Tag Archives: Acupuncture

2024-09-27 Migraine

Migraine – BBC Morning Live feature

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Dr Kiran, on BBC Morning Live recommends Acupuncture as part of the strategy for migraine

Here are the links to the original show: BBC Morning Live Series 6: 27/09/2024 (from 40 to 48 minutes, approximately). Dr Kiran recommends acupuncture at minute 48 – right at the end!

Read on to find out more about migraine, including how many people suffer with it in the UK; who migraine affects; the stages and symptoms; and the triggers and treatments of this debilitating condition.

At the end of the blog are some resources to find out more about the research on acupuncture use for migraine.

    Understanding Migraine: Unravelling the Mystery

    On Friday 27th September, 2024, on Morning Live (BBC), the discussion, led by Dr. Kiran Morjaria, highlighted the significant impact migraines have on individuals and society, including 3 million work absences annually due to this debilitating condition. One of the show’s presenters, Michelle, and Dr Kiran both spoke of their own experience as sufferers, and it was revealed that migraine that affects approximately 1 in 7 people.

    brain and nerve

    What is Migraine?

    Dr. Kiran explained that migraine is a complex neurological condition.

    Migraines are caused by “neurogenic inflammation in the first division of trigeminal sensory neurons”, and Dr Kiran acknowledged that this is just as complex as it sounds: involving blood vessels, nerves, and chemicals in the brain. Migraines can present with various neurological symptoms such as vision changes, weakness, and speech problems.

    Who is Affected?

    Migraines are more common in females aged 25-55 and can run in families, indicating a genetic component. Hormonal changes, particularly during the menstrual cycle, can also trigger migraines.

    Stages of a Migraine

    Migraines typically progress through four stages:

    1. Prodrome: Occurs hours to days before the migraine. Symptoms include tiredness and yawning.
    2. Aura: Happens 5-60 minutes before the headache. Warning signs include changes in vision, sensory disturbances, speech problems, and weakness.
    3. Headache: Lasts 4-72 hours. Characterized by one-sided throbbing pain, nausea, vomiting, and sensitivity to light and sound.
    4. Postdrome: Lasts 24-48 hours. Often described as a “migraine hangover,” it can take a day or two to feel normal again.
    headache migraine

    Common Misconceptions

    Migraines are often misunderstood as just bad headaches. However this is not the case: nor are they a mental health issue, although Dr Kiran pointed out that stress can trigger them, and migraines can affect the mental health of sufferers. Another misconception is around the link to stroke, and Dr Kiran explained that while migraines cannot cause strokes, there is a slight increase in stroke risk for those with migraine with aura, who should be under the care of their GP, as there are some medications they cannot have due to these risks.

    Treatment and Prevention

    Treatment aims to reduce the severity and frequency of migraines. Over-the-counter painkillers like ibuprofen and paracetamol can sometimes help, but overuse can lead to medication-overuse headaches. Prescription medications, such as triptans, are often used for more severe cases.

    Preventative measures include identifying and avoiding triggers, which can be tracked using a migraine diary. Common triggers include lack of sleep, alcohol, caffeine, stress, and certain foods like chocolate. Mindfulness, acupuncture, and vitamin B2 supplements were also recommended preventive treatments that Dr Kiran mentioned.

    headache migraine 2

    Acupuncture with Shaftesbury Clinic

    If you are interested in exploring acupuncture for migraine, see our link here to our resources page: Migraine – Condition Resources | shaftesburyclinic, as Dr Kiran recommended it, is also good to know there is research evidence to back this up, alongside recognised mechanisms of action as to how acupuncture’s effects are achieved, and those are covered (and fully referenced) on that page.

    You should always go in the first instance to your GP and let them know you’re looking at this approach but we are very happy to liaise with them about your care, and we often receive referrals from medical colleagues (GPs and neurology consultants) for these issues.

    Links

    https://www.bbc.co.uk/iplayer/episode/m00238dk/morning-live-series-6-27092024

    Helen
    Posted on: Sep-27-2024 20:01 pm
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    Fibromyalgia – BBC Morning Live feature

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    Dr Punam on BBC Morning Live recommends Acupuncture as part of the strategy for Fibromyalgia symptoms

    Here are the links to the original show: BBC Morning Live Series 6: 13/06/2024 (from 20 to 28 minutes, approximately). Link to the specific 8-minute segment: BBC One – Morning Live, What is fibromyalgia syndrome?

    Understanding Fibromyalgia: Unravelling the Mystery

    Recently, on Morning Live (BBC), Dr Punam shed light on fibromyalgia—a chronic condition that affects countless lives. The show’s presenters emphasized its prevalence, with viewers flooding their social media channels to share their experiences. Among the poignant messages were:

    Amanda – “Professionals have told me it’s in my head or it’s not a real illness!  I lost my job I loved.  I almost lost my home”

    Linda – “No-one believes how much pain you can be in.  it can make you feel down and useless sometimes”

    Sharon – “It is an awful condition in constant pain but because it’s invisible most people don’t understand”

    What is Fibromyalgia?

