Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial

OBJECTIVE

To evaluate the effect of acupuncture on reproductive outcome in patients treated with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day), and both groups were compared with a control group that did not receive acupuncture.

DESIGN

Prospective, randomized trial.

SETTING

Private fertility center.

PATIENT(S)

During the study period all patients receiving IVF or ICSI treatment were offered participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S)

Acupuncture was performed immediately before and after ET (ACU 1 and 2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2 days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy and ongoing pregnancy rates in the three groups.

RESULT(S)

Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S)

Acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2 provided no additional beneficial effect.

A retrospective survey of patients at the University of Salford Acupuncture Clinic

A retrospective survey was undertaken at the University of Salford Teaching Acupuncture Clinic. A postal questionnaire, exploring patient satisfaction and experience with the treatment and clinic, was sent to all persons who had attended the clinic between September 2001 and 2002. Eighty-four (76%) of the 110 patients returned the questionnaire. Nearly all (88%) gained symptom relief and about a half made changes to their lifestyle. No-one reported any negative effects. More than 90% were satisfied with the treatment given, student practitioners and supervisors, although there were mixed views about the supervisor's role. The study is one of the first studies to explore the satisfaction and experiences in a teaching clinical setting. Further research is needed to provide more in-depth insight into the patient experience and effects of acupuncture in this setting and to explore their experience and effects as the treatment unfolds, and over the longer term.

Meaning shift: findings from wellness acupuncture

Wellness or holistic acupuncture places an emphasis on working with and developing the patient's understanding of health and illness. This research project examines changes in meaning in 367 letters from successful wellness acupuncture. Mentions of changes of the meaning of health and illness were categorized into themes using content analysis. Five main meaning shifts were identified in the data. These shifts are (1) from a goal of fixing the problem to a goal of increasing health, (2) from symptoms as problems to symptoms as teachers, (3) from healing as passive to healing as active, (4) from being dominated by illness to moving beyond the illness, and (5) from regarding the practitioner as a technician to regarding the practitioner as a healer or friend. The shifts in meaning seen in the data illustrate a potential pathway for bringing health benefits to patients and may provide a useful strategy for healing. Narrative (defined here as "first-person accounts by respondents of their experience") is thought to play a major role in the manifestation of symptoms and the ability of patients to cope with illness. Patients suffer not only from their primary symptoms, but also from the results and effects of their illnesses, such as depression and changes in their relationships. For the patient, symptoms often hold much meaning beyond physical sensation. A recurrence of symptoms can have other unpleasant results, such as additional trips to doctors, paying for medications, time off from work, not being able to play with children, or changes in relationships with family members. In many cases, the anxiety and depression surrounding the symptoms causes suffering which are greater than the suffering caused by the physical symptoms directly. These factors also change how the ill individual interacts socially, thereby reducing both instrumental and emotional social support, resulting in a downward spiral of suffering. By interacting with narrative, a path to improved health that augments conventional or alternative treatment can be used. Narrative is the point of access to the patient's mental state about illness; it is the manifestation of meaning. Patients express the meaning of their illness in their own narratives. By expressing narratives, patients articulate and develop the meaning of their illness. This process itself can be therapeutic. By shifting the individual's meaning from a detrimental to a beneficial one, a great deal of suffering may be eliminated without any change in the physical sensations. Certain individuals (eg, a socially-sanctioned healer) are given social roles in the ongoing story of someone's illness. These socially sanctioned individuals (ie, physicians) have an important role in interpreting and developing the individual's understanding of his or her illness. Therefore, in addition to physical interventions targeting the cause of the sensations, a great deal of suffering may potentially be alleviated through interacting with the patient's understanding and appraisal of symptoms. Patient meaning shift may be one of the most effective means by which to aid the patient. This article examines patient accounts of acupuncture experience for narrative concerning meaning shifts to gain insight into their role in wellness acupuncture practice.

