain. Acupuncture in Medicine, 35(6), pp.392-403.

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: Jun-13-2021 8:38 am
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Shaftesbury Clinic Star of Conditions

Post Operative Pain – Condition Resources

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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.

Our Nausea page may also be of use regarding Post Operative Nausea and Vomiting Research

Research and Resources on Post Operative Pain and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “post operative pain” yields over 3,860 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 583 results; of which 38% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used in this area, leading to a small but growing body of research,, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

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:

Sun et al’s (2008) systematic review of 15 RCT’s (n=1166) in the British Journal of Anaesthesia drew the conclusion that acupuncture around the time of surgery “may be a useful adjunct for acute postoperative pain management.” They also found lower incidence of opioid side effects such as post-operative nausea and vomiting (PONV); dizziness and urinary retention in acupuncture groups. They also stated that further large and well-designed studies are needed to further examine this area including the most effective points and timings to use.

A systematic review of 5 trials for acupuncture post back surgery (Cho et al, 2015) found encouraging but limited evidence in this area, calling for more rigorously designed trials to further the research body. Chen et al (2021, 9 RCT’s; n=671) systematic review found acupuncture could improve function and reduce PONV after total knee arthroscopy surgery, with pain relief from acupuncture mainly achieved within the 48h post-surgery. Again limitations were acknowledged in the methodical quality of studies, with further large, high quality studies called for.

Wu et al (2016, systematic review of 13 studies) found that the evidence supported acupuncture use as an adjuvant therapy post surgery on the first day, significantly reducing postoperative pain and the use of opioids. A Systematic review of 35 trials into acupuncture and post-operative pain has indicated promise in this area, indicating that further research is needed as to whether using both local and distal points can be beneficial over an either/or approach (Zhu et al, 2019).

Kumar and Tewari (2023) reviewed the evidence for dental treatment during and post-op. Root canal treatment has a high incidence of postoperative pain and potential side effects from drug treatment; and they found that from their review of 5 studies (n=312), acupuncture reduced the failure of nerve block in patients with irreversible pulpitis and controlled pain both during (intraoperative) and postoperative pain from root canal.  Acupuncture lowered the amount of painkiller drugs needed. The researchers noted that more in-depth clinical research with larger studies was warranted due to the small number and variable quality of studies.  Additionally, against a backdrop of Covid-19, researchers advocated acupuncture, as a non-aerosol generating alternative that could assist in pain management whist awaiting treatment, or where other techniques were not appropriate.

Mechanisms of action:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).

Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010). More detail on neurotransmitters in acupuncture for pain is in our blog.

Resources:

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

Post-Operative Pain References:

Chen, Z., Shen, Z., Ye, X., Xu, Y., Liu, J., Shi, X., Chen, G., Wu, J., Chen, W., Jiang, T. and Liu, W., 2021. Acupuncture for Rehabilitation After Total Knee Arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Frontiers in medicine, 7, p.1050.

Cho, Y.H., Kim, C.K., Heo, K.H., Lee, M.S., Ha, I.H., Son, D.W., Choi, B.K., Song, G.S. and Shin, B.C., 2015. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta‐analysis of randomized controlled trials. Pain Practice, 15(3), pp.279-291.

Kumar, G. and Tewari, S., 2023. Acupuncture for Management of Endodontic Emergencies: a Review. Journal of Acupuncture and Meridian Studies, 16(1), pp.1-10.

Sun, Y., Gan, T.J., Dubose, J.W. and Habib, A.S., 2008. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British journal of anaesthesia, 101(2), pp.151-160.

Wu, M.S., Chen, K.H., Chen, I.F., Huang, S.K., Tzeng, P.C., Yeh, M.L., Lee, F.P., Lin, J.G. and Chen, C., 2016. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PloS one, 11(3), p.e0150367.

Zhu, J., Xu, Q., Zou, R., Wu, W., Wang, X., Wang, Y., Ji, F., Zheng, Z. and Zheng, M., 2019. Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice. BMC complementary and alternative medicine, 19(1), pp.1-14.

Mechanism Of Action in Pain References:

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.

Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)

Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

Helen
Posted on: May-31-2021 20:07 pm
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Shaftesbury Clinic Star of Conditions

Neck Pain – 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.

Neck pain is a common, painful condition, and is in the top three musculoskeletal system complaints reported by patients (BAcC factsheet – see link below).

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

Neck Pain

Since 1005, over 50 NHS publications have recommended acupuncture for neck pain (many more worldwide; Birch et al 2018).

