Tag Archives: condition

Back Pain – Condition Resources

May 15, 2021BlogAcupuncture, Back Pain, condition, pain, SciaticaHelen

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.

1.1m people in the UK suffer with back pain every year. Evidence based research has shown that acupuncture is significantly better than no treatment, and better or equal to standard medical care for back pain (BAcC factsheet – see link below). Evidence suggests acupuncture may be a useful adjunct to your usual medical care, and it is important to let you doctor know if you choose to use it alongside the standard approach.

The British Acupuncture Council also has this interesting video from a patient perspective of a patient and acupuncturist discussing his use of acupuncture for back pain, and showing a treatment taking place: you can find it here. A further video from the British Acupuncture Council of another patient for low back pain is also available here

About the research:

Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page. Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.

Research and Resources on Back Pain and Acupuncture:

A scholarly search of the available research studies on “acupuncture” + “back pain” reveals over 58,000 papers from journals, and narrowing this to “RCT” leads to over 7,750 hits, of which over a third have been carried out since 2017. As regards a search on “acupuncture” + “sciatica” in scholarly research, this yields over 11,200 papers, and narrowing this to “RCT” leads to over 1,330 hits, of which just under a third have been carried out since 2017. From this we can deduce that acupuncture is being used traditionally and currently in these area; being scientifically researched in this area, and with an increasing pace of research being carried out – indicating an area 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.

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).

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.

A US government’s National Institutes of Health: “Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).” (NCCIH, 2022).

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.

Mechanisms of Action

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)

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 from our combined 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:

You may also find this of interest; our blog on the NICE (NHS regulatory body) guidelines, where NCE recommended acupuncture use for chronic pain, in an evidence based review: Blog on acupuncture and chronic pain

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

Evidence Based Acupuncture Factsheet on Pain

References:

General Chronic Pain References:

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

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.

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

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.

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

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.

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.

Back Pain 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.

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J. and Grusing, S., 2017. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine, 166(7), pp.493-505.

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J. and Grusing, S., 2016. Noninvasive treatments for low back pain.

NCCIH (2022) LINK: https://www.nccih.nih.gov/health/acupuncture-in-depth viewed GMT19:52 11/08/22

Wong, J.J., Côté, P., Sutton, D.A., Randhawa, K., Yu, H., Varatharajan, S., Goldgrub, R., Nordin, M., Gross, D.P., Shearer, H.M. and Carroll, L.J., 2017. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European journal of pain, 21(2), pp.201-216.

Lewis, R.A., Williams, N.H., Sutton, A.J., Burton, K., Din, N.U., Matar, H.E., Hendry, M., Phillips, C.J., Nafees, S., Fitzsimmons, D. and Rickard, I., 2015. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal, 15(6),

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.pp.1461-1477.

Sciatica References

Chen, M.R., Ping, W., Cheng, G., Xiang, G.U.O., Wei, G.W. and Cheng, X.H., 2009. The warming acupuncture for treatment of sciatica in 30 cases. Journal of Traditional Chinese Medicine, 29(1), pp.50-53

Inoue, M., Kitakoji, H., Yano, T., Ishizaki, N., Itoi, M. and Katsumi, Y., 2008. Acupuncture treatment for low back pain and lower limb symptoms—the relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow. Evidence-Based Complementary and Alternative Medicine, 5(2), pp.133-143

Wang ZX. [Clinical observation on electroacupuncture at acupoints for treatment of senile radical sciatica]. Zhongguo Zhenjiu 2009; 29(2): 126-8.

Helen

Posted on: May-15-2021 13:42 pm

0 comment

Tags: Acupuncture, Back Pain, condition, pain, Sciatica

Asthma – Condition Resources

May 15, 2021BlogAcupuncture, Asthma, conditionHelen

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.

Asthma affects around 5.4 million people in the UK. The British Acupuncture Council has produced a research based fact sheet for patients, as well as a review of the evidence for effectiveness in this area (see Resources, below).

Research and Resources on Asthma and Acupuncture:

A scholarly search of the available research studies on “acupuncture and asthma” reveals over 44,000 papers from journals, and narrowing this to “systematic review” leads to over 15,000 hits, of which 38% have been carried out since 2017. From this we can deduce that acupuncture is being used extensively, traditionally and currently in this area; widely scientifically researched in this area, and that the pace at which the research is being carried is increasing – leading us to understand this is an area worthy of scientific appraisal and consideration.

Interpreting the Evidence:

The Research

Asthma:

There is some evidence from trials to suggest acupuncture may be a useful adjunct to usual care, be beneficial over placebo and can improve quality of life and be cost effective in asthma (Karlson & Bennicke, 2013; Chu et al 2007; Rheinhold et al, 2014).

