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By Marissa Grace
Latin: Acus (needle) Punctura
Values Assessment:
Continuum…….
Cognitive Objectives
• List 3 stated benefits of acupuncture.
• Define sham acupuncture.
• Describe what Qi is.
• Identify...
Origins
• Trace back more than 2000 years in China
• 6th
Century spread to Korea and Japan
• 8th
and 10th
Century trade in...
Stated Benefits
• N/V after
chemotherapy
• Back Pain
• Osteoarthirtis
• Preop surgery pain
• Addiction
• Stroke
• Headache...
Techniques and Practices
• Sham acupuncture
• Okibari - Japanese style
• Moxibustion
• Cupping
• Electroacupuncture (EA)
Needles
• Needles made of flint, thorns of plants, bamboo
slivers or bone
• Very fine and flexible about 1/2in (0.6cm) to ...
Tools of the Trade
http://www.lhasaoms.com/
Traditional Chinese Medicine
• Qi: Life force, vital energy behind all
physiological processes.
– warms body, pathogen pro...
Traditional Chinese Medicine
• Meridians
– Term for each of 20 pathways through body
for flow of qi, accessed through acup...
Theory
• Stimulation of the nervous system to
release chemicals in the muscles, spinal
cord, and brain.
– Beta-endorphin
•...
Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
...
Is acupuncture safe? A systemic review of case
reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83
...
Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-...
Acupuncture for back pain: A meta-analysis
of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-...
Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic
low b...
Randomized trial comparing traditional medical acupuncture,
therapeutic massage, and self-care education for chronic low
b...
Osteoarthritis
• OA most prevalent form of arthritis
• Common site is knee joint and a leading
cause of disability in the ...
A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1...
A randomized trial of acupuncture as an adjunctive
therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1...
Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial.
Berman B...
Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial. Berman
B...
The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M...
The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M...
The use of nonpharmacologic techniques to prevent
postoperative nausea and vomiting (PONV): A meta-
analysis
Lee A, Done M...
Values Assessment:
Continuum……./ Questions????
Acupuncture (2)
Acupuncture (2)
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Acupuncture (2)

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Acupuncture (2)