A randomised trial comparing Alexander technique with acupuncture or usual care alone (MacPherson et al, 2015; n=517) found both acupuncture and Alexander Technique benefitted the participants after a series of sessions, and this benefit ensured at 12 months post treatment, in that their disability level and pain measures were improved.   Essex et al (2017) looked at acupuncture and Alexander technique (ATLAS trial) data, in terms of cost effectiveness, using the NHS standard quality adjusted life years (QALYs) as well as neck pain measures, finding acupuncture to be cost effective as well as effective.  Alexander Technque whilst effect, was not cost effective as it cost more per the amount of gain that could be made.

Van der Velde et al’s (2016) review of whiplash acquired neck pain and disorders, finding acupuncture appeared a cost-effective intervention in these cases.  Seo et al, 2017 in a systematic review and meta-analysis of 16 trials of (electro)acupuncture in chronic neck pain found acupuncture to be effective, and even more so in combination with routine care, their drawings were tentative due to research quality of the trials used.

The British Acupuncture Council has a Research digest where they examined some recent studies on shoulder pain, as well as an evidence based factsheet (links are below).  One such study was Ho et al, (2017), an RCT of abdominal acupuncture in neck pain in Hong Kong (n=154), finding the true acupuncture group experienced symptomatic relief as well as quality of life measurement improvements. 

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic neck pain.

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.

More detail on neurotransmitters in acupuncture for pain is in our blog.

Resources:

The British Acupuncture Council (BAcC) has produced an evidence based Neck Pain Factsheet including specific research, trials and mechanisms of action for acupuncture.

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

General Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Neck pain References:

MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., Eldred, J., Essex, H., Hewitt, C. and Hopton, A., 2015. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: a randomized trial. Annals of internal medicine, 163(9), pp.653-662.

van der Velde, G., Yu, H., Paulden, M., Côté, P., Varatharajan, S., Shearer, H.M., Wong, J.J., Randhawa, K., Southerst, D., Mior, S. and Sutton, D., 2016. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal, 16(12), pp.1582-1597.

Essex, H., Parrott, S., Atkin, K., Ballard, K., Bland, M., Eldred, J., Hewitt, C., Hopton, A., Keding, A., Lansdown, H. and Richmond, S., 2017. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PloS one, 12(12), p.e0178918.

Seo, S.Y., Lee, K.B., Shin, J.S., Lee, J., Kim, M.R., Ha, I.H., Ko, Y. and Lee, Y.J., 2017. Effectiveness of acupuncture and electroacupuncture for chronic neck pain: a systematic review and meta-analysis. The American journal of Chinese medicine, 45(08), pp.1573-1595.

Ho, L.F., Lin, Z.X., Leung, A.W.N., Chen, L., Zhang, H., Ng, B.F.L., Ziea, E.T.C. and Guo, Y., 2017. Efficacy of abdominal acupuncture for neck pain: a randomized controlled trial. PloS one, 12(7), p.e0181360.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Helen
Posted on: May-31-2021 14:30 pm
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Temporomandibular Pain – 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.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

TMJ Pain

The British Acupuncture Council has a Research digest where they examined some recent studies on temporomandibular pain, as well as an evidence based factsheet on chronic pain (links are below), finding promising evidence in the field.  Fernandes et al (2017) systematic review looked at 4 trials into TMD of muscular origin, finding acupuncture appears to relieve symptoms in this condition, albeit they noted evidence quality was limited and further research was needed in future in this area.

Justo et al (2017) carried out a systematic review of 4 articles finding that overall, acupuncture was effective in relieving myofascial pain symptoms in patients with temporomandibular dysfunction, albeit that the quality and quantity of the studies meant further research is needed in the area, including for long term outcomes.  This echoes La Touche et al’s earlier (2010) systematic review where they found that the majority of the studies reported that  acupuncture was statistically significant for short term pain relief of myofascial TMD but with the proviso that more studies with larger sample sizes, longer-term follow-up and higher design quality were required in the future to corroborate these trends.

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.

More detail on neurotransmitters in acupuncture for pain is in our blog.

Resources:

The British Acupuncture Council (BAcC) has produced an evidence based factsheet about Facial Pain (TMJ) including specific research, trials and mechanisms of action for acupuncture

BAcC Headache Factsheet

Evidence Based Acupuncture – Factsheet on Chronic Pain

Refererences:

General Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Temporomandibular Joint Disorder References:

Justo, A.C.B.D.C., Moura, D.M.D., Da Silva, L.G.D., De Almeida, E.O. and Barbosa, G.A.S., 2017. Acupuncture in temporomandibular disorder myofascial pain treatment: a systematic review. CEP, 59056, p.000.