    Chronic Pain

    Dr. Punam explained that fibromyalgia manifests in various ways: widespread pain, extreme fatigue, and cognitive challenges (commonly referred to as “fibro fog”). Despite affecting approximately one in 20 people, the condition remains enigmatic.

    The underlying mechanism involves altered pain processing in the spinal cord and brain. These individuals have elevated levels of certain pain-signalling chemicals, rendering them hypersensitive to pain.  Dr Punam said “I have patients regularly they’re dealing with shooting pains feeling electric shocks […] you can really imagine having to live with that every day”

    Fibromyalgia can run in families and most commonly impacts people between the ages 25 and 55, but cases have even been seen in children. Triggers include trauma (like car accidents), major life events (such as bereavement), post-viral illnesses, and even childbirth. Yet, we lack a comprehensive understanding of why it occurs.

    The Stigma and Struggle

    Sadly, fibromyalgia sufferers face stigma due to widespread ignorance. Many feel unheard, their symptoms dismissed. As a GP, Dr Punam shared that she empathised deeply because her own mother has battled fibromyalgia for decades, and she spoke of her mother’s transformation from an active woman to one crippled by fatigue and pain. Doctors had dismissed her when tests came back clear, with one claiming “it’s all in your head.”

    “When you have instances like this, the person that’s affected will feel like they are unsupported, it increases isolation, it can even lead to depression”  Dr Punam says, “I think it adds to the general lack of empathy we have in society towards invisible conditions, not just fibromyalgia, chronic fatigue syndrome, autoimmune conditions.”  Progress is being made, but there’s still a long road ahead, she reflects.

    The symptoms disrupt lives—people who once held jobs, managed households, and cared for children now feel like shadows of themselves. Diagnosis remains challenging; it’s exclusionary, relying on detailed history, clinical exams, and negative test results.

    Understanding Fibromyalgia Symptoms

    Familiarising ourselves with fibromyalgia symptoms is crucial. Here’s a concise list:

    • Pain sensitivity
    • Muscle Stiffness
    • Fatigue
    • “Fiibro-Fog”
    • Irritable bowel syndrome

    Pain Sensitivity and Muscle Stiffness:

    Fibromyalgia isn’t localized pain; it can affect any part of the body: Individuals become hypersensitive to even the lightest touch.

    Fatigue:

    This is not a generalised tiredness, it’s a depletion of energy and extreme fatigue. “This is like waking up after hours of sleep and still feeling exhausted” says Dr Punam, and overexertion exacerbates the draining effect.

    “Fibro-Fog”:

    1. This cognitive challenge affects memory and concentration.
    2. In the workplace, lack of support can make it particularly difficult.

    Gut Issues:

    1. Irritable bowel syndrome (IBS) is common in fibromyalgia.

    In addition to the above, restless leg syndrome and headaches may also occur.

    Managing Fibromyalgia: Strategies and Support

    According to Dr Punam, while there’s no cure, several approaches can alleviate symptoms and flare-ups:

    1. Heat:
      • Heat helps with stiff joints.
      • Try warm baths, hot water bottles, or soaking hands and feet in warm water.
    2. Pain Relief:
      • Painkillers, both over-the-counter and prescription, can provide relief.
    3. Exercise:
      • Proceed with caution; work within your abilities.
      • Exercise benefits mood, releases endorphins, and improves symptoms.
      • Consult your GP for a referral to specialised exercise guidance.
    4. Talking Therapies:
      • Cognitive-behavioural therapy (CBT) helps manage thought processes.
      • Address issues arising from flare-ups.
    5. Complementary and Integrated Approaches:
      • Acupuncture has shown promise.
      • Yoga and Tai Chi can be beneficial.
    6. Individualized Management:
      • What works varies from person to person.
      • Support from healthcare professionals, family, friends, and colleagues is essential.
    7. Antidepressants:
      • Beyond mood improvement, certain types can manage pain and enhance sleep quality.

    Remember, you’re not alone in this journey. Seek support and tailor your management plan to your unique needs.

    Acupuncture with Shaftesbury Clinic

    Adding to the above, where Dr Punam mentioned studies for acupuncture, we have a dedicated page for information and research: Shaftesburyclinic.com Fibromyalgia: Condition Resources which may be of interest. 

    Acupuncture can be a part of your approach to coping with the symptoms of fibromyalgia, and it is always good to have an overall approach that takes into account your individual needs and symptoms.  You should always go in the first instance to your GP or pain consultant, but we are very happy to liaise with them about your care, and we often receive referrals from medical colleagues for chronic pain.