Informing nurses of the lived experience of acupuncture treatment: a phenomenological account

Acupuncture is a component of Traditional Chinese Medicine, focusing on a holistic, energy-based approach to the individual, rather than a disease-oriented, diagnostic, and treatment model. Nurses are increasingly involving themselves in the use of acupuncture as practitioners and as supporters of acupuncture in mainstream health care. This project described the lived experience of acupuncture treatment, with specific objectives to: inform nurses of people's experiences of having acupuncture; give nurses the language to explain to patients the experience of having acupuncture; and create possibilities for offering acupuncture as an informed choice of treatment in nursing and health care. The phenomenon of experiencing acupuncture was located within the participants' accounts of what it was like for them before, during, and after treatment.

Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia

Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.

Acupuncture as a Complex Intervention: A Holistic Model

OBJECTIVES

Our understanding of acupuncture and Chinese medicine is limited by a lack of inquiry into the dynamics of the process. We used a longitudinal research design to investigate how the experience, and the effects, of a course of acupuncture evolved over time.

DESIGN AND OUTCOME MEASURES

This was a longitudinal qualitative study, using a constant comparative method, informed by grounded theory. Each person was interviewed three times over 6 months. Semistructured interviews explored people's experiences of illness and treatment. Across-case and within-case analysis resulted in themes and individual vignettes.

SUBJECTS AND SETTINGS

Eight (8) professional acupuncturists in seven different settings informed their patients about the study. We interviewed a consecutive sample of 23 people with chronic illness, who were having acupuncture for the first time.

RESULTS

People described their experience of acupuncture in terms of the acupuncturist's diagnostic and needling skills; the therapeutic relationship; and a new understanding of the body and self as a whole being. All three of these components were imbued with holistic ideology. Treatment effects were perceived as changes in symptoms, changes in energy, and changes in personal and social identity. The vignettes showed the complexity and the individuality of the experience of acupuncture treatment. The process and outcome components were distinct but not divisible, because they were linked by complex connections. The paper depicts these results as a diagrammatic model that illustrates the components and their interconnections and the cyclical reinforcement, both positive and negative, that can occur over time.

CONCLUSIONS

The holistic model of acupuncture treatment, in which "the whole being greater than the sum of the parts," has implications for service provision and for research trial design. Research trials that evaluate the needling technique, isolated from other aspects of process, will interfere with treatment outcomes. The model requires testing in different service and research settings.

Measuring the effects of acupuncture and homoeopathy in general practice: an uncontrolled prospective documentation approach

Background

Despite the increasing demand for acupuncture and homoeopathy in Germany, little is known about the effects of these treatments in routine care. We set up a pragmatic documentation study in general practice funded within the scope of project launched by a German health insurer. Patients were followed-up for up to four years.

Methods

The aim of the project was to study the effects and benefits of acupuncture and/or homoeopathy, and to assess patient satisfaction within a prospective documentation of over 5000 acupuncture and over 900 homoeopathy patients. As data sources, we used the documentation made available by therapists on every individual visit and a standardised quality-of-life questionnaire (MOS SF-36); these were complemented by questions concerning the patient's medical history and by questions on patient satisfaction. The health insurer provided us with data on work absenteeism.

Results

Descriptive analyses of the main outcomes showed benefit of treatment with middle to large-sized effects for the quality of life questionnaire SF-36 and about 1 point improvement on a rating scale of effects, given by doctors. Data on the treatment and the patients' and physicians' background suggests chronically ill patients treated by fairly regular schemes.

Conclusion

Since the results showed evidence of a subjective benefit for patients from acupuncture and homoeopathy, this may account for the increase in demand for these treatments especially when patients are chronically ill and unsatisfied with the conventional treatment given previously.

Empathy, Enablement, and Outcome: An Exploratory Study on Acupuncture Patients' Perceptions

OBJECTIVES

To conduct an exploratory, retrospective study of acupuncture patients' perceptions of practitioner empathy, patient enablement, and health outcome, and to investigate the associations between them.

METHODS

In a retrospective, observational study, questionnaires were distributed to 192 patients randomly selected from a population of 6348 who, several months previously, had participated in a survey of acupuncture safety, and had agreed to be contacted again. The main measures included patients' perceptions of their practitioners' empathy using the Consultation and Relational Empathy Measure, the Patient Enablement Instrument, and the Glasgow Homeopathic Hospital Outcome Scale (measuring change in main complaint and well-being).

