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Abstracts Of Current Literature
1999 and 2000 Acupuncture Literature Review including 2000 and 2001 british literature review
Compiled by Russell J. Erickson, MD
part I
ANESTHESIOLOGY
1.Harmon D, Gardiner J, Harrison R, Kelly A. Acupressure and the prevention of nausea and vomiting after laparoscopy. Br J Anaesth. 1999;82:387-390. Reviewed in: FACT. 2000;5:220.
"Another well designed randomly controlled trial showing PC 6 (MH 6) acupressure reduces nausea and vomiting after surgery. Results were clinically and statistically valid. There is no good reason not to use acupressure for postoperative patients!"
Other references given in FACT. 2000; 5:242 include the following:
Park J, White AR, Ernst E. Efficacy of acupuncture as a treatment for tinnitus. Arch Otolaryngol Head Neck Surg. 2000; 126:489-492.
Ernst E, White AR. Acupuncture may be associated with serious adverse events. BMJ. 2000;320:513-514.
Lytle CD, Thomas BM, Gordon EA, et al. Electrostimulators for acupuncture: safety issues. J Altern Complement Med. 2000;6:37-44.
Alimi D, Rubino C, Leandri EP, et al. Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage. 2000;19:81-82.
part II
CARDIOLOGY
1.Wen-zhong C, Xu-fen C. Acupuncture treatment of chronic myocarditis: observation of 66 cases. Int J Clin Acupuncture. 2000;11:83-90.
Sixty-six cases of cardiologist-diagnosed myocarditis, with symptoms of dull pain, dyspnea, palpitations, weakness, depression, fatigue, pallor, and cold extremities, were treated. The average age was 25.3 years and duration of illness was 1 to 3 years (average, 2.7). Thirty-two patients had frequent multifocal ventricular beats, 26 had atrioventricular block, 6 had ST-T segment changes, and 34 had pulses higher than 100/min. Thirty-one had ceased usual occupations. PC 6, RN 17, LI 11, ST 36, and Thoracic 4, 5 Jiaji were used, adding some adjunct points for accompanying symptoms. Two courses of 10 daily sessions with 3-day interludes were given and effects then studied. Moxibustion was also given 3 times daily on ST 36, LI 11, and GV 14 for those with long illness and Qi and Yang depletion. More females than males were cured (66% vs 47%). Five of 6 with illness lasting less than 1 year were cured of all symptoms on 6-month follow-up, and 68% of those with illness lasting 13 months to 3 years. Premature ventricular contractions dropped from occurring in 32 to in 8 patients, without relapse 6 months later. Pulse higher than 100/min decreased from 34 to 6 cases, and ST-T segment changes from 6 to 0 cases.
Comment: It is difficult to accept such figures for a formidable disease state, again requiring an inquisitive and adventurous practitioner willing to try a new paradigm approach to a disorder that
otherwise inhibits life, demands a heart transplant, or kills.
part III
MISCELLANEOUS
1.Groom C. Phobia treatment with acupuncture [letter]. Acupuncture Med. 2000; 18:72-73.
Serendipity led the author to treat phobias with acupuncture when his lifelong spider phobia disappeared after self-treatment for an ankle sprain. He treated a few others and found long-term success with one to a few sessions. His cases now extend to 27 with a wide variety of phobias, with 17 apparently cured or much improved. LR 3, KI 3, ST 36, and the fear point on the dominant earlobe became standard as the author progressed. The time between treatment and exposure to the feared object or situation does not seem important.
Comment: This is one our psychiatrist co-workers will have problems accepting (additionally, it is a low-income approach), but it is intriguing. It may be tried as a side treatment when appropriate, as patients are treated for other disorders.
A few such successes could boost the reputation of the practitioner.
2.Hong CZ. Myofascial triggerpoints: pathophysiology and correlation with acupuncture points. Acupuncture Med. 2000;18:41-47.