    Also good to note, is that the NHS advisory panel, NICE (National Institute for Health and Care Excellence), have recommended acupuncture for chronic pain, as per our blog about this subject here: Shaftesburyclinic.com: acupuncture and chronic primary pain – the new nice draft guidelines  

    Links

    https://www.bbc.co.uk/iplayer/episode/m00202kr/morning-live-series-6-13062024

    https://www.bbc.co.uk/programmes/p0j3yvgz

    Helen
    Posted on: Jun-14-2024 11:31 am
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    Acupuncture for chronic pain in Bedford, UK

    Chronic Pain – Condition Resources

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    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

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    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 for fertility in Bedford, UK

    Infertility IVF, ART, ICSI- Condition Resources

    Blog, , , , , ,

    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 very popular approach for those looking to conceive. See our blog on the research that has been done into the use of acupuncture for fertility reasons

    The British Acupuncture Council has produced an evidence based factsheet about Female Fertility, as well as one on Male Fertility and acupuncture approaches, including specific research, trials and mechanisms of action for acupuncture for this (links are below).

    A systematic review and meta-analysis of studies in the peer-reviewed British Medical Journal (Manheimer et al, 2008) found that complementing the embryo transfer process with a specific traditional acupuncture protocol had a positive effect on the birth rate of sub fertile women having IVF/ICSI treatment.

    About 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. “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.

    A popular and evidence-based choice

    Acupuncture is a popular choice for fertility and conception support, having had mainstream media exposure since 2008, when a large meta-analysis of scientific studies was published in the British Medical Journal (BMJ – Manheimer et al, 2008), and which showed acupuncture’s efficacy in increasing pregnancy rates from IVF procedures, compared to IVF procedures alone. A more recent Iranian RCT study reflected this, (Dehghani et al, 2020) when they looked IVF pregnancy rates with and without acupuncture treatment. They used 3 groups in cluding a control (n=186) and found that: “Acupuncture 25 min before ET [embryo transfer] significantly increased the IVF outcomes in women undergoing IVF compared with no acupuncture.”

    A large body of evidence in this area has grown, both for natural and IVF, ICSI and other types of assisted fertility (ART) procedures.  These studies show that acupuncture improves blood flow to the uterus and ovaries (Khorram et al, 2005, Stener-Victorin et al, 1996), improves the thickness of the endometrium (uterus lining) and regulates the levels of the key hormones that govern the conception process, FSH, LH, GnRH, progesterone and oestrogen (Yu et al, 2007; Zhang et al, 2018; Stener-Victorin, 2006).

    Acupuncture is also effective in PCOS (polycystic ovarian syndrome), and can regulate the menstrual cycle and stimulate ovulation (Lim et al, 2010, Stener-Victorin et al, 2014).

    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 in the decades of experience we personally have at the clinic 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, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, 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:

    British Acupuncture Council evidence based factsheet about Female Fertility, and approaches to treatment including specific research, trials and mechanisms of action for acupuncture in this condition.

    BAcC Male Fertility factsheet

    BAcC Fertility and ART (assisted reproduction – IVF/ICSI) factsheet

    BAcC PCOS (Polycystic Ovarian Syndrome) factsheet

    BAcC Female fertility & IVF briefing paper

    References:

    Dehghani, A.S., Homayouni, K., Kanannejad, Z. and Kanannejad, Z., 2020. The effect of acupuncture on the day of embryo transfer on the in vitro fertilization outcomes: An RCT. International journal of reproductive biomedicine, 18(3), p.209.

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

    Manheimer, E; Zhang, G; Udoff, L; Haramati, A; Langenberg, P; Berman, BM; Bouter, LM; (2008) Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis BMJ (2008) 336:517-518 

    Stener-Victorin E, Waldenstram U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996 Jun;11(6):1314-7.

    Stener-Victorin, E;A. Benrick, M. Kokosar, M. Maliqueo, C. Behre, K. H¸jlund, A. Sazonova Acupuncture increases whole body glucose uptake during and after stimulation in women with polycystic ovary syndrome Fertility and Sterility, Vol.102:3, e29 Published in issue: September 2014

    Yu, B. Horn, B. Acacio, D. Ni, R. Quintero, M. NourianiA Pilot Study Evaluating the Combination of Acupuncture with Sildenafil on Endometrial Thickness Fertility and Sterility, Vol.87:4, S23

    Zhang, X., Lee, M.S., Smith, C.A., Robinson, N., Zhou, Y., Wu, Y., Mao, Y.Y. and Qu, F., 2018. Effects of acupuncture during in vitro fertilization or intracytoplasmic sperm injection: An updated systematic review and meta-analysis. European Journal of Integrative Medicine, 23, pp.14-25.

    Helen
    Posted on: Aug-2-2023 13:10 pm
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    Acupuncture for the Cardiovascular system in Bedford, UK

    Angina, Arrhythmias, Coronary Heart Disease, and Heart Failure- Condition Resources

    Blog, , , , , , , , , , , , , ,

    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 produced an evidence based factsheet about Angina, Coronary Heart Disease, Atrial Fibrillation and Heart Failure including specific research, trials and mechanisms of action for acupuncture in this condition, we recommend taking a look via the underlined link above. Their Factsheet on Hypertension, High Blood Pressure may also be of interest.