Some systematic reviews have been carried out into acupuncture in this area, with the most recent looking at 11 trials, found that many were only small trials and that more research would be needed (Martin et al, 2002) and a Cochrane meta-analysis a year later (McCarney et al, 2003) looked at 12 studies (n=350) drew a similar conclusion. More recently Chen et al, (2020) proposed a protocol for a new systematic review and meta analysis of the research, as they noted that an increasing amount of research trials have been done in this area in recent years, warranting a further, large and structured review.

Pang et al (2023) carried out a systematic review and meta-analysis of 16 RCTs to evaluate the effectiveness of acupuncture for treatment of asthma in adults. Acupuncture was well-tolerated and could improve FEV1% (lung function), Cai’s AQLQ (quality of life in Asthma score)), symptom score, ACT score, and exacerbation frequency compared with sham/placebo acupuncture. However, other lung function and medication use parameters were not statistically significant. The researchers also noted that further studies with appropriate controls, more participants, and high-quality evidence are needed.

Allergic Asthma:

Brinkahus et al, (2017) carried out a large randomised pragmatic trial in Germany (n=1445) giving acupunctrure in addition to usual care for allergic asthma, and comparing to a usual care alone group. They found symptomatic improvement, as well as improvement in quality of life (asthma quality of life questionnaire – AQLQ) measures for the acupuncture group.

Mechanisms of action:

In the condition of allergic asthma, inflammatory considerations may play a key part in the process. Acupuncture has been shown to have anti-inflammatory effects, and a review article (Kavoussi & Ross, 2007) suggests this may be due to activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines which have been seen in studies.

Other studies (Zijlstra et al, 2003) suggest some of the anti-inflammatory effects exhibited in acupuncture may be due to stimulation of vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) within the body when acupuncture is applied, and these 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 influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.

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 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.

Animal Studies in Asthma Models

Wei et al, 2015 investigated the effect of acupuncture on airway inflammation and immune responses in mice with experimental asthma. Acupuncture was effective in reducing airway hyperresponsiveness (AHR); lung inflammation; mucus secretion; and inflammatory markers including Th17 cytokines and NF-κB pathway, in the asthma model. Additionally, acupuncture increased the number and function of Treg cells – a type of white blood cell that can suppress inflammation and prevent autoimmunity. The article suggests that acupuncture may be a useful complementary therapy for asthma patients due to anti-inflammatory and immune modulation effects.

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.

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:

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

British Acupuncture Council Review Paper: Bronchial asthma and acupuncture: the evidence for effectiveness

References:

Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S.N. and Witt, C.M., 2017. Acupuncture in patients with allergic asthma: a randomized pragmatic trial. The Journal of Alternative and Complementary Medicine, 23(4), pp.268-277.

Chen, Y.M., Xie, X.L., Xiao, P.Y., Wang, Q.H., Wang, J.S., Yu, X.D. and Deng, S., 2020. Acupuncture on treating asthma: A protocol for systematic review and meta analysis. Medicine, 99(1).

Chu, K.A., Wu, Y.C., Ting, Y.M., Wang, H.C. and Lu, J.Y., 2007. Acupuncture therapy results in immediate bronchodilating effect in asthma patients. Journal of the Chinese Medical Association, 70(7), pp.265-268.

Karlson, G. and Bennicke, P., 2013. Acupuncture in asthmatic children: a prospective, randomized, controlled clinical trial of efficacy. Alternative therapies in health and medicine, 19(4), p.13.

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

Martin, J., Donaldson, A.N.A., Villarroel, R., Parmar, M.K.B., Ernst, E. and Higginson, I.J., 2002. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. European Respiratory Journal, 20(4), pp.846-852.

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.

McCarney RW et al. Acupuncture for chronic asthma. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD000008. DOI: 10.1002/14651858.CD000008.pub2

Pang, J., Shergis, J.L., Zheng, L., Liu, S., Guo, X., Zhang, A.L., Lin, L., Xue, C.C. and Wu, L., 2023. Clinical Evidence for Acupuncture for Adult Asthma: Systematic Review and Meta-Analysis of Randomised Sham/Placebo-Controlled Trials. Complementary Therapies in Medicine, p.102956.

Reinhold, T., Brinkhaus, B., Willich, S.N. and Witt, C., 2014. Acupuncture in patients suffering from allergic asthma: is it worth additional costs?. The Journal of Alternative and Complementary Medicine, 20(3), pp.169-177.

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

Wei, Y., Dong, M., Zhang, H., Lv, Y., Liu, J., Wei, K., Luo, Q., Sun, J., Liu, F., Xu, F. and Dong, J., 2015. Acupuncture attenuated inflammation and inhibited Th17 and Treg activity in experimental asthma. Evidence-based complementary and alternative medicine, 2015.

