Tag Archives: Acupuncture

New Research : Acupuncture Tapping in Psychotherapy

August 10, 2022Blog, Research, Shaftesbury ClinicAcupuncture, anxiety, Chronic Pain, Evidence, mental health, researchHelen

A new research article looks at acupuncture points and psychotherapy in practise. The interesting new article in the Journal of Psychotherapy Integration, discusses the use of acupuncture points within psychotherapy (the reference, and links to original article are below).

A holistic approach is increasingly being understood to include more that one modality to increase how effective an approach can be. This is well known for crossing the borders between, say mainstream medicine in areas like pain, but possible less so in the sphere of mental health, despite the fat that acupuncture and TCM (Traditional Chinese Medicine) have long included protocols for health on all levels of mind and body.

Traditional acupuncture uses needle stimulation on a network of specific points, tailored to the patient and presenting condition. In addition to, or instead of needles, acupuncturists can also use heat or acupressure (needle-less stimulation of points).

Tapping of a specific set of points in a protocol, is a fairly ew approach to self-care when experiencing anxiety or pain symptoms, for example. This can be done when the patient has been trained on how to do this, and increasingly this has been adopted in other settings. Today, other techniques incorporate some of the benefits of acupuncture alongside talking therapies, and there is a decent and growing research body here.

Per this research article Feinstein (2022 – ref and link below) the research and use of this are coming to the fore; there are “28 systematic reviews and meta-analyses, 125 clinical trials, 24 case studies, 26 reports describing systematic observations, 17 mixed-method clinical trials that included a tapping component, and 88 articles addressing clinical procedures, theory, mechanisms, or related issues” (Feinstein, 2022).

Sometimes called Emotional Freedom Technique (EFT), this shows the way in which cross-modality approaches can be applicable to real life cases. The acupuncture component of this has indeed been shown to be an active part of EFT (Church et al, 2018).

The overall outcome from looking at the state of research into the integration into psychotherapy of using tapping of acupuncture points is promising, and that the growing evidence base documents the effectiveness, speed, and durability of the approach.

References:

Church, D., Stapleton, P., Yang, A. and Gallo, F., 2018. Is tapping on acupuncture points an active ingredient in Emotional Freedom Techniques? A systematic review and meta-analysis of comparative studies. The Journal of nervous and mental disease, 206(10), pp.783-793.

Feinstein, D., 2022. Integrating the manual stimulation of acupuncture points into psychotherapy: A systematic review with clinical recommendations. Journal of Psychotherapy Integration. https://psycnet.apa.org/record/2022-61876-001

Helen

Posted on: Aug-10-2022 13:52 pm

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Tags: Acupuncture, anxiety, Chronic Pain, Evidence, mental health, research

An interview with Gillie Salter, Acupuncturist at Shaftesbury Clinic

May 17, 2022Blog, Interviews, Shaftesbury ClinicAcupuncture, acupuncturist, Bedford, Evidence, GillieSalter, Interview, References, researchHelen

Gillie Salter joined the team at Shaftesbury Clinic in March 2022. Helen caught up with her for a chat to find out what brought her to acupuncture; the types of clients she works with; and what inspires her in her work…

Fact File:

- ☼ Gillie graduated from the Acupuncture Academy (Leamington Spa) in December 2020 after 3 years’ degree level training, with a distinction in the Professional Licentiate in Acupuncture
- ☼ She is a member of the British Acupuncture Council (BAcC), the UK’s leading Regulatory Body for traditional acupuncture, and the largest, with over 2,500 members.
- ☼ BAcC members must have at least 3,600 hours’ degree-level training; 400 or more of which in a clinical setting
- ☼ The BACC is regulated by the Professional Standards Authority (PSA), which is accountable to the UK Parliament

Helen: What was your work background before acupuncture?

Gillie: My background is in nursing, having worked as a district nurse, where I really enjoyed the work, in particular meeting and looking after people from all different backgrounds. Later on, I studied further, gaining a Masters degree in Medical Anthropology.

Helen: For people who haven’t come cross it before, can you tell us a bit more about medical anthropology?

Gillie: Anthropology in general looks at what makes us human, how people live, and is a holistic approach, with medical anthropology specifically looking at how the practise of medicine, and health and wellbeing are understood and approached in different cultures and settings. For my dissertation, I used Ethnography, which is a systematic way to study cultural phenomena, within an elderly day care setting.

Helen: What led you from nursing and medical anthropology, toward acupuncture?

