1
|
Hanabusa Y, Kubo T, Watadani T, Nagano M, Nakajima J, Abe O. Successful transcatheter arterial embolization for a massive hemothorax caused by acupuncture. Radiol Case Rep 2022; 17:3107-3110. [PMID: 35784785 PMCID: PMC9240951 DOI: 10.1016/j.radcr.2022.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
Acupuncture is an alternative treatment for a variety of diseases, and serious complications are rare. We report a case of transcatheter arterial embolization performed in a patient with a massive hemothorax after acupuncture treatment. A 36-year-old woman with no previous medical history was admitted to our hospital with left back pain and respiratory distress after acupuncture treatment. Contrast-enhanced computed tomography showed a left hemothorax and leakage of contrast medium, which was considered to result from an injury to the second intercostal artery, caused by acupuncture treatment. Transcatheter arterial embolization successfully stopped the bleeding, and the hematoma was thoracoscopically removed. No rebleeding was observed 6 months after treatment.
Collapse
|
2
|
Huang JF, Zheng XQ, Chen D, Lin JL, Zhou WX, Wang H, Qin Z, Wu AM. Can Acupuncture Improve Chronic Spinal Pain? A Systematic Review and Meta-Analysis. Global Spine J 2021; 11:1248-1265. [PMID: 33034233 PMCID: PMC8453671 DOI: 10.1177/2192568220962440] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To investigate the effect and safety of acupuncture for the treatment of chronic spinal pain. METHODS MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, the WHO Clinical Trial Registry, and the US National Library of Medicine clinical trial registry were searched from January 1, 2000, to November 1, 2019. Randomized controlled trials (RCTs) involving patients with chronic spinal pain treated by acupuncture versus sham acupuncture, no treatment, or another treatment were included. RESULTS Data was extracted from 22 RCTs including 2588 patients. Pooled analysis revealed that acupuncture can reduce chronic spinal pain compared to sham acupuncture (weighted mean difference [WMD] -12.05, 95% confidence interval [CI] -15.86 to -8.24), mediation control (WMD -18.27, 95% CI -28.18 to -8.37), usual care control (WMD -9.57, 95% CI -13.48 to -9.44), and no treatment control (WMD -17.10, 95% CI -24.83 to -9.37). In terms of functional disability, acupuncture can improve physical function at immediate-term follow-up (standardized mean difference [SMD] -1.74, 95% CI -2.04 to -1.44), short-term follow-up (SMD -0.89, 95% CI -1.15 to -0.62), and long-term follow-up (SMD -1.25, 95% CI -1.48 to -1.03). CONCLUSION In summary, compared to no treatment, sham acupuncture, or conventional therapy such as medication, massage, and physical exercise, acupuncture has a significantly superior effect on the reduction in chronic spinal pain and function improvement. Acupuncture might be an effective treatment for patients with chronic spinal pain and it is a safe therapy.
Collapse
Affiliation(s)
- Jin-Feng Huang
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuan-Qi Zheng
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dong Chen
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia-Liang Lin
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wen-Xian Zhou
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hui Wang
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zongshi Qin
- The University of Hong Kong, Hong Kong, China
| | - Ai-Min Wu
- Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,Ai-Min Wu, Department of Spine Surgery, Zhejiang Spine Surgery Centre, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
| |
Collapse
|
3
|
Abstract
BACKGROUND Chronic nonspecific low back pain (LBP) is very common; it is defined as pain without a recognizable etiology that lasts for more than three months. Some clinical practice guidelines suggest that acupuncture can offer an effective alternative therapy. This review is a split from an earlier Cochrane review and it focuses on chronic LBP. OBJECTIVES To assess the effects of acupuncture compared to sham intervention, no treatment, or usual care for chronic nonspecific LBP. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, two Chinese databases, and two trial registers to 29 August 2019 without restrictions on language or publication status. We also screened reference lists and LBP guidelines to identify potentially relevant studies. SELECTION CRITERIA We included only randomized controlled trials (RCTs) of acupuncture for chronic nonspecific LBP in adults. We excluded RCTs that investigated LBP with a specific etiology. We included trials comparing acupuncture with sham intervention, no treatment, and usual care. The primary outcomes were pain, back-specific functional status, and quality of life; the secondary outcomes were pain-related disability, global assessment, or adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies, assessed the risk of bias and extracted the data. We meta-analyzed data that were clinically homogeneous using a random-effects model in Review Manager 5.3. Otherwise, we reported the data qualitatively. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 33 studies (37 articles) with 8270 participants. The majority of studies were carried out in Europe, Asia, North and South America. Seven studies (5572 participants) conducted in Germany accounted for 67% of the participants. Sixteen trials compared acupuncture with sham intervention, usual care, or no treatment. Most studies had high risk of performance bias due to lack of blinding of the acupuncturist. A few studies were found to have high risk of detection, attrition, reporting or selection bias. We found low-certainty evidence (seven trials, 1403 participants) that acupuncture may relieve pain in the immediate term (up to seven days) compared to sham intervention (mean difference (MD) -9.22, 95% confidence interval (CI) -13.82 to -4.61, visual analogue scale (VAS) 0-100). The difference did not meet the clinically important threshold of 15 points or 30% relative change. Very low-certainty evidence from five trials (1481 participants) showed that acupuncture was not more effective than sham in improving back-specific function in the immediate term (standardized mean difference (SMD) -0.16, 95% CI -0.38 to 0.06; corresponding