Helen

Posted on: May-15-2021 13:39 pm

0 comment

Tags: Acupuncture, Asthma, condition

Anxiety – Condition Resources

May 15, 2021BlogAcupuncture, anxiety, conditionHelen

Roughly 1 in 6 of us experience anxiety, and there has been a modest increase in this during the Covid pandemic – a recent study finding a prevalence of 21.6% at present in a representative sample of the UK population (Shevlin et al, 2020).

The British Acupuncture Council have produced an evidence-based factsheet on Anxiety and acupuncture research, including details of the research studies done (link below) and you can also find and read the original research from this resource.

A Large and Growing Body of Research:

A scholarly search of the available research studies on “acupuncture and anxiety” reveals over 20,800 papers from journals, and narrowing this to “RCT” leads to over 1,500 hits, of which 57% have been carried out since 2017. This demonstrates that acupuncture is being used traditionally and currently in this area; widely scientifically researched, and that the pace at which this research is being carried is increasing – leading us to contend that this is an area worthy of scientific appraisal and consideration.

Interpreting the research:

The Research:

Evidence lies in a positive direction for the use of acupuncture, which is safe, and can be used alongside other modalities. The British Acupuncture Council (BAcC) works with the charity Anxiety UK to provide acupuncture for this condition, and the researchers have generalised anxiety outcomes data from acupuncture patients having a course of six acupuncture treatments, with preliminary results very encouraging (n=30 – see BAcC research digest – link below).

A systematic review and meta-analysis (Au et al, 2015) of the effects of acupressure on anxiety, in 7 RCTs in adults from the anticipation of surgery or treatment, their finding was that treatment was well-tolerated and beneficial. A systematic review and meta-analysis (Church et al, 2018) examined 6 studies (n=403), found that the tapping of acupuncture points is an active ingredient in emotional freedom technique (EFT).

The BAcC Research Digest discusses several recent trials and reviews, including:

An RCT where a statistical difference in anxiety levels was found for hospital nursing staff receiving an acupuncture protocol after 10 sessions (Kurebayashi et al, 2017; n=180);

A systematic review (13 papers) found encouraging evidence for acupuncture in anxiety disorders, and giving few side effects (Amorim et al, 2018), although they noted trial quality was variable, meaning further well-designed RCTs are warranted. Another review (Goyatá et al, 2016) looked at 67 articles for anxiety and acupuncture, stating that this is a promising area and echoing the call for further research.

Mechanisms of Action:

As per the British Acupuncture Council’s factsheet, there are many physiological studies on animals and humans looking at brain scans (fMRI), as well as levels of hormones and neurotransmitters in blood and other bodily fluids after acupuncture treatment that have shown effects of the treatment on downregulating the response to pain and stress in the body, particularly in the limbic system (for example Hui et al, 2010; fMRI in humans).

Resources:

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

British Acupuncture Council Research Digest – Anxiety Section (towards base of document)

BAcC Stress Factsheet

BAcC Depression Factsheet

Our own Blog on Acupuncture, Anxiety and Stress

References:

Amorim, D., Amado, J., Brito, I., Fiuza, S.M., Amorim, N., Costeira, C. and Machado, J., 2018. Acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research. Complementary therapies in clinical practice, 31, pp.31-37.

Au, D.W., Tsang, H.W., Ling, P.P., Leung, C.H., Ip, P.K. and Cheung, W.M., 2015. Effects of acupressure on anxiety: a systematic review and meta-analysis. Acupuncture in Medicine, 33(5), pp.353-359.

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.

Hui, K.K., Marina, O., Liu, J., Rosen, B.R. and Kwong, K.K., 2010. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Autonomic Neuroscience, 157(1-2), pp.81-90.

Kurebayashi, L.F.S., Turrini, R.N.T., Souza, T.P.B.D., Marques, C.F., Rodrigues, R.T.F. and Charlesworth, K., 2017. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Revista latino-americana de enfermagem, 25.

Shevlin, M., McBride, O., Murphy, J., Miller, J.G., Hartman, T.K., Levita, L., Mason, L., Martinez, A.P., McKay, R., Stocks, T.V. and Bennett, K.M., 2020. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open, 6(6).

Takamatsu Goyatá, S.L., Valcanti Avelino, C.C., Marques dos Santos, S.V., Inácio de Souza Junior, D., Lopes Gurgel, M.D.S. and de Souza Terra, F., 2016. Effects from acupuncture in treating anxiety: integrative review. Revista brasileira de enfermagem, 69(3).

Helen

Posted on: May-15-2021 13:31 pm

0 comment

Tags: Acupuncture, anxiety, condition

Addictions – Condition Resources

May 15, 2021BlogAcupuncture, Addiction, Alcohol, condition, Detoxification, Drugs, Gambling, Obesity, Smoking, SubstanceHelen

Detoxification must only be done when the client is under direct medical supervision, and the NADA (acupuncture) protocol or other complementary therapies are to be used in complement to a GP or consultant doctor’s care.

