Acupuncture for chronic pain in Bedford, UK

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.

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).

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

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.

CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body.  They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions.  Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone.  These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.

In an animal study, Sun et al, (2023) were able to show that electroacupuncture worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation.  The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.

Liu et al (2013) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes.  EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.

Inflammatory and Immune Aspects in Research

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.

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

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)

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:

Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.

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.

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.

Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine, 32(4), pp.340-345.

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.

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.

Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine, 2023.

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

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: Aug-9-2023 8:19 am
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Acupuncture for anxiety and stress

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

I am often asked about acupuncture for anxiety and stress. We see a lot of patients for anxiety, stress, depression and other mood or motivational issues. Acupuncture is something that a great number of these patients have said has changed their daily lives for the better. This works best if they can address other lifestyle issues (e.g. diet, exercise, relaxation strategies), and we can very often recommend strategies and experienced colleagues to concurrently support these aspects if this is desirable.
Read More Acupuncture for anxiety and stress →

Helen
Posted on: Aug-8-2023 10:31 am
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Acupuncture Awareness Week 2023

Research Update: Recent 2023 studies on acupuncture for pain

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March 27th, 2023.

In this blog post, for #AcupunctureAwarenessWeek2023, we’ll review some very recent research developments in acupuncture.  Acupuncture is widely used for pain relief, and here we’ll look at brand new (2023) research, to help us consider how effective and safe it is for three specific types of pain; dental pain, thalamic pain (after stroke), and menstrual migraine. We will discuss the studies and then explain some key concepts and terms related to the research methods used in acupuncture.  We’ll also provide the full references so you can enjoy reading the articles and find out more.

We’ll present:

  • A new RCT into acupuncture for a dental pain
  • A systematic review of acupuncture for a specific type of chronic pain after stroke
  • A protocol for an upcoming RCT on a specific type of migraine.

Each of these studies from peer-reviewed journals, and have research questions, methods and outcomes, but they all contribute to the growing evidence base for acupuncture as a valid healthcare choice alongside usual treatment.

To know more about RCT’s, systematic reviews and what they are for, keep reading to the end of the blog.  Full references follow at the end.

1. Kumar & Tewari, 2023. Acupuncture for Management of Endodontic Emergencies: a Review.

Acupuncture needles in a patient's back
Acupuncture needles in a patient’s back

Kumar and Tewari (2023) reviewed the current evidence for the use of acupuncture in endodontics, with a focus on its potential to provide emergency pain relief. Root canal treatment is often used to treat painful endodontic conditions, but comes with a high incidence of postoperative pain and potential side effects from drug treatment; drug treatment not always being effective. Additionally, concerns have been raised about the risk of COVID-19 transmission due to aerosols generated during dental procedures.

Acupuncture is commonly employed for the treatment of pain, including endodontic pain and dental anaesthesia.  The researchers weighed up the current evidence for acupuncture in endodontics with a literature review of five electronic databases. They selected five studies that met their eligibility criteria (n=312).

Overall, acupuncture reduced the failure of nerve block in patients with irreversible pulpitis and in controlling both during (intraoperative) and postoperative pain from root canal.  Acupuncture also reduced dental anxiety, and lowered the amount of painkiller drugs needed by, thus minimising side effects of analgesia. The researchers concluded that acupuncture could play a role in managing these patients, but that more in-depth clinical research with larger studies is needed in this area due to the small number and variable quality of available studies.  On the issue of Covid-19, researchers advocated a role for acupuncture, as a non-aerosol generating approach that could assist in pain management, where other techniques are not appropriate.

2. Li & Chen 2023: Acupuncture for thalamic pain after stroke: A systematic review and meta-analysis

Acupuncture needles in a blister pack
Acupuncture needles in a blister pack

Thalamic pain:  A type of chronic pain caused by damage to the sensory area of the brain – Thalamus.  Causing burning, tingling, stabbing, or freezing sensations it affects one side of the body or face, usually the opposite side to the brain injury site. Coming on straight after a brain injury, or developing months or years later, thalamic pain can impact a person’s quality of life and mental health.