    Research and Resources on Arrhythmia and Heart Failure and Acupuncture:

    A scholarly search of the available research studies on “acupuncture” +”arrhythmia” reveals over 7,400 papers from journals, and narrowing this to “RCT” leads to over 630 hits, of which 40% have been carried out since 2017. A scholarly search of the available research studies on “acupuncture” + “heart failure” reveals over 18,000 papers from journals, and narrowing this to “RCT” leads to over 1,700 hits, of which 52% have been carried out since 2017.  From this we can deduce that acupuncture is being used traditionally and currently in this area; scientifically researched for this, and that the pace of the research is increasing – leading us to see these as areas 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.

    Angina Pectoris

    A systematic review and meta-analysis of 12 studies (Lu et al, 2022; n=1203) looked at treating cardiovascular disease complicated with depression, and found that acupuncture reduced HAMD (Hamilton scale for depression) score, SDS (self-rating depression scale) score and also reduced the attack frequency of angina pectoris and the VAS (visual analogue scale) score for angina pain. They concluded that acupuncture could be a good complementary and alternative therapy for CVD complicated with depression.

    Atrial Fibrillation

    Lomuscio et al, 2011 (n=80) concluded that acupuncture prevented arrhythmic recurrences after cardioversion in patients with persistent AF, and was safe and well tolerated. 

    Li et al, (2022) made a meta-analysis and systematic review of RCTs that had compared acupuncture with pharmacological conversion for treating atrial fibrillation.  They looked at 11 papers, and concluded that “ acupuncture significantly effectively benefitted the patients with atrial fibrillation”, and overall combining the pharmacological (medicinal) cardioversion with acupuncture was significantly more beneficial than was the pharmacological approach alone.

    Following Valve Surgery:  Cardioprotective Effects

    Feingold et al, 2023 (n=100) carried out an RCT with 100 patients undergoing primary valve surgery via sternotomy.  They found acupuncture after valve surgery to be feasible, well tolerated, and having clinical benefit.  Specifically, there were no adverse events, and the acupuncture group had reduction in pain, nausea, stress, and anxiety, as well as reduced postoperative stress and anxiety and reduced postoperative atrial and fewer hours in the intensive care unit than those patients on standard care alone.

    Yang et al, (2010, n-=60) conducted an RCT to investigate the cardioprotective effects of electroacupuncture (EA) pretreatment on patients undergoing heart valve replacement surgery.  They measured the levels of cardiac troponin I (CTnI) which is a protein released into the blood when the heart muscle is damaged (e.g. during a heart attack).  Other outcomes, such as blood pressure, heart rate, use of drugs, and length of stay in the intensive care unit (ICU) were also compared between a pretreatment group and a control (no acupuncture) group.  They found that EA pretreatment significantly lowered the levels of CTnI in acupuncture patients after surgery vs control, therefore EA pretreatment reduced the amount of heart injury caused by the surgery.  EA pretreatment also reduced the use of drugs such as inotropes, after surgery (indicating more improved heart function after surgery, shortened stay in ICU; versus the non-acupuncture group.

    Coronary Artery Disease, PCI procedure

    Ho et al, (1999, n=44) looked at the PC6 point also (note, Nei-Kuan is an alternative spelling), in their case they examined that effect upon Left Ventricular Function in Patients with Coronary Artery Disease (CAD).  The left ventricle is the main pumping chamber of the heart, and in CAD, the blood vessels that supply heart become narrowed or blocked by fatty deposits called plaque.  The study measured how much blood the left ventricle pumps out with each contraction (left ventricular ejection fraction, LVEF) in 22 patients with coronary artery disease and 22 normal subjects.  Acupuncture caused an increase in the LVEF in patients with coronary artery disease, especially in the first 15 minutes of stimulation. This persisted for 15 minutes after acupuncture, but became insignificant after one week.  They concluded acupuncture at PC6 could temporarily improve left ventricular function in CAD patients, but more studies were needed to confirm its long-term effects and mechanisms.

    An RCT (Wang et al, 2015), aimed to understand if pretreatment with electroacupuncture (EA) could reduce the damage to the heart muscle caused by percutaneous coronary intervention (PCI).  PCI is used to treat CAD by inserting a thin, flexible tube called a catheter, where it’s x-ray guided to the and a small balloon is inflated to widen the narrowed coronary artery, and possibly a small metal mesh tube (“stent”) placed like a scaffold to keep it open.  However, PCI can cause damage the heart muscle (ischemia-reperfusion injury).  Wang et al (2015) compared EA with sham EA in 204 CAD patients undergoing PCI.  They found that EA: significantly lowered the levels of cTnI (cardiac troponin I); reduced the use of drugs (inotropes); shortened the length of stay in the intensive care unit (ICU); and decreased the rate of MACCE (major adverse cardiac/cerebrovascular events) at 24 months after PCI, compared to sham EA. They concluded that EA prior to PCI “significantly reduced cTnI release and protected patients with CAD from subsequent myocardial injury after PCI procedure.”