The characteristics of myofascial triggerpoints (MTrPs), relation to acupuncture points, and clinical aspects are well reviewed. Abnormal muscle endplates following mechanical or biochemical irritation appear involved and electrical activity can be recorded from the area. Excessive acetylcholine release locally has been shown. Palpable nodules and taut muscle bands are present with increased energy consumption and reduced supply ensuing. Latent MTrPs have been found to be frequent in otherwise healthy people, and appear to increase slowly in childhood with aging. It is likely that MTrPs are acupuncture Ah Shi points. Referred pain patterns from such points are similar to traditional meridian connections.
3.Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Akupunktur bei leichten bis mittelschweren deppressiven episoden und angststorungen (Acupuncture in patients with minor depressive episodes and generalized anxiety). Fortschr Neurol Psychiatr. 2000; 68:137-144. Reviewed in: FACT. 2000; 5:262-263.
This is a sham acupuncture-controlled, randomized, modified double-blind study of depressed and anxious patients in treatment and sham groups of 28 each. Several depression and anxiety scale tests were used. Responders included 61% of the acupuncture group vs 21% of the sham acupuncture patients. It took 6 or more treatments before the improvement was reliably noticed. DU 20 (GV 20), EX 6, HE 7, PC 6, and BL 62 points were needled.
Good effect on depression shown in other studies is mentioned. The reviewer notes that the quality of this study, unlike most prior ones on this subject, is good, but the N is low and sham needling might have some effect. Including 2 diagnoses in a single study obfuscates results and longer follow-up is needed.
Comment: Antidepressive effects of acupuncture are commonly seen in practice, and likely play a role in alleviation of chronic pain. Related literature, usually of poor quality (considering the desire for statistically proper work, large N, and long follow-up), generally indicates acupuncture is helpful for both depression and anxiety.
2000 & 2001 British Acupuncture
Literature Review
part I
miscellaneous
1.Bivins R. The Needle and the Lancet: Acupuncture in Britain, 1683-2000. Acupuncture Med. 2001;19:2-14.
Acupuncture was first transmitted to Britain in the 17th century, slowly built in the early 1800s to peak in the early 19th century. A second stage transmission occurred in the 1950s and 1960s, with the Medical Acupuncture Society of Britain formed in 1959. Catholic missionaries to China and Japan first sent it to Europe, and a 1671 text, "Les Secrets Chinoise," was published noting acupuncture, moxibustion, and pulse diagnosis. In 1683, Wilhelm Ten Rhyne's Dissertatio de Arthritide reported Japanese acupuncture in Europe, using wording physicians could understand. Acupuncture entered British practice a century later. Acupuncture "surgery" was gentle compared to bleeding, purging, cautery, etc, of the day. Early reports of cures were considered incredible. In mid 1700s, bitter relations between Britain and China affected medical consideration of Chinese practices. By the early 19th century, British practice was going forward, led by James Morss Churchill, a surgeon (monograph 1823). It was recommended for the same chronic conditions as today. Interest in Chinese theory was minimal and maps of meridians and points disappeared! Reports stressed pragmatic results not theory. In 1971, reports of surgery under acupuncture anesthesia by American observers, then British, stirred increasing interest in the medical art in Britain. Since then, the rise of consumer skepticism, and desire for holistic medical treatment has increased, turning patients to complementary practitioners. By 1991, 80% of practitioners were willing to refer for acupuncture and other alternative treatment. Medical commentators in the U.K. remained skeptical and often hostile. BMAS responded by seeking a physiological, biomedical, or neuroanatomical basis for the art. The reception of acupuncture by the orthodox medical community was very similar in the 18th-19th century and the present. We should not make the mistake of separating acupuncture from its Chinese roots and theory as was done in the earlier time.
Comment: Dr Bivins provides a number of interesting vignettes from earlier days, and commentary on the difficulty of accepting a foreign concept.
2.Tillu A, Roberts C, Tillu S. Unilateral versus bilateral acupuncture on knee function in advanced osteoarthritis of the knee: a prospective randomized trial. Acupuncture Med. 2001; 19:15-26.