GIllie: After having my two children, the logistics of going back into nursing just weren’t practical, so I took on other roles including as a teaching assistant, and volunteer work, before combining my experience and interest to study acupuncture. I had looked into acupuncture and became certain that it was for me, after attending an open day at the TAA college in Leamington Spa, which inspired and impressed me.

Helen: What do you value about acupuncture that sets it apart from other approaches?

Gillie: It is the cultural aspect of the TCM (Traditional Chinese Medicine) approach that appeals to me, looking at the whole person within the treatment approach, in contrast to the Biomedicine (Western, allopathic) approach which works from viewing the mind and the body as being separate from each other.

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

Gillie: I enjoy all aspects of the variety that comes my way, as acupuncture can contribute so much to many different people, for their concerns and conditions. I treat all ages, including children.

Helen: How can someone interested in acupuncture find out more, and book in with you?

Gillie: Myself, and the other acupuncturists at Shaftesbury Clinic, offer a free 15 minute phone call, video chat or in-person consultation for a prospective patient to speak to one of us, and ask any questions they have about acupuncture.

This way, they can be given the information they need, and a realistic appraisal of what we can offer, so they can decide whether this is the approach for them.

There are a few ways to book: There’s a link here on the website to book in for a 15 minute chat, or for a treatment; alternatively they could ring the clinic direct to book on 01234 511522; or send the clinic an email, or contact form from the website.

Helen: Finally, when are you available to see patients in Bedford, Gillie?

Gillie: I work Mondays at Shaftesbury Clinic (based at Bedford Consulting Rooms). My colleague Phil Rose-Neil works Tuesdays, Thursdays and Saturdays; Louise England on Tuesdays, and Darren Haines on Wednesday evenings and Fridays.

Helen: Thank you for talking to me about your work today, Gillie!

Helen

Posted on: May-17-2022 10:18 am

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Tags: Acupuncture, acupuncturist, Bedford, Evidence, GillieSalter, Interview, References, research

Pregnancy, Breech baby, and Childbirth – Condition Resources

June 15, 2021Blog, Conditions, Research, Shaftesbury ClinicAcupuncture, Breech, Childbirth, condition, Hyperemesis Gravidarum, Morning Sickness, Moxibustion, Obstetrics, PregnancyHelen

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 D i abetes 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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Tags: Acupuncture, Breech, Childbirth, condition, Hyperemesis Gravidarum, Morning Sickness, Moxibustion, Obstetrics, Pregnancy

Arthritis – Condition Resources

June 13, 2021BlogAcupuncture, Arthritis, condition, Joints, Osteoarthritis, painHelen

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

Interpreting the research:

The research:

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

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

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

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

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

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

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

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

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

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

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

Mechanisms of Action:

A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines. The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”. Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.

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.

Liu et al (2014) 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.

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).

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)

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:

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
reduce inflammation by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins

Animal Models

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

Animal models: A systematic review and meta-analysis of 21 animal studies (Yu et al, 2023) investigated acupuncture’s effect on pain and swelling of arthritis animal models. Acupuncture was found to increase tolerance to pain stimuli and reduce swelling in arthritis animals, the researchers suggested possible mechanisms of action as being via nervous and immune system regulation.

An animal model study (Sun et al, 2023; n=36) investigated the effects of electroacupuncture (EA) on rheumatoid arthritis (RA) in rats, plus its underlying mechanisms. They showed that acupuncture helped RA outcome measures of paw oedema, pain responses, serum cytokines, synovial inflammation, in collagen-induced arthritis (CIA) rats. They were able to show that RA 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.

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.

You may also find this useful: our Rheumatoid Arthritis page

Resources

BAcC Osteoarthritis of the Knee Factsheet

Evidence Based Acupuncture Foundation Osteoarthritis Evidence Summary

References:

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

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

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

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; 6: 251-7.

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

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

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

Liu, 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.

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

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.

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

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

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.

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

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.

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

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

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

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

Yu, W.L. and Kim, S.N., 2023. The effect of acupuncture on pain and swelling of arthritis animal models: A systematic review and meta-analysis. Frontiers in Genetics, 14.

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

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

Helen

Posted on: Jun-13-2021 8:38 am

0 comment

Tags: Acupuncture, Arthritis, condition, Joints, Osteoarthritis, pain

Surgery and Post Operative Pain – Condition Resources

May 31, 2021BlogAcupuncture, condition, Operation, pain, Post Operative, SurgeryHelen

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

Research and Resources on Post Operative Pain and Acupuncture:

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

Interpreting the research:

The Research:

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

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

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

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

Ben-Ayre et al (2023: n=99) conducted a randomised controlled trial that examined the impact of integrative therapies on pain and anxiety among patients undergoing gynaecological oncology (cancer) surgery; addition of intraoperative acupuncture significantly reduced severe pain, compared with the control group and the group that received preoperative touch/relaxation only. The combination of preoperative touch/relaxation and intraoperative acupuncture also improved the patients’ scores in the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire.