Acupuncture is used widely in this field in the United States and the UK (D’Alberto, 2004; Margolin, 2003) as part of a multi-disciplinary approach within a medical team to counter withdrawal effects alongside conventional treatment, and where appropriate. The 5-point NADA (National Acupuncture Detoxification Association) protocol is the most well-known protocol that is used, and is a combination of 5 specific points on the ear.

About the research:

Research Studies:

This is a much-researched area: a scholarly search of the available research studies on “acupuncture and addiction” reveals over 30,000 papers from journals, and narrowing this to “RCT” leads to over 2,300 hits, of which 41% since 2017.

From the amount of research that has been done, this we can deduce that acupuncture is both widely applied, and subject to scientific research in these areas, and that the pace at which the research is being carried out is increasing – leading us to understand this is an area worthy of scientific examination and consideration.

Systematic reviews that have been carried out – (all full references are below): Ge et al, 2020: illicit drug withdrawal syndrome – 30 trials and n=2391; Wang et al, 2019 – smoking cessation, 24 trials and n=3984; Chen et al, 2018 – opioid use disorder, 9 studies and n=1063; Dai et al, 2021 – smoking cessation with 6 treatment arms as comparisons – 23 studies, n=2706; Liu et al, 2018 – alcohol withdrawal syndrome, 11 RCTs and n=875. Systematic review outcomes have been mixed, with some tentatively positive, but consideration is to be taken as to the quality of some of the research papers, and additional study is warranted.

More recently this year there have been two Systematic review protocols published to look at RCT’s for acupuncture and withdrawal from opiate addiction (Zhang et al, 2021; Chen et al, 2021 & Chen at al, 2020 in the BMJ). It will be interesting to see the results of the latter three ongoing systematic reviews as these are published, two of which are looking at opiate addiction and one at internet addiction.

There has also been some interesting discussion on the use of alternative analgesia, with particular emphasis on acupuncture as regard the current iatrogenic opioid crisis in the Unites states (Fan et al, 2017 – White Paper), whereby acupuncture has been mooted as playing a potential role in this picture, with Lee et al, (2019)’s protocol for systematic review being another upcoming paper on the matter.

The NADA, or National Acupuncture Detoxification Association protocol is a set of 5 acupuncture points on the ear (also known as auricular acupuncture), which has been used since the 1970’s for many conditions involving addictions. Whilst the initial development was for substance abuse, it has latterly been used for food addiction and obesity (Chen at el, 2018); nicotine addicion / smoking (Leung, 2012) as well as trauma and PTSD (post traumatic stress, Cronin and Conboy, 2013), and disaster relief efforts (Cole and Yarberry, 2011; Yarberry, 2010).

Studies have shown that in combination with other interventions it can help reduce cravings, and improve the symptoms of depression, and anxiety, mood, headaches and body pains associated with substance withdrawal, as well as improve concentration and energy during the process (Carter et al, 2011; Stiyt et al, 2016)

Mechanisms of action:

Studies in humans and in animals have shown acupuncture to have measurable physiological effects on the brain, nervous system and neurotransmitters, including endogenous (the body’s naturally occurring) opiates (Lin et al, 2012). Studies have also demonstrated the relaxation and de-stressing effects acupuncture can provide from a physiological perspective, beyond placebo.

A recent, interesting paper (Lee et al, 2021): A review of neurobiological mechanisms of acupuncture for drug addiction. The authors examine the context from reward pursuit models, motivation, and the role of the mesolimbic dopamine pathway in drug sensitisation. They connect this to the way in which acupuncture can make neurochemical changes and influence dopamine levels via inhibition of neuronal and behavioural sensitization of the mesolimbic dopamine pathway. The neurotransmitter GABA is implicated along with endogenous opioids. A detailed paper, of interest to those who like a bit of research and technical explanation.

Case Study and Video for Trauma/PTSD

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

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 addictions and substance use including specific research, trials and mechanisms of action for acupuncture in this condition.

British Acupuncture Council Review Paper Substance abuse and acupuncture: the evidence for effectiveness

References:

Carter, K.O., Olshan-Perlmutter, M., Norton, H.J. and Smith, M.O., 2011. NADA acupuncture prospective trial in patients with substance use disorders and seven common health symptoms. Medical Acupuncture, 23(3), pp.131-135.

Chen, J.A., Chen, J.A., Lee, S. and Mullin, G., 2018. Potential role for acupuncture in the treatment of food addiction and obesity. Acupuncture in Medicine, 36(1), pp.52-55.

Cole, B. and Yarberry, M., 2011. NADA training provides PTSD relief in Haiti. Deutsche Zeitschrift für Akupunktur, 54(1), pp.21-24.

