2 Invited Commentarypneumothorax, spinal cord injury, cardiac puncture, pain and function scores at 8 and 26 weeks and in theseptic arthritis, seizure, and drowsiness sufficient to cause Patient Clobal Assessment Score at week 26. To date, thisan automobile accident [7,8]. Serious complications are is the largest acupuncture study performed for treatmentgenerally associated with poor technique and inexpert of any musculoskeletal condition, and included bothneedle placement. It is estimated that serious complica- sham acupuncture and noninvasive control groups. Thetions occur at a rate of 0.05 per 10,000 treatments . sham acupuncture group showed intermediate results, as noted in other studies. Also of note is that the educa- tion control group had higher pain scores at the end ofResearch tbe study despite taking bigher doses of nonsteroidalAcupuncture has been studied by Western medicine anti-inflammatory drugs. Otber studies evaluating acu-increasingly over the past 30 years. Many of tbe early clin- puncture for treatment of osteoartbritis of the knee haveical trials were of poor quality, with unrandomized or no demonstrated significant improvement [25). Two previ-control groups. An additional limitation of acupuncture ous trials involving patients on waiting lists for total kneeresearch is that most of the research protocols are based arthroplasty have shown significant improvement inon specific, predetermined acupuncture points, whereas knee pain and functional improvement; 10% of subjectsin the clinical setting, points are determined individu- in one study  and 25% of patients in another studyally, frequently based on localized tender points.  experienced improvement to an extent that they It is difficult to design an appropriate placebo treat- withdrew themselves from the joint replacement waitingment for acupuncture. Controversy exists in the selection lists.of appropriate control groups for acupuncture studies . Recent attention has been given to tbe effects of acu-Studies utilizing sham acupuncture along with another puncture on immune function. A recent study evaluatingcontrol group (eg, wait list) frequently show intermediate immune function and mood after exhaustive exerciseeffectiveness of sham acupuncture, with tbe sbam acu- found increased salivary IgA and salivary cortisol levelspuncture group falling between acupuncture and the and lower ratings of "fatigue" and "confusion" on the Pro-other control groups [10,11]. The most plausible theory file of Mood States in subjects versus controls . Otherregarding this phenomenon may also explain the basis for studies have shown complex effects on immune func-acupuncture analgesia. Any needling of skin may increase tion, felt to be modulated by the central nervous systemendorphins and activate diffuse noxious inhibitory con- [29,30].trol systems, supraspinal structures that modulate thetransmission of nociceptive signals . A new placeboacupuncture needle has been developed with some early Conclusionsvalidation , although it has not yet been widely used Acupuncture is a minimally invasive, relatively safe medi-in published acupuncture studies. cal procedure that appears to have complex effects on the Early studies convincingly demonstrated an increase central and peripheral nervous system, immune system,in endorphin release into the cerebrospinal fluid [14,15], and pain perception. Although acupuncture should notand inhibition of acupuncture analgesia with naloxone supplant the role of conventional therapies such as reha-. These results have been supported by animal studies bilitation to treat these conditions, it is a useful adjunctas well [17,18]. to treat pain, which can inhibit muscular contraction, Clinical trials and meta-analyses have supported the interfering with rehabilitation and athletic performance.effectiveness of acupuncture for treatment of a variety of It is also useful for treatment of cbronic conditionsconditions treated by sports medicine specialists. These that fail to respond to more conventional therapies.include some of the more chronic and difficult conditions Although recent studies are of higher quality, problemsseen in sports medicine, such as lateral epicondylalgia remain in tbe design and interpretation of acupuncture[19-21], patellofemoral pain , and low back pain research. Larger, better-controlled studies are needed to[23,24]. Several of tbese trials included objective func- determine the effectiveness of acupuncture comparedtional assessment, showing improvement in walking or witb more conventional treatments.stair-climbing performance in addition to improvementin pain scales. One of the more impressive recent trials studied Referencestbe effectiveness of acupuncture for treatment of osteo-arthritis of the knee . A total of 570 patients witb 1. Barnes PM, Powell-Griner E, McFann K, Nahin RL: Comple- mentary and Alternative Medicine Use Among Adults: Unitedosteoarthritis of the knee were included in this trial, States, 2002. CDC Advanee Data Report #343. Bethesda:which compared acupuncture with sham acupuncture Centers for Disease Control and Prevention; 2004.and education control groups. The acupuncture group 2. Bullock ML, PheleyAM, KiresukTJ, etal.: Characteristics and complaints of patients seeking therapy at a hospital-demonstrated significant improvement in the Western based alternative medicine clinic. /A/iern Complement MedOntario and McMaster Universities Osteoarthritis Index 1997,3:212.
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