to the Hannover Function Ability Questionnaire (HFAQ, 0 to 100, higher values better) change (MD 3.33 points; 95% CI -1.25 to 7.90)). Three trials (1068 participants) yielded low-certainty evidence that acupuncture seemed not to be more effective clinically in the short term for quality of life (SMD 0.24, 95% CI 0.03 to 0.45; corresponding to the physical 12-item Short Form Health Survey (SF-12, 0-100, higher values better) change (MD 2.33 points; 95% CI 0.29 to 4.37)). The reasons for downgrading the certainty of the evidence to either low to very low were risk of bias, inconsistency, and imprecision. We found moderate-certainty evidence that acupuncture produced greater and clinically important pain relief (MD -20.32, 95% CI -24.50 to -16.14; four trials, 366 participants; (VAS, 0 to 100), and improved back function (SMD -0.53, 95% CI -0.73 to -0.34; five trials, 2960 participants; corresponding to the HFAQ change (MD 11.50 points; 95% CI 7.38 to 15.84)) in the immediate term compared to no treatment. The evidence was downgraded to moderate certainty due to risk of bias. No studies reported on quality of life in the short term or adverse events. Low-certainty evidence (five trials, 1054 participants) suggested that acupuncture may reduce pain (MD -10.26, 95% CI -17.11 to -3.40; not clinically important on 0 to 100 VAS), and improve back-specific function immediately after treatment (SMD: -0.47; 95% CI: -0.77 to -0.17; five trials, 1381 participants; corresponding to the HFAQ change (MD 9.78 points, 95% CI 3.54 to 16.02)) compared to usual care. Moderate-certainty evidence from one trial (731 participants) found that acupuncture was more effective in improving physical quality of life (MD 4.20, 95% CI 2.82 to 5.58) but not mental quality of life in the short term (MD 1.90, 95% CI 0.25 to 3.55). The certainty of evidence was downgraded to moderate to low because of risk of bias, inconsistency, and imprecision. Low-certainty evidence suggested a similar incidence of adverse events immediately after treatment in the acupuncture and sham intervention groups (four trials, 465 participants) (RR 0.68 95% CI 0.46 to 1.01), and the acupuncture and usual care groups (one trial, 74 participants) (RR 3.34, 95% CI 0.36 to 30.68). The certainty of the evidence was downgraded due to risk of bias and imprecision. No trial reported adverse events for acupuncture when compared to no treatment. The most commonly reported adverse events in the acupuncture groups were insertion point pain, bruising, hematoma, bleeding, worsening of LBP, and pain other than LBP (pain in leg and shoulder). AUTHORS' CONCLUSIONS We found that acupuncture may not play a more clinically meaningful role than sham in relieving pain immediately after treatment or in improving quality of life in the short term, and acupuncture possibly did not improve back function compared to sham in the immediate term. However, acupuncture was more effective than no treatment in improving pain and function in the immediate term. Trials with usual care as the control showed acupuncture may not reduce pain clinically, but the therapy may improve function immediately after sessions as well as physical but not mental quality of life in the short term. The evidence was downgraded to moderate to very low-certainty considering most of studies had high risk of bias, inconsistency, and small sample size introducing imprecision. The decision to use acupuncture to treat chronic low back pain might depend on the availability, cost and patient's preferences.
Collapse
Affiliation(s)
- Jinglan Mu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Andrea D Furlan
- Institute for Work & Health, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Wai Yee Lam
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Marcos Y Hsu
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhipeng Ning
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Lixing Lao
- School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
- Virginia University of Integrative Medicine, Fairfax, Virginia, USA
| |
Collapse
|
4
|
Huang F, Qiu M, Zhao S, Dai L, Xu Y, Yang Y, Lu L, Guo R, Tian Q, Fan Z, Wu S. Evaluating the Characteristics, Reporting and Methodological Quality of Systematic Reviews of Acupuncture for Low Back Pain by Using the Veritas Plot. J Pain Res 2020; 13:2633-2652. [PMID: 33116806 PMCID: PMC7585549 DOI: 10.2147/jpr.s254234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate systematic reviews (SRs) of acupuncture for low back pain (LBP) in terms of characteristics, reporting and methodological quality using a Veritas plot and to explore factors that may be associated with methodological quality and reporting quality. Study Design and Setting We searched 8 electronic bibliographic databases to find all SRs, and we evaluated the SRs' quality in 6 dimensions, including publication year, design type, homogeneity, risk of publication bias, methodological quality by Assessment of Multiple Systematic Reviews (AMSTAR) 2 and reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Excel 2010 and Adobe Illustrator CC were used to draw and optimize Veritas plots. Exploratory analysis was done using SPSS software version 23.0 to explore factors related to AMSTAR-2 and PRISMA scores. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence quality evaluation tool was used to grade all the outcome indicators in the included literature. Results We included 19 SRs in the analysis. Literature quality rank scores ranged from 9.67 to 17.00, with an average score of 13.18 ± 2.35. The average score of AMSTAR-2 was 7.47, and the average score of PRISMA was 18.47. Overall, the main issues were research strategies, inclusion and exclusion criteria, publication bias, and registration in PROSPERO. The results of exploratory analysis showed that duplication of literature selected and appropriate tools to assess the risk of bias were related to the AMSTAR-2 score, and the summary of evidence was related to the PRISMA score. The GRADE quality evaluation results showed mainly low quality. Conclusion The quality of SRs on acupuncture for low back pain should be improved, mainly by strengthening the methodological quality and reporting quality. The Veritas plot is an effective graphical evaluation method that is worth popularizing.
