How might acupuncture work? A systematic review of physiologic rationales from clinical trials

BACKGROUND: Scientific interest in acupuncture has led numerous investigators to conduct clinical trials to test the efficacy of acupuncture for various conditions, but the mechanisms underlying acupuncture are poorly understood. METHODS: The author conducted a PubMed search to obtain a fair sample of acupuncture clinical trials published in English in 2005. Each article was reviewed for a physiologic rationale, as well as study objectives and outcomes, experimental and control interventions, country of origin, funding sources and journal type. RESULTS: Seventy-nine acupuncture clinical trials were identified. Twenty-six studies (33%) offered no physiologic rationale. Fifty-three studies (67%) posited a physiologic basis for acupuncture: 33 (62% of 53) proposed neurochemical mechanisms, 2 (4%) segmental nervous system effects, 6 (11%) autonomic nervous system regulation, 3 (6%) local effects, 5 (9%) effects on brain function and 5 (9%) other effects. No rationale was proposed for stroke; otherwise having a rationale was not associated with objective, positive or negative findings, means of intervention, country of origin, funding source or journal type. The dominant explanation for how acupuncture might work involves neurochemical responses and is not reported to be dependent on treatment objective, specific points, means or method of stimulation. CONCLUSION: Many acupuncture trials fail to offer a meaningful rationale, but proposing a rationale can help investigators to develop and test a causal hypothesis, choose an appropriate control and rule out placebo effects. Acupuncture may stimulate self-regulatory processes independent of the treatment objective, points, means or methods used; this would account for acupuncture's reported benefits in so many disparate pathologic conditions

Couples' experiences of interacting with outside others in Chronic Fatigue Syndrome: a qualitative study

Objectives Social isolation and stigma are frequently reported by patients with Chronic Fatigue Syndrome (CFS/ME) and relationships in the home environment with those close to the patients (their ‘significant others’) may thus be particularly important. Rather little attention has yet been paid to the beliefs and experiences of ‘significant others’ themselves in this context. This study sought to explore in-depth the beliefs and experiences of both patients and ‘significant others’ in relation to CFS/ME. Methods In-depth interviews using a semi-structured interview schedule designed around the core constructs of the Common-Sense Model of self-regulation (CSM) were conducted with two patients with CFS/ME and their spouses. Interpretative Phenomenological Analysis (IPA) was used to analyse interview data. Results Experiences of social interactions in relation to CFS/ME with others outside of the relationship dyad emerged as a key issue for all participants when reflecting on their experiences of living with the condition. These concerns are presented under two themes: interactions with healthcare professionals and interactions with the social world. Conclusions It is evident that significant others play an important role in the lived experience of CFS/ME. For both patients and significant others, the wider social world and interactions with outside others may be important influences on dyadic coping in CFS/ME. Both future research and treatment interventions could usefully include a ‘significant other’ perspective

A double-blind placebo needle for acupuncture research

<p>Abstract</p> <p>Background</p> <p>Placebo needles that can mask acupuncture practitioners to the type of needle used have been considered almost impossible to develop until now.</p> <p>Methods</p> <p>We designed a double-blind non-penetrating placebo needle, the needle tip of which simply presses against the skin, and a matched penetrating needle. The needles are encased inside an opaque guide tube and the appearance and feel of the pair are designed to be indistinguishable. To validate the masking effect for the practitioner, 10 acupuncturists each applied 23 non-penetrating needles and 17 penetrating needles to the Large Intestine-4 point. After removing each needle, they judged whether the needle was 'penetrating', 'non-penetrating' or 'unidentifiable'. For the validation of patient masking, an acupuncturist randomly applied a non-penetrating/penetrating needle pair to the bilateral Sanjiao-5 points in 60 volunteers. When both applications were completed, we asked them to write down anything that they noticed regarding the needle application and associated sensations.</p> <p>Results</p> <p>The mean ± SD of correct/unidentifiable/incorrect answers given by the 10 acupuncturists were 17.0 ± 4.1/6.4 ± 3.6/16.6 ± 3.0, respectively. Regarding patient masking, none of the subjects commented in the questionnaire that they had received a non-penetrating needle. Of 60 penetrating and 60 non-penetrating needle applications, 48 (80.0%) and 25 (41.7%) applications elicited skin penetration sensation and 48 (80.0%) and 20 (33.3%) applications elicited <it>de qi</it>, respectively.</p> <p>Conclusion</p> <p>These needles have the potential to mask both practitioners and patients from the type of needle used in acupuncture research.</p

Efeito da acupuntura na melhora da dor, sono e qualidade de vida em pacientes fibromiálgicos: estudo preliminar Effect of acupuncture on pain, sleep and quality of life improvement in fibromyalgia patients: preliminary study

A fibromialgia é uma síndrome definida por dor crônica generalizada e em pelo menos 11 dos 18 tender points, pontos dolorosos específicos. Este ensaio clínico randômico visou verificar a eficácia da acupuntura na melhora da dor, sono e qualidade de vida de pacientes fibromiálgicas. Dentre 20 mulheres com média de idade 44 anos, com diagnóstico de fibromialgia segundo critérios do Colégio Americano de Reumatologia, finalizaram o estudo 12, distribuídas aleatoriamente em dois grupos: A (GA, n=5), que recebeu acupuntura segundo a medicina tradicional chinesa; e B (GB, n=7), que teve a inserção de agulhas nos tender points base do occipital, trapézio, supraespinhoso e epicôndilo lateral. A dor foi avaliada por escala visual analógica e dolorimetria; o sono, pelo Inventário do Sono; e a qualidade de vida, pelo Questionário de Impacto da Fibromialgia (QIF). Os grupos receberam acupuntura uma vez por semana, durante oito semanas, com inserção de oito agulhas por 25 minutos. Os dados foram tratados estatisticamente, adotando-se o nível de significância ±=0,05. No GA, houve melhora estatisticamente significante do sono; e no GB, na dor, limiar de dor nos tender points, no sono e nos itens do QIF dor, cansaço matinal, ansiedade e depressão (p<0,05). Os resultados sugerem que a acupuntura, especialmente com inserção de agulhas nos tender points, promove a diminuição da dor e melhora da qualidade de vida e do sono em indivíduos com fibromialgia.<br>Fibromyalgia is a syndrome defined by chronic widespread pain and sensitivity to pressure at at least 11 of 18 tender points. The aim of this random blind clinical trial was to assess the effectiveness of acupuncture on pain relief, on quality of sleep and life in fibromyalgia patients. From 20 female fibromyalgic patients (diagnosed according to the American College of Rheumatology), mean aged 44 years, 12 completed the study, randomly assigned into two groups: group A (GA, n=5) received acupuncture according to the traditional Chinese medicine; and group B (GB, n=7) received acupuncture at eight tender points: at the occiput, trapezius muscle, supraspinatus muscle, and lateral epicondyle. Pain was assessed by a visual analogue scale and by dolorimetry; quality of life, by the Fibromyalgia Impact Questionnaire (FIQ); and sleep, by the Post Sleep Inventory. Both groups received acupuncture once a week for eight weeks, with insertion of eight needles for 25 minutes. Data were statistically analysed and significance level set at ±=0.05. Results show significant sleep improvement in GA; and, in GB, lesser pain as detected by VAS, higher pain threshold on tender points, better sleep and improvement in FIQ items pain, morning tiredness, anxiety, and depression (p<0.05). These data suggest that acupuncture, especially that with tender point needle insertion, provides pain relief, better quality of life and of sleep in fibromyalgic patients