A small Chinese study, Zhang et al’s (2013; n=40) RCT compared the effect of electroacupuncture (EA) combined with cervical plexus block (CPB) versus sham EA plus CPB on the stress response of patients undergoing thyroid surgery. EA plus CPB significantly reduced peri-operative cardiovascular stress responses and inhibited abnormal increases of stress hormones (as measured by blood pressure, ACTH and, epinephrine, glucose and cortisol levels) and inflammatory reaction (as measured by CRP levels) in patients undergoing thyroid surgery.

Mechanisms of action:

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)

Animal Models

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

Dental Surgery: Immune and Anti-Inflammatory Benefits

Lisboa et al (2015) looked at the effects of electroacupuncture (EA) on experimental periodontitis in 32 rats over 10 days. Rats with induced periodontitis were divided into three groups: electroacupuncture; sham electric needles; or no treatment. A control group of healthy rats without periodontitis was also included. Post treatment measures included alveolar bone loss and periodontal ligament space around the teeth; osteoclast activity and number as indicated by RANKL and TRAP; and cytokine levels (IL-1β, MMP-8, IL-6, and COX-2) in the gums. The electroacupuncture group had less bone loss, less osteoclast activity and number, and decreased inflammatory cytokines; these suggest modulation of the inflammatory response.

Post-Operative Inflammation and Immunity Study

Immune suppression can be a complication of major surgery, so Li et al (2013) carried out an RCT to examine the effect of electroacupuncture (EA) on immune function and point specificity in patients undergoing supratentorial craniotomy. With n=29 in three groups; control, EA group, and sham acupoints. EA partially reduced immune suppression after surgery, as measured by the levels of cytokines and immunoglobulins in peripheral blood, however without point specificity. They concluded EA may be a useful adjunct to general anaesthesia for improving immune function in patients undergoing major surgery, although sham acupuncture also produced some benefits, so further research in larger trials would be needed.

Resources:

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

Post-Operative Pain References:

Ben‐Arye, E., Segev, Y., Galil, G., Marom, I., Gressel, O., Stein, N., Hirsh, I., Samuels, N., Schmidt, M., Schiff, E. and Lurie, I., 2023. Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety. Cancer, 129(6), pp.908-919.

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

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

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

Li, G., Li, S., Wang, B. and An, L., 2013. The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy. Experimental and Therapeutic Medicine, 6(3), pp.699-702.

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

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

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

Zhang, C.J., Yang, F. and Li, M., 2013. Effect of electroacupuncture combined with cervical plexus block on stress responses in patients undergoing thyroid surgery. Zhen ci yan jiu= Acupuncture Research, 38(1), pp.1-6

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

Mechanism Of Action in Pain References:

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

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

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

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

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

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

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

Helen

Posted on: May-31-2021 20:07 pm

0 comment

Tags: Acupuncture, condition, Operation, pain, Post Operative, Surgery

Pain & Painful disorders – Condition Resources

May 16, 2021BlogAcupuncture, Chronic Pain, condition, pain, Pain ManagmentHelen

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

Chronic Pain in General

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

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

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

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

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

Mechanisms of action on pain:

Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987). Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)

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.

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

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.

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

Resources:

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

Chronic Pain in General References:

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

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

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

Mechanism of Action References:

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

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

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

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

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

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

Helen

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

0 comment

Tags: Acupuncture, Chronic Pain, condition, pain, Pain Managment

Musculoskeletal System – Resources

May 16, 2021BlogAcupuncture, condition, Joint, MSK, Muscles, Musculoskeletal SystemHelen

The MusculoSkeletal (MSK) system concerns the joints, bones, tendons, ligaments and muscles of the body and is often a cause for patients to present to acupuncture as symptoms in this system can be of pain, stiffness, affects on flexibility and mobility in joints and muscles.

Interpreting the research:

The Research:

Chronic Pain in General

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

Plantar Fasciitis

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

Tennis Elbow

The British Acupuncture Council has a Research digest where they examined some recent studies on lateral elbow pain, as well as an evidence based factsheet (tennis elbow – links are below), finding promising evidence in the field.

Gadau et al, (2014) conducted a systematic review of 19 RCTs of varying quality were examined, and overall the evidence suggested acupuncture was more effective than sham control. Tang et al (2015) looed at a smaller number of RCT and were more tentative about the outcomes due to concern over trial designs and highlighted a need for further research.