In this study, Li and Chen examined this type of pain, secondary to stroke.  Acupuncture is used effectively for various types of pain, including thalamic pain, and in China it’s used first-line alongside mainstream medicine immediately post-stroke.  The researchers searched five electronic databases for randomized controlled trials (RCTs) that compared acupuncture with drugs for thalamic pain after stroke:  Five studies met their criteria (n=368).

This review found acupuncture effective in reducing thalamic pain after stroke, with higher success rates and no significant safety difference compared to drugs.  Li and Chen (2023) concluded that acupuncture is a promising treatment for thalamic pain, but called for further large-scale and high-quality trials to confirm their findings.

Note: Acupuncture should complement medical treatment, and not replace it.  Acute and life-threatening situations, medical emergencies like stroke require seeking emergency medical input, without delay. 

3. Wu et al, 2023: Determining the Efficacy and Safety of Acupuncture for the Preventive Treatment of Menstrual Migraine: A Protocol for Systematic Review and Meta-Analysis

Shaftesbury Clinic Star of Conditions
A to Z of conditions

This protocol in the Journal of Pain Research, is for Wu et al’s (2023) forthcoming systematic review and meta-analysis into the clinical efficacy and safety of acupuncture in preventing menstrual migraine. The researchers state that current treatments are lacking in effectiveness in this area.

Nine databases will be searched, and the Cochrane risk of bias instrument used to assess trial quality. The results will inform treatment decisions and be useful to patients, physicians, and policy makers alike: We’ll let you know, as soon as we see any update: This will be an interesting addition to the research base.

Conclusion

We covered three brand new research papers on acupuncture for three sorts of pain: dental, thalamic (after stroke), and menstrual migraine. Acupuncture may offer an effective and low-risk option for managing these types of pain, per the research we’ve seen.

Further resources on our conditions page, lead to articles about acupuncture research in different conditions here: https://shaftesburyclinic.com/conditions/. 

As with this growing research field, more high-quality and large-scale studies are needed to confirm the efficacy and safety of acupuncture for these pain conditions, as well as which are the most successful protocols or point combinations to use in each case.

Acupuncture represents a valid healthcare choice alongside usual treatment for many conditions.  We love to talk about what we do: You can always schedule a free 15 minute consultation with one of our acupuncturists, to find out more!

Book here: https://shaftesburyclinic.janeapp.co.uk/

A note on the research

A randomized controlled trial (RCT) is a study design used in health research, to test the effectiveness of a medical treatment:

  • Participants are randomly assigned to receive either the treatment being tested, or a placebo/sham/no treatment/wait list control
  • Researchers look to determine whether the treatment arm is more effective than placebo
  • RCTs are the “gold standard” in research, designed to minimise bias and give us the most reliable evidence

Systematic reviews of randomized controlled trials (RCTs) are highly useful and reliable in research: 

  • Systematic reviews entail a comprehensive overview of the evidence; assess the quality of the evidence and many go on to meta-analyse the data by putting together the results of numerous (RCT) studies to give a more powerful view of trends. 

Good quality evidence is needed for people to make the best and most appropriate treatment decisions; for patients, their caregivers and those who make recommendations and fund healthcare (e.g. NICE, NHS England)

Next up: Mechanisms of Action

We have seen that acupuncture has been shown to benefit pain, what are the underlying mechanisms of action in the body and the brain that make this happen?  

In our next blog, we’ll look the mechanisms of action for acupuncture in pain.  In the meantime, check out our related pages:

Pain & Painful disorders – Condition Resources | shaftesburyclinic

Chronic Pain – Condition Resources | shaftesburyclinic

References:

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.

Li, W. and Chen, S., 2023. Acupuncture for thalamic pain after stroke: A systematic review and meta-analysis. Medicine, 102(9), pp.e33006-e33006.

Wu, Q., Wang, J., Lin, X., Han, D., Hu, H. and Gao, H., 2023. Determining the Efficacy and Safety of Acupuncture for the Preventive Treatment of Menstrual Migraine: A Protocol for a PRISMA-Compliant Systematic Review and Meta-Analysis. Journal of Pain Research, pp.101-109.

