Category Archives: acupuncture
I frequently use acupuncture in the treatment of headache of several types such as from tension, neck/shoulder pain and migraine. Generally the response is good and well worth a series of treatments before other more toxic therapies are tried providing there are no serious underlying issues. Efficacy of acupuncture for migraine is also good when added to standard care for this condition which I find is how acupuncture for migraine is usually approached in integrative medical care.
The following are summaries made by researchers – K Linde, G Allais, B Brinkhaus, E Manheimer, A Vickers, A R White – of the Cochrane database, one of the main databases for evidence-based medicine.
The researchers refer to “true” acupuncture as opposed to “fake” or “inadequate” acupuncture. As I have pointed out elsewhere these are misleading distinctions as there’s no absolutely right place to put acupuncture needles. Even so-called fake acupoints can stimulate physiological mechanisms resulting in an acupuncture response.
For an experienced evidence-based acupuncturist any anatomically safe area on the skin may be used for needle placement in a well designed treatment plan. Response may be a little more robust when some of the classical acupoints are used in the treatment plan however. This probably arises from greater sensory nerve concentration in areas near these points making a stronger signal through the nervous system possible.
Thomas Martin LAC
Acupuncture for tension-type headache
Patients with tension-type headache suffer from episodes of pain which is typically bilateral (affects both sides of the head), pressing or tightening in quality, mild to moderate in intensity, and which does not worsen with routine physical activity. In most patients tension-type headache occurs infrequently and there is no need for further treatment beyond over-the-counter pain killers. In some patients, however, tension-type headache occurs on several days per month or even daily. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for tension-type headache prophylaxis – that is, to reduce the frequency and intensity of tension-type headaches.
We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies.
In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.
Acupuncture for migraine headache
Migraine patients suffer from recurrent attacks of mostly one-sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis – that is, to reduce the frequency and intensity of migraine attacks.
We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects.
Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.
Many of my clients express interest in reducing their pain medication (with their physicians oversight) due to unwelcome side effects.
The following study reported in MedPage Today shows acupuncture significantly reduced pain and other symptoms following surgery. Naturally patients felt better so needed less medication.
Though not measured the acupuncture intervention may likely assist in making surgery safer as well.
Thomas Martin LAC
SAN FRANCISCO, Oct. 16 — Acupuncture immediately before surgery may reduce postoperative pain, allowing for lower opioid analgesic doses, researchers found.
Acupuncture reduced rates of postoperative nausea by 32%, pruritus by 25%, dizziness by 38%, and urinary retention by 71% compared with controls, according to a meta-analysis presented at the American Society of Anesthesiologists’ meeting here.
“Acupuncture and related techniques are an effective adjunct for postoperative pain management as demonstrated by a significant reduction in postoperative pain scores and opioid consumption,” said Tong Joo Gan, M.D., of Duke in Durham, N.C., and colleagues.
The acupuncture procedures were mainly begun in the 30 minutes before surgery, and the needles were often left in place during the procedure, said Dr. Gan.
Many studies have shown acupuncture effective in reducing postoperative nausea and vomiting compared with other medications, and numerous small clinical trials have shown acupuncture may help manage postoperative pain as well.
The mechanism is not clear, but some research suggests that acupuncture may stimulate the release of hormones or endorphins, “like our own body morphine,” Dr. Gan said.
“Your body endorphins, while reducing the level of pain, don’t produce the opioid-related side effects,” he said.
He and colleagues identified 15 small randomized placebo controlled trials of acupuncture or related techniques, such as acupressure or moxibustion, for postoperative pain in their literature search from 1966 through 2007. The studies ranged in size from 25 to 98 participants for a pooled total of 664 patients.
Postoperative pain was significantly lower with acupuncture than non-acupuncture controls at every time point. The weighted mean difference in visual analog pain scores was:• -14.57 mm at eight hours after surgery (95% confidence interval -23.02 to -6.13).• -8.16 at 24 hours postoperatively (95% CI -10.82 to -5.49).• -9.75 mm at 72 hours (95% CI -13.82 to -5.68).
Likewise, postoperative opioid analgesic use among patients who underwent acupuncture was significantly lower at every time point through 72 hours compared with patients who did not receive acupuncture. The weighted mean difference in morphine-equivalent consumption favoring acupuncture was:• -2.37 mg at eight hours after surgery (95% CI -3.20 to -1.54).• -8.16 mg at 24 hours after surgery (95% CI -10.82 to -5.49).• -7.74 mg at 72 hours after surgery (95% CI -12.08 to -3.40).
As could be expected, the most common opioid-related side effects were also less common among patients in the acupuncture group compared with the control group. The findings included:• Lower incidence of nausea (relative risk 0.68, 95% CI 0.57 to 0.8).• Fewer cases of pruritus – itching (RR 0.75, 95% CI 0.59 to 0.97).• A lower rate of urinary retention (RR 0.29, 95% CI 0.12 to 0.74).• Reduced incidence of dizziness (RR 0.62, 95% CI 0.49 to 0.79).