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Research: Bones, muscles and joint disorders






Sprains (Acupuncture)

Intro

Sudden injury or sprains usually respond well to acupuncture. The pain resulting from a sprained shoulder will often continue for some days or weeks after the initial injury. Once a clear diagnosis has been made acupuncture can usually be used to relieve this type of pain. Many of these 'acute pains' represent a self-limiting disease process; for instance a small burn is usually excruciatingly painful for a few days and then settles. If acupuncture is used as a form of pain relief for burns then its 'pain relieving' effect is only required for a few days. Because of the natural history of the pain it is therefore difficult to produce a clear picture of the effect of acupuncture on this type of 'short-lived pain'. In China, acupuncture is usually given for acute pain, but in the West acupuncture is not generally available for 'short-lived pain' as there are not enough acupuncturists to provide this service.

The experience of a variety of acupuncturists, myself included, shows that, of the people treated for differing acutely painful conditions, about 70 per cent obtain swift and significant pain relief. If a fracture of the bone is present then the pain relief gained from acupuncture is less effective than if the injury is due to a strain or tear of the muscles, tendons or ligaments. The main advantage of treating these acute pains with acupuncture is that chronic pain can be avoided. A sudden shoulder injury may produce pain and immobility for many months, sometimes years, but if acupuncture is used when the pain occurs then it seems that chronic pain may be avoided. These 'impressions' about the use of acupuncture in acute pain are consistently quoted, both in the West and China, but until adequate statistical research is completed the effectiveness of acupuncture in 'acute pain' will remain no more than a clinical impression.

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Osteoarthritis (Acupuncture)

Intro

Osteoarthritis and the rheumatic pains that result from this type of joint damage, are quite a common problem. People frequently complain that their arthritic knee pain is worse in cold or damp weather and this demonstrates quite clearly the origin of the concept of pathogens in traditional Chinese medicine. The pathogen in osteoarthritis is almost always cold or damp and therefore these pains should be treated by the use of localized heat.

A great deal of research work has been done to investigate the effects of acupuncture on the pain caused by osteoarthritis. Some of this work is excellent but, for a variety of technical reasons, some is poor. Clinical trials have been completed on knee, hip, elbow, neck and lower back pain, and the information from these trials shows that significant pain relief can be achieved in about 70 per cent of those who receive acupuncture. Some work suggests that only 50 per cent of people benefit from acupuncture while other trials show 95 per cent of the patients benefiting.

The effect of acupuncture in osteoarthritis pain does not last for ever, the available research showing that its effects gradually diminish after about six to nine months. Some people may have significant pain relief for up to two years, but the majority of people who gain relief from acupuncture will require further treatment after about six months. Treatment is usually just as effective on the second or third occasion as it was initially.

Osteoarthritis is a condition that naturally causes intermittent pain and discomfort. Patients may find that their osteoarthritis knee is relatively painless for nine months and then goes through a painful period for a further six months. For this reason the effects of any treatment must be compared to the natural history of the disease process and this can cause difficulty in interpreting the results of individual treatments. Acupuncture also has a 'magical quality' that pills do not have, so it is difficult to sort out the effects of the 'magic' as compared to the real effects of acupuncture. In spite of these problems, acupuncture is a safe and effective form of treatment for osteoarthritis.

Acupuncture as an adjunctive therapy in osteoarthritis of the knee

A randomized and controlled study was performed in order to determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. For the 570 patients with osteoarthritis of the knee, 23 real acupuncture sessions were given over 26 weeks and 23 sham acupuncture sessions were given over 26 weeks. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. The secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

The patients in the real acupuncture group experienced greater improvement in the WOMAC function scores than the sham acupuncture group at 8 weeks but not in the WOMAC pain score or the patient global assessment. At 26 weeks, the real acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score, the WOMAC pain score, and patient global assessment. In conclusion, acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups. Berman BM, et al. University of Maryland School of Medicine, Baltimore, Maryland 21207, USA.

Acupuncture treatment of severe knee osteoarthrosis

Abstract:

Purpose: Acupuncture treatment of patients waiting for arthroplasty surgery.

Methods: 29 patients with a total of 42 osteoarthritic knees were randomized to two groups. Group A was treated while Group B served as a no-treatment control group. After 9 weeks Group B was treated too. Analgesic consumption, pain and objective measurements were registered. All objective measures were done by investigators who were "blinded" as to Group A & B. In the second part of the study 17 patients (26 knees) continued with treatments once a month. Registration of analgesic consumption, pain and objective measurements continued. Total study period 49 weeks.

Results: Comparing Group A to B there was a significant reduction in pain, analgesic consumption and in most objective measures. In Group A + B combined there was an 80% subjective improvement, and a significantly increased knee range movement - an increase mainly in the worst knees. Results were significantly better in those who had not been ill for a long time. In the second part of the study, it was shown that it was possible to maintain the improvements.