Collapse
Affiliation(s)
- Fan Huang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Mingwang Qiu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Siyi Zhao
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Lin Dai
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Yanpeng Xu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Yunying Yang
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Liming Lu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China
| | - Rusong Guo
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China.,Guangdong Province Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Qiang Tian
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China.,Guangdong Province Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Zhiyong Fan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China.,Guangdong Province Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Shan Wu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, People's Republic of China.,Guangdong Province Hospital of Chinese Medicine, Guangzhou, Guangdong, 510120, People's Republic of China
| |
Collapse
|
5
|
The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 1: Kinesio Tape, Sports Massage Therapy, and Acupuncture. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900104. [PMID: 32672727 PMCID: PMC7028772 DOI: 10.5435/jaaosglobal-d-19-00104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
There are a number of nonsurgical modalities used by athletes in attempts to improve performance or prevent, treat, and rehabilitate musculoskeletal injuries. A concise review of available evidence on common nonsurgical modalities used today is necessary so that practitioners may appropriately counsel patients.
Collapse
|
6
|
Showalter K, Hoffmann A, DeCredico N, Thakrar A, Arroyo E, Goldberg I, Hinchcliff M. Complementary therapies for patients with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:187-199. [PMID: 35382503 PMCID: PMC8922560 DOI: 10.1177/2397198319833503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/27/2019] [Indexed: 11/16/2022]
Abstract
Patients with systemic sclerosis often seek information regarding complementary and nutrition-based therapy. Some study results have shown that vitamins D and E, probiotics, turmeric, l-arginine, essential fatty acids, broccoli, biofeedback, and acupuncture may be beneficial in systemic sclerosis care. However, large randomized clinical trials have not been conducted. This review summarizes current data regarding various complementary therapies in systemic sclerosis and concludes with recommendations.
Collapse
Affiliation(s)
- Kimberly Showalter
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Aileen Hoffmann
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicole DeCredico
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anjali Thakrar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Esperanza Arroyo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isaac Goldberg
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Monique Hinchcliff
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medicine, Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
7
|
Kebede A, Abebe SM, Woldie H, Yenit MK. Low Back Pain and Associated Factors among Primary School Teachers in Mekele City, North Ethiopia: A Cross-Sectional Study. Occup Ther Int 2019; 2019:3862946. [PMID: 31360145 PMCID: PMC6644225 DOI: 10.1155/2019/3862946] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/06/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is the most prevalent musculoskeletal disorder among teachers. The pain, which is widely considered to be caused by occupational activities, has a significant impact on teachers' quality of life because it results in frequent sick leaves, functional impairment, and early retirement. It is also demanding in terms of treatment costs, individual suffering, and discontinuation of jobs. Therefore, this study assessed the magnitude of low back pain and associated factors among primary school teachers in Mekele City, north Ethiopia. METHODS An institution-based cross-sectional study which included 611 public primary school teachers of Mekele City was conducted from March to April 2015. A multivariable logistic regression analysis was used to identify factors associated with low back pain. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to show the strength of the associations, and variables with a p value of less than 0.05 were considered statistically significant. RESULTS In this study, the prevalence of low back pain was 74.8% (95% CI: 71.4-78.2). According to the multivariate analysis, the pain was associated with teachers' sleeping disturbance (AOR = 6.99; 95% CI: 2.20, 13.63), prolonged standing (AOR = 4.78; 95% CI: 3.75, 9.32), and irregular physical exercise (AOR = 1.46; 95% CI: 1.29, 5.10). CONCLUSION The study showed that the prevalence of low back pain was high. Sleeping disturbance, prolonged standing during sessions, and irregular physical activity were significantly associated with the problem. Therefore, addressing work-related and individual factors is essential for decreasing the burden.