Sixty patients waiting knee surgery were contacted, excluding those with acupuncture within a year, steroid injection within 3 months, and non-idiopathic arthritis. Forty-eight replied and 44 completed the trial. Using randomized envelopes, 2 groups were formed. The Hospital for Special Surgery knee score (walk, climb, and pain VAS) was used. Six treatments were given weekly for 15 minutes at SP 9, SP 10, ST 34, 36, and LI 4. Knee function improved statistically at 2 months for both unilateral and bilateral therapy, both by HSS and VAS. Benefits held at 6 months. Ten patients also slept better at night, 3 discarded walking sticks, and 4 removed themselves from surgery consideration (though 3 required "top-up" treatments).
3.Haslam R. A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip: a randomized control trial. Acupuncture Med. 2001;19:19-26.
Thirty-two patients waiting total hip arthroplasty were randomized to 6 weekly acupuncture sessions of 25 minutes or advice and exercise sessions given weekly. A modified WOMAC questionnaire (Western Ontario and McMaster Universities osteoarthritis index) was used. Acupuncture points GB 29, 30, 34, 43, ST 44, LI 4, and 4 "Ashi" points were used at the compass points around the greater trochanter of the hip. The approach is well detailed. Four of 16 control patients withdrew and 3 further dropped out by the 8-week follow-up. More in the acupuncture group reduced analgesics and there was a significant reduction in pain and increase in function compared to control. There was no reported side effect. A prior review by Ernst (1977) provided 7 studies with pain relief compared to controls and 6 with no difference. Research quality in most was poor.
4.Cummings M. Percutaneous electrical nerve stimulation-electroacupuncture by another name? a comparative review. Acupuncture Med. 2001;19:32-35.
The author reviewed 8 papers on PENS, 7 RCTs and 1 case study. In EA, pulse widths over 0.5 ms are avoided as more painful, biphasic waves are the norm, and pulse width most used is 0.2 ms. In 4 PENS papers, a pulse width of unipolar square wave of 0.5 ms is reported. Frequencies used are often 15/30, as well as 4 Hz and 100. PENS application intensity is at maximum tolerable without muscle contractions, equal to mild EA. PENS papers stress dermatome approaches. In classical EA, segmental distribution of points is also often used. Segmental EA has been taught by BMAS for 10 years. Active intervention proved significantly better than sham control in 7 RCTs with no significant change with sham, despite needling at the same sites and depths, unlike most other acupuncture series published where a 50% sham response is found. The author feels describing PENS as a novel therapy is not supported by the publications reviewed. The reviewer could mimic the stimulation parameters with a Cefar Acus II device, except for a pulse width of 0.45 ms at maximum.
5.Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekell PG. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: a randomized controlled study. JAMA. 2000;284:2755-2761. Reviewed in FACT. 2001;6(2):110-111 by AR White.
This 3-arm RCT used a 5-day study period and 9-day follow up. 104 women with high-risk breast cancer were randomized to low frequency EA at classic antiemetic acupoints daily for 5 days (N=37), given minimal needling and mock EA (33), or no adjunctive needling with chemotherapy and standard antiemetics. Emesis episodes during therapy were 5, 10, and 15, respectively. Differences during the 9-day follow-up period were not significant. AR White, in his review, finds the study first class, but limited by small numbers. Cost effectiveness, he states, needs to be studied.
6.Stellon A. An audit of acupuncture in a single-handed general practice over one year. Acupuncture Med. 2001;19: 36-42.
One hundred forty patients in a practice were treated during 1 year, with a further year follow-up. A "measure yourself medical outcome profile" (MYMOP) was used. Most problems were musculoskeletal. 31% had no response, 31% improved, and 39% were much improved. Those benefiting had a high relapse rate with 50% returning for another treatment by 6 months, increasing practice work load. When patients benefiting were compared with those with no response, there appeared no change in wellbeing other than the reduced symptoms and activity score. The MYMOP is printed in the article.
7.Ross J. An audit of the impact of introducing microacupuncture into primary care. Acupuncture Med. 2001;19:43-45.