RESULTS

A total of 143 (74%) patients responded (27% men and 73% women) with an average age of 51 years. Comparisons between the population, the sample selected, and the responding sample showed reasonable equivalence. The majority of patients (71%) were in the middle of an ongoing course of treatment at the time of completing the questionnaires for this study. 36% of patients were attending for reasons of "general well-being," 34% for musculoskeletal problems, 11% for emotional or psychological problems, and 19% for other reasons. Empathy and enablement scores were not influenced by age or reason for attendance, but men showed significantly lower scores than women (p < 0.05). Patient enablement was significantly positively correlated with perception of their practitioners' empathy (Spearman's rho = 0.256, p < 0.01). Enablement in turn was strongly positively correlated with the outcome of both the main complaint (rho = 0.457, p < 0.0001) and improved well-being (rho = 0.521, p < 0.0001).

CONCLUSION

Patients' perceptions of consultations with their acupuncturists suggest that their experience of empathy is significantly associated with patient enablement, which in turn is highly correlated with improved self-reported health outcomes.

Effects of acupuncture on skin and muscle blood flow in healthy subjects

In 14 healthy female subjects, the effects of needle stimulation (acupuncture) on skin and muscle blood flow were investigated using a non-invasive custom-designed probe and photoplethysmography (PPG). In randomised order, 2-7 days apart, three modes of needle stimulation were performed on the anterior aspect of the tibia: superficial insertion (SF), insertion into the anterior tibial muscle (Mu), and insertion into the muscle including manipulation of the needle in order to elicit a distinct sensation of distension, heaviness or numbness (DeQi). Before intervention, the subjects rested for 30 min. After the intervention, the needle was left in situ for 20 min. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. In a fourth session, serving as control, corresponding measurements were performed without any needle stimulation. Area under curve was calculated for 5-min periods prior to and after stimulation, respectively, and for the remaining 15-min period after stimulation. Compared to the control situation, muscle blood flow increased following both Mu and DeQi for 20 min, with the latter being more pronounced for the initial 5 min. Skin blood flow increased for 5 min following DeQi. However, no increase was found following SF. The DeQi stimulation was preceded by higher visual analogue scale ratings of anxiety prior to stimulation, which might have influenced skin blood flow to some extent. The results indicate that the intensity of the needling is of importance, the DeQi stimulation resulting in the most pronounced increase in both skin and muscle blood flow.

Mental disorders and reasons for using complementary therapy

OBJECTIVE

To compare patients with and without mental disorders who seek services from a complementary therapy practitioner with regard to quality of life, reasons for seeking complementary therapies, complaints, and physical conditions.

METHOD

We studied new patients who attended a complementary therapy clinic offering acupuncture treatment between July 1, 1993, and March 31, 1995. We collected data from a self-administered questionnaire and from a physician-conducted psychiatric assessment.

RESULTS

Of the 826 new patients at the clinic, 578 (70%) presented with a mental disorder. Patients with a mental disorder perceived their quality of life as poorer and reported greater levels of stress than did those without a mental disorder. However, the groups did not differ in their self-reported reasons for seeking complementary therapies, in their complaints, or in their physical conditions. Among patients with a mental disorder, the major reasons for choosing complementary therapies were personal preference, interest, or belief in complementary therapies (44.3%) and perceiving complementary therapies as a last resort (30.7%). Most patients with a mental disorder saw a complementary practitioner for musculoskeletal and connective-tissue disorders (44.1%), fatigue (26.6%), and headache (15.2%). The most frequent physical illnesses among patients with a mental disorder were diseases of the musculoskeletal system and connective tissue (42.6%).

CONCLUSION

Like their counterparts without a mental disorder, individuals with a mental disorder use complementary therapies because of personal beliefs. The wide use of complementary therapies among individuals with a mental disorder may be ascribed to a poor quality of life and high levels of distress.

