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Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain - ClinicalTrials.gov includes fibromyalgia

Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain -  ClinicalTrials.gov includes fibromyalgia | Acupuncture for CFS and ME | Scoop.it

Neuroimaging Approaches to Deconstructing Acupuncture for Chronic PainThis study is not yet open for participant recruitment.Verified February 2014 by University of MichiganSponsor:University of MichiganCollaborators:National Center for Complementary and Alternative Medicine (NCCAM)Massachusetts General HospitalInformation provided by (Responsible Party):Richard Harris, University of MichiganClinicalTrials.gov Identifier:NCT02064296First received: February 11, 2014Last updated: February 14, 2014Last verified: February 2014History of ChangesFull Text ViewTabular ViewNo Study Results PostedDisclaimerHow to Read a Study Record  Purpose

The aim of this study is to evaluate the impact of electro-acupuncture in pain processing on patients with fibromyalgia (FM). The investigators hypothesize that electro-acupuncture is effective for FM because it functions as a desensitization therapy, which when applied repeatedly over multiple treatment sessions, gradually habituates the nervous system to continuing pain and sensory signaling.


ConditionInterventionFibromyalgiaDevice: Needle acupuncture (Traditional Acupuncture)
Device: Laser acupuncture (Non-traditional Acupuncture)
Study Type:InterventionalStudy Design:Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: DiagnosticOfficial Title:Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain
Resource links provided by NLM:
MedlinePlus related topics: Acupuncture Acute Bronchitis Chronic Pain FibromyalgiaU.S. FDA Resources 
Further study details as provided by University of Michigan:
Primary Outcome Measures:Neurocircuitry underlying chronic pain [ Time Frame: At baseline ] [ Designated as safety issue: No ]Characterize the altered somatosensory-related neurocircuitry underlying chronic pain in FM.Change in brain connectivity and neurochemistry with acupuncture treatment [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]Brain neurochemistry and connectivity will be assessed at baseline and following either electroacupuncture or laser acupuncture.
Secondary Outcome Measures:Predicting response to acupuncture [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]Baseline neuroimaging outcomes of connectivity and neurochemistry will be used to predict subsequent response to electroacupuncture and laser acupuncture.
Estimated Enrollment:100Study Start Date:March 2014Estimated Study Completion Date:July 2019Estimated Primary Completion Date:October 2018 (Final data collection date for primary outcome measure)ArmsAssigned InterventionsNo Intervention: ControlsHealthy pain free controls will be recruited for comparison with fibromyalgia patients. Active Comparator: Non-Traditional Acupuncture40 fibromyalgia patients will be randomized to non-traditional laseracupuncture (Vita Laser 650, Lhasa OMS). They will receive 2 treatments per week for 4 weeks.Device: Laser acupuncture (Non-traditional Acupuncture)For non-traditional acupuncture, a laser acupuncture device will be positioned over all of the same acupoints used in EA. There will be no palpation prior to positioning these devices, and there will be no physical contact between device and skin.Active Comparator: Traditional Acupuncture40 fibromyalgia patients will be randomized to receive electro acupuncture (AS Super 4 digital needle stimulator, Harmony Medical Co) . They will receive 2 treatments per week for 4 weeks.Device: Needle acupuncture (Traditional Acupuncture)This group will receive needle acupuncture at 3 pairs of sites. The needles will be stimulated with low intensity, low frequency electric current using a constant-current electro-acupuncture device.
Detailed Description:

This study design has two components: 1) a cross sectional assessment of brain chemistry, connectivity and response to pain in healthy controls and age- and sex-matched fibromyalgia patients, and 2) a longitudinal assessment of the same outcomes in fibromyalgia patients randomized to either electro-acupuncture or laser acupuncture.

The investigators will evaluate 80 fibromyalgia patients who will receive acupuncture treatment twice a week for 4 weeks, for a total of 8 treatments. Baseline data from these patients will be compared to results from 20 pain-free controls.

Participants will undergo experimental pain assessments as well as brain neuroimaging.

  Eligibility

Ages Eligible for Study:  18 Years to 65 YearsGenders Eligible for Study:  FemaleAccepts Healthy Volunteers:  YesCriteria

Inclusion Criteria for Fibromyalgia Participants

Met the American College of Rheumatology (1990) criteria for the diagnosis of FM [2] for at least one year.Continued presence of pain more than 50% of days.Pain greater than 4 on a 10cm Visual Analog Scale (VAS) for pain; 7-day recall; [Note: The VAS is widely used in clinical pain research and as such we chose to use it for inclusion criteria and for clinical pain assessment below. Within our group numerical ratings scales 0-100 are more commonly used in quantitative sensory assessment, and as such we chose to use NRS scales for evoked pain assessments below.]Willing to limit the introduction of any new medications or treatment modalities for control of FM symptoms during the study.Able to travel to the study site to receive acupuncture treatments up to two times weekly.Over 18 and under 65 years of age.Right-handed.Female.Capable of giving written informed consent.

Inclusion Criteria for Healthy Control Participants

Over 18 and under 65 years of age.Female.Right-handed.Pain less than 4 on a 10cm Visual Analog Scale (VAS) for pain; 7-day recallWilling to complete all study procedures.Capable of giving written informed consent.

Exclusion Criteria for Fibromyalgia Participants:

Acupuncture within last 6-months.Presence of a known coagulation abnormality, thrombocytopenia, or bleeding diathesis that may preclude the safe use of acupuncture.Presence of a concurrent autoimmune or inflammatory disease such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc. that causes pain.Routine daily use of narcotic analgesics or history of substance abuse.Stimulant medications, such as those used to treat ADD/ADHD (e.g., amphetamine/ dextroamphetamine [Adderall®], methylphenidate, dextroamphetamine), or the fatigue associated with sleep apnea or shift work (e.g., modafinil), are excluded.Concurrent participation in other therapeutic trials.Pregnant or nursing.Severe psychiatric illnesses (current schizophrenia, major depression with suicidal ideation, substance abuse within two years).Contraindications to fcMRI, fMRI, or 1H-MRS methods. These may include but are not limited to: surgical clips, surgical staples, metal implants, and certain metallic dental material. [Note: a more formal description of contraindications for MRI is present in our DSM Plan].Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator that would prevent satisfactory completion of the study protocol. This includes unreliable, or inconsistent pain scores as deemed by the principal investigator.

Exclusion Criteria for Healthy Control Participants:

Have met the American College of Rheumatology (1990) criteria for the diagnosis of FM.Presence of a concurrent autoimmune or inflammatory disease such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc. that causes pain.Routine daily use of narcotic analgesics or history of substance abuse.Stimulant medications, such as those used to treat ADD/ADHD (e.g., amphetamine/ dextroamphetamine [Adderall®], methylphenidate, dextroamphetamine), or the fatigue associated with sleep apnea or shift work (e.g., modafinil), are excluded.Concurrent participation in other therapeutic trials.Pregnant or nursing.Severe psychiatric illnesses (current schizophrenia, major depression with suicidal ideation, substance abuse within two years).Contraindications to fcMRI, fMRI, or 1H-MRS methods. (see above section)Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator that would prevent satisfactory completion of the study protocol.  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT02064296

ContactsContact: U-M CPFRC1-866-288-0046acuafference@umich.edu
LocationsUnited States, MichiganChronic Pain and Fatigue Research CenterNot yet recruitingAnn Arbor, Michigan, United States, 48106Contact: CPFRC    866-288-0046    acuafference@umich.edu   Principal Investigator: Richard E Harris, PhD         Sub-Investigator: Steve E Harte, phD         Sub-Investigator: Bradly Foerster, MD         Sub-Investigator: Alex Tsodikov, PhD         Sub-Investigator: Daniel J Clauw, MD         Sponsors and CollaboratorsUniversity of MichiganNational Center for Complementary and Alternative Medicine (NCCAM)Massachusetts General HospitalInvestigatorsPrincipal Investigator:Richard E Harris, PhDUniversity of MichiganPrincipal Investigator:Viataly Napadow, PhDMassachusetts General Hospital  More Information
No publications provided 

Responsible Party:Richard Harris, Assistant Professor, University of MichiganClinicalTrials.gov Identifier:NCT02064296     History of ChangesOther Study ID Numbers:AcuAfference, R01AT007550Study First Received:February 11, 2014Last Updated:February 14, 2014Health Authority:United States: Institutional Review Board
Keywords provided by University of Michigan:Fibromyalgia Chronic Pain
Additional relevant MeSH terms:Fibromyalgia
Myofascial Pain Syndromes
Muscular Diseases
Musculoskeletal DiseasesRheumatic Diseases
Neuromuscular Diseases
Nervous System Diseases
ClinicalTrials.gov processed this record on March 05, 2014

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Acupuncture effects in CFS study - Effect of acupuncture intervention on learning-memory ability and cerebral superoxide dismutase activity and malonaldehyde concentration in chronic fatigue syndro...

Acupuncture effects in CFS study - Effect of acupuncture intervention on learning-memory ability and cerebral superoxide dismutase activity and malonaldehyde concentration in chronic fatigue syndro... | Acupuncture for CFS and ME | Scoop.it

Zhen Ci Yan Jiu. 2013 Dec;38(6):478-81.[Effect of acupuncture intervention on learning-memory ability and cerebral superoxide dismutase activity and malonaldehyde concentration in chronic fatigue syndrome rats].[Article in Chinese]Liu CZ1, Lei B2.Author information1School of Aesthetic Medicine of Yichun College, Yichun 336000, China. liuchangzheng1980@yahoo.com.cn2School of Aesthetic Medicine of Yichun College, Yichun 336000, China.AbstractOBJECTIVE:

To observe the effect of acupuncture intervention on learning-memory ability and cerebral superoxide dismutase (SOD) activity and malonaldehyde (MDA) content in chronic fatigure syndrome (CFS) rats so as to reveal its mechanism underlying improvement of clinical CFS.

