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“Time for Acupuncture to Become Part of Standard Care”

8 Dec

The following article by Dr.Lorenzo Cohen, Ph.D., Professor and Director of the Integrative Medicine Program at the University of Texas, MD Anderson Cancer Center appeared in Huffington Post on December 7th, 2013. The article confirms many of the clinical uses for acupuncture in the area of Oncology. These uses are certainly confirmed by myself and other colleagues who have been working in this field utilizing acupuncture and herbal therapy for the past 20 years. Also medical treatment for cancer can easily feel ‘industrial’ and depersonalizing and the care received in acupuncture clinics can help people going through treatment for cancer feel re-empowered, nourished and supported.

In the article the author states that the “mechanisms are not well understood”,  this however is not true any longer with several writers/researchers outlining much of acupuncture’s modes of action in modern scientific understanding. See for example - http://www.amazon.com/Biomedical-Acupuncture-Pain-Management-Integrative/dp/0443066590 and http://www.amazon.com/Introduction-Western-Medical-Acupuncture-1e/dp/0443071772/ref=sr_1_1?s=books&ie=UTF8&qid=1386465583&sr=1-1&keywords=western+acupuncture

Thomas Martin LAc.

See also - http://www.ncbi.nlm.nih.gov/pubmed/23341529

“Acupuncture, the insertion of small, stainless steel needles into points on the body to stimulate specific areas, has been used in recent years by many cancer patients to help with symptom management. Because the mechanisms are not well understood, deciding when and how to safely add acupuncture to one’s treatment plan can be challenging. A recent systematic review conducted by researchers in the Integrative Medicine Program at the MD Anderson Cancer Center can now help patients and their oncologists make more informed choices.

The systematic review, published in the Journal of Clinical Oncology, searched the worldwide literature for randomized, controlled trials evaluating the use of acupuncture for symptom management in cancer patients.[1] Forty-one studies were found for the treatment of eight symptoms (pain — 11, nausea/vomiting — 11, postoperative ileus (constipation) — eight, xerostomia (dry mouth) — four, hot flashes — seven, fatigue — three, anxiety/depression/mood disorders — five, and sleep disturbance — three), and were rated for study quality and whether outcomes were positive or negative.

One well-designed large study undefined for the treatment of chemotherapy-induced nausea and vomiting, found electroacupuncture worked better than anti-nausea medications or sham acupuncture (minimal needling) in women with breast cancer.[2] Although less clear, the evidence also suggests acupuncture is helpful for pain control. None of the identified studies were classified as having a low risk of bias due to study weaknesses, but nine of the 11 pain studies had positive results favoring its use. For the other symptoms assessed, the quality of the studies was lower, but there is reason to believe that with larger more rigorous studies, acupuncture may be found beneficial for some of these conditions as well.

The use of acupuncture for symptom control in oncology is important to consider. Findings from this review and others indicate it is an appropriate treatment alongside conventional care for chemotherapy-induced nausea/vomiting, although additional studies are needed to better understand how it works and which patients might benefit most. For other symptoms, the specific effects of acupuncture remain undetermined, primarily due to weaknesses in the studies. As a low-risk, cost-effective treatment option, acupuncture may be helpful when combined with conventional care for patients suffering from uncontrolled treatment-related side effects or in those for whom other treatment approaches have failed.”

References:

1. Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Palmer JL, Yang P, Cohen L. “Acupuncture in cancer care: a systematic review.” Journal of Clinical Oncology (Published online before print Jan. 22, 2013). doi: 10.1200/JCO.2012.43.5818)

2. Shen J, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C, Shekelle PG. “Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial.” JAMA 284:2755-61, 2000.

Acupuncture for Depression

30 Sep

A small study comparing outcomes for moderate to severe depression in three groups; standard care, counseling and acupuncture was published last this week in PLOS Medicine.

In this pragmatic randomised controlled trial conducted in the North of England, patients with depression were randomised to receive 12 weekly sessions of acupuncture plus usual care (302 patients), or 12 weekly sessions of counselling plus usual care (302 patients), or usual care alone (151 patients).

Both the acupuncture and the counseling groups resulted in significant improvement in depression scores over standard care alone. Improvements were stable at 3 months post treatment. All study groups continued with standard medical treatments such as antidepressants.

Commentary given considered the study as validating acupuncture as an evidence-based treatment for depression in an integrative environment.