An audit of self-acupuncture in primary care

This paper presents early experiences with self-acupuncture (i.e. patients treating themselves with acupuncture), in a medium sized, mainly urban, General Practice. It has been useful in allowing greater access to acupuncture in this setting. Fifteen conditions were treated; the majority of which were musculoskeletal. Ten out of fifteen reported their treatment to be successful. No adverse eventswere reported by any of the patients.

Assessment of beliefs in the effectiveness of acupuncture for treatment of psychiatric symptoms

OBJECTIVES

Research has demonstrated that beliefs or expectancies can exert a powerful influence on treatment and/or drug effects. As patients participate in more complementary and/or alternative treatments for psychiatric conditions, it is important to assess the role of belief or expectancy on response to nontraditional treatment approaches. The Acupuncture Beliefs Scale was developed to assess belief in the efficacy of acupuncture for both physical and psychiatric symptoms and conditions. Development and psychometric properties of the scale are described.

DESIGN AND SUBJECTS

Research personnel solicited statements regarding the potential experience and effects of acupuncture. These items were collapsed into a set of 36 items, with some rotated to avoid response bias. Outpatients diagnosed with bipolar disorder and undergraduates completed the scale (n = 118).

RESULTS

The scale yielded excellent internal consistency (coefficient alpha = 0.97), and item-total score correlations between 0.37 and 0.83. Principal component analysis with a varimax rotation revealed three significant and meaningful factors that were consistent across both subject groups. Factors appeared to capture general endorsement of acupuncture treatment, beliefs in the scientific value and credibility of acupuncture treatment, and beliefs about the procedures and physical experience of acupuncture.

CONCLUSIONS

The Acupuncture Beliefs Scale is a 36-item self-report scale that may be useful for measurement of beliefs in the effectiveness of acupuncture treatment.

Integrating patient preferences in clinical trials: a pilot study of acupuncture versus midazolam for gastroscopy

BACKGROUND AND OBJECTIVES

Patient preferences play an important role when choosing between different treatment options and may have an influence on outcome. We performed a study to investigate (1) to what extent patients make use of the offer to receive acupuncture as a pretreatment for gastroscopy, (2) whether this is perceived as being as effective as sedation, and (3) whether characteristics and outcomes differ between patients giving consent to random allocation and patients choosing their pretreatment.

DESIGN

Partially randomized patient preference trial. Patients who gave consent to randomization were allocated randomly while patients who had a preference received the treatment of their choice.

PATIENTS

One hundred and six (106) inpatients of a district hospital in southern Germany undergoing gastroscopy for diagnostic purposes.

INTERVENTIONS

Pretreatment with a sedative (midazolam) or acupuncture.

MAIN OUTCOME MEASURE

Patient's overall assessment on a visual analogue scale (VAS).

RESULTS

Twenty-eight (28) patients (26%) agreed to be randomized, 21 (20%) chose acupuncture, 51 (47%) midazolam, and 8 (7%) did not want pretreatment. Patients receiving midazolam rated the examination as slightly less troublesome than those receiving acupuncture. Oxygen saturation, blood pressure, and heart rate were significantly lower in patients receiving midazolam. Characteristics and outcomes of randomized and nonrandomized patients did not differ significantly.

CONCLUSIONS

Because of the low number of patients giving consent to random allocation conclusions on effectiveness are difficult to draw. The partially randomized patient preference design is recommended for use in future trials of acupuncture for gastroscopy. Such trials should be performed in an outpatient setting.

[Alternative medicine methods applied in patients before surgical treatment of lumbar discopathy]

Case records of 200 patients operated on in 1998/99 for herniated lumbar disc in Neurosurgery Dept. showed that 95 patients (47.5%) had been treated previously by 148 alternative medical or non-medical procedures. The authors discuss the problem of non-conventional treatment methods applied for herniated lumbar disc by professionals or non professionals. The procedures are often dangerous.