METHODS:

Thirty-six male SD rats were randomly divided into control group, model group and acupuncture group (n = 12 in each group). CFS model was established by double stress stimulation of suspending (1.0 - 2.5 h increasing gradually) and forced swimming [Morris water maze tasks, 7 min in (10 +/- 1) degrees C water], once daily for 12 days. Manual acupuncture stimulation was applied to "Baihui" (CV 20), bilateral "Zusanli" (ST 36) and "Sanyinjiao" (SP 6), once daily for 21 days (with 3 days' interval between every two weeks). Learning-memory ability was determined by Morris water maze tests, and SOD activity and MDA concentration in the brain tissues were detected by xanthine oxidase method and thiobarbiturif acid method, respectively.

RESULTS:

Compared with the control group, the escape latencies at time-points of day 1, 2, 3, 4 and 5 of Morris water maze tests were significantly longer, the target platform crossing times were markedly fewer and the target platform quadrant staying time obviously shorter, cerebral SOD activity was considerably decreased, and cerebral MDA content remarkably increased in the model group (P < 0.05, P < 0.01). Following acupunctureintervention, the escape latencies at time-points of day 1, 2, 3, 4 and 5 were significantly decreased, both target platform crossing times and staying time, and cerebral SOD activity were apparently increased, as well as cerebral MDA level was markedly lowered in comparison with the model group (P<0.05, P<0.01).

CONCLUSION:

Acupuncture intervention can improve the learning-memory ability in CFS rats, which may be related to its effect in regulating metabolism of free radicals in the brain tissues.

PMID: 24588031 [PubMed - in process]

 

 

PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Acupuncture as Fibromyalgia and Chronic Fatigue Syndrome, including the research base

Acupuncture as Fibromyalgia and Chronic Fatigue Syndrome, including the research base | Acupuncture for CFS and ME | Scoop.it

Acupuncture treatments for fibromyalgia(FMS) and chronic fatigue syndrome (CFS orME/CFS) are becoming much more common, either alone or as a complementary therapy.

Chinese acupuncture dates back thousands of years as traditional Chinese medicine (TCM) but only caught the attention of the American public in the 1970s. The National Institutes of Health formally recognized acupuncture as part of mainstream medicine in 1997, saying the procedure is safe and effective at treating a wide range of conditions, including fibromyalgia.

 

The Research

Multiple studies from both the East and the West suggest that acupuncture is effective for treating FMS. In the West, it hasn't been studied as much for ME/CFS, but many Chinese studies suggest it's effective for that condition. Meta analyses of acupuncture for both conditions conclude that it appears to be a beneficial treatment, but that further high-quality research is needed.

As acupuncture has moved more into the mainstream, many insurance companies have added it to their policies, and some doctor's offices and clinics have begun to offer it at their facilities. Make sure you know the details of your insurance policy before assuming it will cover acupuncture treatments.

How Does Acupuncture Work?

While multiple studies have shown that acupuncture does have the effects taught by TCM, researchers can't pinpoint exactly why it has the effects. Research suggests that it may produce complex changes in the brain and body, possibly by stimulating nerve fibers that then send signals to the brain and spinal cord to release certain hormones that block pain and makes you feel better. A study using images of the brain showed that acupuncture raises your pain threshold -- which is low in people with FMS and ME/CFS -- and therefore gives you long-term pain relief. One British experiment using magnetoencephalography (MEG) brain scans showed that acupuncture actually can deactivate part of your brain's pain matrix.

 

 

According to TCM, acupuncture works by correcting energy pathways through your body. This life-force energy is called qi or chi (pronounced "chee"). Qi flows through meridians in the body, each of which corresponds to an organ or group of organs. If you have too much, too little, or blocked qi, TCM teaches that it will create health problems.

If this is hard to understand, picture a stream. If something blocks the flow of water, pressure builds up behind the blockage and water can go spilling out over the banks. Too much water can lead to floods, while too little water can kill off plants and animals that live there. The purpose of acupuncture is to keep the stream flowing free and at desired amounts.

Benefits vs. Risks

When you consider treatment options for FMS and ME/CFS, or any health condition for that matter, it's important to weigh the potential benefits against the potential risks.

According to experts, both Eastern and Western, the potential benefits of acupuncture include:

Less painBetter sleepRelaxationPossible immune system boostBetter overall health

Research released in 2008 showed that after 20 acupuncture treatments, people with FMS had significant improvements in pain and quality of life that lasted for 3 months after treatment was stopped, with a gradual decline in those areas until all benefit was gone after 2 years.

Acupuncture can be much safer than other therapies, especially if you're combining several different treatments. Benefits as a complementary therapy include:

No negative interactions with other treatments, including drugsExtremely mild side effectsLow risk

Possible risks of acupuncture are extremely rare, especially with a licensed acupuncturist. Risks include:

Infection from non-sterile needlesOrgan puncture (very rare occurrence)NauseaDizziness & faintingBruising

Licensed practitioners in the United States are required to use sterile needles and dispose of them after each use, but this is not required in all parts of the world.

An Acupuncture Exam

When you go to an acupuncturist, he/she will likely take your pulse at several points along both wrists. Don't be surprised if you're asked to stick out your tongue; in TCM, the tongue's shape, color and coating are important diagnostic tools.

The needles only go in about a centimeter. After inserting them, the acupuncturist will twist or gently wiggle them to get them firmly into the proper point. You might get a muscle twitch or brief ache, or you might feel nothing at all. Once all the needles are in (the amount used varies), you'll stay in place and rest for anywhere from 15 minutes to an hour. You'll probably be extremely relaxed and could even fall asleep. Afterward, the acupuncturist will pluck out the needles, which doesn't hurt at all.

A few hours after your first treatment, you could feel some aches around your body. This is normal, and practitioners say it's a sign that the treatment is working. The aches don't typically last long, and over-the-counter pain relievers will help. It's common to sleep more deeply than usual that night, which is a definite bonus for anyone with FMS and ME/CFS.

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FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Tender points Trigger points and Pressure points

FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Tender points Trigger points and Pressure points | Acupuncture for CFS and ME | Scoop.it

NOV2

Tender points Trigger points and Pressure points

 

Tender points, Trigger points and Pressure points (usually called acupressure points) are all different, but they are often mixed up, even by doctors.

Tender points (TPs)

Tender points, not trigger points, are part of the American College of Rheumatology's criteria for the diagnosis of Fibromyalgia Syndrome (Fibro).

The anatomic and physiological mechanisms accounting for the presence of TPs have received great attention, but nothing special about TPs has been found in research. Many experts now agree that they are just points on the body where everyone is more sensitive and so where it is easier to note and in some way quantify the hypersensitivity to pain of Fibro patients.

TPs occur in pairs on various parts of the body [1]. TPs hurt where pressed, but do not refer pain elsewhere and they are not hard knots (unlike Trigger Points)[2] - in fact there is nothing to be found at a TP site other than tenderness.

The American College of Rheumatology's guidelines for the diagnosis of Fibromyalgia [3] is that the patient should have widespread pain in all four quadrants of the body for a minimum duration of three months and tenderness or pain in at least 11 of the 18 specified tender points when a specific amount of pressure is applied (see figure below). Most healthy individuals experience pain in only a small number of tender points in response to this test. [4]

However, the criteria of “11 of 18" specific Fibro tender points were originally meant to screen patients for clinical study and not as diagnosis [1]. A range of things affect TPs including illness progression, injuries [2] and also gender - men with Fibro tend to "score" lower than women with Fibro, which is one factor behind the under-diagnosis of Fibro in men. For the tender point exam to have any meaning, you need a doctor who really knows what they are doing. See the article Explaining thr Tender Point Test for more details. A key part of this is knowing the difference between Tender Points and Trigger Points and being able to differentiate between them in the examination.

(Myofascial) Trigger points (TrPs or MTPs)

Trigger points are hard points in the myofascia that hurt to the touch and refer pain and/or other symptoms elsewhere.

There is no such thing as a Fibromyalgia Syndrome trigger point.[2]

Fascia is the semiflexible fibrous membrane of connective tissue that binds together the various components of the body. [5] The Myofascia is the fascia relating to the muscles - it covers individual muscle fibers, bundles them together and covers the whole muscles [5].

A substance within the myofascia is involved with the transfer of nutrients and removal of waste products in the muscles, and also keeps the muscle supple, preventing microadhesions from forming. If the myofascia is subjected to biochemical or mechanical trauma, then the fluids in it can thicken, even becoming hard, making the myofascia tighten. Microadhesions then form between the muscle fibres, which is what the tight bands or knots of the TrPs are. [2][6]

This fibrous myofascial adhesion affects the nerves around the muscle, disrupting their normal function, which is how the TrPs trigger symptoms away from themselves. [6]

TrPs seem to form as a response to things happening to our bodies, such as overuse, repetitive motion trauma, bruises, strains, joint problems, surgery, or stress. Pain creates a neuromuscular response, and the muscle around the pain site tightens, "guarding" the hurt area. Stress can cause you to tense muscles for no reason other than a stilled form of the fight or flight instinct. [6]

When muscles are in a state of sustained tension, they are working, even if you're not. A working muscle needs more nutrition and oxygen, and produces more waste, than a muscle at rest. And unlike when you exercise and work muscles that way, increased blood flow isn't supplied to deal with the demands. This creates an area in the myofascia starved for food and oxygen and loaded with toxic waste — a TrP. [6]

An active TrP not only hurts when it is pressed, but it "triggers" a referred pain pattern or other symptoms locally or elsewhere in the body. This pattern from specific TrPs is usually similar from patient to patient and charts are available depicting pain referral patterns from TrPs. An active TrP hurts whenever you use the involved muscle and if a TrP becomes very active, symptoms occur even when the muscle is at rest.[6]

TrPs can cause a wide range of symptoms including:

Stabbing pains.Burning pain.Stuffy sinuses.Headaches & migraine.Nausea.Reduced mobility.

 

Acupressure points

Acupressure (a combination of "acupuncture" and "pressure") is a traditional Chinese medicine technique based on the same ideas as acupuncture. Acupressure involves placing physical pressure by hand, elbow, or with the aid of various devices on different acupuncture points on the surface of the body. Acupressure points can do a variety of things including relieve pain.