Helen
Posted on: Mar-27-2023 15:15 pm
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Acupuncture Research Updates: Anxiety in Parkinson’s; IBS-D and Fibromyalgia

Blog, Conditions

Let’s start with a round-up the 3 studies that hit the top spots the day this post was written, in a Google Scholar search for “acupuncture research”:

New Research:

• Effectiveness of acupuncture for anxiety among patients with Parkinson disease: a randomized clinical trial. (Fan et al, 2022)
• Qi, L.Y., Yang, J.W., Yan, S.Y., Tu, J.F., She, Y.F., Li, Y., Chi, L.L., Wu, B.Q. and Liu, C.Z., 2022. Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial. JAMA Network Open, 5(12), pp.e2248817-e2248817
• Yu, G., Chen, L., Huang, H., Nie, B. and Gu, J., 2022. Research Trends of Acupuncture Therapy on Fibromyalgia from 2000 to 2021: A Bibliometric Analysis. Journal of Pain Research, pp.3941-3958

About the research: It is worth noting that in research, randomised controlled studies (RCT) which are published in a peer-reviewed and reputable journal, are the most reliable in terms of quality of evidence as they compare an intervention with a control group and and these are matched and blinded to which intervention they receive. Next up, a systematic review or meta analysis of numerous such studies is the best way of seeing the overall picture of the state of the evidence by aggregating a number of RCTs together in a scientific manner. The n= figure tells you how many people were participants in the study, and a larger study is able to more powerfully predict whether an intervention is effective, as the statistics are more robust; smaller studies can be pilots, or give ideas of trends to be explored in later ones.

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

Approximately a third of Parkinson’s patients experiences anxiety symptoms, which negatively affects upon their quality of life. Fan et al (2022) examined 64 Parkinson’s patients through a double-blind, randomised controlled trial. They compared real acupuncture (RA) with sham (SA) as a control group. Scores on anxiety measures (HAM-A; UPDRS; PDQ-39), Parkinson’s disease rating scale, and measures of blood levels of cortisol (stress hormone) and adrenocorticotropic hormone (related to cortisol release) were evaluated before and after the treatment course, and repeated 8 weeks after the end of the treatment course.

Results: Both groups showed clinical improvements in anxiety by the end of the treatment, but only the RA group maintained an improvement after 8 weeks. This suggests that sham acupuncture may produce short-term effects based on expectation, while real acupuncture has a longer-lasting effect.

The researchers observed that the RA group had lower ATCH levels than the SA group. potentially confirming that acupuncture can reduce ACTH levels in the blood and alleviate stress hormone levels and anxiety: “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“. The previous finding they mention to Seo et al, (2021), another recent study using an animal model to look at the effects acupuncture has on specific neurotransmitters and hormones in a stress model.

Thoughts: The trend in recent research is to not only compare patient or practitioner-rated outcomes between groups but also to include objective measures, such as blood samples, biomedical measures, and brain scans, linking the subjective and objective aspects of the patient’s experience and the researcher’s observations. This type of research is valuable and provides a more comprehensive understanding. We look forward to more of this type of research. The present study has some limitations due to its small size, and the researchers recommend a larger, multi centre study for a broader perspective.


Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial

Qi et al. (2022) aimed to examine the biological mechanism behind acupuncture’s potential benefit for IBS patients, which they hypothesised to be by reducing “visceral hypersensitivity” and regulating the gut-brain axis. The study was a pilot, multi-centre randomized controlled trial (RCT) involving 90 participants across 4 Chinese hospitals, who were divided into three groups: specific acupuncture (using real points), non-specific acupuncture, and sham acupuncture. All participants received 12 acupuncture sessions over 4 weeks.

The researchers compared abdominal pain scores and stool type to evaluate the results.

Findings: Both the specific and non-specific acupuncture groups demonstrated significant improvement in IBS-D symptoms from the baseline. There was a 20% difference between the specific acupuncture group and the sham group. The researchers suggested conducting a larger, multi-centre trial for further investigation.

Thoughts: The use of non-specific treatment in this study is noteworthy as it raises questions about the appropriate comparison to active treatment. Although using real points even out of context still has a noticeable effect, it is important to understand which specific points were considered non-specific and yet still showed an impact within the acupuncture model, as each point has numerous connections and influences.