    Mechanisms of action

    Li et al (2014) proposed a possible mechanism of action for the lowering of blood pressure, in that acupuncture could regulate the renin-angiotensin-aldosterone system (RAAS), which is involved in blood pressure regulation, by stimulating specific acupoints that correspond to the kidney and liver meridians. The other mechanism is based on the Western medicine theory of modulating the autonomic nervous system (ANS), which controls the heart rate and vascular tone. They further hypothesized that acupuncture might activate the parasympathetic branch of the ANS, thus lowering the sympathetic activity and reducing the release of stress hormones that constrict the blood vessels.

    Li et al, (2022), theorised about specific points in the process of cardioversion, whereby acupuncture in addition to medication was shown to benefit the outcome.  In particular a specific point on the arm called Neiguan (pericardium 6), which has mechanisms of action including:  Downregulating the amygdala (involved in stress response) in the brain; desensitising the nucleus tractus solitarius, (area in the brain that controls heart rate and blood pressure); reducing levels of inflammatory substances in the blood, including CRP, IL-8, and TNF-α (which can cause swelling and pain, damage the heart tissue and make AF worse); improving the index of heart rate variability (HRV) – is a measure of how well the heart adapts to different situations.

    Yang et al (2010) in their RCT on cardioprotective effects of EA for valve surgery discussed possible mechanisms for how EA pretreatment could protect the heart from injury, such as activating certain pathways in the brain and nerves that regulate blood flow and inflammation. Specifically, they put forward the way in which EA at Neiguan (PC-6) can influence the neuroendocrine system and the inflammatory response, which are both involved in the pathogenesis and progression of coronary artery disease. Stimulating this point can activate certain pathways in the brain and nerves that regulate blood pressure, heart rate, vascular tone, and stress hormones, as well as reduce the levels of substances in the blood that cause inflammation, such as cytokines, chemokines, and adhesion molecules.

    Li et al (2012) also discussed PC6, and the sympathoexcitatory cardiovascular reflex responses, which are reactions that make the heart beat faster and stronger when the body is under stress or danger.  Point PC6 can reduce the sympathoexcitatory cardiovascular reflex responses, reducing this effect and relaxing the heart muscle to modulate the response to an appropriate level.  They also discuss brain activity that may govern the cardiovascular response, and be influenced by acupuncture, namely some parts of the brain that are involved in acupuncture, such as the rostral ventrolateral medulla (RVLM), the arcuate nucleus (ARC), and the ventrolateral periaqueductal gray (vlPAG), which are parts of the brain that control the blood pressure, heart rate, and stress response.  Acupuncture can do this by activating some pathways in the brain that send messages to the heart and blood vessels to relax, and can also make these pathways less sensitive to signals from other organs or tissues that can trigger these reflexes.  Acupuncture can have a long-lasting effect on these reflexes, even after the needles are removed. Acupuncture can do this by changing some proteins or chemicals in the brain that are involved in these reflexes, such as opioids, serotonin, or nitric oxide.

    Another mechanism of action involved adenosine receptors, as examined by Malik et al (2019); EA activates the A2a adenosine receptors in the RVLM (rostral ventrolateral medulla of the brain), making the nerve cells in the RVLM less active and less likely to increase the blood pressure and heart rate.  This process is dependent on the body’s natural opioids, and the fact that EA can increase the amount of opioids in the RVLM, can help activate the A2a adenosine receptors. This process has been proven further by the fact that if the opioids are deliberately blocked by some drugs, EA’s effect on the A2a adenosine receptors is also blocked.

    Animal Models

    In a rat model, Su et al (2022) used PC6 point to study atrial fibrillation, in order to understand the mechanism of action whereby electroacupuncture at this point was demonstrated in many previous studies to benefit AF.  EA at PC6 was shown to affect the brain and the nerves that control the heart in different ways: making it harder for AF to start or continue by changing how the heart cells react to certain chemicals, such as ACh and CaCl2, that can trigger AF; improving the HRV; balancing the activity of the sympathetic and vagal nerves, which are part of the nervous system that controls the heart rate and blood pressure (the sympathetic nerve makes the heart beat faster and stronger, while the vagal nerve makes it slower and weaker); reducing the sympathetic nerve activity and increase the vagal nerve activity, which can help lower the heart rate and make it more stable; affecting the expression of c-Fos, which is a protein that shows how active certain brain regions are, and decreasing the activity of some brain regions that are involved in stress and blood pressure regulation, such as PVN, RVLM, and DMV; whilst increasing the activity of another brain region that is involved in heart rate regulation.