References:

Starlanyl DJ, 2003. Fibromyalgia and Chronic Myofascial Pain: Keys to Diagnosis and Treatment [website]. Available: http://www.sover.net/~devstar/physinfo.htm [Nov 2008]Starlanyl DJ, 2004. Trigger Points and Tender Points: Why the Difference Is Important to You [online paper]. Available: http://www.sover.net/~devstar/TrPs_and_TPs.pdf [Nov 2008]Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990;33:160---72.National Fibromyalgia Association. Glossary of Research and Other Fibromyalgia Terms and Definitions [website]. Available: http://www.fmaware.org/site/PageServer?pagename=resources_glossaryTermsDefinitions#T [Nov 2008]Clark GA. Fascia & Myofascia [website]. Available: http://www.painbustersclinic.com.au/body/fascia.htm [Nov 2008]Starlanyl DJ, Copeland ME, 2007. Fibromyalgia and Chronic Myofascial Pain: Patient Information [website]. Available: http://www.sover.net/~devstar/define.htm [Nov 2008]

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Article: "Acupuncture Heals Chronic Fatigue Syndrome"

Article: "Acupuncture Heals Chronic Fatigue Syndrome" | Acupuncture for CFS and ME | Scoop.it
Acupuncture heals CFS (Chronic Fatigue Syndrome) and is enhanced by electroacupuncture with ICT.

 

Acupuncture Heals Chronic Fatigue Syndrome

on 20 June 2014.

 

Researchers conclude that acupuncture is effective for the treatment of chronic fatigue syndrome (CFS). A remarkable finding was made in this study. Acupuncture combined with interferential current therapy increased the success rate of acupuncture. The total effective rate of acupuncture as a standalone procedure was 80.0%. Adding interferential current therapy to the regime of care increased the total effective rate to 93.3%. 

A complete recovery rate of 20.0% was achieved with acupuncture as a standalone therapy for CFS patients in 20 office visits. In the same period of time and same number of treatments, the combined therapy approach of acupuncture plus interferential current therapy (ICT) raised the complete recovery rate to 43.3%. As a result the researchers conclude, “Electroacupuncture plus ICT can produce a remarkable efficacy in treating CFS.”

The total effective rate and complete recovery rate increased significantly by adding ICT to acupuncture therapy. This is an important finding now that studies indicate that CFS exceeds 10% of the white-collar working population. CFS is characterized by extreme fatigue often without an identifiable biochemical or organic cause. CFS may also involve musculoskeletal pain, sleep disorders, headaches, impaired cognition and memory, swollen or tender lymph nodes, chronic sore throat, persistent low grade fever, mental illness and exhaustion after physical or mental exertion.

Doctors and scientists note that the etiology may not be known or may be due to viral infections, immune system disorders and/or hormonal imbalances. Chronic fatigue syndrome occurs at any age but is most prevalent in the 40s and 50s. Women are more susceptible to CFS. Patients that are either overweight or inactive have a higher incidence of CFS. Many sources cite stress as a causative, aggravating and/or exacerbating factor. Complications due to CFS may be restrictions on activities of daily living, increases in work absenteeism and depression. 

This CFS study was conducted by researchers from the Taihe Hospital affiliated with the Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine. Diagnostic criteria for inclusion followed standard Centers for Disease Control and Prevention (CDC) guidelines. Patients were required to have at least 6 months of unexplained persistent or recurrent extreme fatigue that is debilitating and cannot be relieved by rest. Activities of daily living must have shown a decrease by at least 50%. Each patient must have had at least 4 of the following symptoms: persistent post-exertion fatigue, sleep dysfunction, musculoskeletal pain, pharyngolaryngitis, cognition impairment or memory loss, joint pain that is not accompanied by redness or swelling, lymph node swelling in the armpit or neck, headaches. 

Hubei University of Chinese Medicine

The type of acupuncture employed in the study was electroacupuncture. The process was as follows. Once deqi arrived at the acupoints, manual acupuncture was applied with an even reinforcing-reducing method. The needles were retained for 20 minutes. Next, between 4-6 acupuncture points were given electroacupuncture stimulation using a sparse-dense wave to a perceptibly tolerable intensity level. The electroacupuncture device was machine G-6805 produced by Suzhou Hwato Medical Instrument Co. Ltd.

Acupuncture points used in the study were: GV20 (Baihui), CV4 (Guanyuan), CV6 (Qihai), BL25 (Xinshu), BL18 (Ganshu), BL13 (Feishu), BL20 (Pishu), BL23 (Shenshu), PC6 (Neiguan), HT7 (Shenmen), SP6 (Sanyinjiao), ST36 (Zusanli). Many of these acupuncture points are classically used in Traditional Chinese Medicine (TCM) for the tonification of qi. Between 5-7 of the aforementioned points were chosen for each patient using sterilized filiform needles of 0.30 mm diameter and 40 mm length to depths ranging from 1-1.3 cun. A total of 10 sessions comprised 1 course of care and 2 courses of care were administered.

A stereo dynamic interferential electrotherapy device, model LDG-2 (Japan), was used for the ICT. Two groups of 4 X 4 cm electrodes were used with a 5 kHz frequency. One group of electrodes was applied to the trapezius muscles and the other group was applied to the spine between acupuncture points BL15 and BL23. Intensity levels were set to patient tolerance levels wherein tingling could be felt at the site of the electrodes. ICT was applied for a total of 30 minutes for each treatment. A total of ten sessions comprised one course of care and 2 courses of care were administered.

A complete recovery was defined as all major symptoms and complications were completely resolved. In addition, a complete recovery included the criteria that a patient returned to both a normal social life and a normal work life and schedule. Electroacupuncture as a standalone procedure was significantly effective but the addition of ICT enhanced the positive patient outcomes significantly.

Reference:
Huang, Fang, Xiong Chen, Li-zhi Zhou, Ping Huang, and Li-hong Guo. "Clinical study on electroacupuncture plus interferential current therapy for chronic fatigue syndrome." Journal of Acupuncture and Tuina Science 12, no. 3 (2014): 156-159.

 

 

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1333-acupuncture-heals-chronic-fatigue-syndrome#sthash.nexAILUE.dpuf

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Acupuncture for treating fibromyalgia - The Cochrane Library - Deare - Wiley Online Library

 

One in five fibromyalgia sufferers use acupuncture treatment within two years of diagnosis.

 

Objectives

 

To examine the benefits and safety of acupuncture treatment for fibromyalgia.

 

Search methods

 

We searched CENTRAL, PubMed, EMBASE, CINAHL, National Research Register, HSR Project and Current Contents, as well as the Chinese databases VIP and Wangfang to January 2012 with no language restrictions.

 

Selection criteria

 

Randomised and quasi-randomised studies evaluating any type of invasive acupuncture for fibromyalgia diagnosed according to the American College of Rheumatology (ACR) criteria, and reporting any main outcome: pain, physical function, fatigue, sleep, total well-being, stiffness and adverse events.

 

Data collection and analysis

 

Two author pairs selected trials, extracted data and assessed risk of bias. Treatment effects were reported as standardised mean differences (SMD) and 95% confidence intervals (CI) for continuous outcomes using different measurement tools (pain, physical function, fatigue, sleep, total well-being and stiffness) and risk ratio (RR) and 95% CI for dichotomous outcomes (adverse events). We pooled data using the random-effects model.

 

Main results

 

Nine trials (395 participants) were included. All studies except one were at low risk of selection bias; five were at risk of selective reporting bias (favouring either treatment group); two were subject to attrition bias (favouring acupuncture); three were subject to performance bias (favouring acupuncture) and one to detection bias (favouring acupuncture). Three studies utilised electro-acupuncture (EA) with the remainder using manual acupuncture (MA) without electrical stimulation. All studies used 'formula acupuncture' except for one, which used trigger points.

 

Low quality evidence from one study (13 participants) showed EA improved symptoms with no adverse events at one month following treatment. Mean pain in the non-treatment control group was 70 points on a 100 point scale; EA reduced pain by a mean of 22 points (95% confidence interval (CI) 4 to 41), or 22% absolute improvement. Control group global well-being was 66.5 points on a 100 point scale; EA improved well-being by a mean of 15 points (95% CI 5 to 26 points). Control group stiffness was 4.8 points on a 0 to 10 point; EA reduced stiffness by a mean of 0.9 points (95% CI 0.1 to 2 points; absolute reduction 9%, 95% CI 4% to 16%). Fatigue was 4.5 points (10 point scale) without treatment; EA reduced fatigue by a mean of 1 point (95% CI 0.22 to 2 points), absolute reduction 11% (2% to 20%). There was no difference in sleep quality (MD 0.4 points, 95% CI -1 to 0.21 points, 10 point scale), and physical function was not reported.

 

Moderate quality evidence from six studies (286 participants) indicated that acupuncture (EA or MA) was no better than sham acupuncture, except for less stiffness at one month. Subgroup analysis of two studies (104 participants) indicated benefits of EA. Mean pain was 70 points on 0 to 100 point scale with sham treatment; EA reduced pain by 13% (5% to 22%); (SMD -0.63, 95% CI -1.02 to -0.23). Global well-being was 5.2 points on a 10 point scale with sham treatment; EA improved well-being: SMD 0.65, 95% CI 0.26 to 1.05; absolute improvement 11% (4% to 17%). EA improved sleep, from 3 points on a 0 to 10 point scale in the sham group: SMD 0.40 (95% CI 0.01 to 0.79); absolute improvement 8% (0.2% to 16%). Low-quality evidence from one study suggested that MA group resulted in poorer physical function: mean function in the sham group was 28 points (100 point scale); treatment worsened function by a mean of 6 points (95% CI -10.9 to -0.7). Low-quality evidence from three trials (289 participants) suggested no difference in adverse events between real (9%) and sham acupuncture (35%); RR 0.44 (95% CI 0.12 to 1.63).