Collapse
Affiliation(s)
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Haile Woldie
- Department of Human Nutrition, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
8
|
Integrative treatment package for degenerative disc disease in the lumbar spine: A retrospective case series. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Foster NE, Bishop A, Bartlam B, Ogollah R, Barlas P, Holden M, Ismail K, Jowett S, Kettle C, Kigozi J, Lewis M, Lloyd A, Waterfield J, Young J. Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial. Health Technol Assess 2018; 20:1-236. [PMID: 27133814 DOI: 10.3310/hta20330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many pregnant women experience low back pain. Acupuncture appears to be a safe, promising intervention but evidence is needed about its clinical effectiveness and cost-effectiveness. OBJECTIVES To assess the feasibility of a future large randomised controlled trial (RCT) testing the additional benefit of adding acupuncture to standard care (SC) for pregnancy-related back pain. DESIGN Phase 1: a questionnaire survey described current care for pregnancy-related back pain. Focus groups and interviews with midwives, physiotherapists and pregnant women explored acceptability and feasibility of acupuncture and the proposed RCT. Phase 2: a single-centre pilot RCT. Participants were identified using six methods and randomised to SC, SC plus true acupuncture or SC plus non-penetrating acupuncture. PARTICIPANTS Phase 1: 1093 physiotherapists were surveyed and 15 midwives, 21 physiotherapists and 17 pregnant women participated in five focus groups and 20 individual interviews. Phase 2: 125 women with pregnancy-related back pain participated. INTERVENTIONS SC: a self-management booklet and onward referral for one-to-one physiotherapy (two to four sessions) for those who needed it. SC plus true acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising true (penetrating) acupuncture, advice and exercise. SC plus non-penetrating acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising non-penetrating acupuncture, advice and exercise. MAIN OUTCOME MEASURES Pilot RCT outcomes included recruitment rates, treatment fidelity, follow-up rate, patient-reported pain and function, quality of life and health-care resource use. Birth and neonatal outcomes were also assessed. Staff overseeing outcome data collection were blind to treatment allocation. RESULTS Phase 1: 629 (57.5%) physiotherapists responded to the survey, 499 were experienced in treating pregnancy-related back pain and reported 16 advice and 18 treatment options. Typical treatment comprised two to four individual sessions of advice and exercise over 6 weeks. Acupuncture was reported by 24%. Interviews highlighted the impact of back pain and paucity of effective interventions. Women and midwives strongly supported a RCT and expressed few concerns. Physiotherapists' concerns about acupuncture in pregnancy informed a training programme prior to the pilot RCT. Phase 2: We recruited 125 of 280 potentially eligible women (45%) in 6 months and randomised 41 to SC and 42 each to the SC plus true acupuncture and SC plus non-penetrating acupuncture arms. Analysis was conducted with 124 participants (41, 42 and 41, respectively) as one participant was randomised in error. Three of six recruitment methods were the most successful. In total, 10% of women (n = 4) randomised to SC alone accessed one-to-one physiotherapy and received an average of two treatments. The average number of treatments was six for both SC plus true acupuncture and SC plus non-penetrating acupuncture. Treatments were in line with protocols. Eight-week follow-up was 74%. Patient-reported outcomes (pain, function and quality of life) favoured the addition of acupuncture. There was no evidence of serious adverse events on mothers or birth and neonatal outcomes. The Pelvic Girdle Questionnaire was found to be an appropriate outcome measure for a future trial. CONCLUSIONS A future main RCT is feasible and would be welcomed by women and clinicians. Longer-term follow-up and further follow-up efforts are recommended for a main trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN49955124. FUNDING This project was funded by the National Institute of Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 33. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Nadine E Foster
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Annette Bishop
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Bernadette Bartlam
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Reuben Ogollah
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Panos Barlas
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Melanie Holden
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Khaled Ismail
- Reproduction, Genes and Development Department, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, West Midlands, UK
| | - Sue Jowett
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Christine Kettle
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Jesse Kigozi
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Martyn Lewis
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Alison Lloyd
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Jackie Waterfield
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Julie Young
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| |
Collapse
|
10
|
Lemmon R, Roseen EJ. Chronic Low Back Pain. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
A cross sectional study on complementary and alternative medicine use among a sample of Turkish hospital outpatients with chronic lower back pain. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
12
|
Li X, Han Y, Cui J, Yuan P, Di Z, Li L. Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation. J Evid Based Complementary Altern Med 2016; 21:311-9. [PMID: 26378088 DOI: 10.1177/2156587215605419] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022] Open
Abstract
Background. Clinical studies on the efficacy of warm needle moxibustion to treat lumbar disc herniation are increasing, while studies on the assessment of its efficacy are still lacking. Objective. To assess the clinical effect of warm needle moxibustion on lumbar disc herniation. Methods. We searched relevant trials that compared warm needle moxibustion with other methods for lumbar disc herniation from 9 databases. Results. Warm needle moxibustion showed statistical significance efficiency rate compared with acupuncture and manipulation but had a similar rate with nonsteroidal anti-inflammatory drugs (NSAIDs). It showed a statistically significanty excellent rate when compared with acupuncture and manipulation but had a similar rate with NSAIDs. Regarding Japanese Orthopedic Association scores, it showed statistical significance with acupuncture and manipulation, but the rate was similar with Chinese medicine and NSAIDs. Regarding visual analog scale score, it demonstrated statistical significance when compared with acupuncture, manipulation, and NSAIDs but had a similar rate with Chinese medicine. Conclusion. Warm needle moxibustion is superior to acupuncture and manipulation in terms of efficiency rate, excellent rate, and controlling of pain for lumbar disc herniation, but it is similar when compared with NSAIDs and Chinese medicine.