    Summary

    Several hypotheses have been proposed based on anatomical, physiological, pharmacological, and neuroscientific evidence. One of the main mechanisms is the modulation of the autonomic nervous system, which regulates the heart rate, blood pressure, and vascular tone. Acupuncture can activate specific reflexes that involve peripheral nerves, spinal cord, brainstem, hypothalamus, and other brain regions to inhibit sympathetic activity and enhance parasympathetic activity. This can result in vasodilation, decreased cardiac output, and reduced blood pressure.

    Another mechanism is the release of endogenous substances that have cardiovascular effects, such as endorphins, enkephalins, serotonin, nitric oxide, and angiotensin II. These substances can act on various receptors and channels to modulate vascular tone, cardiac contractility, inflammation, and oxidative stress.

    A third mechanism is the stimulation of angiogenesis and neurogenesis in the heart and brain tissues. Acupuncture can increase the expression of growth factors and cytokines that promote the formation of new blood vessels and nerve fibres. This can improve blood supply and oxygen delivery to the ischemic areas and enhance tissue repair and regeneration.

    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:

    BAcC Factsheet: Angina, Coronary Heart Disease, Atrial Fibrillation and Heart Failure

    BAcC Factsheet: Hypertension

    BAcC Factsheet: Stroke

    Related pages: Hypertension/High Blood Pressure ; Stroke

    References:

    Feingold, K.L., Moskowitz, J.T., Elenbaas, C., Andrei, A.C., Victorson, D., Kruse, J., Grote, V., Patil, K.D., Shafiro, T., Grimone, A. and Lin, F., 2023. Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial. JTCVS Open.

    Ho, F.M., Huang, P.J., Lo, H.M., Lee, F.K., Chern, T.H., Chiu, T.W. and Liau, C.S., 1999. Effect of acupuncture at nei-kuan on left ventricular function in patients with coronary artery disease. The American journal of Chinese medicine, 27(02), pp.149-156.

    Li, D.Z., Zhou, Y., Yang, Y.N., Ma, Y.T., Li, X.M., Yu, J., Zhao, Y., Zhai, H. and Lao, L., 2014. Acupuncture for essential hypertension: a meta-analysis of randomized sham-controlled clinical trials. Evidence-Based Complementary and Alternative Medicine, 2014.

    Li, J., Li, J., Chen, Z., Liang, F., Wu, S. and Wang, H., 2012. The influence of PC6 on cardiovascular disorders: a review of central neural mechanisms. Acupuncture in Medicine, 30(1), pp.47-50.

    Li, Y., Song, J., Wu, B., Wang, X., Han, L. and Han, Z., 2022. Acupuncture versus pharmacological conversation in treatment of atrial fibrillation in a randomized controlled trial: a systemic review and meta-analysis. European Journal of Medical Research, 27(1), pp.1-14.

    Lomuscio, A., Belletti, S., Battezzati, P.M. and Lombardi, F., 2011. Efficacy of acupuncture in preventing atrial fibrillation recurrences after electrical cardioversion. Journal of cardiovascular electrophysiology, 22(3), pp.241-247.

    Lu, L., He, W., Guan, D., Jiang, Y., Hu, G., Ma, F. and Chen, L., 2022. Acupuncture in treating cardiovascular disease complicated with depression: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, p.1051324.

    Ma, J., Zhang, Y., Ge, Q. and Wu, K., 2023. The effect of auricular acupuncture on preoperative blood pressure across age groups: a prospective randomized controlled trial. Clinical and Experimental Hypertension, 45(1), p.2169452.

    Malik, S., Samaniego, T. and Guo, Z.L., 2019. Adenosine receptor A2a, but not A1 in the rVLM participates along with opioids in acupuncture-mediated inhibition of excitatory cardiovascular reflexes. Frontiers in Neuroscience, p.1049.

    Su, Y., Huang, J., Sun, S., He, T., Wang, T., Fan, M., Yu, H., Yan, J., Yao, L., Xia, Y. and Zhang, M., 2022. Restoring the Autonomic Balance in an Atrial Fibrillation Rat Model by Electroacupuncture at the Neiguan Point. Neuromodulation: Technology at the Neural Interface.

    Wang, Q., Liang, D., Wang, F., Li, W., Han, Y., Zhang, W., Xie, Y., Xin, W., Zhou, B., Sun, D. and Cao, F., 2015. Efficacy of electroacupuncture pretreatment for myocardial injury in patients undergoing percutaneous coronary intervention: a randomized clinical trial with a 2-year follow-up. International journal of cardiology, 194, pp.28-35.

    Yang, L., Yang, J., Wang, Q., Chen, M., Lu, Z., Chen, S. and Xiong, L., 2010. Cardioprotective effects of electroacupuncture pretreatment on patients undergoing heart valve replacement surgery: a randomized controlled trial. The Annals of thoracic surgery, 89(3), pp.781-786.