La Touche, R., Angulo-Díaz-Parreño, S., de-la-Hoz, J.L., Fernández-Carnero, J., Ge, H.Y., Linares, M.T., Mesa, J. and Sánchez-Gutiérrez, J., 2010. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. The Journal of Alternative and Complementary Medicine, 16(1), pp.107-112.

Fernandes AC, Duarte Moura DM, Da Silva LGD, De Almeida EO, Barbosa GAS. Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review. J Oral Facial Pain Headache. 2017 Summer;31(3):225-232. doi: 10.11607/ofph.1719. PMID: 28738107.

Helen
Posted on: May-31-2021 14:00 pm
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Plantar Fasciitis – 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.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

Plantar Fasciitis

The British Acupuncture Council has a Research digest where they examined some recent studies on plantar heel pain (plantar fasciitis – link below).  Systematic reviews by Thiagarajah (2017) found promising evidence for short term pain relief in the condition, but looked to future long-term studies to improve the evidence base, and Salvioli et al’s (2017) systematic review of the same looked at 20 studies entailing 9 different types of intervention found improvement over placebo, but looked toward future studies to corroborate this.

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:

Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Plantar Fasciitis Refrences:

Salvioli, S., Guidi, M. and Marcotulli, G., 2017. The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: a systematic review with meta-analysis. The Foot, 33, pp.57-67.

Thiagarajah, A.G., 2017. How effective is acupuncture for reducing pain due to plantar fasciitis?. Singapore medical journal, 58(2), p.92.

Helen
Posted on: May-31-2021 13:37 pm
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Post Traumatic Stress Disorder (PTSD) – 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.

The British Acupuncture Council (BAcC) has a research digest of recent articles, with a small section on recent studies in this area (toward the base of the document – see Resources below).

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.

In the UK, a trial was done by the British Acupuncture Council with HealthWatch Norfolk (2018) to evaluate the usefulness and acceptability of acupuncture for PTSD in veterans in Norfolk, UK. This small trial gave very encouraging results for the veterans who took part in it (link below) and further larger trials involving a greater number of patients and practitioners would be useful to corroborate this.

There have been a number of research trials in the United States of America in particular working with veterans groups, where acupuncture and a particular protocol of ear acupuncture are often used in this area.

Elsewhere, a systematic review and meta-analysis of 7 trials was not able to draw strong conclusions (Grant et al, 2018 n=709 overall), of note many trials had a lower quality of evidence, meaning further high quality RCT trials and large reviews are warranted in this growing area.

References:

BAcC and Healthwatch Norfolk (2018) Stand Easy: An Evaluation of the effectiveness and acceptability of acupuncture as a treatment for PTSD for veterans in Norfolk

Grant, S., Colaiaco, B., Motala, A., Shanman, R., Sorbero, M. and Hempel, S., 2018. Acupuncture for the treatment of adults with posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Trauma & Dissociation, 19(1), pp.39-58.

Resources:

British Acupuncture Council PTSD factsheet including specific research, trials and mechanisms of action for acupuncture in this condition,

British Acupuncture Council Research Digest

Helen
Posted on: May-30-2021 16:00 pm
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Pain & Painful disorders – Condition Resources

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See our in-depth blog about the NICE guidelines regarding recommendation of acupuncture for Chronic Pain, which is an evidence base piece informing NHS practise.

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.

Chronic Pain in General

“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)

Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture  as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.

The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”

Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).

There are many painful conditions for which patients seek acupuncture to address their symptoms. We have dedicated pages for arthritis, back pain, carpal tunnel, facial (TMJ) pain, shoulder and frozen shoulder, headache, migraine, kidney stones, plantar fasciitis, knee pain, sciatica, neuropathic (nerve) pain, rheumatoid arthritis, tennis and golfer’s elbow, neck pain, and pelvic pain each of which give references and further resources to evidence based factsheets and may be of use.

Mechanisms of action on pain:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).

Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010).

More detail on neurotransmitters in acupuncture for pain is in our blog.

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:

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

Chronic Pain in General References:

Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.

Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.

NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021

Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.

Mechanism of Action References:

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.

Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.

Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.

Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.

Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)

Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.

Helen
Posted on: May-16-2021 13:56 pm
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