Collapse
Affiliation(s)
- Xinhua Li
- East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingchao Han
- East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Cui
- East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Yuan
- Tongji Hospital of Shanghai, Shanghai, China
| | - Zhi Di
- Tongji Hospital of Tongji University Branch, Shanghai, China
| | - Lijun Li
- East Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. J Orthop Sports Phys Ther 2016; 46:409-29. [PMID: 27117725 DOI: 10.2519/jospt.2016.6270] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Little is known about the effectiveness of acupuncture therapies for musculoskeletal disorders. Objective To assess the effectiveness and safety of acupuncture therapies for musculoskeletal disorders of the extremities. Methods We searched MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015 for randomized controlled trials, cohort studies, and case-control studies. Eligible studies were appraised with Scottish Intercollegiate Guidelines Network criteria. A best-evidence synthesis was performed to synthesize results from included studies with a low risk of bias. A sensitivity analysis was conducted to determine the impact of excluding studies with a high risk of bias. Results The search revealed 5180 articles; 15 were included (10 with a low risk of bias, 5 with a high risk of bias). The studies with a low risk of bias suggested that (1) traditional needle acupuncture was superior to oral steroids (1 RCT, n = 77) and may be superior to vitamin B1/B6 supplements (1 RCT, n = 64) for carpal tunnel syndrome (CTS), and was superior to exercise for Achilles tendinopathy (1 RCT, n = 64). Traditional needle acupuncture did not provide important benefit over placebo for upper extremity pain (1 RCT, n = 128), or no intervention for patellofemoral pain (1 RCT, n = 75), and was inconclusive for shoulder pain (2 RCTs, n = 849), suggesting no important benefit; (2) electroacupuncture may be superior to placebo for shoulder injuries (1 RCT, n = 130) and may not be superior to night splinting for persistent CTS (1 RCT, n = 78); and (3) dry needling may be superior to placebo for plantar fasciitis (1 RCT, n = 84). Sensitivity analysis suggests that including studies with a high risk of bias might have impacted the evidence synthesis in support of managing shoulder pain with traditional needle acupuncture, and that would suggest traditional needle acupuncture may be effective for lateral epicondylitis and piriformis syndrome. Conclusion Evidence for the effectiveness of acupuncture for musculoskeletal disorders of the extremities was inconsistent. Traditional needle acupuncture may be beneficial for CTS and Achilles tendinopathy, but not for nonspecific upper extremity pain and patellofemoral syndrome. Electroacupuncture may be effective for shoulder injuries and may show similar effectiveness to that of night wrist splinting for CTS. The effectiveness of dry needling for plantar fasciitis is equivocal. Level of Evidence Therapy, 1a-. J Orthop Sports Phys Ther 2016;46(6):409-429. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6270.
Collapse
|
14
|
The Anti-Inflammatory Actions of Auricular Point Acupressure for Chronic Low Back Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:103570. [PMID: 26170869 PMCID: PMC4480805 DOI: 10.1155/2015/103570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 12/12/2022]
Abstract
Background. Auricular point acupressure (APA) is a promising treatment for pain management. Few studies have investigated the physiological mechanisms of APA analgesics. Method. In this pilot randomized clinical trial (RCT), a 4-week APA treatment was used to manage chronic low back pain (CLBP). Sixty-one participants were randomized into a real APA group (n = 32) or a sham APA group (n = 29). Blood samples, pain intensity, and physical function were collected at baseline and after 4 weeks of treatment. Results. Subjects in the real APA group reported a 56% reduction of pain intensity and a 26% improvement in physical function. Serum blood samples showed (1) a decrease in IL-1β, IL-2, IL-6, and calcitonin gene-related peptide [CGRP] and (2) an increase in IL-4. In contrast, subjects in the sham APA group (1) reported a 9% reduction in pain and a 2% improvement in physical function and (2) exhibited minimal changes of inflammatory cytokines and neuropeptides. Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified. Conclusion. These findings suggest that APA treatment affects pain intensity through modulation of the immune system, as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels.
Collapse
|
15
|
Zeng Y, Chung JWY. Acupuncture for chronic nonspecific low back pain: An overview of systematic reviews. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2014.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: an overview of systematic reviews. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:328196. [PMID: 25821485 PMCID: PMC4364128 DOI: 10.1155/2015/328196] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 01/07/2023]
Abstract
Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.
Collapse
Affiliation(s)
- Lizhou Liu
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, P.O. Box 56, 325 Great King Street, Dunedin 9054, New Zealand
| | - Margot Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, P.O. Box 56, 325 Great King Street, Dunedin 9054, New Zealand
| | - Suzanne McDonough
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Shore Road, Newtownabbey, County Antrim BT37 0QB, UK
| | - Leon Mabire
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, P.O. Box 56, 325 Great King Street, Dunedin 9054, New Zealand
| | - George David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, P.O. Box 56, 325 Great King Street, Dunedin 9054, New Zealand
| |
Collapse
|
17
|
Berman B, Lewith G, Manheimer E, Bishop FL, D'Adamo C. Complementary and alternative medicine. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
18
|
Shin JS, Lee J, Kim MR, Shin BC, Lee MS, Ha IH. The long-term course of patients undergoing alternative and integrative therapy for lumbar disc herniation: 3-year results of a prospective observational study. BMJ Open 2014. [PMCID: PMC4158220 DOI: 10.1136/bmjopen-2014-005801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives This study aimed to assess the efficacy and safety of an integrative complementary and alternative medicine (CAM) approach in the management of lumbar herniated disc (LHD) with sciatic pain and investigate pain relapse, use of medical care and surgery rates in patients who actively chose non-surgical CAM treatment for LHD. Study design/Setting This prospective observational study was undertaken at a Korean medicine hospital outpatient setting in Korea. Participants A total of 128 consecutive patients with LHD with a numeric rating scale for leg pain of ≥5 completed 6 months of CAM treatment after recruitment from November 2006, and 73/128 participants (57%) attended follow-up 3 years later. Interventions 6 months of CAM treatment (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation). Primary outcome measures Visual analogue scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI), and Short Form (SF)-36 Health Survey. Secondary outcome measures Neurological impairment (muscular weakness, sensory loss, Straight Leg Raise test), MRIs, recurrence of low back pain and/or radiating pain, and use of medical care. Results 92 patients could be assessed for surgical state, of whom 4 replied that they had received surgery. 73 patients attended the 3-year follow-up. The baseline VAS of back pain (4.37±2.70) decreased after treatment (0.90±1.01; p<0.001) and was maintained at 3 years (1.12±1.64; p=0.19). The baseline VAS of leg pain (7.57±1.40) also decreased on treatment (0.82±1.18; p<0.001) and was sustained at 3 years (0.99±1.58; p=0.34). ODI scores declined from 40.74±16.15 to 9.84±9.67 (p<0.001), then decreased further to 6.30±7.19 (p<0.01). SF-36 scores increased from 34.96±13.30 to 69.20±14.96 (p<0.001), reaching 76.19±14.45 (p<0.001) at 3 years. 37 patients reported recurrence of pain and most chose CAM treatment for management of relapse symptoms. Conclusions Although the absence of a control group prevents validation of effectiveness, many patients showed favourable long-term outcomes. Trial registration number ClinicalTrials.gov Identifier: NCT01989403.