Needle acupuncture in tension-type headache: a randomized, placebo-controlled study

A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture

METHOD

Sixty-nine patients (mean age 48.1 years, SD = 14.1) fulfilling the International Headache Society criteria for tension-type headache were randomly assigned to verum or placebo condition. No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately, 6 weeks and 5 months after the end of treatment. There was a significant but weak improvement in quality of life parameters (clinical global impressions, Nottingham Health Profile) after verum treatment. In decision tree analyses, the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month. High values in the von Zerssen Depression Score resulted in high mean visual analogue scale values.

Clinical management of needle-phobia patients requiring acupuncture therapy

Both acupuncture and hypnosis have their distinct applications in the health profession, but combining acupuncture therapy with hypnosis has rarely been done for the purpose of therapeutic treatment, perhaps because few clinicians have proper training in both disciplines. For needle phobic patients, acupuncture treatment can be a dreadful experience, as multiple needles are usually used. It is stressful for both clinicians and patients when the patients are put in an extremely apprehensive state. Our research for combining both acupuncture and hypnosis has revealed that synergy does exist in both, and that hypnosis does augment the effect of acupuncture, resulting in better treatment outcomes. Since many acupuncture patients who are needle phobic do not return for further treatment even though acupuncture has rendered good therapeutic results for them, stress reduction with hypnosis is, therefore, a welcome complimentary adjunct that would enable them to return for further needed acupuncture treatment if and when the factor of fear of the needle is removed.

Are psychosocial factors related to response to acupuncture among patients with knee osteoarthritis?

CONTEXT

Acupuncture has been found to be beneficial in the treatment of patients with knee osteoarthritis. However, response among such patients is highly variable. Identification of subjects with greater response would facilitate a more rational use of acupuncture.

OBJECTIVE

To examine the relationship between demographic and psychosocial variables and response to acupuncture as defined by reduction in pain and disability at the end of an 8-week course of treatment.

DESIGN

Retrospective study.

SETTING

Outpatients attending rheumatologists or primary care physicians.

PATIENTS

37 patients with symptomatic knee osteoarthritis who had previously participated in a controlled trial using acupuncture were recalled for an interview approximately 1 year later.

INTERVENTION

Structured interview, questionnaire completion, and an examination.

MAIN OUTCOME MEASURES

Depression, anxiety, helplessness, self-efficacy, and fatigue were measured by standard instruments. Knee examination and assessment of pain threshold were measured by dolorimetry.

RESULTS

Response at 8 weeks was significantly related to duration of symptoms. A statistically nonsignificant trend was found for older and more educated subjects to have a better response; anxiety and fatigue were found to be inversely related to response (also statistically nonsignificant). Subjects with localized medial pain had significantly better response in terms of pain and disability than did subjects with generalized knee pain.

CONCLUSION

Other than a weak relationship with anxiety (at 8 weeks only), no evidence of a link between psychosocial variables and response to acupuncture was found. Prospective studies are needed to confirm these results.

Caring needs of patients with rheumatoid arthritis

The goal of this study was to identify, through the application of Watson's 10 carative factors, the caring needs specific to the human experience of having rheumatoid arthritis and undergoing acupuncture treatment. The study was conducted at a large university hospital in Stockholm, Sweden. Interviews were conducted during manual acupuncture treatment employing a conversation guide derived from Watson's theory of caring. Six women had 20 sessions each over an 11-week period. A thematic analysis of the resulting 120 audiotaped sessions revealed four predominant themes: seeking help, searching for meaning, uncertainty, and fear of being disappointed. These four phenomena captured the complexities of the physical, emotional, social, and existential experiences of the patients.

Chinese medicine users in the United States. Part I: Utilization, satisfaction, medical plurality

OBJECTIVES

Chinese medicine is growing in popularity and offers an important alternative or complement to biomedical care, but little is known of who uses it or why they purchase it. This article reports the first in-depth, large-scale (n = 575) survey of United States acupuncture users.

DESIGN

An anonymous mixed quantitative-qualitative survey questionnaire assessed user demographics, Chinese medicine modalities used, complaints, response to care, other health-care used, and satisfaction with care in six general-service clinics in five states.