    Yin, C., Seo, B., Park, H.J., Cho, M., Jung, W., Choue, R., Kim, C., Park, H.K., Lee, H. and Koh, H., 2007. Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial. Neurological research, 29(sup1), pp.98-103.

    Helen
    Posted on: Jul-15-2023 13:35 pm
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    Acupuncture Awareness Week 2023

    Research Update: Recent 2023 studies on acupuncture for pain

    Blog, Conditions, Research, , , , ,

    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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    Darren Haines

    An interview with Darren Haines, Acupuncturist at Shaftesbury Clinic

    Blog, Interviews, Shaftesbury Clinic, , , , , , ,

    Acupuncturist Darren Haines joined the team at Shaftesbury Clinic in March 2022.   Helen caught up with him to find out more about his journey into acupuncture, what he does in his everyday practise, and what inspires him in his work.

    Fact File:

    • ☼ Darren qualified in from The Acupuncture Academy in Leamington Spa, with a Licentiate in Acupuncture (Lic.Ac.) after 3 years’ degree-level training
    • ☼ As a member of the British Acupuncture Council (BAcC), Darren adheres to the BAcC Codes of Safe Practice and Professional Conduct
    • ☼  Darren has full public liability insurance and professional indemnity cover, and is licensed by Bedford Borough Council to work as an acupuncturist at Shaftesbury Clinic
    • ☼  BAcC members are also registered with the Professional Standards Authority (PSA) a government body which regulates the regulatory and registration bodies of health and social care providers and is accountable to parliament

    Helen:  What was your work before acupuncture?

    Darren:  I worked in PR for over 20 years, with leading High Street retailers and Sports brands, at a high level, but over the years I found that the sector had changed, and it was different to the industry I started out in at the beginning of my career.  At that stage, I began to feel like I wanted to make a move into a more fulfilling role, in a career that could be more rewarding. 

    At around this time, I had an experience where acupuncture made a real difference to the outcome of a life-changing event; seeing the difference for a family member from treatment with Philip Rose-Neil, here at Shaftesbury Clinic proved to be a strong inspiration.  I then also came to see Phil myself as a patient, and speaking with him about the theories and mechanisms behind acupuncture, my interest in acupuncture as a career was piqued, and I looked into training in this field. 

    Helen:  What attracted you about acupuncture as a career?

    Darren:  It was seeing the difference acupuncture could make in people’s lives; I realised that I wanted to be able to do this for others.  I was also attracted by this being a holistic approach to health, and that as an acupuncturist, I would be looking to find the root cause of the patient’s presenting complaint, and to make a difference to their long-term health, rather than just a “sticking plaster” approach of short-term, or localised symptomatic benefit.

    Now that I am working in this field, it is enjoyable work, and is rewarding to be able to help people back to better heath.  It can give you a buzz when you are part of seeing those changes and outcomes for patients.

    Helen:  What does training in acupuncture entail?

    Darren:  It is a three-year, degree-level course, and in order to be a member of the British Acupuncture Council, it must be BAAB (British Acupuncture Accreditation Board) accredited and entail at least 3,600 hours’ training.  My professional Licentiate training at The Acupuncture Academy in Leamington Spa (BAAB accredited) was centred on the traditional Five Element model of Chinese medicine theory, together with anatomy, physiology, with particular emphasis on surface anatomy for point location.

    There were modules on Western Medical view of the body’s organs and systems so that we can spot red flag symptoms, and refer and treat appropriately.  From a practical perspective, there was needle technique, point selection, and practical work in clinic.  At least 400 hours are in the clinical setting, including treatment observations; of which 200 hours’ direct clinical work with our own patients.     

    I treated my pre-qualification supervised patients and my clinical assessments here at the clinic, under the mentorship and supervision of Philip Rose-Neil; having carried out my observations in his clinic.  I was good to have such an experienced mentor as a sounding board, and to continue to be part of the same team [Phil has been at Shaftesbury Clinic over 11 years].

    Helen:  What is a typical day like for you in clinic?

    Darren:  As an acupuncturist you train as a generalist, which means I could be seeing patients from for many different presenting reasons.  Patients very often access acupuncture for painful conditions such as back pain or migraine, but it can also be for chronic conditions such as eczema, sinusitis, and even seasonally for hay fever.  Acupuncture is also known to support general wellbeing, relaxation and balance, and for these reasons people will also access it for stress, anxiety and related issues in their busy lives.

    Needles are used to stimulate acupuncture points, which are chosen in relation to the presenting issues for each patient.  I may also use Moxibustion (an acupuncture technique used to gently heat acupoints), Cupping, or Gua Sha, which are all acupuncture techniques used for specific situations, such as muscular and stagnation issues.  The treatment plan is tailored to each patient.

    As an acupuncturist, I see people from all walks of life, and approaches each patient as an individual, considering all aspects of their health and context within the treatment model, so no two days are the same. 

    Helen:  Do you have any special interests within acupuncture practise, or patient groups that you work with specifically?