 

Moderate quality evidence from one study (58 participants) found that compared with standard therapy alone (antidepressants and exercise), adjunct acupuncture therapy reduced pain at one month after treatment: mean pain was 8 points on a 0 to 10 point scale in the standard therapy group; treatment reduced pain by 3 points (95% CI -3.9 to -2.1), an absolute reduction of 30% (21% to 39%). Two people treated with acupuncture reported adverse events; there were none in the control group (RR 3.57; 95% CI 0.18 to 71.21). Global well-being, sleep, fatigue and stiffness were not reported. Physical function data were not usable.

 

Low quality evidence from one study (38 participants) showed a short-term benefit of acupuncture over antidepressants in pain relief: mean pain was 29 points (0 to 100 point scale) in the antidepressant group; acupuncture reduced pain by 17 points (95% CI -24.1 to -10.5). Other outcomes or adverse events were not reported.

Moderate-quality evidence from one study (41 participants) indicated that deep needling with or without deqi did not differ in pain, fatigue, function or adverse events. Other outcomes were not reported.

Four studies reported no differences between acupuncture and control or other treatments described at six to seven months follow-up.

No serious adverse events were reported, but there were insufficient adverse events to be certain of the risks.

 

Authors' conclusions

 

There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.

 Jump to…Plain language summaryAcupuncture for fibromyalgia

This summary of a Cochrane review presents what we know from research about the effect of acupuncture on fibromyalgia.

 

The review shows that in people with fibromyalgia:

 

- acupuncture is probably better than non-acupuncture treatment in reducing pain and stiffness and improving overall well-being and fatigue;

- acupuncture with electrical stimulation is probably better than needling alone in reducing pain and stiffness, and improving overall well-being, sleep and fatigue;

- acupuncture without electrical stimulation probably does not reduce pain or improve fatigue, overall well-being or sleep; and

- acupuncture probably enhances the effect of drugs and exercise on pain.

 

What is fibromyalgia and what is acupuncture?

 

When you have fibromyalgia, you experience pain in many sites of your body, with a range of other symptoms including joint stiffness, sleep disturbance, fatigue and mood disorders, which affect the quality of life. There is no cure and few treatment options for fibromyalgia at present, so the treatments aim to relieve pain and improve your well-being and the ability to function.

Acupuncture is a form of Chinese medicine and uses fine needles to stimulate certain areas of the body, called acupuncture points. Acupuncture is commonly used by people to reduce various forms of pain. It works by reducing inflammation, stimulating the release of your body's own pain killer, that is endorphins, and calming your brain. It is safe with few, short-lasting side effects. If supported by the overall body of evidence, acupuncture will offer much needed effective symptom relief for fibromyalgia.

Best estimate of what happens to people with fibromyalgia who use acupuncture:

Comparing acupuncture with sham interventions

Pain (higher scores mean worse or more severe pain)

- People who had needle acupuncture with electrical stimulation rated their pain to be 13 points lower on a 100-point scale (absolute improvement) after six sessions of treatment.

- People who had fake acupuncture rated their pain to be 70 on a scale of 0 to 100 at the end of treatment.

- People who had needle acupuncture with electrical stimulation rated their pain to be 57.

Physical function (higher scores mean better function):

- People who used needle acupuncture without electrical stimulation rated their physical function to be six points lower (absolute deterioration).

- People who had fake treatment rated their physical function to be 28 on a scale of 0 to 100 at the end of treatment.

- People who had needle acupuncture without electrical stimulation rated their physical function to be 22.

- There are no data on needle acupuncture with electrical stimulation.

Global well-being rated by participants (higher scores mean better function):

- People who had needle acupuncture with electrical stimulation rated their well-being to be 11 points higher (absolute improvement).

- People who had fake treatment rated their well-being to be 41 on a scale of 0 to 100 at the end of treatment.

- People who had needle acupuncture with electrical stimulation rated their well-being to be 52.

Sleep (higher scores mean better sleep):

- People who used acupuncture rated their sleep to be eight points higher (absolute improvement).

- People who had fake treatment rated their sleep to be 30 on a scale of 0 to 100 at the end of treatment.

- People who had needle acupuncture with electrical stimulation rated their sleep to be 38.

Fatigue (higher scores mean more severe fatigue):

- People who had needle acupuncture with electrical stimulation rated their fatigue to be 15 points lower (absolute improvement).

- People who had fake treatment rated their fatigue to be 78 on a scale of 0 to 100.

- People who had needle acupuncture with electrical stimulation rated their fatigue to be 63.

Stiffness (higher scores mean more severe stiffness):

- People who had needle acupuncture with electrical stimulation rated their stiffness to be nine points lower (absolute improvement).

- People who had fake treatment rated their stiffness to be 66 on a scale of 0 to 100 at the end of treatment.

- People who had needle acupuncture with electrical stimulation rated their stiffness to be 57.

- Data on needle acupuncture without electrical acupuncture were not available.

Adverse effects:

- One in six people who had acupuncture reported adverse events.

- One in three people who had fake treatments reported adverse events.

- Overall, such events were minor and lasted less than one day.

Acupuncture as an adjunct therapy

Pain (higher scores mean more severe pain):

- People who had needle acupuncture in addition to a standard treatment of exercise and medication (antidepressants) rated their pain to be 30 points lower on a scale of 0 to 100 (absolute improvement) after 20 sessions of acupuncture.

- People who had standard therapy rated their pain to be 80 on a scale of 0 to 100 at the end of treatment.

- People who had additional acupuncture treatment rated their pain to be 50.

Acupuncture compared with antidepressants

Pain (higher scores mean more severe pain):

- People who had acupuncture rated their pain to be 17 points lower (absolute improvement) after 28 sessions of acupuncture.

- People who had antidepressants rated their pain to be 29 on a scale of 0 to 100 at the end of treatment.

- People who had acupuncture treatment rated their pain to be 12.

Comparing acupuncture with non-acupuncture (wait list)

- People who had needle acupuncture with electrical stimulation rated 23, 11 and 9 points lower on a 100-point scale for pain, fatigue and stiffness, respectively; and reported their global well-being to be 15 points better than those who did not have acupuncture.

Bedford Acupuncture's insight:

"acupuncture probably enhances the effect of drugs and exercise on pain."

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Understanding Acupuncture - NIH News in Health, February 2011 - fibromyalgia and chronic fatigue

Understanding Acupuncture - NIH News in Health, February 2011 - fibromyalgia and chronic fatigue | Acupuncture for CFS and ME | Scoop.it
Scientists have found that acupuncture can help with certain conditions, such as back pain, knee pain, headaches and osteoarthritis. But how it works is something of a mystery.

 

t’s hard to design placebo-controlled studies of acupuncture when we don’t understand what the active component of the intervention is,” explains Dr. Richard E. Harris, an NIH-funded researcher at the Chronic Pain and Fatigue Research Center in Ann Arbor, Michigan.

 

Treatment for pain is the best-studied aspect of acupuncture. Many parts of the brain are connected in the processing of pain, and how much pain you feel partly depends on context. “If a person has an injury in battle, they might not feel it,” Sherman explains, “but if they have a similar injury just walking down the street, they might just think it was dreadful.”

 

“If you look at some of the data, what you find is that sham acupuncture and true acupuncture both produce some pain relief in whatever condition they’re looking at,” Nahin says. “But while both treatments turn on areas of the brain, they turn on different areas of the brain.”

 

Harris and his colleagues, in studies of fibromyalgia patients, have found differences at the molecular level as well. “We were able to show that sham acupuncture and real acupuncture both reduced pain in fibromyalgia patients equally,” he says, “but they do it by different mechanisms.”

 

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EVIDENCE MAP OF ACUPUNCTURE FOR PAIN - Evidence Map of Acupuncture - NCBI Bookshelf

EVIDENCE MAP OF ACUPUNCTURE FOR PAIN - Evidence Map of Acupuncture - NCBI Bookshelf | Acupuncture for CFS and ME | Scoop.it

Legend: The bubble plot shows an estimate of the evidence base for pain-related indications judging from systematic reviews and recent large RCTs. The plot depicts the estimated size of the literature (y-axis, number of RCTs included in largest review), the estimated effect (x-axis), and the confidence in the estimate (bubble size).

The figure provides a broad visual overview over the evidence base. The bubble plot depicts the estimated research volume based on the number of acupuncture RCTs included in the largest review summarizing the clinical indication, the estimated treatment effect of acupuncture compared to passive control, and the confidence in the effect, judging from published systematic reviews. Estimates of the size of the treatment effect based on specific individual reviews as well as reason for classifying the evidence base as inconclusive are reported in the narrative synthesis. The evidence map used the clinical topics as addressed in existing reviews, and individual research studies may have contributed to a number of included reviews and clinical indications. All 3 depicted dimensions (literature size, effect, and confidence) are estimates and can only provide a broad overview of the evidence base.

EXECUTIVE SUMMARY: PAIN

As shown in the bubble plot, a large number of studies have addressed the treatment of headaches with acupuncture; a 2008 review included 31 RCTs124 and 5 independent systematic reviews have been published since 2005. A Cochrane review on tension-type headache by Linde et al., last updated in 2009, reported that 3 to 4 months after randomization, the pooled responder rate ratio was 1.24 (95% confidence interval [CI]: 1.05, 1.46) with 50% responders in the acupuncture groups compared to 41% in sham groups across 4 RCTs.120 The review concluded that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches. A 2012 individual patient data meta-analysis published by Vickers et al for the Acupuncture Trialists' Collaboration included data from 29 RCTs evaluating acupuncture for chronic pain.47 The review reported that patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI: 0.13, 0.33), 0.16 (95% CI: 0.07, 0.25) and 0.15 (95% CI: 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache. The review concluded that acupuncture is effective for the treatment of chronic pain and is a reasonable referral option. However, the most recent available best evidence syntheses concentrating on back pain, neck pain, or osteoarthritis individually do not summarize the evidence as equally unrestrictedly positive, as outlined further below. Thus, the conclusion that acupuncture had evidence of effectiveness with high confidence for chronic pain patients is currently still limited by the lack of conclusive evidence syntheses for the individual conditions that make up 50-65% of chronic pain, namely back pain and neck pain. There is considerable research available for migraine prophylaxis; a 2009 Cochrane review by the same author group working on headaches included 22 acupuncture RCTs.121 The review reported sufficient detail for a reanalysis and a positive effect across all passive controlled RCTs as defined in this review of reviews was identified. However, it should be noted that effects were driven by RCTs comparing acupuncture to no acupuncture (relative risk [RR] 2.33; 95% CI: 2.02, 2.69), not RCTs comparing acupuncture and sham (RR 1.13; 95% CI: 0.95, 1.35). The review concluded that acupuncture should be considered a treatment option for patients willing to undergo this treatment. More than half of the 7 included RCTs on chronic headaches included in the chronic pain IPD meta-analysis47 are also included in the Cochrane reviews on headaches and migraine.

