Some Problems Encountered in the Scientific Evaluation of Acupuncture Antiemesis

Acupuncture and the Cardiovascular System: A Scientific Challenge

In acupuncture research two main issues have to be addressed. One is whether the needle has a biological effect of its own. The other is whether acupuncture is of help to patients in their daily lives. With reference to this, acupuncture is a complex form of treatment in which the needles modulate physiological mechanisms of the body and the doctor supports the patient to achieve a life-style that assists with this.

To evaluate the biological effects of needling, a randomised, controlled trial group of 49 patients with angina pectoris had acupuncture while cardiological, neurophysiological and psychological observations were made in a mutually independent manner. Needling was found to improve the working capacity of the heart. In addition, acupuncture was found to activate cardiovascular autoregulatory mechanisms in 24 healthy persons.

To evaluate the effect of acupuncture in daily life, a controlled trial group of 69 patients with severe angina pectoris were followed for 2 years after treatment. The incidence of cardiac death or myocardial infarction was 7%, compared to 15–21% for the control group of published results concerning invasive treatments. Due to clinical improvement, surgery was postponed in 61% of the patients. The annual number of in-hospital days was reduced by 90%, leading to a US$ 12,000 saving for each patient.

Acupuncture: Where to Place the Needles and for how Long

There are many ways of choosing positions on the body to needle in acupuncture treatment. Similarly there are many ways of stimulating the points chosen. Despite the variety of acupuncture methods advocated, most good-quality trials seem to show a similar 70% success rate, suggesting that there is little clinical difference between techniques. In order to simplify the Western medical usage of acupuncture, the author offers a composite view of needling techniques in which the term “Acupuncture treatment area” (ATA) refers to any suitable site of needle insertion. This may be a single traditional point, it may be a local painful area, a distant strong point, the periosteum around a joint, or it could be a large area of subcutaneous tissue, as in the lower abdomen.

The author suggests that the concept of ATAs will allow acupuncture development free of theoretical expectations, and has the advantage that clinically most medical acupuncturists have already adopted this way of working.

Acupuncture in Modern Medicine

Acupuncture, developed thousands of years ago in the Orient, is increasingly being integrated into modern Western Medicine. Its neurophysiological basis is partly understood, and controlled trials are demonstrating its efficacy and safety.

The Effect of Acupuncture on Post-Operative Oral Surgery Pain: A Pilot Study

An important problem with acupuncture research has been the difficulty in designing appropriate control groups. This pilot study attempted to resolve this problem. Ten patients with third molar extractions were assigned to an acupuncture group (n=7) or a placebo acupuncture group (n=3). Pain intensity and length of time to reach moderate pain after dental surgery were recorded by standard patient self-report. Results indicate that subjects treated with acupuncture reported longer pain-free duration times (mean 212min vs 65min) and experienced a 56.5% mean pain reduction compared to those who received placebo acupuncture. Even though the limited sample size reduced statistical power, this pilot study provides a model for placebo acupuncture control that will be utilised in future large-scale clinical acupuncture studies.

Acupuncture in the Management of Postoperative Nausea and Vomiting in Patients Receiving Morphine via a Patient-Controlled Analgesia System

This single-blind, randomised, controlled trial was undertaken to assess the efficacy of acupuncture (ACP) at the PC.6 (Neiguan) point in the management of established postoperative nausea and vomiting (PONV) in patients receiving parenteral morphine via a Patient-Controlled Analgesia System (PCAS). Eighty patients were recruited on the first postoperative day and 30 were treated with ACP after developing PONV lasting more than 10min. Patients were randomly allocated to receive ACP bilaterally at either PC.6 or at a dummy point near the elbow, with manual stimulation for a total of 4min. Only patients with no knowledge of ACP antiemesis were studied, and each patient was thus unaware of the group to which they were allocated. Patients treated with PC.6 ACP had a greater mean improvement in their visual analogue score for nausea (p<0.05). All patients in the PC.6 group improved their score by 20% or more, while only one third in the control group did so (p<0.001). In the PC.6 group 53% of patients did not require any further antiemetic while receiving PCAS morphine. All patients in the control group required further antiemetic treatment (p<0.001). No adverse effects were recorded.

WITHDRAWN: Interventions for nausea and vomiting in early pregnancy

BACKGROUND

Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting.

OBJECTIVES

To assess the effects of different methods of treating nausea and vomiting in early pregnancy.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).

SELECTION CRITERIA

Randomised trials of any treatment for nausea and/or vomiting in early pregnancy.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the trial quality and extracted the data independently.

MAIN RESULTS

Twenty-eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33).

AUTHORS' CONCLUSIONS

Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

Interventions for nausea and vomiting in early pregnancy

BACKGROUND

Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting.

OBJECTIVES

To assess the effects of different methods of treating nausea and vomiting in early pregnancy.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002).

SELECTION CRITERIA

Randomised trials of any treatment for nausea and/or vomiting in early pregnancy.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the trial quality and extracted the data independently.

MAIN RESULTS

Twenty-eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33).

REVIEWER'S CONCLUSIONS

Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

Efficacy of Chinese acupuncture on postoperative oral surgery pain

One of the challenges of acupuncture research is designing appropriate control groups. To address this problem, after surgical third molar extractions 19 patients were randomly assigned to an acupuncture group (n = 11) or a placebo acupuncture group (n = 8). The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by standard patient self-report. The results indicated that subjects treated with acupuncture reported longer pain-free duration times (mean, 181 versus 71 minutes; p < or = 0.046) and experienced less pain intensity than those who received placebo acupuncture. This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research.