Collapse
Affiliation(s)
- Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republicof Korea
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republicof Korea
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republicof Korea
| | - Byung-Cheul Shin
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republicof Korea
| | - Myeong Soo Lee
- Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republicof Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republicof Korea
| |
Collapse
|
19
|
Lee TC, Cheng TL, Chen WJ, Lo LC. On the hazard caused by the heat of acupuncture needles in warm needling (wēn zhēn). J Tradit Complement Med 2014; 3:119-25. [PMID: 24716166 PMCID: PMC3897215 DOI: 10.4103/2225-4110.110410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Due to its simplicity and convenience, acupuncture has become popular as a complementary therapy. In this Chinese medicine, doctors have to find the traditional meridian acupuncture points before puncturing the needles into them. Moxibustion (艾灸 Ài Jiǔ) is also an important part of the acupuncture remedy. Treatment by acupuncture can be classified roughly into two types – direct moxibustion and indirect moxibustion. Warm-needling acupuncture (溫針灸 Wēn Zhēn Jiǔ) is classified under the method of indirect moxibustion. In the present study, 10 standard stainless steel acupuncture needles with 10 pieces of cylinder-shaped moxa cone (艾柱 Ài Zhù) as the heat source of warm needles were used. In order to prevent the practitioners from getting burns, it is necessary to study the temperature changes in some designated parts of the needles. Two sizes, 0.6 g and 1.0 g, of moxa cones were used for comparison of the measured temperatures. The needles are typically divided into two parts – the handle part and the needle body. In our experiment, the temperatures of WNA at different parts of the needles were measured. The larger the size of moxa cone is, the longer is the burning time. Based on the observations we suggest that when 0.6 g moxa is used, the physicians should better pick out the needles around 9 min after ignition; however, while using the 1 g moxa, it might be safer to pick out the needles around 13 min after ignition.
Collapse
Affiliation(s)
- Tsung-Chieh Lee
- Department of Chinese Medicine, Changhua Christian Hospital, Taiwan
| | - Tsung-Lin Cheng
- Department and Graduate Institute of Mathematics, National Changhua University of Education, Taiwan
| | - Wen-Jiuan Chen
- Department of Chinese Medicine, Changhua Christian Hospital, Taiwan
| | - Lun-Chien Lo
- Department of Chinese Medicine, Changhua Christian Hospital, Taiwan. ; Department and Graduate Institute of Mathematics, National Changhua University of Education, Taiwan
| |
Collapse
|
20
|
Cho HW, Hwang EH, Lim B, Heo KH, Liu JP, Tsutani K, Lee MS, Shin BC. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews. PLoS One 2014; 9:e88027. [PMID: 24505363 PMCID: PMC3914865 DOI: 10.1371/journal.pone.0088027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/02/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. METHODS We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. RESULTS Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. CONCLUSIONS The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.
Collapse
Affiliation(s)
- Hyun-Woo Cho
- Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
| | - Eui-Hyoung Hwang
- Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Byungmook Lim
- Division of Humanities and Social Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Kwang-Ho Heo
- Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Kiichiro Tsutani
- Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Myeong Soo Lee
- Brain Disease Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Byung-Cheul Shin
- Department of Rehabilitation Medicine of Korean Medicine, Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| |
Collapse
|
21
|
|
22
|
A randomized clinical trial of auricular point acupressure for chronic low back pain: a feasibility study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:196978. [PMID: 23554825 PMCID: PMC3603381 DOI: 10.1155/2013/196978] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/20/2022]
Abstract
Objectives. This prospective, randomized clinical trial (RCT) was designed to investigate the feasibility and effects of a 4-week auricular point acupressure (APA) for chronic low back pain (CLBP). Methods. Participants were randomized to either true APA (true acupoints with taped seeds on the designated ear points for CLBP) or sham APA (sham acupoints with taped seeds but on different locations than those designated for CLBP). The duration of treatment was four weeks. Participants were assessed before treatment, weekly during treatment, and 1 month following treatment. Results. Participants in the true APA group who completed the 4-week APA treatment had a 70% reduction in worst pain intensity, a 75% reduction in overall pain intensity, and a 42% improvement in disability due to back pain from baseline assessment. The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group (P < 0.01) at the completion of a 4-week APA and 1 month followup. Discussion. The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP.