RESULTS AND CONCLUSIONS

The user demographic picture was of mid-age, well-educated, employed, mid-income patients. They sought care for a wide variety of conditions; top uses were for relief of musculoskeletal dysfunction, mood care, and wellness care. A large majority reported "disappearance" or "improvement" of symptoms, improved quality of life, and reduced use of selected measures including prescription drugs and surgery. Respondents reported utilizing a wide array of practices in addition to Chinese medicine, while also expressing extremely high satisfaction with Chinese medicine care. The evidence indicates that these respondents behave as astute consumers within a plural health care system. Part II (in press) details reasons given for satisfaction and situates respondent attitudes within a larger sociocultural framework.

Prior treatments in a group of tinnitus sufferers seeking treatment

BACKGROUND

Tinnitus is a common problem for which many treatments have been proposed and implemented. Patients tend to seek renewed treatment after treatment failure. The aim of this descriptive study was to describe a group of consecutive tinnitus patients in terms of prior treatments received.

METHODS

Sixty-nine tinnitus patients seeking treatment were asked about prior treatments and completed the short Tinnitus Effect Questionnaire (TEQ). Four groups were obtained: No treatment (n = 24), acupuncture (n = 19), relaxation (n = 13), and other treatments (n = 13). Six subscales were derived from the TEQ measuring helplessness, capacity for rest, acceptability of change, emotional effects, hearing speech and sounds, and ability to ignore. The groups were compared with multivariate analyses of covariance and Tukey's post-hoc tests.

RESULTS

Results showed minor differences between the groups, the exception being that the untreated group showed more acceptability for change.

CONCLUSIONS

Clinicians should be aware of the fact that patients may have tried at least one treatment when entering the audiology clinic. Controlled studies are needed in order to avoid the spread of nonspecific and non-effective treatments in the management of tinnitus.

Why do patients turn to complementary medicine? An empirical study

Over 250 patients from three complementary medicine practices-acupuncture, osteopathy and homoeopathy-completed a questionnaire rating 20 potential reasons for seeking complementary treatment. The reasons that were most strongly endorsed were "because I value the emphasis on treating the whole person'; "because I believe complementary therapy will be more effective for my problem than orthodox medicine'; "because I believe that complementary medicine will enable me to take a more active part in maintaining my health'; and "because orthodox treatment was not effective for my particular problem'. Five factors were identified, in order of importance: a positive valuation of complementary treatment, the ineffectiveness of orthodox treatment for their complaint, concern about the adverse effects of orthodox medicine, concerns about communication with doctors and, of less importance, the availability of complementary medicine. Groups were compared, using analysis of covariance to control for demographic differences between the three patient groups. Osteopathy patients' reasons indicated they were least concerned about the side effects of orthodox medicine and most influenced by the availability of osteopathy for their complaints. Homoeopathy patients were most strongly influenced by the ineffectiveness of orthodox medicine for their complaints, a fact which was largely accounted for by the chronicity of their complaints. Results are discussed in terms of the limited research in this area. Future studies should separate the reasons for beginning complementary treatment from the reasons for continuing it. It is possible, for instance, that the failure of orthodox medicine is the strongest motive for seeking complementary treatment but that, once treatment has been experienced, other more positive factors become more important.

[Attitudes to acupuncture--a questionnaire study among medical students in Tromsø]

In February 1992, 80% of the medical students at Tromsø University filled in a questionnaire concerning attitudes to acupuncture. 63% of the students would recommend acupuncture when the diagnosis was migraine, while 14% of the students would support a patient who tried acupuncture as cancer therapy. 86% of the students thought that placebo could account for 25-50% of the effect of acupuncture. Most of the students wanted more scientific documentation, although 75% said that acupuncture already was, or at least should be, part of the ordinary health care system. The main result of this study was a generally positive attitude towards acupuncture. The students want to learn the method, and they will recommend acupuncture for their future patients.