Cronin, C. and Conboy, L., 2013. Using the NADA Protocol to Treat Combat Stress-Induced Insomnia: A Pilot Study. Journal of Chinese Medicine, (103).

Chen, Z., Wang, Y., Wang, R., Xie, J. and Ren, Y., 2018. Efficacy of acupuncture for treating opioid use disorder in adults: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.

Chen, Z., Wang, R., Zhang, M., Wang, Y. and Ren, Y., 2020. Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis. BMJ open, 10(6), p.e034554.

Chen, Y., Zhang, L., Liu, Y., Yang, Y., Qiu, M., Wang, Y., Peng, W., Li, H. and Zhu, T., 2021. Acupuncture for Internet addiction: A protocol for systematic review. Medicine, 100(12), p.e24872.

D’alberto, A., 2004. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points. Journal of Alternative & Complementary Medicine, 10(6), pp.985-1000.

Dai, R., Cao, Y., Zhang, H., Zhao, N., Ren, D., Jiang, X., Zheng, G., Bao, S., Yan, X. and Fan, J., 2021. Comparison between Acupuncture and Nicotine Replacement Therapies for Smoking Cessation Based on Randomized Controlled Trials: A Systematic Review and Bayesian Network Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2021.

Fan, Arthur Yin, David W. Miller, Bonnie Bolash, Matthew Bauer, John McDonald, Sarah Faggert, Hongjian He et al. “Acupuncture’s role in solving the opioid epidemic: evidence, cost-effectiveness, and care availability for acupuncture as a primary, non-pharmacologic method for pain relief and management–white paper 2017.” Journal of integrative medicine 15, no. 6 (2017): 411-425.

Ge, S., Lan, J., Yi, Q., Wen, H., Lu, L. and Tang, C., 2020. Acupuncture for illicit drug withdrawal syndrome: A systematic review and meta-analysis. European Journal of Integrative Medicine, 35, p.101096.

Lee, S. and Jo, D.H., 2019. Acupuncture for reduction of opioid consumption in chronic pain: A systematic review and meta-analysis protocol. Medicine, 98(51).

Lee, M.Y., Lee, B.H., Kim, H.Y. and Yang, C.H., 2021. Bidirectional role of acupuncture in the treatment of drug addiction. Neuroscience & Biobehavioral Reviews, 126, pp.382-397.

Leung, L., Neufeld, T. and Marin, S., 2012. Effect of self-administered auricular acupressure on smoking cessation–a pilot study. BMC complementary and alternative medicine, 12(1), p.11.

Lin, J.G., Chan, Y.Y. and Chen, Y.H., 2012. Acupuncture for the treatment of opiate addiction. Evidence-Based Complementary and Alternative Medicine, 2012.

Liu, X., Qin, Z., Zhu, X., Yao, Q. and Liu, Z., 2018. Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome. Acupuncture in Medicine, 36(5), pp.275-283.

Margolin, A., 2003. Acupuncture for substance abuse. Current psychiatry reports, 5(5), pp.333-339.

Stuyt, E.B. and Voyles, C.A., 2016. The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Substance abuse and rehabilitation, 7, p.169.

Wang, J.H., van Haselen, R., Wang, M., Yang, G.L., Zhang, Z., Friedrich, M.E., Wang, L.Q., Zhou, Y.Q., Yin, M., Xiao, C.Y. and Duan, A.L., 2019. Acupuncture for smoking cessation: A systematic review and meta-analysis of 24 randomized controlled trials. Tobacco induced diseases, 17.

Yarberry, M., 2010. The Use of the NADA Protocol for PTSD in Kenya. Deutsche Zeitschrift für Akupunktur, 53(4), pp.6-11.

Zhang, T., He, X., Wu, L., Feng, X., Yang, Y. and Deng, L., 2021. Electro Acupuncture Combined Methadone for Withdrawal Symptoms of Opioid Addiction: A Protocol for Systematic Review and Meta Analysis. Acupuncture & Electro-Therapeutics Research.

Helen

Posted on: May-15-2021 10:44 am

0 comment

Tags: Acupuncture, Addiction, Alcohol, condition, Detoxification, Drugs, Gambling, Obesity, Smoking, Substance

Pelvic Pain – Condition Resources

May 1, 2021BlogAcupuncture, condition, Pelvic, Pelvic PainHelen

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.

Chronic Pain in General

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

Pelvic Pain and Conditions

Prostatitis related bladder symptoms and pain: Acupuncture has been found to be beneficial in reducing the symptoms of prostatitis, including urinary symptoms (Franco et al, 2019).

Chronic prostatitis/chronic pelvic pain syndrome: A systematic review and meta-analysis found that acupuncture showed promise from the RCTs that they reviewed (Chang et al, 2017).

Mechanisms of action:

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

Acupuncture 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.

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).