Dysmenorrhea has also been addressed in a large number of primary studies; a 2010 systematic review on primary dysmenorrhea included 27 RCTs.92 A Cochrane review on dysmenorrhea last updated in 2012 reported an improvement in pain relief from acupuncture compared with placebo control (odds ratio [OR] 9.5, 95% CI: 21.17, 51.8) and concluded that acupuncture may reduce period pain but further well-designed RCTs are needed.72 Osteoarthritis has also been targeted in a large number of systematic reviews (we identified 6 recent reviews from independent author groups) and individual research studies; a 2012 Centre for Reviews and Dissemination (CRD) network meta-analysis on the relief of chronic pain due to osteoarthritis of the knee included 22 acupuncture RCTs.174 The report, comparing different physical treatments, concluded that acupuncture is one of a number of physical treatments that produces a clinically-relevant effect in alleviating pain in the short-term, and although further research is needed to substantiate these conclusions, acupuncture should be considered as an evidence-based treatment option for relieving pain due to osteoarthritis of the knee. A 2010 Cochrane review on acupuncture for peripheral joint osteoarthritis reported positive results for acupuncture in comparison to sham and waiting list control but not as add-on treatment compared to exercise-based physiotherapy alone. The review concluded that benefits compared to shame were small, did not meet pre-defined thresholds for clinical relevance, and were probably due at least partially to placebo effects from incomplete blinding, while effects compared to waiting list were clinically relevant but could be associated with expectation or placebo effects.97 A recent RCT206 not yet included in the existing systematic reviews and one of the largest available studies on acupuncture and osteoarthritis (N=527) reported no statistically significant differences between acupuncture and sham, but a reanalysis combining the largest review and this trial showed that the pooled treatment effect would remain positive if included in an updated meta-analysis. The IPD meta-analysis on chronic pain47 included 9 osteoarthritis RCTs. Acupuncture for pain management regardless of the underlying conditions has been addressed in some of the identified reviews; the largest review on auriculotherapy for pain management included 17 RCTs.78The review reported auriculotherapy was superior to controls for studies evaluating pain intensity (standardized mean difference [SMD] 1.56, 95% CI: 0.85, 2.26) but concluded that a more accurate estimate of the effect requires further large, well-designed trials. A 2009 systematic review on acupuncture for pain treatment published in the BMJ concluded that a small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias.119 A 2013 review on acupuncture for ankle sprain included 17 RCTs.30 The review found that significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture (RR 0.56, 95% CI: 0.42, 0.77), but the review was primarily based on non-indexed publications, trial quality was poor, no sham controlled RCT was identified, and the review concluded that given methodological shortcomings and the small number of high-quality primary studies, the available evidence is insufficient to recommend acupuncture as an evidence-based treatment option. Cancer-associated pain has been addressed in 15 RCTs according to the largest recent review.59 A 2012 Cochrane review identified one relevant RCT that showed statistically significant differences between the acupuncture and placebo groups but the review concluded there is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.73 Labor pain has also been addressed in a number of primary studies; a 2010 review included 10 RCTs.85 A 2011 Cochrane review reported less intense pain from acupuncture compared with no intervention (SMD -1.00, 95% CI: -1.33, -.067) and positive effects for other outcomes and comparators; however, all comparisons were based on one RCT each and the review concluded acupuncture may have a role in relieving pain during labor but more research is needed.67

Positive effects were also reported for other clinical indications; however the evidence base was considerably smaller. A review onprostatitis / chronic pelvic pain syndrome included 9 acupuncture RCTs in total and reported a positive effect of acupuncture compared to sham (RR 1.56, 95% CI: 1.09, 2.24); however this result was based on one RCT only.71 The largest of 4 recent reviews on temporomandibular joint disorders included 7 RCTs in total.195 The review reported significant improvements in pain intensity for a visual analogue scale (weighted mean difference [WMD] -12.6, 95% CI: -21.2, -6.1) but concluded that further rigorous studies are required to establish beyond doubt whether acupuncture has therapeutic value for this indication. A review on acupuncture for plantar heel pain included 5 RCTs and the passive controlled RCTs reported statistically significant positive results for pain outcomes, but only 2 RCTs were classified as high quality and no pooled result was presented to determine the size of the treatment effect.44 A review specific to pregnancy-associated pelvic and back pain included 3 RCTs in total and both acupuncture as add-on treatment RCTs reported statistically significant results. However, no pooled effect was presented to estimate the size of the treatment effect.143

Acupuncture for the treatment of back pain has received a great deal of research attention but the evidence base regarding the effectiveness of acupuncture remains unclear judging from the available systematic reviews. We identified 10 recent systematic reviews on acupuncture for back pain and the largest review, a review on the efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine published by Furlan et al in 2012, included 33 acupuncture RCTs.62 The review showed a positive effect of acupuncture compared to no treatment but noted that sham-acupuncture controlled trials tended towards statistically nonsignificant results. A 2005 evidence synthesis on low back pain within the framework of the Cochrane Collaboration concluded that the data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain.170 It is noteworthy that the IPD meta-analysis (see above) on chronic pain which concluded that acupuncture is effective for treating chronic pain also included 10 back pain studies. The largest review on neck pain is the review by Furlan et al. 62 published in 2012; it includes 24 acupuncture RCTs. The review came to the same conclusion as for back pain while 2 smaller reviews reported favorable results for acupuncture. The IPD meta-analysis by Vickers at al included some back pain and neck pain studies but was limited to chronic pain (defined as the current episode of pain being of at least 4 weeks' duration), a pooled result was only given for a combined back and neck pain analysis, and indication-specific effects or the individual size of the treatment effect are not known. Acupuncture effects on analgesia during surgery were reviewed by Lee and Ernst in 2005; the review included 19 RCTs and the evidence was judged to be inconclusive. Two systematic reviews on postoperative pain were published in 2008. The study selection was not identical across reviews and there were inconsistent results across included studies; one of the review concluded the evidence that auricular acupuncture reduces postoperative pain is promising but not compelling.123 Fibromyalgia has been addressed in 12 RCTs according to one of 3 recent systematic reviews; effectiveness results are inconsistent within and across reviews. Results regarding shoulder pain are also inconclusive. A 2012 review on shoulder pain after stroke included 3 relevant acupuncture RCTs but did not report a pooled treatment effect estimate; a Cochrane review on shoulder pain, last updated in 2005, identified 9 RCTs with varying results and concluded that due to a small number of clinical and methodological diverse trials, little can be concluded from the review.167,207 The evidence base for rheumatoid arthritis is also unclear and insufficient data were reported to determine the effectiveness across reviews and included trials. A Cochrane review last updated in 2005 highlighted that conclusions are limited by methodological considerations such as the type of acupuncture, the site of intervention, the small number of clinical trials, and the small sample size of the included studies.165

A single review on carpal tunnel syndrome was identified that included 6 RCTs. The review did not find statistically significant differences in 2 sham controlled RCTs and conflicting results across outcomes for acupuncture as an add-on treatment in a further RCT.

In addition, a small number of reviews were identified that could not be incorporated in the bubble plot. They addressed primarily the comparative effectiveness of acupuncture in relation to other treatments. The reviews reported that acupuncture was more effective than conventional pharmacological therapies in the treatment of gouty arthritis35 and neurovascular headache (although this is based on a very limited number of studies),69 more effective than Chinese herbal medicine for endometriosis,65 but no more effective than pharmacological sedation for egg retrieval during assisted reproductive therapy173 and of similar efficacy ascarbamazepine for trigeminal neuralgia in the existing low-quality studies.181 One systematic review on myofascial trigger point pain reported positive results. However, the number of traditional acupuncture trials, rather than trials on dry needling inserted directly into the trigger points, supporting the result was not reported. A systematic review on acupuncture or acupoint injection for management of burning mouth syndrome180 found injections to be superior to laser acupuncture; no passive controlled acupuncture RCTs were identified.

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The Status and Future of Acupuncture Mechanism Research: Fibromyalgia

The Status and Future of Acupuncture Mechanism Research: Fibromyalgia | Acupuncture for CFS and ME | Scoop.it

[...]

 

Functional Neuroimaging of Acupuncture in Fibromyalgia: Insights into Mechanisms and Clinical Trial Design (Harris)

Fibromyalgia (FM) is a common chronic pain condition that afflicts approximately 2%–4% of individuals in industrialized countries.67Although the underlying pathology of this condition is unknown, a disturbance in central neural function has been suggested. Research using fMRI has shown that brain regions known to process and modulate pain information have augmented activity in these patients.68,69 More recently, positron emission tomography (PET), a brain-imaging technique that can be used to assess static and dynamic aspects of neurotransmitter systems, has been used to studyμ-opioid receptor (MOR)–binding ability in FM.70MORs within the nucleus accumbens, the cingulate, and the amygdala show reduced binding ability in patients with FM. Because these receptors normally function to inhibit neural activity, these patients may have reduced inhibitory neurotransmission in pain-modulating brain regions.