Recent small trials include one comparing acupuncture and manipulation (n=35; Hsu et al, 2016) in which both groups experienced improvement in pain and function. Another looked at ultrasound imaging of the affected tendon to evaluate acupuncture’s effect, finding reduction of tendon thickness after 10 sessions as well as improvement in pain scores (Ural et al 2017; n-41). A further trial (Wong et al, 2017; n=34) compared acupuncture and extracorporeal shockwave therapy (ESWT), finding a trend of improvement in pain scores in both groups.

Temporomandibular Pain (TM / TMJ)

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

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

Shoulder Pain

The British Acupuncture Council has a Research digest where they examined some recent studies on shoulder pain, as well as an evidence based factsheet (links are below)

Shoulder pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827), acupuncture showed a significant clinical superiority over usual care and a smaller advantage over sham.

Another systematic review and meta analysis of acupuncture in shoulder pain post stroke (Lee & Lim, 2016), saw that over 12 RCTs found it more effective that rehabilitation alone finding it a useful for this, with the authors calling for further trials of high quality to corroborate this.

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 shoulder pain.

Neck Pain

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

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

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

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

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

Back pain

Back pain is the single most common condition for which patients seek acupuncture, and many parts of the NHS either offer or recommend acupuncture for back pain, with over 100 clinical practice guidelines worldwide giving positive recommendations for acupuncture for back pain (Birch et al, 2018). The Scottish Intercollegiate Guidelines Network recommends acupuncture for back pain.

Back pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827) acupuncture showed a significant clinical superiority over usual care and a smaller advantage over sham. The researchers found that treatment effects persisted over time and couldn’t be explained solely in terms of placebo effects, meaning that acupuncture treatment was a reasonable option for some types of chronic pain, including back pain.

The American College of Physicians’ clinical practise guidelines nonpharmacologic treatment options for low back pain reviewed new evidence and found acupuncture useful for pain relief and to some extent function, although they had reservations about the strength of the evidence, meaning long term studies are needed (Chou et al, 2016, 2017).

The Clinical Practise Guidelines for managing low back pain, a systematic review on 13 sets of guidelines by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration looked at non-invasive techniques including acupuncture – acupuncture was one of the top recommended (non-invasive) interventions in the guidelines, where 10 sessions over 12 weeks was the recommended intervention for low back pain, and commented that high-quality guidelines support this whilst underlining that different techniques have different levels of effectiveness (Wong et al, 2017).

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 pain.

Sciatica

Sciatica is also known by its medical name lumbar radiculopathy, and is where nerves become impinged in the lower back, causing referred pain and neurological (nerve-related) symptoms into the areas that nerve supplies, usually buttock and lower limb.

Evidence suggests acupuncture may provide pain relief in sciatica; RCTs such as Wang (2009; n=139) comparing acupuncture and TENS and finding in favour of acupuncture; another finding for acupuncture’s effectiveness along with an increase in pain threshold in the true acupuncture group (Chen et al, 2009; n=90).

Other studies have looked at how the above may come about, for example Inoue et al (2008), in a clinical trial where patients had improvement in pain and nerve symptoms from lower back impingement, and put forward the theory that as seen in animal studies the blood flow in the region of the sciatic nerve was modulated by acupuncture, as well as the well known mechanisms of action of acupuncture in pain relief and inflammation reduction.

A network meta-analysis comparing 21 different therapies for sciatica (Lewis et al, 2015), finding acupuncture the second-best therapy in terms of addressing pain intensity and in terms of overall effect and having a statistically significant effect, leading them to suggest it should be considered as a treatment option.

Knee pain

Knee pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827) acupuncture showed a significant clinical superiority over usual care.

Mechanisms of action:

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)

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.

Animal Model Research

Regarding Your Individual Condition and Symptoms:

Resources:

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

British Acupuncture Council Research Digest – Musculoskeletal chronic pain conditions (plantar fasciitis; tennis elbow; temporomandibular pain, shoulder pain, sciatica, back pain) (approx halfway down the document)

BAcC Sciatica Factsheet

BacC Back Pain Factsheet

BAcC Sports Injuries Factsheet

BAcC Tendonitis (Tennis / Golfer’s Elbow) Factsheet

BAcC Facial Pain Factsheet

BAcC Frozen Shoulder Factsheet

BAcC Headache Factsheet

BAcC Neck Pain Factsheet

BAcC Osteoarthritis of the Knee Factsheet

References General:

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.