Microacupuncture is a brief treatment introduced by Felix Mann, used in standard 10-minute consultations, combining brief trigger point acupuncture, periosteal pecking, and more classical Chinese points (especially LR 3, BL 57, SP 6, LI 4, GB 30). 20% of the practice population received acupuncture over a 4-year period. The cervical articular pillar is often needled for neck pain and the coracoid process for shoulder complaints. Referrals to physiotherapy decreased by 86% and referrals to outpatient rheumatology fell by 51%. Despite this, the Primary Care Group (PCG) refused to fund acupuncture. Many patients now ask for the treatment.
8.White EA. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110:481-485. Reviewed in FACT. 2001;6(2):112-113 by TM Cummings.
Medline, EMBASE, Cochrane library, and individual sources were searched. Nine surveys were included, with varied results. Relaxation was reported in 86% of patients, tiredness in up to 38%, needle pain occurred in 1%-45%, and bleeding was common but seldom more than a drop or 2. Pneumothorax, a chief worry, occurred in only 2:250,000 treatments. The reviewer notes that an unknown side effect is delay of appropriate therapy if the patient is not adequately evaluated. Serious adverse effects seem to occur at a rate of less than 1:100,000.
9.Franke A, Gebauer S, Franke K, Brockow T. Acupuncture massage versus Swedish massage and individual exercises versus group exercises in low back pain sufferers: a randomized controlled clinical trial in a 2x2 factorial design. Forsch Komplementarmed Klass Naturheilkd. 2000;7: 286-293. Reviewed in FACT. 2001;6(2): 111-112 by K Kraft.
Acupuncture massage according to Penzel (reflex zone massage) was compared in a rehabilitation clinic with 190 patients. Functional ability and pain VAS were used as measurements. Disability and pain were helped significantly more by acupressure massage. Individual exercise and group exercise differed little in effect, which was only moderate. Function increased less than 12% with therapy, less than expected in all groups. K. Kraft, the reviewer, notes further that 3 to 4 sessions of APM beat 6 to 8 with Swedish massage.
10.White AR, Resch K-L, Chan JCK, Norris CD, Modi SK, Patel JN, Ernst E. Acupuncture for episodic tension-like headache: a multicentre randomized controlled trial. Cephalalgia. 2000;20:632-637. Reviewed in FACT. 2001;6(2):115-116 by TJ Kaptchuk.
This single-blind, sham-controlled RCT involved several centers. The number of patients is not noted. The acupuncture was given briefly at GB 20, LI 4 and up to 4 head and neck tender or symptom related points. Manipulation was 15 seconds or to de Qi. Sham was done with a tapped cocktail stick in a tube. Treatment was weekly for 6 weeks. Follow-up at 1 and 2 months found no difference in rate of headache. Blinding (patient) was successful. The reviewer questions whether acupuncture was sufficient or adequate. He notes both real and sham acupuncture had a 1/week decrease in headache; 30% reported themselves much better or without headache. "What goes on in the acupuncture clinic is more complex and significant than stating acupuncture was no better than sham."
11.Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y. Incidence of adverse reactions associated with acupuncture. J Altern Complement Med. 2000;6:345-350. Reviewed in FACT. 2001; 6 (1):9-10 by AR White.
All patients attending an acupuncture college over a 3-month period were closely observed and questioned for evidence of side effects. In 1441 sessions involving 30,338 needle insertions in 391 patients, side effects were minor; 8% tiredness was the chief effect and aggravation of symptoms second (2.8%). Minor bleeding occurred in 2.8%, but Dr White notes this as a drop of blood or less in 86%. He cautions that the Japanese experience occurred in a reputable school and with gentle superficial needling compared to that in many other approaches. A much larger but less thoroughly detailed study of 65,482 treatments over 6 years in Japan showed a 0.14% incidence of adverse effects.
REVIEWER INFORMATION
Dr Russell Erickson is retired from private practice in Berkeley, California. He is also retired from Kaiser-Permanente Hospital in Richmond, California where he was Senior Consultant and former Chief of Pediatrics.
Russell J. Erickson, MD*
10 Ridge Place
Pleasant Hill, CA 94523
Phone: 925-229-0889 • Fax: 925-228-4976
E-mail: Russpat@netvista.net
*Send all correspondence and reprint requests to Dr Erickson at the above address.
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