Resources:

Evidence Based Acupuncture Factsheet on Pain

References:

General Chronic Pain References:

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 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.

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.

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.

Prostatitis References:

Chang, S.C., Hsu, C.H., Hsu, C.K., Yang, S.S.D. and Chang, S.J., 2017. The efficacy of acupuncture in managing patients with chronic prostatitis/chronic pelvic pain syndrome: a systemic review and meta‐analysis. Neurourology and urodynamics, 36(2), pp.474-481.

Franco, J.V., Turk, T., Jung, J.H., Xiao, Y.T., Iakhno, S., Garrote, V. and Vietto, V., 2019. Non‐pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU international, 124(2), pp.197-208.

Helen

Posted on: May-1-2021 13:58 pm

0 comment

Tags: Acupuncture, condition, Pelvic, Pelvic Pain

Sciatica – Condition Resources

March 16, 2021BlogAcupuncture, Back Pain, condition, Lumbar Radiculopathy, Nerve Pain, Neuralgia, Neurological, pain, Referred Pain, SciaticaHelen

Sciatica

Back pain

There is a strong correlation between back pain and sciatica, for which reason the following may be of interest.

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.

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.

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)

Resources:

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

References:

Sciatica References:

Inoue, M., Kitakoji, H., Yano, T., Ishizaki, N., Itoi, M. and Katsumi, Y., 2008. Acupuncture treatment for low back pain and lower limb symptoms—the relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow. Evidence-Based Complementary and Alternative Medicine, 5(2), pp.133-143.

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

Wang ZX. [Clinical observation on electroacupuncture at acupoints for treatment of senile radical sciatica]. Zhongguo Zhenjiu 2009; 29(2): 126-8.

Back Pain 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.

Chou, R., Deyo, R., Friedly, J., Skelly, A., Hashimoto, R., Weimer, M., Fu, R., Dana, T., Kraegel, P., Griffin, J. and Grusing, S., 2016. Noninvasive treatments for low back pain.

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.pp.1461-1477.

Helen

Posted on: Mar-16-2021 14:17 pm

0 comment

Tags: Acupuncture, Back Pain, condition, Lumbar Radiculopathy, Nerve Pain, Neuralgia, Neurological, pain, Referred Pain, Sciatica

Gynaecology – Condition Resources

March 16, 2021BlogAcupuncture, condition, gynaecology, women's healthHelen

Acupuncture is a popular choice for women for a number of issues relating to the menstrual cycle, fertility, pregnancy, post-partum, PMS and the menopause. A large number of research-based factsheets have been produced by the British Acupuncture Council, outlining research finding for many gynaecological conditions (see “resources” at the base of this page for links).

A scholarly search of the available research studies on “acupuncture” + “gynaecology” reveals over 8,400 papers from journals, and narrowing this to + “RCT” leads to over 1,250 hits, of which 40% have been carried out since 2017. From this we can deduce that acupuncture is widely used and scientifically researched in gynaecological conditions, and that the pace at which the research is being carried is increasing – leading us to understand this is an area worthy of appraisal.

Below (under Resources) is a list of specific conditions for which the British Acupuncture Council (BAcC) has produced evidence-based factsheets regarding many aspects of women’s reproductive health.

The BAcC has also produced a paper on gynaecology and acupuncture, which in addition looks at the use and evidence of effectiveness of acupuncture in dysmenorrhoea, dysfunctional uterine bleeding and chronic pelvic inflammatory disease, where the BAcC concluded that there is a growing body of evidence to support the value of acupuncture in addressing these conditions.

Pregnancy: Acupuncture is safe in pregnancy, but do ensure you tell your midwife (and consultant if you are under one) that you’re using it, and also tell your acupuncturist if you are pregnant or trying for a baby, as there are certain points which must be avoided in pregnancy.

About the research:

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). It is very important to note that “sham” acupuncture where needles are placed other than in acupuncture points it not an inert process and 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, conventional treatment or a different approach also form part of the evidence base.

A large number of resources are available in the References section below, as well as in the BAcC’s factsheets. When reading the 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 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” of no treatment). As mentioned above, the control group is of particular interest in how acupuncture trials are carried out 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 to this. In the case of animal studies (as discussed below) it is easier to make more objective measures and avoid placebo effect. In studies the n= figure tells you how many people were participants in the study.

Research studies have been done on various aspects of acupuncture and the female reproductive system, to examine measurable effects occurring in the body following acupuncture, these look at levels of certain hormones and neurotransmitters (chemical messengers) in the blood, scans of the brain in action (fMRI) and other objective measures that can be compared on a before- and after- basis.