This information could help differentiate the placebo effect, which is present to some extent in all types of treatments, including Western and drug treatments. The distinction between placebo and genuine effects is usually more apparent after the end of treatment, as evidenced by a follow-up review a few weeks later. As seen in this study, the real acupuncture group using specific points had a more lasting outcome.

A large number of trials have looked at IBS and acupuncture in the past, with promising results. Shaftesbury Clinic’s website has a page about this specifically

The outcomes of a number of large, systematic reviews is expected very soon, the protocols for which came out in 2020/2021 (Li et al, 2021, 2021b; Guo et al, 2020), which will to add to the research and be of interest.


Research Trends of Acupuncture Therapy on Fibromyalgia from 2000 to 2021: A Bibliometric Analysis

Yi and co-authors (2022) conducted a review of the growing trend of research studies on fibromyalgia. They analyzed a total of 868 studies published between 2000 and 2021 and found an increasing trend in the number of studies conducted. The United States was identified as the most active country in terms of conducting research studies on fibromyalgia, which was unexpected, as one might expect a high number of studies to originate from China.

The studies reviewed by the researchers covered a wide range of topics, including the efficacy of acupuncture and electroacupuncture, long-term efficacy, and possible mechanisms of action through animal models. The Journal of Pain was the top publisher of these studies, with JAMA and the Annals of Internal Medicine close behind.

It’s useful to examine the scope of existing literature and identify areas where further research is necessary when considering the current state of the research field. This helps to highlight any gaps in the current knowledge and determine what needs to be done to address these gaps and build upon what has already been accomplished.

In terms Fibromyalgia, and the published literature on it; there are numerous RCTs and at least 3 systematic reviews, Shaftesbury Clinic’s website has an informational article on this.


What is on the horizon?

To stay informed about new research in acupuncture, a good strategy is to monitor Google Scholar using the search term “acupuncture protocol.”

Here are the top 3 upcoming studies to look out for in the near future:

The efficacy and safety of acupuncture for depression-related insomnia: protocol for a systematic review and meta-analysis (Hu et al, 2022). In the Journal of Pain Research, the authors aim to explore the correlation between depression and insomnia, and the potential role of acupuncture. They will conduct a comprehensive analysis of the efficacy and safety of acupuncture for depression-related insomnia by synthesizing data from numerous RCTs. The analysis will be based on a search of nine databases using the Cochrane database. With prior evidence supporting acupuncture in the treatment of depression, including a large multi-centre UK study (MacPherson et al, 2017), this area holds great promise for future research.

Efficacy and safety of acupuncture in the treatment of foot drop in post-stroke: A protocol for systematic review and meta-analysis (Gao et al, 2022). are exploring the topic of foot-drop, a widespread issue resulting from strokes and causing the risk of falls and injuries. The study aims to fill the gap of lack of systematic review in this area by utilizing the Cochrane Register of Controlled Trials along with 7 other databases to analyze the existing evidence.

Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis (Chen et al, 2022). The researchers aim to consolidate the data from various RCTs on acupuncture’s application in a specific area of interest, as there has been a substantial amount of literature in this promising field.

It’s important to keep in mind that synthesizing data in this manner serves not only to determine the effectiveness of acupuncture, but also to uncover insights about which acupuncture points, techniques, and approaches may be most effective. This approach also allows us to identify any gaps in our understanding that future research can explore.

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.

References:

Chen, C., Liu, J., Liu, B., Cao, X., Liu, Z., Zhao, T., Lv, X., Guo, S., Li, Y., He, L. and Ai, Y., 2022. Efficacy of acupuncture in subpopulations with functional constipation: A protocol for a systematic review and individual patient data meta-analysis. PloS one, 17(4), p.e0266075.

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.

Gao, Y., Gang, X., Yuan, Y., Yin, K. and Gong, X., 2022. Efficacy and safety of acupuncture in the treatment of foot drop in post-stroke: A protocol for systematic review and meta-analysis. Medicine, 101(40), p.e30994.

Guo, J., Xing, X., Wu, J., Zhang, H., Yun, Y., Qin, Z. and He, Q., 2020. Acupuncture for Adults with Diarrhea-Predominant Irritable Bowel Syndrome or Functional Diarrhea: A Systematic Review and Meta-Analysis. Neural plasticity, 2020.