    Darren:  Having recently qualified, I have some areas where I have professional interests where I am planning to attend further training courses.  Of these, I have a continued interest in sport from my previous work in PR, and am attending a Musculoskeletal acupuncture training course in November, which will give in-depth experience in MSK issues and their treatment, including sports injuries.  I have an interest in acupuncture for fertility and pregnancy, and am looking to train further in this in the Spring, alongside Facial Acupuncture later next year.

    Helen:  What are your interests outside of acupuncture?

    Darren: I really like watching sport, particularly to watch it live; this was a part of my previous work that I enjoyed a great deal.  I love to go cycling, which is something I’ve been able to get back into recently, after a hiatus when I spent a lot of time of travelling to college (Leamington Spa), studying at home, and getting my clinical hours in.  I will cycle anywhere, the roads in Bedfordshire a pretty good for it, and it is quite helpful that it’s not too hilly!

    At home, I love to cook, I will make all sorts of different things, and again after qualifying from college, it is great to be able to find the time to do this again.

    Having previously lived in London for work, and moved this way for quality of life, I do like to be able to go back into London for leisure.

    Helen:  How can prospective patient find out more about acupuncture, and book in with you?

    Darren:  The clinic offers a free 15 minute call back from one of us acupuncturists, to help a you find out about acupuncture, and whether it could be suitable and helpful for your needs.  This gives a realistic appraisal of what we can offer, so you can decide whether this is the approach for you.  I’m available for bookings on Wednesday evenings from 5:30pm to 8pm, and Fridays 9:30am to 6pm.  You can call the secretaries on 01234 511522, or book online via our website. 

    My colleague Louise England works on Tuesdays; Gillie Salter on Mondays; and Philip Rose-Neil Tuesdays, Thursdays and Saturdays.  We are always really happy to chat about what we do

    Helen:  Thank you for talking to me about your work today, Darren!
    Helen
    Posted on: Nov-6-2022 18:29 pm
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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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    Robot and Human Hands

    Acupuncture and AI?

    Blog, Research, ,

    New Research Paper: Here is an interesting concept for future development in acupuncture: “Artificial intelligence-directed acupuncture: a review”, in the Journal of Chinese Medicine.

    How might this work? Wang (2022) and colleagues say that using computing, our ability to quantify, objectify and standardise acupuncture can be increased. Not only this, but using AI perhaps the research and outcomes from published data can be used to identify the best approaches, and even predict treatment outcomes.

    It’s worth keeping in mind that from the acupuncturist’s perspective (an usually that of the patient, too), a large part of the appeal of acupuncture as a complementary medicine is that the patient is considered as an individual, and that even for the same condition, the treatment plan can vary from patient to patient as it is tailored to their need, therefore full standardisation is perhaps not the goal here, but more of a case of defining approaches and benefitting from looking at the data in novel ways.

    The researchers do say that “The use of AI-based data mining has led to the discovery of hidden knowledge on acupuncture point selection and prescription.” As with any field where there is complexity, it is good to have alternative approaches and paths to choose from, and as practitioners, evidence-led there is always a combination of training and experience, alongside the updates and research insights that come through from the increasing research body.

    At the moment the research is focussing on AI for common conditions that have large bodies of data and research for them, e.g. Osteoarthritis of the knee and dysmenorhhoea, and looking at particular pairs and combinations of points that arise in numerous studies.

    Other uses for AI to analyse the research and effectiveness have been in the manipulation of needles, which has very many possible forms, including electroacupuncture as an adjunct.

    An interesting area, which promises to deliver much insight in the coming years.

    If you’d like to look into it more, a few other resources are below, including recent papers from Wang et al (2021), who predict more unified guidelines for specific TCM syndromes to come forth from AI-assisted TCM therapies in the future. Feng et al (2021) also weigh in on the ability to over come subjectivity by using AI; and Alice et al (2021) look into its application to pulse diagnosis in TCM.

    References:

    Feng, C., Shao, Y., Wang, B., Qu, Y., Wang, Q., Li, Y. and Yang, T., 2021. Development and application of artificial intelligence in auxiliary tcm diagnosis. Evidence-based Complementary and Alternative Medicine, 2021.

    Feng, C., Shao, Y., Wang, B., Qu, Y., Wang, Q., Li, Y. and Yang, T., 2021. Development and application of artificial intelligence in auxiliary tcm diagnosis. Evidence-based Complementary and Alternative Medicine, 2021.

    Wang, Y., Shi, X., Efferth, T. and Shang, D., 2022. Artificial intelligence-directed acupuncture: a review. Chinese Medicine, 17(1), pp.1-10.

    Wang, Y., Shi, X., Li, L., Efferth, T. and Shang, D., 2021. The impact of artificial intelligence on traditional Chinese medicine. The American Journal of Chinese Medicine, 49(06), pp.1297-1314.

    Helen
    Posted on: Aug-15-2022 14:19 pm
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