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March 2013

Acupuncture for Phantom Limb Pain

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http://online.liebertpub.com/doi/full/10.1089/acu.2012.0928?utm_source=031413+CIM+eNewsletter&utm_campaign=031413+eNews&utm_medium=email&

A recent research review has been published in the journal, Medical Acupuncture, comparing 16 studies of acupuncture done to help patients with pain and functional limitation after amputation. This type of study is called a meta-analysis, in which many different studies are grouped together to try to make some meaningful interpretation of their collected results.

One problem with a meta-analysis is that there are differences between the individual studies that may detract from the strength of the evidence. In this case, enough evidence was found to support the idea that acupuncture is helpful in several ways in the treatment of phantom pain and related problems.

Quoted from the study—Results: Level C evidence showed acupuncture treatment reduced phantom-limb pain and sensation (14 studies), improved functional capacity or mobility (5 studies), and reduced levels of analgesic (pain medicine) use (3 studies).

Conclusions: Acupuncture therapy has been shown to have a positive effect on the symptoms of phantom-limb syndrome. However, further investigations of superior quality are needed to support these findings and de- termine the most effective method of acupuncture for this purpose.

The previous paragraph points to a problem that is well known in the field of acupuncture research. That problem is that there are significant challenges to designing acupuncture research that is meaningful. Two of the reasons are that these studies: 1) rarely accurately reflect the way that acupuncture is done in clinical practice, and 2) don’t always use appropriate controls such as ‘placebo’ acupuncture. Good controls are considered essential to producing meaningful research data. There are many other problems inherent in doing good research on acupuncture, but these are two of the main ones.

Despite the fact that this publication has pointed out the well-known shortcomings of acupuncture research, we are happy to see this evidence supporting the usefulness of acupuncture for those people suffering the terrible effects of phantom limb syndrome.

 

 

Acupuncture Treats Fibromyalgia

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http://www.healthcmi.com/acupuncturist-news-online/713-acupuncturefmsresearch

New research concludes that acupuncture reduces pain sensitivity for patients suffering from fibromyalgia syndrome (FMS). The study also showed that patients receiving acupuncture had significant reductions in anxiety and depression. Further, the overall quality of life score improved for FMS patients receiving acupuncture therapy.

 

The treatment method was the application of five acupuncture points at a rate of once per week. The points were located in areas of discomfort near the occipital bone, rhomboid and trapezius muscles and in the region of the upper chest and lateral epicondyle. The results were published in the Journal of Acupuncture and Meridian Studies.

Fibromyalgia is a pain syndrome affecting the soft tissues and often involves sleep disturbances, tenderness at specific points, muscle pain, fatigue and depression. A literal translation of the term is pain of the muscles and fibrous tissues. Fibromyalgia is distinguished from most other forms of pain because it is non-nociceptive. Nociceptive pain involves inflammation and is triggered by pain receptors in the skin, muscles, joints and other tissues. FMS and other non-nociceptive types of pain conditions do not inherently involve inflammation and is a result of a disruption in central processing. Examples of non-nociceptive pain include irritable bowel syndrome, migraine headaches and FMS. It is estimated that FMS affects up to approximately 4% of the US population. In Chinese Medicine, FMS is due to Liver Qi stagnation, Bi syndrome, dampness with Wei Qi  obstruction, Qi deficiency and Yin deficiency. Acupuncture and herbal medicine are commonly used to treat FMS. Biomedical treatments for FMS include anti-depressants, serotonin reuptake inhibitors, sleep drugs, pain medications and nutritional supplements.

More Research
Another recent study published in Clinical Rheumatology concludes that acupuncture is effective for the treatment of fibromyalgia syndrome. The researchers concluded that acupuncture demonstrates definitive “beneficial effects” in the treatment of fibromyalgia. Researchers from the University of Maryland School of Medicine in Baltimore also conclude that acupuncture is significantly effective in the treatment of fibromyalgia syndrome in their new research. Other research performed at the prestigious Mayo Clinic College of Medicine in Rochester concluded that acupuncture is effective in treating fibromyalgia and showed specific efficaciousness in its ability to reduce pain, fatigue and anxiety.