Collapse
|
23
|
Kordi R, Rostami M, Noormohammadpour P. Letter to the editor: other interventions in approach to lumbar disorders. Sports Health 2012; 4:14-5. [PMID: 23016062 PMCID: PMC3435899 DOI: 10.1177/1941738111431062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
24
|
Auricular point acupressure for chronic low back pain: a feasibility study for 1-week treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:383257. [PMID: 22811745 PMCID: PMC3395299 DOI: 10.1155/2012/383257] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 12/19/2022]
Abstract
Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA) to reduce chronic low back pain (CLBP) and estimate minimum clinically important differences (MCIDs) for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI) was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5-24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients' expectation of the APA treatment.
Collapse
|
25
|
Chronic Low Back Pain. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Lee FH, Raja SN. Complementary and alternative medicine in chronic pain. Pain 2011; 152:28-30. [DOI: 10.1016/j.pain.2010.09.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/11/2010] [Accepted: 09/15/2010] [Indexed: 12/20/2022]
|
27
|
Affiliation(s)
- Brian M Berman
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD 21207, USA.
| | | | | | | |
Collapse
|
28
|
Park JJ, Shin J, Choi Y, Youn Y, Lee S, Kwon SR, Lee H, Kang MH, Ha IH, Shin I. Integrative package for low back pain with leg pain in Korea: a prospective cohort study. Complement Ther Med 2010; 18:78-86. [PMID: 20430290 DOI: 10.1016/j.ctim.2010.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 02/23/2010] [Accepted: 02/28/2010] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED Back pain significantly affects both patients and society through personal suffering, supporting burden, work loss, and incurred expenses. With no unequivocal support for surgery versus conservative treatment, an integrative approach has become popular in Korea. OBJECTIVES To investigate the outcomes of an integrative package for low back pain with leg pain. METHODS A prospective cohort study involving patients with low back and leg pain and confirmed disc herniation was carried out at an outpatient clinic in Korea. The treatment package comprised of herbal medicines, acupuncture, bee venom acupuncture, and a Korean version of spinal manipulation (Chuna). Study participants were evaluated at baseline and every 4 weeks for 24 weeks. Low back and leg pain intensity levels were measured on a visual analog scale (0-10), back function was evaluated with the Oswestry Disability Index (0-100), and the overall quality of life was assessed using the SF-36 Health Survey (0-100 in 8 different subcategories). RESULTS Out of 150 patients, 128 completed the 24 weeks of therapy. Patients reported improvements in all outcome measures. At the completion of the study, low back pain scores improved by a mean of 3.3 (95% CI=2.8 to 3.8), and leg pain scores improved by a mean of 6.3 (95% CI=5.9 to 6.6). Significant improvements in ODI and SF-36 scores were observed at 4 weeks and sustained throughout. CONCLUSIONS This integrative package was effective in the treatment of LBP with leg pain and warrants further rigorous investigations.
Collapse
Affiliation(s)
- Jongbae J Park
- Asian Medicine and Acupuncture Research, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina, Memorial Hospital, Chapel Hill, NC 27599, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Rubinstein SM, van Middelkoop M, Kuijpers T, Ostelo R, Verhagen AP, de Boer MR, Koes BW, van Tulder MW. A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1213-28. [PMID: 20229280 PMCID: PMC2989199 DOI: 10.1007/s00586-010-1356-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/24/2010] [Accepted: 02/21/2010] [Indexed: 12/17/2022]
Abstract
The purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple databases up to December 22, 2008. Randomised controlled trials (RCTs) of adults with chronic non-specific LBP, which evaluated at least one clinically relevant, patient-centred outcome measure were included. Two authors working independently from one another assessed the risk of bias using the criteria recommended by the CBRG and extracted the data. The data were pooled when clinically homogeneous and statistically possible or were otherwise qualitatively described. GRADE was used to determine the quality of the evidence. In total, 35 RCTs (8 SMT, 20 acupuncture, 7 herbal medicine), which examined 8,298 patients, fulfilled the inclusion criteria. Approximately half of these (2 SMT, 8 acupuncture, 7 herbal medicine) were thought to have a low risk of bias. In general, the pooled effects for the studied interventions demonstrated short-term relief or improvement only. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low- to very-low-quality evidence, suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities or any other intervention for treatment of chronic low-back pain. There is evidence, however, that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention. Although there are some good results for individual herbal medicines in short-term individual trials, the lack of homogeneity across studies did not allow for a pooled estimate of the effect. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. These results are also in agreement with recent reviews on acupuncture and herbal medicine. Randomized trials with a low risk of bias and adequate sample sizes are direly needed.