Several clinical trials of acupuncture in FM have been performed to date; however, the findings have been equivocal, with most studies showing that acupuncture and sham acupuncture (SA) are equally effective for reducing pain.71–73 As a consequence, the acupuncture field has had trouble separating acupuncture analgesic effects from placebo effects in FM. Neuroimaging methods such as PET may provide insights into this problem. Because MORs have been implicated in both acupuncture as well as placebo analgesia,74,75 functional imaging of these receptors may provide information into acupuncture effects.

We utilized PET imaging to find out whether acupuncture and SA would have the same effects on central opioid receptors in patients with FM. Seventeen (17) patients with FM were randomized to receive either 9 traditional acupuncture (TA; n=9) or 9 SA (n=8) sessions over the course of 1 month. PET imaging and clinical pain ratings, assessed with the short form of the McGill Pain Questionnaire (SFMPQ), were performed pre- and post-treatment.

As expected there, was no difference in clinical pain reduction for both groups (SFMPQ total: MeanDiff (standard deviation) TA=5.4 (9.6); SA=2.3 (6.4); p=0.44). However the two interventions had dramatically different effects on central MOR binding ability. In the insula, the amygdala, the thalamus, the cingulate (anterior and perigenual), the caudate, and the prefrontal cortex, TA caused an increase in MOR binding ability, whereas SA caused a decrease in receptor binding ability (all p<0.001; uncorrected). These data suggest that, while acupuncture and SA have similar effects on clinical pain, their underlying opioid-receptor mechanisms are not equivalent.

Results from neuroimaging studies such as these have had minimal impact on clinical trials of acupuncture to date. If TA is not simply the sum of SA plus any specific needling effects, this finding has implications for the design of acupuncture clinical trials. One may not be able to assume that the effects of SA are embedded in the active treatment arm in the same way that “placebo effects” are thought to operate in the active arm of a drug trial. Replication and validation of these findings requires further investigation.

 

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Search of: Acupuncture | Open Studies | Exclude Unknown | NCCAM - List Results - ClinicalTrials.gov

Search of: Acupuncture | Open Studies | Exclude Unknown | NCCAM - List Results - ClinicalTrials.gov | Acupuncture for CFS and ME | Scoop.it

RankStatusStudy1

Not yet recruiting

 

Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain

 

Condition:

Fibromyalgia

 

Interventions:Device: Needle acupuncture (Traditional Acupuncture);   Device: Laser acupuncture (Non-traditional Acupuncture)2RecruitingS1200: Acupuncture, Sham Acupuncture,

 

or Wait List for Joint Symptoms Related to Aromatase Inhibitors in Pts W/Early-Stage Breast CancerConditions:Breast Cancer;   PainInterventions:Procedure: acupuncture therapy;  

 

Procedure: sham acupuncture3RecruitingBrain Imaging Study of Acupuncture in Chronic Low Back PainConditions:Low Back Pain;  

 

Back Pain Lower Back Chronic;  

 

Low Back Pain, RecurrentIntervention:Procedure: Acupuncture4RecruitingBrain Mechanisms of Acupuncture Treatment in Chronic Low Back PainConditions:Chronic Low Back Pain;   Low Back Pain;   Back PainIntervention:Procedure: Acupuncture5RecruitingBack Pain Response to Different Acupuncture

MethodsCondition:Lower Back PainInterventions:Procedure: Traditional Acupuncture;   Procedure: Laser Acupuncture6RecruitingEffect of Acupuncture and Pain Medication on Radicular Pain Using QSTCondition:PainInterventions:Other: Acupuncture or Sham Acupuncture;   Other: Gabapentin or Placebo7RecruitingA Functional Magnetic Resonance Imaging (fMRI) Study of Expectancy on Acupuncture Treatment Outcomes in Knee Osteoarthritis (OA)Condition:Osteoarthritis, KneeIntervention:Other: Acupuncture8RecruitingAcupuncture for the Treatment of InsomniaCondition:Primary InsomniaIntervention:Other: Acupuncture


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Relationship of acupuncture points and meridians to connective tissue planes - Langevin - 2002 - The Anatomical Record - Wiley Online Library

Relationship of acupuncture points and meridians to connective tissue planes - Langevin - 2002 - The Anatomical Record - Wiley Online Library | Acupuncture for CFS and ME | Scoop.it

Abstract

Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture's mechanism of action and suggests a potentially important integrative role for interstitial connective tissue. Anat Rec (New Anat) 269:257–265, 2002. © 2002 Wiley-Liss, Inc.

 

Jump to…INTRODUCTION

During acupuncture treatments, fine needles traditionally are inserted at specific locations of the body known as acupuncture points. According to classic Chinese theory, acupuncture points are linked together in a network of “meridians” running longitudinally along the surface of the body (Figure 1). Despite considerable efforts to understand the anatomy and physiology of acupuncture points and meridians, the definition and characterization of these structures remains elusive (NIH Consensus Statement, 1997).

Despite considerable efforts to understand the anatomy and physiology of acupuncture points and meridians, the definition and characterization of these structures remains elusive.

The goal of this article is to present evidence supporting a conceptual model linking traditional Chinese acupuncture theory with conventional anatomy. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue and that this relationship is relevant to acupuncture's therapeutic mechanism.

Figure 1. Acupuncture meridians of the arm. Acupuncture points were located by palpation in a living subject, according to anatomical guidelines provided in a major reference acupuncture textbook (Cheng, 1987). Connective tissue planes associated with Yin meridians are more inward and deep, compared with the generally outward and superficial planes associated with Yang meridians.

Jump to…TRADITIONAL CONCEPTS

Acupuncture meridians are traditionally thought to represent “channels” through which flows “meridian qi” (Kaptchuk, 2000). Although the concept of meridian qi has no known physiological equivalent, terms used in acupuncture texts to describe the more general term “qi” evoke dynamic processes such as communication, movement, or energy exchange (O'Connor and Bensky, 1981). Disruption of the meridian channel network is believed to be associated with disease, and needling of acupuncture points is thought to be a way to access and influence this system (Cheng, 1987).

Charts representing acupuncture points and meridians date as far back as 300 B.C. (Veith, 1949). Modern acupuncture charts indicate 12 principal meridians “connecting” the limbs to the trunk and head. In addition, many other “accessory” meridians are also described, as well as deep “internal branches” starting at specific points on the principal meridians and reaching internal organs. The names of the principal meridians (e.g., lung, heart) represent physiological functions thought to be specifically related to each meridian, rather than the actual lung or heart organ itself. One meridian named Triple Heater is thought to be related to temperature balance between different parts of the body. Acupuncture points are mostly located along the meridians, although “extra” points outside the meridian system are also believed to exist. Although acupuncture texts and atlases generally agree on the location of the principal meridians, considerable variability exists as to the number and location of internal branches and extra points.

The Chinese character signifying acupuncture point also means “hole” (O'Connor and Bensky, 1981), conveying the impression that acupuncture points are locations where the needle can gain access to some deeper tissue components. Modern acupuncture textbooks contain visual charts as well as written guidelines for locating each acupuncture point. These guidelines refer to anatomical landmarks (such as bony prominences, muscles, or tendons) as well as proportional measurements (e.g., fraction of distance between elbow and wrist) (Cheng, 1987). During acupuncture treatments, acupuncturists use these landmarks and measurements to determine the location of each point within approximately 5 mm. Precise point location within this range is achieved by palpation, during which the acupuncturist searches for a slight depression or yielding of the tissues to light pressure.

Jump to…ARE ACUPUNCTURE POINTS DIFFERENT FROM SURROUNDING TISSUE?

Over the past 30 years, studies aimed at understanding the acupuncture point/meridian system from a “Western” perspective mainly have searched for distinct histological features that might differentiate acupuncture points from surrounding tissue. Seveal structures, such as neurovascular bundles (Rabischong et al., 1975; Senelar, 1979; Bossy, 1984), neuromuscular attachments (Liu et al., 1975; Gunn et al.,1976; Dung, 1984), and various types of sensory nerve endings (Shanghai Medical University, 1973; Ciczek et al., 1985), have been described at acupuncture points. However, none of these studies included statistical analyses comparing acupuncture points with appropriate “nonacupuncture” control points.

Other studies have turned their attention to possible physiological differences between acupuncture points and surrounding tissues. Skin conductance has been reported by several investigators to be greater at acupuncture points compared with control points (Reishmanis et al., 1975; Comunetti et al., 1995). Several factors, on the other hand, are known to affect skin conductance (e.g., pressure, moisture, skin abrasion; Noordegraaf and Silage, 1973; McCarroll and Rowley, 1979), and to date, no study has both controlled for these factors and included sufficient numbers of observations to confirm these findings. Attempts to identify anatomical and/or physiological characteristics of acupuncture points, therefore, have remained mostly inconclusive.

Ancient acupuncture texts contain several references to “fat, greasy membranes, fasciae and systems of connecting membranes” through which qi is believed to flow (Matsumoto and Birch, 1988), and several authors have suggested that a correspondence may exist between acupuncture meridians and connective tissue (Matsumoto and Birch, 1988; Oschman, 1993; Ho and Knight, 1998). Recent work done in our laboratory has begun to provide experimental evidence in support of this hypothesis. We have characterized a connective tissue response to acupuncture needling that is quantitatively different at acupuncture points compared with control points (Langevin et al.,2001b) and that may constitute an important clue to the nature of acupuncture points and meridians.

Jump to…BIOMECHANICAL RESPONSE TO NEEDLING: “NEEDLE GRASP”

An important aspect of traditional acupuncture treatments is that acupuncture needles are manually manipulated after their insertion into the body. Needle manipulation typically consists of rapid rotation (back-and-forth or one direction) and/or pistoning (up-and-down motion) of the needle (O'Connor and Bensky, 1981). During needle insertion and manipulation, acupuncturists aim to elicit a characteristic reaction to acupuncture needling known as “de qi” or “obtaining qi.” During de qi, the patient feels an aching sensation in the area surrounding the needle. Simultaneously with this sensation, the acupuncturist feels a “tug” on the needle, described in ancient Chinese texts as “like a fish biting on a fishing line” (Yang, 1601). We refer to this biomechanical phenomenon as “needle grasp.”