  1. 1. By Marissa Grace Latin: Acus (needle) Punctura Values Assessment: Continuum…….
  2. 2. Cognitive Objectives • List 3 stated benefits of acupuncture. • Define sham acupuncture. • Describe what Qi is. • Identify the most significant adverse effect related to safety and explain what it was related to. • Explain which treatment application (Back pain, OA of the Knee, or PONV) has the most evidence of benefits based on results, strengths and limitations.
  3. 3. Origins • Trace back more than 2000 years in China • 6th Century spread to Korea and Japan • 8th and 10th Century trade into Vietnam • 16th Century Western France by Jesuit missionaries • 1972- Visit to China from President Nixon- – Member of US Press Corps with emergency appendectomy received acupuncture. – Experienced shared with New York Time
  4. 4. Stated Benefits • N/V after chemotherapy • Back Pain • Osteoarthirtis • Preop surgery pain • Addiction • Stroke • Headache • Menstrual Cramps • Tennis elbow • Fibromyalgia • Asthma • Carpal Tunnel
  5. 5. Techniques and Practices • Sham acupuncture • Okibari - Japanese style • Moxibustion • Cupping • Electroacupuncture (EA)
  6. 6. Needles • Needles made of flint, thorns of plants, bamboo slivers or bone • Very fine and flexible about 1/2in (0.6cm) to 1 ½ in (38cm) • Attract or disburse energy along meridians • FDA approved needles by use of licensed practitioners in 1996. Sterile, non toxic, single use only
  7. 7. Tools of the Trade http://www.lhasaoms.com/
  8. 8. Traditional Chinese Medicine • Qi: Life force, vital energy behind all physiological processes. – warms body, pathogen protection, promotes growth – Meridian network system – Disruption of flow results in illness – Mechanism of Qi still mysterious
  9. 9. Traditional Chinese Medicine • Meridians – Term for each of 20 pathways through body for flow of qi, accessed through acupuncture points – 12 main and 8 secondary – Up to 2000 points along meridian complex – Points regulate different areas of the body
  10. 10. Theory • Stimulation of the nervous system to release chemicals in the muscles, spinal cord, and brain. – Beta-endorphin • Analgesia. • Placebo effect.
  11. 11. Is acupuncture safe? A systemic review of case reports Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83 • Method –202 cases reported (40% from US) from 1965-1999, –First hand reports included, case reports
  12. 12. Is acupuncture safe? A systemic review of case reports Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83 • Results – Infection: Hepatitis 80% (94cases/35 years) • Needles not cleans/ repeated use/ inadequateNeedles not cleans/ repeated use/ inadequate sterilizationsterilization –Internal Organ/tissue injury –Fewer complications after 1988: no further Hepatitis reports. – 20% of practitioners with no recognized qualifications
  13. 13. Acupuncture for back pain: A meta-analysis of randomized controlled trials. Ernst, Arch of internal Med. 1998;158:20:2235-2241 • Methods – Randomized controlled trials of acupuncture of back pain in humans – 377 subjects, mostly with chronic poor prognosis back pain – Consulted by 6 experienced acupuncturists – 12 studies included (9 suitable for meta-analysis) • Conclusion – Insufficient evidence to state whether superior to placebo – Long term effect of back pain with acupuncture uncertain
  14. 14. Acupuncture for back pain: A meta-analysis of randomized controlled trials. Ernst, Arch of internal Med. 1998;158:20:2235-2241
  15. 15. Randomized trial comparing traditional medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of internal medicine. 2001; 161, 8: 1081-1088. • Design – Only 17% of invited Washington State Group Health HMO patients participated (262 patients, age 20-70 years). – Ten acupuncture or massage visits in a 10 week period. – 95% of patients w/ Follow-up after 4, 10, and 52 weeks. • Symptoms and dysfunctions assessed • Results – F/U with 95% of participants – massage is an effective short-term treatment for chronic low back pain with benefits to last at least 1 year
  16. 16. Randomized trial comparing traditional medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of internal medicine. 2001; 161, 8: 1081-1088. • Results – If acupuncture has a positive effect it seems to be during the first 4 weeks with limited improvement thereafter. • Strengths- randomized design, involvement of therapist with protocol development, and high compliance rate. • Limitations -absence of control group, restriction of single form of acupuncture (TCM), possibility of atypical therapists, use of protocols that excluded treatments often used by some TCM acupuncturist.
  17. 17. Osteoarthritis • OA most prevalent form of arthritis • Common site is knee joint and a leading cause of disability in the elderly • Acupuncture for OA is a therapeutic approach common in Asian societies
  18. 18. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee Berman BM, et. al. Rheumatology 1999;38: 346-354 • Design – 73 patients from the Baltimore area (average age 65 years). – Inclusion criteria ≥ 50 older Dx of OA ≥ 6 months, moderate pain in knee most days in the last month, taking analgesic or anti- inflammatory agents for pain control at least one month. – protocol included TCM treatment for Bi syndrome which uses local and distal points on channels that cross the area of pain
  19. 19. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee Berman BM, et. al. Rheumatology 1999;38: 346-354 – Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) – The patient’s scores were determined at 0, 4, 8 and 12 weeks during trial. • Results – the acupuncture group with about 34% ↓ on WOMAC at week 4 and 42% at week 8. – There were no significant changes in the control group from baseline to week 12. – Limitations noted lack of placebo control group.
  20. 20. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004 • Design – Reduce pain/improve function among patients with knee OA as compared to both sham acupuncture and education control groups – 8 week intense acupuncture treatment, followed by an 18 week tapering regime – 570 participants – Assessments conducted at baseline, 4, 8, 14, and 26 weeks
  21. 21. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004 • Results – True acupuncture groups improvement from baseline was significantly greater than the sham control group at weeks 8 (P=0.01), 14 (P=0.04), 26 (P=0.009) – Most believe they received true acupuncture at both times, suggesting the sham acupuncture to be a credible blinding strategy • At 4 weeks 67% of the true acupuncture group and 58% of sham believed they were receiving true acupuncture (P=0.06) and at 26 weeks 75% in acupuncture group and 58% in sham (P=0.003).
  22. 22. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta- analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369. • Design – Stimulation of wrist at pericardium (P6) – Systemic review 24 randomized controlled trials (1679 patients) • Nonphamacologic- acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation and acupressure – Measured incidence of nausea, vomiting or both after surgery 0-6h (early) or 0-48h (late)
  23. 23. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta- analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369. • Results – Pediatric studies failed to show significant benefit. – Antiemetic use in preventing early or late PONV in adults was comparable to the non- pharmacologic techniques. – Significant reduction of early vomiting in nonpharm. group compared with placebo w/in 6h of surgery for adults.
  24. 24. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta- analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369. • Limitations – Combining different non-pharmacologic techniques. • May have different effects to prevent PONV – Optimal methods of applying techniques unknown. – Length of treatment (5min- 7days) – No statistical heterogeneity • Conclusions – Further RCT with better study methodology needed in adults. – Mechanism for prevention of PONV not established.
  25. 25. Values Assessment: Continuum……./ Questions????

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