Swedish Study Finds that women With PCOS Benefit from Acupuncture and Exercise
18/09/11 15:46
Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electro-acupuncture (EA) would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention. We randomized 84 women with PCOS, aged 18–37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Outcomes were assessed at baseline, after 16 wk of intervention, and after a 16-wk follow-up. After 16 wk of intervention, circulating T decreased by −25%, androsterone glucuronide by −30%, and androstane-3α,17β-diol-3-glucuronide by −28% in the EA group (P = 0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P = 0.018 vs. exercise). After the 16-wk follow-up, the acne score decreased by −32% in the EA group (P = 0.006 vs. exercise). Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.
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Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
06/07/09 20:45 | Acupuncture research
Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs).
by: Richard E. Harris, Jon-Kar Zubieta, J">David J. Scott, Vitaly Napadow, Richard H. Gracely, J">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.
by: Richard E. Harris, Jon-Kar Zubieta, J">David J. Scott, Vitaly Napadow, Richard H. Gracely, J">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.
NICE recommand acupuncture for back pain
27/05/09 07:56 | Latest developments
Patients 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
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
Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist's perspective
25/05/09 14:39 | Acupuncture research
Abstract
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
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
Is Evidence Based Medicine the panacea?
25/05/09 09:55 | Evidence Based Medicine
In evidence-based medicine (EBM), the gold standard for strength of evidence is the randomized controlled trial, an important method in pharmacotherapy but with serious limitations when applied to acupuncture, complementary medicine, and conventional medical practice such as surgery