Hu, H., Li, Z., Cheng, Y. and Gao, H., 2022. The efficacy and safety of acupuncture for depression-related insomnia: protocol for a systematic review and meta-analysis. Journal of Pain Research, pp.1939-1947.

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021a. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

Li, H., Chen, Y., Hu, Z., Jiang, J., Ye, J., Zhou, Y., Yu, Z. and Tang, H., 2021b. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(8).

MacPherson, Hugh, Andrew Vickers, Martin Bland, David Torgerson, Mark Corbett, Eldon Spackman, Pedro Saramago et al. “Acupuncture, Counselling or Usual Care for Depression (ACUDep): a randomised controlled trial.” In Acupuncture for chronic pain and depression in primary care: a programme of research. NIHR Journals Library, 2017.

Qi, L.Y., Yang, J.W., Yan, S.Y., Tu, J.F., She, Y.F., Li, Y., Chi, L.L., Wu, B.Q. and Liu, C.Z., 2022. Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial. JAMA Network Open, 5(12), pp.e2248817-e2248817.

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

Yu, G., Chen, L., Huang, H., Nie, B. and Gu, J., 2022. Research Trends of Acupuncture Therapy on Fibromyalgia from 2000 to 2021: A Bibliometric Analysis. Journal of Pain Research, pp.3941-3958.

Helen
Posted on: Feb-27-2023 10:24 am
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Mechanisms of action – Acupuncture and neurotransmitters in the body

Blog, Conditions, Research, , ,

We know from research that acupuncture affects many bodily systems, so here we shall take a look at the nervous system and its chemical messengers: neurotransmitters.

In simple terms, a neurotransmitter is a chemical substance released at the end of a nerve fibre, which diffuses across a synapse (junction between nerves), and transmits the signal along to a nerve fibre or muscle fibre, for example.

This process is involved in the transmission of pain signals in the body, and is also one of the well-understood mechanisms of acupuncture pain relief. The role of acupuncture in modulating neurotransmitters involved in pain has been well discussed, as well as researched in great detail.

Specific neurotransmitters, and acupuncture’s effect on them:

Model of a brain and nerve cell

Zhang et al (2022) give the research on those in turn; opioid peptides; γ-Aminobutyric acid (GABA); Norepinephrine; 5-Hydroxytryptamine (5-HT) aka serotonin; and glutamate.  

The researchers look in detail about what acupuncture research has shown in terms of mechanisms of action for each neurotransmitter, and to summarise:

  • Endogenous opioid peptides (a type of neurotransmitter) are produced in the body as a direct result of acupuncture treatment. These have been shown in numerous studies to have a positive effect on analgesia (pain relief).  By name, these are enkephalins, endomorphins, dynorphins, and nociceptin, and they are the body’s own natural painkilling substances
  • γ-Aminobutyric acid (GABA); this is an inhibitory neurotransmitter in the central nervous system.  It has a painkilling effect. It has been demonstrated through research studies that acupuncture can upregulate GABA expression; another part of how acupuncture helps with pain
  • Norepinephrine (noradrenalin in the UK); another neurotransmitter, the release of which is enhanced by acupuncture. 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 analgesia
  • Glutamate; a central nervous system neurotransmitter, is involved in the transmission of pain signals in the spinal cord.  Acupuncture downregulates glutamate, as part of how it provides pain relief

Overall a combination of demonstratable mechanisms is clearly at play, and can be seen and measured to be the cause of why acupuncture can help pain. 

How were the studies done?

Research models

Studies on mechanisms of acupuncture analgesia are based on animal models, where levels of neurotransmitters and their effects are measured objectively, removing the possibility of placebo effect as a cause of pain relief. 

Human trials are also used where this is measurable in an ethical and objective way, through fMRI (brain scans showing which areas light up), and blood levels of neurotransmitters as well as pain ratings.

A complicated picture

There are other analgesic mechanisms of acupuncture besides those above, and it is hard to unpick the overall contributions of each, and it may be the case that it depends upon the region targeted, quality of pain and other factors.  For this reason, the acupuncturist’s experience and overall assessment of the individual on the day of treatment contribute to the overall outcome.

