http://www.acupuncture-info.org/index.htmlHot News!enpierrejeancousin@blueyonder.co.ukCopyright 2009 Pierre Jean Cousin2009-07-06T20:45:16+01:00 hourly 1 2000-01-01T12:00+00:00 Sun, 03 May 2009 16:30:25 +0100pierrejeancousin@blueyonder.co.ukAcupuncture research2009-07-06T20:45:16+01:00http://www.acupuncture-info.org/page0/files/1f77f367a07bdcac9b6eb34e1d3c15bd-7.php#unique-entry-id-7http://www.acupuncture-info.org/page0/files/1f77f367a07bdcac9b6eb34e1d3c15bd-7.php#unique-entry-id-7Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
by: Richard E. Harris, Jon-Kar Zubieta, David J. Scott, Vitaly Napadow, Richard H. Gracely, Daniel J. Clauw
NeuroImage (09 June 2009)



Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, USA.

Controversy remains regarding the mechanisms of acupuncture analgesia. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors (MORs). This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. We compared both short- and long-term effects of traditional Chinese acupuncture (TA) versus sham acupuncture (SA) treatment on in vivo MOR binding availability in chronic pain patients diagnosed with fibromyalgia (FM). Patients were randomized to receive either TA or SA treatment over the course of 4 weeks. Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment. Acupuncture therapy evoked short-term increases in MOR binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in MOR binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala. These short- and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies. Long-term increases in MOR BP following TA were also associated with greater reductions in clinical pain. These findings suggest that divergent MOR processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture.
Published 30 June 2009 in Neuroimage.
]]>pierrejeancousin@blueyonder.co.ukLatest developments2009-05-27T07:56:11+01:00http://www.acupuncture-info.org/page0/files/7b07f4ef55b5077e36afe998120793df-6.php#unique-entry-id-6http://www.acupuncture-info.org/page0/files/7b07f4ef55b5077e36afe998120793df-6.php#unique-entry-id-6Patients with persistent low back pain should be offered acupuncture, massages or exercises on the NHS, says guidance from the National Institute for Health and Clinical Excellence
Offer one of the following treatment options, taking patient
preference into account
Consider offering:
G Structured exercise programme:
– up to 8 sessions over up to 12 weeks
– supervised group exercise programme in a group of up to
10 people, tailored to the person
– one-to-one supervised exercise programme only if a group
programme is not suitable
– may include aerobic activity, movement instruction, muscle
strengthening, postural control and stretching
G Manual therapy2:
– course of manual therapy, including spinal manipulation
– up to 9 sessions over up to 12 weeks
G Acupuncture:
– course of acupuncture needling
– up to 10 sessions over up to 12 weeks
The new nice guideline will be welcomed by acupuncturist, osteopath and chiropractor who finally get the recognition they deserve for the effectiveness of their treatment

]]>pierrejeancousin@blueyonder.co.ukAcupuncture research2009-05-25T14:39:31+01:00http://www.acupuncture-info.org/page0/files/2f6577862b02d2f2c81068e039d59f92-5.php#unique-entry-id-5http://www.acupuncture-info.org/page0/files/2f6577862b02d2f2c81068e039d59f92-5.php#unique-entry-id-5Abstract
Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and
the non-specific ones. During 'true' acupuncture treatment in general, the needles are inserted into
acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles
are inserted into non-acupoints and/or superficially (so-called minimal acupuncture). A sham
acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture
and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke
activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the
functional connectivity in the brain resulting in a 'limbic touch response'. Clinical studies showed
that both acupuncture and minimal acupuncture procedures induced significant alleviation of
migraine and that both procedures were equally effective. In other conditions such as low back pain
and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and
conventional non-acupuncture treatment. It is probable that the responses to 'true' acupuncture
and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and
healthy individuals may have different responses. In this paper, we argue that minimal acupuncture
is not valid as an inert placebo-control despite its conceptual brilliance.