Collapse
Affiliation(s)
- Sidney M Rubinstein
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Hopton A, MacPherson H. Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract 2010; 10:94-102. [PMID: 20070551 DOI: 10.1111/j.1533-2500.2009.00337.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There is controversy as to whether or not acupuncture is more effective than placebo. To help clarify this debate, we synthesized the evidence gathered from systematic reviews on the pooled data of high-quality randomized controlled trials comparing acupuncture to sham acupuncture for chronic pain. METHOD Systematic reviews of acupuncture for the most commonly occurring forms of chronic pain (back, knee, and head) published between 2003 and 2008 were sourced from Ovid databases: Medline, Allied and Complementary Medicine database, Cochrane Library and Web of Science during December 2008. Eight systematic reviews with meta-analyses of pooled data were eligible for inclusion. Data were extracted for short- and longer-term outcomes for the most commonly occurring forms of pain. Two independent reviewers assessed methodological quality. RESULTS For short-term outcomes, acupuncture showed significant superiority over sham for back pain, knee pain, and headache. For longer-term outcomes (6 to12 months), acupuncture was significantly more effective for knee pain and tension-type headache but inconsistent for back pain (one positive and one inconclusive). In general, effect sizes (standardized mean differences) were found to be relatively small. DISCUSSION The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions. If this conclusion is correct, then we ask the question: is it now time to shift research priorities away from asking placebo-related questions and shift toward asking more practical questions about whether the overall benefit is clinically meaningful and cost-effective?
Collapse
Affiliation(s)
- Ann Hopton
- Department of Health Sciences, University of York, York YO10 5DD, U.K.
| | | |
Collapse
|
31
|
Mayer JM, Haldeman S, Tricco AC, Dagenais S. Management of Chronic Low Back Pain in Active Individuals. Curr Sports Med Rep 2010; 9:60-6. [DOI: 10.1249/jsr.0b013e3181caa9b6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
32
|
Rickards LD. Therapeutic needling in osteopathic practice: An evidence-informed perspective. INT J OSTEOPATH MED 2009. [DOI: 10.1016/j.ijosm.2009.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Lai X, Zhang G, Huang Y, Tang C, Yang J, Wang S, Zhou SF. A cerebral functional imaging study by positron emission tomography in healthy volunteers receiving true or sham acupuncture needling. Neurosci Lett 2009; 452:194-9. [PMID: 19383438 DOI: 10.1016/j.neulet.2009.01.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 01/20/2009] [Accepted: 01/21/2009] [Indexed: 11/28/2022]
Abstract
Our recent studies have demonstrated that needling in Baihui, Shuigou and Shenmen enhances glucose metabolism in the frontal lobes, thalamus, temporal lobe, and the lentiform nucleus in vascular dementia. This study examined the effect of true, sham and overt needling in Waiguan (TE5) on cerebral changes by positron emission tomography (PET) technique. Eighteen healthy volunteers were randomized to receive overt control, true or sham needling therapy. To manipulate true needling, a needle was inserted into 15+/-2mm into Waiguan and "deqi" was achieved by proper needle manipulation. For sham needling, needles with a blunt tip were pushed against the skin as the shaft moved into the handle, giving an illusion of insertion. For overt placebo, blunt needles were used and subjects did not receive any needling penetration. The tracer used was (18)fluoride-deoxygluocse. PET images obtained were processed and analyzed by the SPM2 software. Compared with overt needling, brain areas BA7, 13, 18, 19, 21, 22, 27, 38, 40, 42 and 45 in Waiguan true needling group were significantly activated and areas BA4, 6, 7, 19, 22 and 41 in sham needling group showed obvious activation. Compared to sham needling group, marked activation points were found in the areas of BA13 and 42 and left cerebellum in true needling group. Our study revealed a marked difference in brain metabolic changes between true and sham needling in Waiguan. Further studies are needed to explore the cerebral changes in patients with acupuncture and the pathological implications.
Collapse
Affiliation(s)
- Xinsheng Lai
- College of Acupuncture and Massage, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510407, China
| | | | | | | | | | | | | |
Collapse
|
34
|
Tu B, Johnston M, Hui KK. Elderly patient refractory to multiple pain medications successfully treated with integrative East-West medicine. Int J Gen Med 2008; 1:3-6. [PMID: 20428398 PMCID: PMC2840549 DOI: 10.2147/ijgm.s3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Polypharmacy is a common and serious problem in the elderly today. Few solutions have been effective in reducing its incidence. Case summary: An 87-year-old female with a history of osteoarthritis and spinal stenosis presented with a five month history of severe right hip pain. She had been seen by multiple specialists and hospitalized many times. During these encounters, she was prescribed a long list of pain medications. However, these medications did not improve her pain and added to her risk of adverse drug events. After exhausting traditional Western medical therapies, she received a referral to the UCLA Center for East–West Medicine. There, clinicians treated her with a nonpharmacological integrative East-West medicine approach that included acupuncture, dry needling of trigger points, and education on self-acupressure. Her pain began improving and she was able to cut back on analgesic use under physician supervision. Ultimately, she improved to the point where she was able to discontinue all of her pain medications. Symptomatic relief was evidenced by improvement in health-related quality of life (HRQOL). Conclusions: This case study suggests that integrative East–West medicine may have the potential to reduce the incidence of polypharmacy in elderly patients presenting with pain conditions and improve their quality of life.
Collapse
Affiliation(s)
- Bill Tu
- UCLA Center for East-West Medicine, Department of Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | |
Collapse
|