According to traditional teaching, de qi is essential to acupuncture's therapeutic effect (O'Connor and Bensky, 1981). One of the most fundamental principles underlying acupuncture is that acupuncture needling is thought to be a way to access and influence the meridian network. The characteristic de qi reaction, perceived by the patient as a needling sensation and by the acupuncturist as needle grasp, is thought to be an indication that this goal has been achieved (Cheng, 1987). The biomechanical phenomenon of needle grasp, therefore, is at the very core of acupuncture's theoretical construct.

Needle grasp is enhanced clinically by manipulation (rotation, pistoning) of the acupuncture needle. In previous human and animal studies using a computerized acupuncture-needling instrument (Langevin et al., 2001b, 2002), we have quantified needle grasp by measuring the force necessary to pull the acupuncture needle out of the skin (pullout force). We have shown that pullout force is indeed markedly enhanced by rotation of the needle. Needle grasp, therefore, is a measurable tissue phenomenon associated with acupuncture needle manipulation. In a quantitative study of needle grasp in 60 healthy human subjects (Langevin et al., 2001b), we measured pullout force at eight different acupuncture point locations, compared with corresponding control points located on the opposite side of the body, 2 cm away from each acupuncture point. We found that pullout force was on average 18% greater at acupuncture points than at corresponding control points. We also found that needle manipulation increased pullout force at control points as well as at acupuncture points. Needle grasp, therefore, is not unique to acupuncture points, but rather is enhanced at those points.

Needle grasp is not unique to acupuncture points but rather is enhanced at those points.

Jump to…ROLE OF CONNECTIVE TISSUE IN NEEDLE GRASP

Although previously attributed to a contraction of skeletal muscle, we have shown that needle grasp is not due to a muscle contraction but rather involves connective tissue (Langevin et al., 2001a, 2002). In both in vivo and in vitro experiments, we have found that, during acupuncture needle rotation, connective tissue winds around the acupuncture needle, creating a tight mechanical coupling between needle and tissue. This needle-tissue coupling allows further movements of the needle (either rotation or pistoning) to pull and deform the connective tissue surrounding the needle, delivering a mechanical signal into the tissue.

Observation under a microscope of an acupuncture needle inserted into dissected rat subcutaneous tissue reveals that a visible “whorl” of tissue can be produced with as little as one turn of the needle (Figure 2A). When the needle is placed flat onto the subcutaneous tissue surface and then rotated, the tissue tends to adhere to and follow the rotating needle for 180 degrees, at which point the tissue adheres to itself and further rotation results in formation of a whorl. This phenomenon can be observed to varying degrees with acupuncture needles of different materials (stainless steel, gold) as well as with other objects not customarily used as acupuncture tools such as regular hypodermic needles, glass micropipettes, siliconized glass, and Teflon-coated needles. An important factor appears to be the diameter of the rotating needle. Acupuncture needles are very fine (250–500 μm diameter). With needles greater than 1 mm in diameter, the tissue invariably follows the rotating needle for less than 90 degrees and then falls back, failing to stick to itself and initiate winding. Initial attractive forces between the rotating needle and tissue, thus, may be important to initiate the winding phenomenon. These may include surface tension and electrical forces and may be influenced by the material properties of the needle.

Figure 2. A: Formation of a connective tissue “whorl” with needle rotation. Rat subcutaneous connective tissue was dissected and placed in physiological buffer under a dissecting microscope. An acupuncture needle was inserted through the tissue and progressively rotated. Numbers 0 through 7 indicate numbers of needle revolutions. A visible whorl of connective tissue can be seen with as little as one revolution of the needle. B: Scanning electron microscopy imaging of reusable gold (left) and disposable stainless steel (right) acupuncture needles. Original magnification, 350×. C,D: Scanning electron microscopy of gold (C) and stainless steel (D) needles. Original magnification, 3,500×. The surface of the gold needle is visibly rougher than that made of stainless steel. Scale bars = 2.5 mm in A, 100 μm in B, 10 μm in C,D.

When we compared two equal diameter acupuncture needles, one reusable needle made of gold (ITO, Japan) and one disposable made of stainless steel (Seirin, Japan), the gold needle appeared to initiate winding more readily than the stainless steel one. Scanning electron microscopy images of the two needles (Figure 2B–D) showed that the gold needle had a rougher surface, which may have more successfully “engaged” the tissue during the initiation of winding. These observations also suggest that mechanical coupling between needle and tissue can occur even when the amplitude of needle rotation is very small (less than 360 degrees) as commonly used in clinical practice. We have also shown that, with back-and-forth needle rotation, which is generally preferred clinically over rotation in one direction, winding alternates with unwinding, but unwinding is incomplete, resulting in a gradual buildup of torque at the needle–tissue interface (Langevin et al., 2001b).

The importance of establishing a mechanical coupling between needle and tissue is that mechanical signals (1) are increasingly recognized as important mediators of information at the cellular level (Giancotti and Ruoslahti, 1999), (2) can be transduced into bioelectrical and/or biochemical signals (Banes et al., 1995; Lai et al., 2000), and (3) can lead to downstream effects, including cellular actin polymerization, signaling pathway activation, changes in gene expression, protein synthesis, and extracellular matrix modification (Chicurel et al., 1998; Chiquet, 1999). Changes in extracellular matrix composition, in turn, can modulate the transduction of future mechanical signals to and within cells (Brand, 1997). Recent evidence suggests that both tissue stiffness and stress-induced electrical potentials are affected by connective tissue matrix composition (Bonassar et al., 1996) and that changes in matrix composition in response to mechanical stress may be an important form of communication between different cell types (Swartz et al., 2001). Acupuncture needle manipulation, thus, may cause lasting modification of the extracellular matrix surrounding the needle, which may in turn influence the various cell populations sharing this connective tissue matrix (e.g., fibroblasts, sensory afferents, immune and vascular cells).

In addition, we have hypothesized previously that, in the vicinity of the needle, acupuncture-induced actin polymerization in connective tissue fibroblasts may cause these fibroblasts to contract, causing further pulling of collagen fibers and a “wave” of connective tissue contraction and cell activation spreading through connective tissue (Langevin et al., 2001a). This mechanism may explain the phenomenon of “propagated sensation,” i.e., the slow spreading of de qi sensation sometimes reported by patients along the course of an acupuncture meridian (Huan and Rose, 2001).

Jump to…CORRESPONDENCE OF ACUPUNCTURE POINTS AND MERIDIANS TO CONNECTIVE TISSUE PLANES

Acupuncture meridians tend to be located along fascial planes between muscles, or between a muscle and bone or tendon (Cheng,1987). A needle inserted at the site of a connective tissue cleavage plane will penetrate first through dermis and subcutaneous tissue, then through deeper interstitial connective tissue. In contrast, a needle inserted away from a connective tissue plane will penetrate dermis and subcutaneous tissue, then reach a structure such as muscle or bone. Because needle grasp involves interaction of the needle with connective tissue (Langevin et al., 2002), the enhanced needle grasp response at acupuncture points may be due to the needle coming into contact with more connective tissue (subcutaneous plus deeper fascia) at those points. The presence of needle grasp at control points as well as at acupuncture points is consistent with some amount of connective tissue (subcutaneous) being present at all points. This concept is illustrated in Figure 3, which shows ultrasound images of the same acupuncture point and corresponding control point in two normal human subjects. The acupuncture point is located on the skin overlying the fascial plane separating the vastus lateralis and biceps femoris muscles. The control point, located 3 cm away from the acupuncture point, is located over the belly of the vastus lateralis muscle.

Figure 3. Ultrasound imaging of acupuncture (AP) and control (CP) points. Acupuncture point GB32 was located by palpation in two normal human volunteers, as well as a control point located 3 cm away from the acupuncture point. After marking both points with a skin marker, ultrasound imaging was performed with an Acuson ultrasound machine equipped with a 7 MHz linear probe. A visible connective tissue intramuscular cleavage plane can be seen at acupuncture points but not at control points. V.Lat, vastus lateralis; B.Fem, biceps femoris; Sc, subcutaneous tissue.

To investigate the hypothesis that acupuncture points are preferentially located over fascial planes, we marked the location of all acupuncture points and meridians in a series of gross anatomical sections through the human arm (Research Systems Visible Human CD, Boulder, CO) (Figure 4). The interval between sections corresponded to one “cun” or anatomical inch (a proportional unit measurement used in acupuncture textbooks to locate acupuncture points) representing 1/9 of the distance between the elbow crease and the axially fold (in this case 2.5 cm). This section interval allowed us to include all acupuncture points located on the six principal meridians of the arm between the olecranon (Figure 4, section 0) and the superior edge of the humeral head (Figure 4, section 12). In each section, we marked all acupuncture points and the intersection of all meridians with the plane of section (meridian intersection).

Figure 4. Location of acupuncture points and meridians in serial gross anatomical sections through a human arm. The interval between sections corresponds to one “cun” or anatomical inch representing 1/9 of the distance between the elbow crease and the axially fold (in this case, 2.5 cm). Sections begin at the olecranon (0) and end at the superior edge of the humeral head (12). Acupuncture points, meridian intersections, and specific meridians are labeled according to the legend.

Acupuncture points and meridian intersections were located according to written guidelines (based on anatomical landmarks and proportional measurements) and acupuncture charts provided in a major textbook of traditional Chinese acupuncture (Cheng, 1987). Because connective tissue planes were visible on the anatomical sections, every attempt was made to minimize bias by adhering to these guidelines as objectively as possible. In a live subject, palpation is used to locate acupuncture points precisely once the approximate location has been determined by using anatomical landmarks and proportional measurements. For some points, body parts are manipulated and positioned in a specific way to perform this palpation. In the case of our postmortem sections, the points needed to be located in the anatomical position without the benefit of palpation. When written descriptions referred to anatomical landmarks palpable in the anatomical position (such as the olecranon or biceps tendon), we used the position of the bones, tendons, and muscles in the cross-sections to determine where these landmarks would have been palpable on the surface of the body. For those points where palpation is traditionally performed in a position other than the anatomical position, we guided ourselves on (1) charts from acupuncture textbooks drawn in the anatomical position, and (2) a live human model on which we located acupuncture points by palpating them in the position specified in the textbook, and then placed the model's arm in the anatomical position (Figure 1). Textbook guidelines referring to proportional measurements (such as a fraction of the distance between the elbow crease and axially fold) are traditionally defined in the anatomical position. We, therefore, were able to apply these measurements directly to the postmortem tissue sections by determining appropriate section numbers based on the section interval, and making measurements on individual cross-sections.