The mounting evidence suggests that acupuncture is a primary treatment for FMS. Emerging integrative medical clinics within the hospital and general medical system are helping in the delivery of acupuncture services to patients. However, most acupuncturists have individual or family group style medical practices in the US.

Acupuncture Numbers
Currently, there are slightly over 20,000 licensed acupuncturists in the USA. California has the most acupuncturists with a total of 6,682. New York has 1,909 licensed acupuncturists followed by Florida with a total of 1,719. Those numbers are up from 2009 when California had 6,578 acupuncturists, New York had 854 licensed acupuncturists and Florida had only 2,027 licensed acupuncturists. Massachusetts comes in fourth place with a total of 1,048 licensed acupuncturists. Colorado has 893 acupuncturists, Oregon has 830 acupuncturists, Texas has 796 acupuncturists and Washington has 753 acupuncturists. The numbers begin to drop-off at this point with Maryland having 667 acupuncturists, Illinois with 587 and New Jersey with 567 acupuncturists. Many states have under 100 acupuncturists and 6 states do not even have acupuncture licensing laws at all. Acupuncture has been proven to be an important and effective method for the treatment of fibromyalgia syndrome but access to care remains an issue.
References:
Bastos, Jessica Lucia Neves, et al. “Effect of Acupuncture at Tender Points for the Management of Fibromyalgia Syndrome: A Case Series.” Journal of Acupuncture and Meridian Studies (2013).

An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Rohini Terry, Rachel Perry and Edzard Ernst. Clinical Rheumatology?Volume 31, Number 1 (2012), 55-66, DOI: 10.1007/s10067-011-1783-5.

Berman BM, Ezzo J, Hadhazy V, Swyers JP. Complementary Medicine Program, University of Maryland School of Medicine, Baltimore 21207, USA. The Journal of Family Practice [1999, 48(3):213-218].

Mayo Clin Proc. 2006 Jun;81(6):749-57. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Martin DP, Sletten CD, Williams BA, Berger IH. Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Acupuncture after Knee Replacement Surgery

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http://www.healthcmi.com/acupuncturist-news-online/714-acupuncturekneereplacementsurgery

New research concludes that acupuncture reduces pain and inflammation after knee replacement surgery. The research also finds that acupuncture improves range of motion following knee replacement surgery. Further, physical measurements of the swelling around the knee were significantly lower in the acupuncture group than in the control group.

Acupuncture for the Knee

Acupuncture was applied to patients with total knee arthroplasty starting at day 7 following knee replacement surgery. Acupuncture was administered three times per week until day 21 when the treatment regime was discontinued. Range of motion improved, swelling measurably decreased and pain levels were significantly lower in the acupuncture study group than in the group that did not receive acupuncture therapy. As a result of these findings, the researchers conclude that acupuncture is effective in the post-acute phase of knee rehabilitation following total knee replacement surgery.

This study builds on earlier findings that acupuncture benefits the knee. In other recent research, investigators discovered that acupuncture reduces knee pain and increases range of motion for patients with osteoarthritis. An interesting study, it compared sham acupuncture with modern acupuncture and classical acupuncture techniques. The sham acupuncture, a form of simulated placebo acupuncture, did not significantly improve the knee condition. However, both modern and classical approaches to acupuncture were highly effective in reducing pain and improving range of motion. The modern acupuncture style involved the application of points known to benefit the knees and the classical acupuncture style derived custom acupuncture prescriptions based on a differential diagnosis. The modern acupuncture style was over 60% effective and the classical acupuncture was over 70% effective in the treatment of osteoarthritis of the knee. The researchers concluded that the efficaciousness of acupuncture is “method-specific.”
Reference:
Mikashima, Y., et al. “Efficacy of acupuncture during post-acute phase of rehabilitation after total knee arthroplasty.” Journal of traditional Chinese medicine= Chung i tsa chih ying wen pan/sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine 32.4 (2012): 545.

Max Karner, Frank Brazkiewicz, Andrew Remppis, et al., “Objectifying Specific and Nonspecific Effects of Acupuncture: A Double-Blinded Randomised Trial in Osteoarthritis of the Knee,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 427265, 7 pages, 2013.