Full article is available from: http://www.cmjournal.org/content/4/1/1]]>pierrejeancousin@blueyonder.co.ukEvidence Based Medicine2009-05-25T09:55:03+01:00http://www.acupuncture-info.org/page0/files/35fd5e8adf412d6c652984207fb87fd7-4.php#unique-entry-id-4http://www.acupuncture-info.org/page0/files/35fd5e8adf412d6c652984207fb87fd7-4.php#unique-entry-id-4]]>pierrejeancousin@blueyonder.co.ukEvidence Based Medicine2009-05-22T22:46:43+01:00http://www.acupuncture-info.org/page0/files/3f728cae4c1d28eb2a28b77e16eb780d-3.php#unique-entry-id-3http://www.acupuncture-info.org/page0/files/3f728cae4c1d28eb2a28b77e16eb780d-3.php#unique-entry-id-3
The two new studies reconstructed the Lancet review and the main conclusions of that reconstruction are:

* That the results of the Lancet review were very sensitive to the definition of 'large' trials.
* Because of heterogeneity between the trials included in the review, its results are less definite than claimed. The conclusion that homeopathy is, and that conventional treatment is not, a placebo effect, was not based on a comparative analysis and is unjustified because of the heterogeneity of trials and lack of sensitivity analysis.
* The review did however, demonstrate that the quality of homeopathy trials was on average better than the conventional trials analysed.

'The review gave no indication of which trials were analysed nor of the various vital assumptions made about the data. This is not usual scientific practice. If we presume that homeopathy works for some conditions but not others, or change the definition of a 'larger trial', the conclusions change. This indicates a fundamental weakness in the conclusions: they are NOT reliable", said George Lewith, Professor of Health Research at Southampton University

The background to the ongoing debate is as follows:

In August 2005, The Lancet published an editorial entitled 'The End of Homeopathy', prompted by a review comparing clinical trials of homeopathy with trials of conventional medicine. The claim that homeopathic medicines are just placebo was based on 6 clinical trials of conventional medicine and 8 studies of homeopathy but did not reveal the identity of these trials. The review was criticised for its opacity as it gave no indication of which trials were analysed or the various assumptions made about the data.

Sufficient detail to enable a reconstruction was eventually provided and these two new studies are based on such a reconstruction and challenge the Lancet review. Specifically these two studies show:

* Analysis of all high quality trials of homeopathy yields a positive conclusion.
* The 8 larger higher quality trials of homeopathy were all for different conditions. Homeopathy works for some of these but not others, implying that homeopathy is not placebo.
* The comparison with conventional medicine was meaningless.
* Doubts remain about the opaque, unpublished criteria used in the review, including the definition of 'higher quality'.

The Lancet review, led by Prof Matthias Egger of the Department of Social and Preventive Medicine at the University of Berne, started with 110 matched clinical trials of homeopathy and conventional medicine, reduced these to 'higher quality trials' and then to 8 and 6 respectively 'larger higher quality trials'. Based on these 14 studies the review concluded that there is 'weak evidence for a specific effect of homoeopathic remedies, but strong evidence for specific effects of conventional interventions'.

Due to a lack of funding, there are a limited number of homeopathic studies. As a result, it is quite possible to interpret homeopathic data selectively and unfavourably, which is what appears to have been done in the Lancet paper. If we assume that homeopathy does not work for just one condition (Arnica for post-exercise muscle stiffness), or alter the definition of 'larger trial', the results are positive. The comparison with conventional medicine was meaningless: the original 110 trials were matched, but matching was lost after the trials were reduced to 8 in one group and 6 in the other. Interestingly, the quality of homeopathic trials was better than conventional trials.

This reconstruction casts serious doubts on the Lancet review, showing that it was based on a series of hidden judgments unfavourable to homeopathy. An open assessment of the current evidence suggests that homeopathy is probably effective for a number of conditions including allergies, upper respiratory tract infections and 'flu, but more research is desperately needed.

Prof Egger has declined to comment on these findings.

###

References
Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol 2008. doi:10.1016/j.jclinepi.2008.06.015 Rutten ALB, Stolper CF. The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy 2008. doi:10.1016/j.homp.2008.09.008.

For further information, please contact:
Prof George Lewith Tel: +44 (0)7970 067884 email: gl3@soton.ac.uk
Rainer Lüdtke Tel: +49 201 5630516 email: r.luedtke@carstens-stiftung.de
Dr Lex Rutten Tel: +31 765 227340 email: lexrtn@concepts.nl
]]>pierrejeancousin@blueyonder.co.ukEvidence Based Medicine2009-05-20T08:03:12+01:00http://www.acupuncture-info.org/page0/files/bf428e5c11744b34023824e7be2873e7-2.php#unique-entry-id-2http://www.acupuncture-info.org/page0/files/bf428e5c11744b34023824e7be2873e7-2.php#unique-entry-id-2Designing an acupuncture study to meet evidence-based medical criteria: methodological considerations for logistic design and development of treatment interventions arising from the German randomized controlled acupuncture trial on chronic shoulder pain (GRASP).