Research into mechanisms of action indicates that acupuncture can modulate activity in many of the body’s regulatory systems, including the nervous system; endocrine system and influence the levels of different hormones and neurotransmitters (chemical signals) in the body, blood stream and brain (Stener-Victorin, 2006; Stener-Victorin and Wu, 2010; Gerhard et al, 1992). Experimental studies have also shown acupuncture to improves blood flow to the uterus and ovaries (Stener-Victorin et al, 1996 (n=10 women’s uterine artery blood flow impedance was measured after electro-acupuncture treatment).

Another type of research commonly carried out is in animal models, primarily rats, where measurements can be made as to the effects of acupuncture. Here, any placebo effect and subjectivity on outcomes is overcome by the fact that objective measures of levels of hormones in the blood, etc can be made. The hormones and neurotransmitters that have been shown to be thus influenced in physiological studies include:

Gonadotrophin releasing hormone (GnRH) increased in the hypothalamus in a rat model using specific acupuncture points and channels, (Wang et al, 2010; Zhu et al, 2019 – points used SP6 and ST36); electroacupuncture normalised circulating gonadotrophin levels in a rat model (Maliqueo et al, 2015)
LH (luteinizing hormone) and progesterone blood levels have been found to be significantly raised by true acupuncture treatment at points ST36 and SP6 in a rat model, (He et al, 2009), the same study also found vascular endothelial growth factor levels in the ovaries to be raised in the rats which received true acupuncture (versus sham acupuncture at nearby non-points
Blood Cortisol and Prolactin (PRL) levels were normalised in acupuncture patients a study of 67 women undergoing IVF during ovarian stimulation (Magarelli et al, 2009, Magarelli et al, 2006), prolactin levels influenced by acupuncture in laboratory rat models (Sheng and Xie, 1989; Xiong et al, 2015; Liu et al, 2007)
Testosterone and Estradiol – in a rat model the use of CV4, CV3, SP6 and Zigong points downregulated testosterone and estradiol (in females) and improved the development of their reproductive organs (Zhang et al, 2009)

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 Dysmenorrhoea (painful periods) and acupuncture factsheet

BACC Diabetes (includes Gestational Diabetes)

BAcC Endometriosis and acupuncture factsheet

BAcC Female Fertility and acupuncture factsheet

BAcC Infertility and ART factsheet

BAcC Fertility and IVF briefing paper

BAcC Male Infertility Factsheet

BAcC Menopausal Symptoms and acupuncture factsheet

BAcC Obstetrics (pregnancy and childbirth) and acupuncture factsheet

BAcC PCOS (Polycystic Ovarian Syndrome) and acupuncture factsheet

BAcC Premenstrual Syndrome and acupuncture factsheet

BAcC Puerperium (postnatal / postpartum) acupuncture factsheet

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

Our own page on Fertility, Pregnancy and Acupuncture

Our own blog on Acupuncture and the Menopause

References:

Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. GynecolEndocrinol. 1992 Sep;6(3):171-81.

He, D.J. Huang G.Y. Zhang M.M. [Effects of acupuncture on the luteal function of rats with dysfunctional embryo implantation] [Chinese]. Zhongguozhenjiu. 2009; 29(11):910-913

Magarelli, P.C.; M. Cohen, D.K. Cridennda Proposed mechanism of action of acupuncture on IVF outcomes Fertility and Sterility, Vol. 86, Issue 3, S174-175 Published in issue: September 2006

Magarelli, Paul C.; Diane K. Cridennda, Mel Cohen, Changes in serum cortisol and prolactin associated with acupuncture during controlled ovarian hyperstimulation in women undergoing in vitro fertilization embryo transfer treatment, Fertility and Sterility, Volume 92, Issue 6, December 2009, Pages 1870-1879

Maliqueo, M., Benrick, A., Alvi, A., Johansson, J., Sun, M., Labrie, F., Ohlsson, C. and Stener-Victorin, E., 2015. Circulating gonadotropins and ovarian adiponectin system are modulated by acupuncture independently of sex steroid or β-adrenergic action in a female hyperandrogenic rat model of polycystic ovary syndrome. Molecular and Cellular Endocrinology, 412, pp.159-169.

Sheng, P.L. and Xie, Q.W., 1989. Relationship between effect of acupuncture on prolactin secretion and central catecholamine and R-aminobutyric acid. Zhen ci yan jiu= Acupuncture research, 14(4), pp.446-451.

Stener-Victorin, E. and Humaidan, P., 2006. Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupuncture in Medicine, 24(4), pp.157-163.

Stener-Victorin E, Waldenstraum 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. and Wu, X., 2010. Effects and mechanisms of acupuncture in the reproductive system. Autonomic Neuroscience, 157(1-2), pp.46-51.

Wang, S.J., Bing, Z.H.U., Ren, X.X. and Tan, L.H., 2010. Experimental study on acupuncture activating the gonadotropin-releasing hormone neurons in hypothalamus. Journal of Traditional Chinese Medicine, 30(1), pp.30-39.