Conclusions: Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery. Seven patients have responded so well that at present they do not want an operation. (USD 9000 saved per operation).

Acta Anaesthesiologica Scandinavica, 1992 Aug, 36(6):519-25.
(UI: 92383960) Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.
AT: UCLA siomed W1 AC7175 (PE title: Acta anaesthesiologica Scandinavica.)


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Rheumatoid Arthritis (Acupuncture)

The effects of acupuncture on rheumatoid arthritis are not so clear cut. During the early, acute, inflammatory stage of rheumatoid arthritis there is some evidence to suggest that acupuncture might worsen the pain and therefore many acupuncturists do not treat acute rheumatoid arthritis. After some months the acute inflammatory stage subsides and the residual joint destruction may then lead to the development of a secondary osteoarthritis. This type of pain is amenable to acupuncture and responds in the same way as other osteoarthritic aches and pains. Chronic pain, due to disease of the musculo-skeletal system, is frequently amenable to acupuncture treatment. The published research shows that pain, which has been present for many years can respond as well as pain that has been present for only a few months; therefore, from the available information, it is fair to say that acupuncture is 'always worth a try' in this type of condition.

Experimental study on the influence of acupuncture and moxibustion on interlukin-2 in patients with rheumatoid arthritis

Abstract: Rheumatoid arthritis (RA) is referred to the category of Bi syndromes in traditional Chinese medicine. It is regarded as an autoimmune disease, but the pathogenic mechanism is still to be clarified. In order to observe the effects of the treatment of RA with acupuncture and moxibustion on IL-2, 41 patients were divided into warming needle and point injection groups at random, and 19 healthy subjects as control group.

The results showed that the IL-2 levels in two RA groups before treatment were obviously lower than that in control group (P 0.05). After treatment the IL-2 level in control group was unchanged, but increased considerably in two RA groups (P 0.01). Generally, IL-2 is considered as a very important signal for regulating immune response.

Our results have shown that the decrease of IL-2 in patients with RA should be one of main causes of internal environment disorder, acupuncture and moxibustion as a stress stimulation exerts an influence on the immunity system through neuroendocrine system to improve the IL-2 production. Xiao J; Liu X; Sun L;

Ying S; Zhang Z; Li Q; Li H; Zhang Z; Jin B; Wang
Chen Tzu Yen Chiu Acupuncture Research, 1992, 17(2):126-8, 132.
Language: Chinese. (UI: 93169756)
Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.
(Library locations not linked. To locate, try F PE . )

Long term treatment of chronic pain with acupuncture

A 5-year trial of acupuncture therapy in the Finnish NHS is surveyed. In total 348 patients attending Halikko Health Centre in SW Finland were treated with needle-stimulation for a wide variety of chronic pain syndromes. The mean number of acupuncture sessions was 5 in the primary series and 41% of patients received more than one series.

An analysis of results showed significant relief of pain (more than 40% reduction on the visual analogue scale) in myofascial syndromes affecting the head, neck, shoulder and arm. Osteoarthrosis of major joints, and backache, responded less favourably. In total 65% of those patients who had taken analgesics before acupuncture therapy, either stopped totally or reduced their dose considerably. Those with headache could significantly more often reduce their drug intake than those with arthritis or osteoarthrosis.

Musculoskeletal clinic in general practice

Background: A musculoskeletal clinic, staffed by a general practitioner trained in osteopathy, medical acupuncture and intralesional injections, was set up in an inner London general practice in 1987. AIM. A retrospective study was undertaken of one year's referrals to the clinic in 1989-90 to determine how general practitioners were using the clinic in terms of problems referred; consultation patterns of patients attending the clinic and 12 months after initially being seen; and how access to the clinic influenced referrals to relevant hospital departments.

Method:
Day sheets were studied which recorded information on demographic characteristics of patients referred to the clinic and their problems, diagnoses made, duration of symptoms, number and range of treatments given, and recurrence of problems. Use of secondary referral sources was also examined.

Results: During the study year 154 of 3264 practice patients were referred to the musculoskeletal clinic, and attended a mean of 3.5 times each. Of all the attendees 64% were women and 52% were 30-54 years old. Eighty one patients (53%) presented with neck, back or sciatic pain. A specific traumatic, inflammatory or other pathological process could be ascribed to only 19% of patients. Regarding treatment, 88% of patients received osteopathic manual treatment or acupuncture, or a combination of these treatments and 4% received intralesional injections. Nine patients from the clinic (6%) were referred to an orthopaedic specialist during the year, two with acute back pain. Referrals to orthopaedic specialists by the practice as a whole were not significantly lower than the national average, although the practice made fewer referrals to physiotherapy and rheumatology departments than national figures would have predicted. Seventeen patients (11%) returned to the clinic with a recurrence of their main complaint within a year of their initial appointment; second courses of treatment were usually brief.