Molsberger AF, Mau J, Gotthardt H, Schneider T, Drabik A.

Forschungsgruppe Akupunktur, Kasernenstr. 1b, D-40213 Düsseldorf, Germany. a.molsberger@facm.de

The results from studies on potential treatment effects of acupuncture are often limited due to serious difficulties in methodology. Randomized controlled trials on acupuncture should test a widely accepted treatment strategy of verum and sham acupuncture. However, in clinical practice various patterns of acupuncture techniques are employed, and up to now no generally accepted guidelines on how to perform a reliable verum or sham treatment have been established. Another limitation is that in most studies the study populations are too small to obtain reliable data and to detect subtle differences between the unspecific needling of sham acupuncture and specific needling of verum acupuncture with sufficient statistical power. Moreover, only a multicenter trial in an outpatient setting would guarantee a naturalistic environment in which acupuncture is used in clinical practice. In the present report we discuss such methodological aspects in detail and summarize some practical considerations for planning an acupuncture trial that fulfills evidence-based medical criteria. The largest German study on the treatment effects of acupuncture in patients with chronic shoulder pain (recruited patients n = 452), might serve as an example for such a well-designed study. Before we could conduct our study, clear definitions and protocols for the verum and sham acupuncture treatments as well as adequate endpoints had to be developed. For this we used a combination of a comprehensive study of the literature and structured interviews with experienced physicians followed by an expert panel. A total of 41 physicians had to be trained to achieve a homogeneously high quality of acupuncture treatment. The latter represents a prerequisite for reproducibility, constituting a critical component of rigorous efficacy trials in scientific acupuncture research.
]]>pierrejeancousin@blueyonder.co.ukacupuncture info Blog2009-05-11T14:50:20+01:00http://www.acupuncture-info.org/page0/files/9b1774de5226196aed490c375ac949eb-1.php#unique-entry-id-1http://www.acupuncture-info.org/page0/files/9b1774de5226196aed490c375ac949eb-1.php#unique-entry-id-1This is taken from Clinical Evidence http://clinicalevidence.bmj.com/ceweb/about/index.jsp the international source of the best available evidence on the effects of common clinical interventions. (Clinical Evidence is owned by the respected British Medical Journal

"Clinical Evidence aims to help people make informed decisions about which treatments to use. It can also show where more research is needed. For clinicians and patients we wish to highlight treatments that work and for which the benefits outweigh the harms, especially those treatments that may currently be underused. We also wish to highlight treatments that do not work or for which the harms outweigh the benefits. For the research community our intention is to highlight gaps in the evidence, where there are currently no good RCTs or no RCTs that look at groups of people or at important patient outcomes.

So what can Clinical Evidence tell us about the state of our current knowledge? What proportion of commonly used treatments are supported by good evidence, what proportion should not be used or used only with caution, and how big are the gaps in our knowledge? Of around 2500 treatments covered 13% are rated as beneficial, 23% likely to be beneficial, 8% as trade off between benefits and harms, 6% unlikely to be beneficial, 4% likely to be ineffective or harmful, and 46%, the largest proportion, as unknown effectiveness (see figure 1). Dividing treatments into categories is never easy hence our reliance on our large team of experienced information specialists, editors, peer reviewers and expert authors. Categorisation always involves a degree of subjective judgement and is sometimes controversial. We do it because users tell us it is helpful, but judged by its own rules the categorisation is certainly of unknown effectiveness and may well have trade offs between benefits and harms. However, the figures above suggest that the research community has a large task ahead and that most decisions about treatments still rest on the individual judgements of clinicians and patients."

Double standards are often used by opponents of acupuncture and other complementary therapies to "prove" that all complementary medicines are at best just a placebo
With articles in newspapers, dedicated websites and blogs, radio talks and television appearances, they are increasingly vocals and aggressive in their condemnation of all complementary medicines.
To back up their claim, they select carefully a few scientific papers that appears to go along with their assertion, while ignoring the vast number of good clinical research that support the use of acupuncture and other alternative treatments
The above little excerpt from a well respected organization show that all is not well proven in the field of conventional medicine, anymore that it is in many other treatment modalities.
The purpose of this website is to inform the public about the benefits of acupuncture, the conditions that can be treated, and the scientific and clinical evidence that is available today.



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