Acupuncture and emotion: the influence of acupuncture anesthesia on the sensory and emotional components of pain

Objective indices (heart rate, perspiration quantity, finger plethysmograph curves, and facial expression) and subjective indices (sensory and emotional subject reports) were recorded for 25 young Chinese adults (16 men, 9 women) during and after the simultaneous application of a strong pain stimulus and either foot classical (alloneural points Tsusanli and Yanglingchuan) or hand classical (alloneural points Hegu and Neiguan) acupuncture. Both forms of acupuncture were equally effective, showing that stimulation of the same nerve is not essential for pain relief. Acupuncture assuaged the emotional, but not the sensory, response to the painful stimulation.

Cognitive orientation as predictor of pain relief following acupuncture

The study investigated the role of beliefs concerning pain relief after treatment. Following the cognitive orientation theory, we hypothesized that beliefs concerning goals, norms, oneself, and general beliefs would predict the extent of improvement following acupuncture. Subjects were 30 Israeli chronic-pain patients (22 women, 8 men; mean age 41.6 years). They were administered a questionnaire assessing the 4 belief types, and control measures assessing personality traits, demographic variables, and pain characteristics. All underwent 4-6 acupuncture sessions. Improvement was determined by patient and physician ratings, and an index based on medication, subjective evaluations, and duration of resting. There were two follow-ups. Three improvement groups were defined: none (n = 8), slight (n = 12), and high (n = 10). These groups did not differ on any of the variables tested except the 4 belief types. A discriminant analysis with belief types as predictors enabled correct classification of the patients in 83% of the cases. A stepwise regression analysis showed that beliefs accounted for 85% of the variance. Discussion focuses on the nature of pain relief and the role of beliefs in disease.

Credibility of placebo transcutaneous nerve stimulation and acupuncture

In a study comparing the credibility of acupuncture and sham transcutaneous nerve stimulation (TNS) within a group of chronic pain patients, equal suggestion of the sham TNS was achieved by incorporating a visual display and strong verbal suggestion into the placebo treatment. The analgesic effect of placebo is a confounding factor in controlled trials of physical methods of pain relief, and the use of sham therapy distinguishable from active therapy requires that the placebo be validated as a true control for the non-specific components that constitute the placebo aspect of the active treatment. This study uses a questionnaire designed to assess patient expectancy of effectiveness and concludes that sham TNS with strong visual and verbal suggestion may be a valid placebo for controlled studies of the analgesic effect of acupuncture.

Psychological aspects of components of pain

The present study investigated the inhibitory effects of acupuncture on the separate sensory and emotional components of pain and their relation to each other. Electro-acupuncture as practiced in China was applied to the same nerve used for initiating pain, and the responses of 9 adult volunteers (5 males, 4 females) were assessed. The results indicate that (a) pain involves at least two related but different components (the sensory component and the emotional component) and (b) electro-acupuncture has a stronger inhibitory effect on the emotional component of pain. The findings provide a new outlook for the improvement of the clinical effects of acupuncture and for further study of the pain mechanism.

A psychophysical analysis of acupuncture analgesia

A psychophysical analysis of acupuncture analgesia was carried out in which low back pain patients made visual analogue scale (VAS) responses both to their chronic pain and to different levels of experimental heat pain (5 sec exposures to 43-51 degrees C) before and after electroacupuncture. VAS (sensory) responses to chronic pain, direct temperature matches to chronic pain, and VAS (sensory) responses to experimental pain were reduced in an internally consistent manner 1-2 h after treatment. The magnitude of this analgesic response was similar for dermatomes within the region of chronic pain and acupuncture needle placement (lower back) as well as for dermatomes remote from needle placement and chronic pain (forearm). Individual patients manifested either (1) a central-inhibitory pattern of analgesia wherein experimental and chronic pain in back regions and experimental pain in forearm regions were reduced, or (2) an origin-specific pattern wherein only the chronic low back pain was reduced. Patients tested several days after treatment all manifested the latter pattern of analgesia. VAS sensory and VAS affective analgesic responses to electroacupuncture treatment showed a delayed onset (1-24 h) to maximum effect and a duration of 10-14 days. Cumulative sensory and affective analgesic effects were observed at the end of 4 months of biweekly acupuncture treatments. The results of this analysis reveal the unique spatial and temporal properties of electroacupuncture analgesia and the extent to which it is mediated by at least two different mechanisms.