Conclusion: The clinic encouraged a relatively low referral rate to musculoskeletal specialists outside the practice. However, a need was identified for better communication about the potential of the approaches used in order that referrals to secondary specialists, particularly orthopaedic specialists, could be further reduced.

Peters D; Davies P; Pietroni P Address: Marylebone Health Centre, London.

BBC News website

You can find positive findings and scientific research confirming the effectiveness of acupuncture in this condition on the BBC news website: Arthritis and How acupuncture may reduce pain

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Tennis Elbow (Acupuncture)

Electro-stim acupuncture and Fu needling for tennis elbow

A study of one hundred patients with tennis elbow was performed in order to see the effects of combining Fu needling with electro-stim acupuncture. For three weeks, the patients were divided into three random groups. One group received treatment with Fu needling (n=30), another group was treated with electric acupuncture (n=30), and the third group was treated with the combination of the above two methods (n=40). At the end of three weeks, all three groups had good results, but the combined therapy showed the best effect on tennis elbow. The study concluded that Fu needling combined with electro-stim acupuncture might produce a higher cure rate of tennis elbow than either used alone.

Xia DB, Huang Y. Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

Acupuncture's analgesic effect on tennis elbow

Abstract: The immediate analgesic effect of a single non-segmental acupuncture stimulation treatment on chronic tennis elbow pain was studied with placebo-controlled single-blind trial completed by 48 patients. Before and after treatment, all patients were examined physically by an unbiased independent examiner. Eleven-point box scales were used [13] for pain measurement. Patients in the verum group were treated at non-segmental distal points (homolateral leg) for elbow pain following Chinese acupuncture rules, whereas patients in the placebo group were treated with placebo acupuncture avoiding penetration of the skin with an acupuncture needle.

Overall reduction in the pain score was 55.8% (S = 2.95) in the verum group and 15% (S = 2.77) in the placebo group. After one treatment 19 out of 24 patients in the verum group (79.2%) reported pain relief of at least 50% (placebo group: six patients out of 24). The average duration of analgesia after one treatment was 20.2 h in the verum group (S = 21.54) and 1.4 h (S = 3.50) in the placebo group. The results are statistically significant (P < 0.01); they show that non-segmental verum acupuncture has an intrisic analgesic effect in the clinical treatment of tennis elbow pain which exceeds that of placebo acupuncture.

Molsberger A; Hille E. British Journal of Rheumatology, 1994 Dec, 33(12):1162-5. (UI: 95093857)
Pub type: Clinical Trial; Journal Article; Randomized Controlled Trial.

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Shoulder Pain (Acupuncture)

Acupuncture for shoulder pain

The purpose of the study is to compare the efficacy of electro-acupuncture with placebo-acupuncture for the treatment of shoulder pain. The participants are patients aged from 25 to 83 years with shoulder pain. They were randomly given two treatments over eight weeks, with electro-acupuncture or skin non-penetrating placebo-acupuncture, both able to take diclofenac, a NSAID, if needed for intense pain. The main outcome measure was the difference between groups in pain intensity (visual analogue scale-VAS). Secondary outcomes were differences between groups in pain intensity measured by Lattinen index, in range of motion (goniometer), functional ability (SPADI), quality of life (COOP-WONCA charts), NSAIDS intake, credibility (Borkoveck and Nau scale) and global satisfaction (10 points analogue scale).

Assessments were performed before, during and three and six months after treatment. At six months, the acupuncture group showed a much greater improvement in pain intensity compared with the placebo group. The acupuncture group had consistently better results in every secondary outcome measure than the placebo group. Acupuncture is an effective long-term treatment for patients with shoulder pain (from soft tissues lesions).

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Neck Pain (Acupuncture)

Treating chronic mechanical neck pain with acupuncture versus placebo

In order to compare acupuncture and placebo for neck pain, a randomized, single-blind, placebo-controlled, parallel-arm study was conducted with 135 patients 18 to 80 years of age who had chronic mechanical neck pain. A total of 124 patients completed the study. The patients were randomly assigned to receive, over 4 weeks, 8 treatments with acupuncture or with mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electro-acupuncture stimulation unit. Both groups improved statistically from baseline, and acupuncture and placebo had similar credibility. In conclusion, acupuncture did reduce neck pain and it produced a statistically, but not clinically, significant effect compared with placebo. The beneficial effects of acupuncture for pain may be due to both nonspecific and specific effects.

White P., et al. Complementary Medicine Research Unit, Mail Primary Medical Care, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom.