Reference:

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. https://www.hindawi.com/journals/ecam/2022/1451342/

Bibliography:

Li, S.K., Liao, W.D., Zhao, J. and Cao, X.W., 2020. Effects of acupuncture on plasma endogenous opioid peptides in patients with stroke-associated headache in convalescence. Zhen ci yan jiu= Acupuncture Research, 45(12), pp.995-999.

Lin, J.G., Kotha, P. and Chen, Y.H., 2022. Understandings of acupuncture application and mechanisms. American Journal of Translational Research, 14(3), p.1469.

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.

Trento, M.M.S., Moré, A.O.O., Duarte, E.C.W. and Martins, D.F., 2021. Peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture: a state-of-the-art review. Pflügers Archiv-European Journal of Physiology, 473(4), pp.573-593.

Wang, W.S., Xi, H.Y., Fu, G., Fan, X.Z. and Guo, M., 2022. Study on the Mechanism of Electroacupuncture in the Treatment of Neuropathic Pain Based on Vesicular Glutamate Transporter 2/Toll Like Receptor 4 Signal Pathway. Indian Journal of Pharmaceutical Sciences, pp.31-37.

Wu, W.Z., Zheng, S.Y., Liu, C.Y., Qin, S., Wang, X.Q., Hu, J.L., Wan, Q.Y., Zhao, Y.N. and Xi, H.Q., 2021. Effect of Tongdu Tiaoshen acupuncture on serum GABA and CORT levels in patients with chronic insomnia. Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion, 41(7), pp.721-724.

Helen
Posted on: Aug-30-2022 20:32 pm
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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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Acupuncture for pregnancy in Bedford, UK

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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Acupuncture and depression, mental health

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by Helen Smallwood, Shaftesbury Clinic

This blog post will concentrate on the use and research regarding acupuncture and mental health, and with a particular focus on depression.

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 known by many as being holistic, which means it looks at the workings of the body and the mind overall in an integrated way, as opposed to seeing them as separate entities. Some people are surprised to the extent to which acupuncture has been used and researched for mental health as their first impression is that acupuncture is a very physical therapy and they are mainly associating it with its uses for pain and injuries.

On a research database search, “acupuncture” + “mental health” yields over 48,000 hits of academic articles, 5,600 of which are “RCT”‘s (Randomised Controlled Trials) which are a high standard of research comparing acupuncture to another procedure, an inert control or “sham acupuncture” intervention.  Finding that of these 5,600 studies, 43% have been carried out since 2017 shows that wide and increasing scientific research is ongoing in this area. 

Read More Acupuncture and depression, mental health →

Helen
Posted on: Mar-18-2021 9:56 am
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Raynaud’s Phenomenon – Condition Resources

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The British Acupuncture Council (BAcC) has an evidence based factsheet on Raynaud’s Phenomenon and acupuncture.

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.

Resources:

British Acupuncture Council (BAcC) Raynaud’s Phenomenon factsheet

BAcC Research Digest

Helen
Posted on: Jul-17-2019 14:13 pm
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Can acupuncture help me reduce my medications?

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I am often asked permutations of this question, and my answer is that acupuncturists are not doctors, and deciding to change or reduce medication must always be done under a doctor’s supervision. It is important to have these conversations with your medical team, and it’s crucial if you are considering making changes to medications, that your GP and any consultants whose care you are under, are up to date on what you are doing.

Pharmacists can also be a very helpful resource, and in particular if you are using over the counter medications, they can advise you of contraindications and interactions they may have with your prescribed medications.

In terms of acupuncture and working with patients, some of the reasons people are looking at introducing complementary medicines and coming to us, is for example to help them reduce the number of painkillers they are taking, or see if we can do something to help their side-effects.  This can be very helpful as long as we have a team approach, realistic expectations and discussions, and the patient is also working with their GP or consultant.

The research evidence for acupuncture is growing, and we find that medical professionals are more and more aware of what we do, in some cases recommending acupuncture for particular conditions, so be sure to tell you GP if you are thinking of acupuncture, and keep them up to date on how you are getting along.

Helen
Posted on: Jan-19-2018 15:42 pm
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