In search of a status for acupuncture

Acupuncture treatment is currently generating increased interest in various parts of the world. The effectiveness of this quasi-medical procedure, which has survived for almost 5 000 years, is considered on the strength of statistical data obtained at an institution where such treatment is applied under acceptable scientific circumstances. Explanations are sought for the encompassing extent of treatment claims and the continued support for this technique which is often subjected to severe criticism in modern contexts. The roles of literacy, tradition and convention, a placebo effect and psychological factors as explanatory agents are discussed. The procedure also has possible psychophysical and physiological foundations which sufficiently warrant further scientific effort to find an explanation for this phenomenon.

Acupuncture relief of chronic pain syndrome correlates with increased plasma met-enkephalin concentrations

In twenty patients with chronic pain syndrome, acupuncture treatment resulted in significant improvement of both pain and psychiatric symptoms and higher plasma concentrations of metenkephalin. Plasma beta-endorphin concentrations were unchanged. The degree of symptom relief was correlated with the increase in plasma met-enkephalin.

[Acupuncture in rheumatology. Case contribution]

Results obtained by acupuncture treatment of patients with rheumatic diseases were analysed. Clinical, serological and psychological parameters were evaluated at the beginning and end of treatment. Results showed variations in pain intensity, articular function, inflammation, anxiety and bodily condition. The results are accompanied by a description of the limits of the research conducted.

[Preliminary study on the physician-patient relation in acupuncture]

A preliminary attempt to analyse and interpret the doctor-patient relationship in acupuncture is presented. The study was based on questionnaires completed by doctors and patients and patients' pictures of the acupuncture session. Early data reveal the importance of the doctor's personality and the doctor-patient relationship as well as the influence of the needle as a particular therapeutic medium with magic, symbolic and menacing connotations. What emerges is that the doctor must be aware of his role and personal dynamics as well as of the symbolic connotations of the needle if the is to obtain optimum therapeutic results.

[Psychotherapeutic aspects of acupuncture]

Several psychological tests were applied in order to get some information about the spontaneous effect of acupuncture in diseases of the locomotor system and cephalea. No significant therapeutic success was achieved in cases not reporting about remarkable feelings during the session. Acupuncture was more effective in lowering pain if the disorders were relatively homogeneous than with a generally high subjective strain. Further findings revealed besides personality aspects the therapist-patient relationship to be a determinate factor for effectivity of acupuncture. This is interpreted as an evidence for psychotherapeutic elements underlying the therapeutic outcome in addition to neurophysiological stimulation.

Analgesia for operative dentistry: a comparison of acupuncture and placebo

Fifty-one volunteer patients participated in a study to evaluate the effectiveness of acupuncture as an analgesic for operative dentistry. For the twenty-six patients randomly assigned to an acupuncture group, needles were inserted through specially designed holders into the Ho-Ku points, located between the first and second metacarpals. An acupuncture pulse generator provided electrical current. For the twenty-five patients in a placebo group, the identical needle and holder arrangement was used. When inserted, however, the needles became embedded in plastic on the undersurface of the holders and did not touch the skin of the patient or receive any electrical stimulation. The patients and dentists were blind to this procedural variation. Analysis of ratings and responses indicated no differences in findings for the acupuncture and placebo procedures, with both having 100% success and high levels of patient acceptance. Since there was no electric current or penetration of the skin in the placebo group, the findings suggest that the successful use of acupuncture for restorative dentistry may be due to psychological and/or placebo effects in combination with a possible diminished need for analgesia because of the modern use of the high-speed drill.

Reception of acupuncture by the scientific community: from scorn to a degree of interest

This article presents a comprehensive review of the clinical phenomenon of acupuncture. The historical development of this technique, in China, in other parts of Asia, and in the West is discussed. Contemporary advances in acupuncture applications, such as in anesthesia and in the treatment of drug addiction are reviewed. Up-to-date material regarding current physiological theories of acupuncture's mechanism is included. Acupuncture is seen as presenting of challenge to the scientific community which is moving from a posture of scorn to justifiable interest.