Xiong, F., Gui, J., Yang, W., Li, J. and Huang, G.Y., 2015. Effects of acupuncture on progesterone and prolactin in rats of embryo implantation dysfunction. Chinese journal of integrative medicine, 21(1), pp.58-66.

Zhang WY, Huang GY, Liu J. [Influences of acupuncture on infertility of rats with polycystic ovarian syndrome] [in Chinese] ZhongguoZhong Xi Yi Jie He ZaZhi. 2009 Nov;29(11):997-1000.

Zhu, H., Nan, S., Suo, C., Zhang, Q., Hu, M., Chen, R., Wan, J., Li, M., Chen, J. and Ding, M., 2019. Electro-acupuncture affects the activity of the hypothalamic-pituitary-ovary axis in female rats. Frontiers in physiology, 10, p.466.

Helen

Posted on: Mar-16-2021 9:29 am

0 comment

Tags: Acupuncture, condition, gynaecology, women's health

Raynaud’s Phenomenon – Condition Resources

July 17, 2019Blog, Conditions, Research, Shaftesbury ClinicAcupuncture, condition, Joint Pain, Knee, Knee PainHelen

Under Construction

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

Resources:

British Acupuncture Council (BAcC) Raynaud’s Phenomenon factsheet

BAcC Research Digest

Helen

Posted on: Jul-17-2019 14:13 pm

0 comment

Tags: Acupuncture, condition, Joint Pain, Knee, Knee Pain

Viral disease – Condition Resources

July 16, 2017BlogAcupuncture, condition, ViralHelen

Page under construction

References:

Helen

Posted on: Jul-16-2017 14:29 pm

0 comment

Tags: Acupuncture, condition, Viral

Rheumatoid Arthritis – Condition Resources

October 16, 2016BlogAcupuncture, condition, Rheumatoid ArthritisHelen

Rheumatoid Arthritis is a chronic inflammatory disorder, primarily affecting the joints in the body. It can have a pattern of relapses and remissions, and pain and inflammation are some of the primary symptoms that patients are looking to address.

Studies

Feng et al (2023) conducted a systematic review and meta-analysis of 17 RCTs comparing electroacupuncture (EA) plus medication with other treatments, such as medication alone, or sham acupuncture for Rheumatoid Arthritis. Measures of clinical efficacy, pain scores (visual analogue scale, VAS), disease activity score in 28 joints (DAS28), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and adverse events were compared. The results showed that EA plus medication had a superior effect than medication alone or other treatments, in improving clinical efficacy, VAS, DAS28, CRP, and ESR. The authors concluded that EA plus medication is an effective and safe treatment for RA, but more high-quality studies are needed to confirm its long-term benefits and mechanisms.

Electroacupuncture has been shown to alleviate symptomatic knee pain in rheumatoid arthritis (Casimiro et al 2005; Cochrane review).

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.

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 seen in acupuncture trials 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.

Inflammatory and immune markers: Wang et al (2008) reviewed the evidence from 8 RCTs for acupuncture as a treatment for rheumatoid arthritis (RA) that compared acupuncture with placebo or active drug interventions. Five studies observed a reduction in the inflammatory/immune marker of ESR and three noted a reduction in CRP level after acupuncture treatment.

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)

Acupuncture has also been shown in human research trials, to downregulate the areas of the brain associated with sensitivity to pain and stress, which may also contribute to its contribution to addressing pain issues (Hui et al, 2010).

Animal Models

Specifically acupuncture in an animal model has also demonstrated improvement in inflamed synovium which is characteristic of Rheumatoid Arthritis (He et al, 2010).

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.

Inflammation modulation: 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.

References:

Casimiro, L., Barnsley, L., Brosseau, L., Milne, S., Welch, V., Tugwell, P. and Wells, G.A., 2005. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database of Systematic Reviews, (4).

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.

He, T.F., Zhang, S.H., Li, L.B., Yang, W.J., Zhu, J. and Chen, Y.F., 2010. Effects of acupuncture on the number and degranulation ratio of mast cells and expression of tryptase in synovium of rats with adjuvant arthritis. Zhong xi yi jie he xue bao= Journal of Chinese integrative medicine, 8(7), pp.670-677.

Hui, K.K., Marina, O., Liu, J., Rosen, B.R. and Kwong, K.K., 2010. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Autonomic Neuroscience, 157(1-2), pp.81-90.

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.

MacPherson H, Blackwell R, 1994. Rheumatoid Arthritis and Chinese Medicine: a Review. European J of Oriental Medicine 1(3) 17-29

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, C., De Pablo, P., Chen, X., Schmid, C. and McAlindon, T., 2008. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 59(9), pp.1249-1256.

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

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.

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: Oct-16-2016 14:15 pm

0 comment

Tags: Acupuncture, condition, Rheumatoid Arthritis