A frequent side-benefit of acupuncture treatment for a variety of conditions is improved wellbeing. The study demonstrates this effect to be robust enough to improve moderate to severe depression scores. It seems reasonable to expect an even greater treatment effect in mild to moderate depression.

Clinically I have seen good success in managing bouts of mild to moderate depression combining acupuncture with an Albizzia based Chinese herbal formula.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001518

 

Thomas Martin LAc.

 

Effectiveness of Depression Drugs Questioned

15 Jan

The discussion and links in this post are not meant to discourage anyone from listening to their healthcare provider or from taking medical drugs where deemed necessary. It does however serve to show how complex the mind/body is, how being informed and how conscientiousness and self-reliance are important no matter what treatment approach is followed

As to the much lauded effect of the best-selling antidepressant drugs turning out to be very little more than the depression alleviating effect of an inert placebo pill see Sharon Begley’s excellent expose from Newsweek

 …let me show you the studies on PubMed. It seems I am not alone in having moral qualms about blowing the whistle on antidepressants. That first analysis, in 1998, examined 38 manufacturer-sponsored studies involving just over 3,000 depressed patients. The authors, psychology researchers Irving Kirsch and Guy Sapirstein of the University of Connecticut, saw—as everyone else had—that patients did improve, often substantially, on SSRIs, tricyclics, and even MAO inhibitors, a class of antidepressants that dates from the 1950s. This improvement, demonstrated in scores of clinical trials, is the basis for the ubiquitous claim that antidepressants work. But when Kirsch compared the improvement in patients taking the drugs with the improvement in those taking dummy pills—clinical trials typically compare an experimental drug with a placebo—he saw that the difference was minuscule. Patients on a placebo improved about 75 percent as much as those on drugs. Put another way, three quarters of the benefit from antidepressants seems to be a placebo effect. “We wondered, what’s going on?” recalls Kirsch, who is now at the University of Hull in England. “These are supposed to be wonder drugs and have huge effects.”

The study’s impact? The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005.

http://www.thedailybeast.com/newsweek/2010/01/28/the-depressing-news-about-antidepressants.html

For more on this subject see my post here - http://www.wellnessclarity.com/?p=89

 

See also Harriet Fraad’s article in The Guardian

So-called miracle drugs like Prozac are taken by 11% of the population – and Prozac is only one of the 30 available antidepressants on the market. …

Anti-psychotics drugs alone net the pharmaceutical industry at least $14.6bn dollars a year. Psycho-pharmaceuticals are the most profitable sector of the industry, which makes it one of the most profitable business sectors in the world. Americans are less than 5% of the world’s population, yet they consume 66% of the world’s psychological medications.

Do these psycho pharmaceuticals work to restore mental health? Actually, the evidence is overwhelming that they fail. Antidepressants, the most popular psycho-pharmaceuticals, work no better than placebos. They work 25% of the time and stop working when the user stops taking them. In addition, they may actually harm patients in the long run. They disrupt brain neurotransmitters and may usurp the brain’s organic soothing functions.

http://www.guardian.co.uk/commentisfree/cifamerica/2011/mar/15/psychology-healthcare

Until quite recently there used to be a fairly clear demarcation between reactive sadness and major depression that is sustained and apparently without cause – a distinction going back as far as the ancient Greeks. In past years however this distinction has been confused and normal sadness that most people experience from time to time has been increasingly medicalized into a treatable disorder and actively marketed as such.

Here Gordon Parker in the British Medical Journal, discusses this increasing medicalization of sadness.

http://www.bmj.com/content/335/7615/328.full

Also on the over-diagnosis of depression from the Guardian

http://www.guardian.co.uk/lifeandstyle/2007/aug/17/world.health

 

Andrew Weil’s Integrative approach to improving Mood

See Andrew Weil’s (who has experienced bouts of depression life-long) book Spontaneous Happiness on the wholistic approach to emotional wellbeing. Weil also recommends acupuncture, exercise and meditation for this mood condition.

http://www.amazon.com/Spontaneous-Happiness-Andrew-Weil/dp/0316129445/ref=sr_1_1?s=books&ie=UTF8&qid=1326240423&sr=1-1

Exercise Improves Depression

The following study demonstrated exercise to be  equal to Zoloft in improving depression in older adults at 4 months of intervention.

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&doptcmdl=Citation&defaultField=Title%20Word&term=Blumenthal%5Bauthor%5D%20AND%20Effects%20of%20exercise%20training%20on%20older%20patients%20with%20major%20depression.

 

Thomas Martin LAc