Small study shows reduced stiff neck pain

The use of subjective end-points such as VAS pain scales in studies of acupuncture for chronic neck pain have resulted in equivocal results. This study introduces an objective parameter as the primary end-point for the assessment of acupuncture in patients with acute torticollis (stiff neck).

Eighteen patients underwent a single 20-minute treatment session needling two acupuncture points -- Hou Xi (SI-3) and Zuo Zhen (M-UE-24) -- on the side ipsilateral to the predominantly involved side of the neck.
Measuring the angle of lateral head rotation using a simple compass and protractor revealed a mean improvement of 52.9%, more so among those presenting within less than 24 hours as opposed to more than 72 hours.

The author concludes that objective parameters, as seen in acupuncture research of the gastrointestinal and respiratory tracts, should be incorporated into studies of acute and chronic neck pain. The use of sham needle points and placebo needles is problematic since both may elicit physiological responses.

Samuels, N. Acupuncture for acute torticollis: a pilot study. The American Journal of Chinese Medicine 31(5): 803-7.

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Low Back Pain (Acupuncture)

Acupuncture for low back pain

The acupuncture treatment situation was beneficial to the majority of people with low back pain. This was shown by the use of short-term controls and long-term controls, although the latter were not intended in the study design. After acupuncture, there was a 51% pain reduction in the average pain score in the Immediate Treatment Group.

The short-term controls, the Delayed Treatment Group, had no reduction whatsoever in their pain scores at the comparable follow-up period. Later, the Delayed Treatment Group also treated by acupuncturists, and reported 62% less pain.

When these two treatment groups were compared at 40 weeks with long-term controls (Inadequate Treatment Group), the Inadequate Treatment Group still had the same pain scores, on the average, as when they enrolled in the study. Both treatment groups, on the average, had 30% lower pain scores. Furthermore, 58% of the treatment groups felt that they were definitely improved at 40 weeks, while only 11% of the Inadequate Treatment Group felt definitely improved at 40 weeks.

Coan RM; et al . Am J Chin Med, 8: 1-2, 1980 Spring-Summer, 181-9.

Transcutaneous electrical stumulation and acupuncture: comparison of treatments for low back pain

Twelve patients suffering chronic low-back pain were treated with both acupuncture and transcutaneous electrical stimulation. The order of treatments was balanced, and changes in the intensity and quality of pain were measured with the McGill Pain Questionnaire.

The results, based on a measure of overall pain intensity, show that pain relief greater than 33% was produced in 75% of the patients by acupuncture and in 66% by electrical stimulation. The mean duration of pain relief was 40 h after acupuncture and 23 h after electrical stimulation.

Although the mean scores are larger for acupuncture than for transcutaneous stimulation, statistical analyses of the data failed to reveal significant differences between the two treatments on any of the measures.

Both methods, therefore, appear to be equally effective, and probably have the same underlying mechanism of action. Consideration of the advantages and disadvantages of the two methods suggests that that transcutaneous electrical stimulation is potentially the more practical, since it can be administered under supervision by paramedical personnel.

By Fox EJ; Melzack R. Pain, 2: 2, 1976 Jun, 141-8

Efficacy of electroacupuncture and tens in the rehabilitation of chronic low back pain patients

Fifty-four patients treated in a 3-week inpatient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain (on a Visual Analogue Scale) and disability by both physician and patient, physical measures of trunk strength and spine range of motion, as well as the patient's perceptions of the relative contribution of the education, exercise training, and the electrical stimulation.

Analyses of variance were utilized to determine effects of treatment (electroacupuncture, TENS, placebo) across time (admission, discharge, and return) for the outcome measures.

There were no significant differences between treatment groups with respect to their overall rehabilitation. All 3 treatment groups ranked the contribution of the education as being greater than the electrical stimulation. However, the electroacupuncture group consistently demonstrated greater improvement on the outcome measures than the other treatment groups. For the visual analogue scale measure of average pain, there was a statistical trend at the return visit suggesting that the acupuncture group was experiencing less pain.

Lehmann TR; Russell DW; Spratt KF; Colby H; Liu YK; Fairchild ML; Christensen S. Pain, 26: 3, 1986 Sep, 277-90

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Scoliosis (Acupuncture)

Acupuncture reduces scoliosis

One session of acupuncture seems to have an influence on the deformity of some scoliosis patients. In a controlled single blind crossover study, verum acupuncture, carried out according to TCM principles, was compared with sham acupuncture and just lying in a group of 24 girls with adolescent idiopathic scoliosis. In a subgroup of patients with Cobb’s angle (a measurement used for evaluation of curvature in scoliosis) of no more than 35 degrees, significant changes in surface rotation and lateral deviation of vertebrae were found after real acupuncture only.

(Acupuncture in the treatment of scoliosis - a single blind controlled pilot study. Scoliosis. 2008 Jan 28;3:4.)

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