By using these guidelines, we marked three acupuncture points on the heart meridian (H3, H2, H1), two points on the pericardium meridian (P3, P2), five points on the lung meridian (L5, L4, L3, L2, L1), five points on the large intestine meridian (LI11, LI12, L113, LI14), five points on the triple heater meridian (SJ10, SJ11, SJ12, SJ13, SJ14), and four points on the small intestine meridian (SI8, SI9, SI10, SI11) for a total of 24 acupuncture points. Meridians intersected with the plane of section at 51 other sites that were not acupuncture points.

As shown in Figure 4, three of six meridians included portions that followed fascial planes between muscles (biceps/triceps [heart meridian, Figure 4, sections 2–7], biceps/brachialis [lung meridian, Figure 4, sections 4–5], and brachialis/triceps [large intestine meridian, Figure 4, sections 3–5]). Some points on those meridians (H2, LI14, H1) also appeared to be located at the intersection of two or more fascial planes. Two other meridians included portions that followed intramuscular cleavage planes [between heads of biceps (pericardium meridian, Figure 4, sections 5–7) and triceps (triple heater meridian, Figure 4, sections 2–6)]. One meridian (small intestine meridian) did not itself follow any recognizable inter- or intramuscular plane. However, three out of the four acupuncture points on this portion of the meridian (SI9, 10, and 11) clearly coincided with the intersection of multiple fascial planes. Overall, more that 80% of acupuncture points and 50% of meridian intersections of the arm appeared to coincide with intermuscular or intramuscular connective tissue planes.

To estimate the probability that such an event would be due to chance, we tested a model representing the middle portion of the arm (sections 2–7) approximated to a cylinder 12.5 cm long and 30 cm in circumference, and including eight acupuncture points and 28 meridian intersections. Assuming that the average width of the five major fascial planes of the arm (triceps/triceps, biceps/brachialis, brachialis/triceps, between heads of triceps, and between heads of biceps) is 1/60 of the circumference of the cylinder (or approximately 5 mm), 1/12 of the surface of the cylinder will intersect with a fascial plane. If we also assume that the “width” of an acupuncture point is 5 mm, the probability that a random point in any given section of the cylinder will fall on a fascial plane is 1/12 or 0.083. Using the hypergeometric distribution (sampling without replacement), the probability that either six or seven of eight points (75 or 87%) randomly distributed in six sections through the cylinder would fall on fascial planes is P < 0.001. Likewise, taking 5 mm as the “width” of a meridian, the probability of 14 of 28 meridian intersections (50%) falling on fascial planes is also P < 0.001.

These findings suggest that the location of acupuncture points, determined empirically by the ancient Chinese, was based on palpation of discrete locations or “holes” where the needle can access greater amounts of connective tissue. Some portions of meridians clearly follow one or more successive connective tissue planes, whereas others appear to simply “connect the dots” between points of interest. On the basis of these findings and our previous experimental results (Langevin et al., 2001b, 2002), we propose that acupuncture charts may serve as a guide to insert the needle into interstitial connective tissue planes where manipulation of the needle can result in a greater mechanical stimulus. A greater therapeutic effect at acupuncture points may be at least partly explained by more powerful mechanical signaling and downstream effects at those points.

We chose the arm for this study because it offers relatively simple anatomy and widely spaced fascial planes (compared with, for example, the forearm) and also because the arm illustrates how both meridians and connective tissue planes “connect” the arm with the shoulder girdle and chest (see below). We, however, expect that similar results would be obtained in other body regions. In the forearm, leg, and thigh, meridians also appear to generally follow connective tissue planes separating muscles or within muscles. On the trunk, meridians close to the midline (kidney, stomach, spleen, and bladder) run longitudinally in the front and back, whereas more laterally placed meridians (liver, gall bladder) run obliquely, paralleling the orientation of main muscle groups and the connective tissue planes separating them. On the face, meridians criss-cross each other in an intricate pattern compatible with the complexity of facial muscular and connective tissue structures.

Jump to…MERIDIAN/CONNECTIVE TISSUE NETWORK

Acupuncture meridians are believed to form a network throughout the body, connecting peripheral tissues to each other and to central viscera (Kaptchuk, 2000). Interstitial connective tissue also fits this description. Interstitial “loose” connective tissue (including subcutaneous tissue) constitutes a continuous network enveloping all limb muscles, bones, and tendons, extending into connective tissue planes of pelvic and shoulder girdles, abdominal and chest walls, neck, and head. This tissue network is also continuous with more specialized connective tissues such as periosteum, perimysium, perineurium, pleura, peritoneum, and meninges. A form of signaling (mechanical, bioelectrical, and/or biochemical) transmitted through interstitial connective tissue, therefore, may have potentially powerful integrative functions. Such integrative functions may be both spatial (“connecting” different parts of the body) as well as across physiological systems (connective tissue permeates all organs and surrounds all nerves, blood vessels, and lymphatics). In addition, because the structure and biochemical composition of interstitial connective tissue is responsive to mechanical stimuli, we propose that connective tissue plays a key role in the integration of several physiological functions (e.g., sensorineural, circulatory, immune) with ambient levels of mechanical stress.

One of the salient features of acupuncture theory is that the needling of appropriately selected acupuncture points has effects remote from the site of needle insertion, and that these effects are mediated by means of the acupuncture meridian system (O'Connor and Bensky,1981). To date, physiological models attempting to explain these remote effects have invoked systemic mechanisms involving the nervous system (Ulett et al., 1998; Pomeranz, 2001). A mechanism initially involving signal transduction through connective tissue, with secondary involvement of other systems including the nervous system, is potentially closer to traditional Chinese acupuncture theory, yet also compatible with previously proposed neurophysiological mechanisms.

Jump to…CONCEPTUAL MODEL FOR ACUPUNCTURE POINTS AND MERIDIANS

Rather than viewing acupuncture points as discrete entities, we propose that acupuncture points may correspond to sites of convergence in a network of connective tissue permeating the entire body, analogous to highway intersections in a network of primary and secondary roads. One of the most controversial issues in acupuncture research is whether the needling of acupuncture points has “specific” physiological and therapeutic effects compared with nonacupuncture points (NIH Consensus Statement, 1997). By using the road analogy, interaction of an acupuncture needle with connective tissue will occur even at the smallest connective tissue “secondary road.” Needling a major “highway intersection,” however, may have more powerful effects, perhaps due to collagen fiber alignment leading to more effective force transduction and signal propagation at those points.

In summary, the anatomical correspondence of acupuncture points and meridians to connective tissue planes in the arm suggests plausible physiological explanations for several important traditional Chinese medicine concepts summarized in Table 1. We propose that acupuncture needle manipulation produces cellular changes that propagate along connective tissue planes. These changes may occur no matter where the needle is placed but may be enhanced when the needle is placed at acupuncture points. This conceptual model would be further strengthened by an expanded investigation of the whole body, including lower extremity, trunk, and head. The anatomy of acupuncture points and meridians, thus, may be an important factor that will begin to unravel the veil of mystery surrounding acupuncture.

Table 1. Summary of proposed model of physiological effects seen in acupunctureTraditional Chinese medicine conceptsProposed anatomical/physiological equivalentsAcupuncture meridiansConnective tissue planesAcupuncture pointsConvergence of connective tissue planesQiSum of all body energetic phenomena (e.g. metabolism, movement, signaling, information exchange)Meridian qiConnective tissue biochemical/bioelectrical signalingBlockage of qiAltered connective tissue matrix composition leading to altered signal transductionNeedle graspTissue winding and/or contraction of fibroblasts surrounding the needleDe qi sensationStimulation of connective tissue sensory mechanoreceptorsPropagated de qi sensationWave of connective tissue contraction and sensory mechanoreceptor stimulation along connective tissue planesRestoration of flow of qiCellular activation/gene expression leading to restored connective tissue matrix composition and signal transductionJump to…Acknowledgements

We thank James R. Fox, M.S., Bruce J. Fonda, M.S., John P. Eylers, Ph.D., Gary M. Mawe, Ph.D., William L. Gottesman, M.D., Junru Wu, Ph,D., and Douglas J. Taatjes, Ph.D. for their valuable assistance. Data from the Visible Human Project Initiative was made available through the National Library of Medicine and the University of Colorado. This study was funded in part by National Institutes of Health Center for Complementary and Alternative Medicine Grant RO1AT-00133.

Jump to…LITTERATURE CITEDBanes AJ, Tsuzaki M, Yamamoto J, et al. 1995. Mechanoreception at the cellular level: The detection, interpretation and diversity of responses to mechanical signals. Biochem Cell Biol 73: 349–365.CrossRef,PubMed,CAS,Web of Science® Times Cited: 213Bonassar LJ, Stinn JL, Paguio CG, et al. 1996. Activation and inhibition of endogenous matrix metalloproteinases in articular cartilage: Effects on composition and biophysical properties. Arch Biochem Biophys 333: 359–367.CrossRef,PubMed,CAS,Web of Science® Times Cited: 26Brand RA. 1997. What do tissues and cells know of mechanics? Ann Med 29: 267–269.CrossRef,PubMed,CAS,Web of Science® Times Cited: 5Bossy J. 1984. Morphological data concerning the acupuncture points and channel network. Acupunct Electrother Res 9: 79–106.PubMed,CAS,Web of Science® Times Cited: 13Cheng X. 1987. Chinese acupuncture and moxibustion. Beijing: Foreign Language Press.Chicurel ME, Chen CS, Ingber DE. 1998. Cellular control lies in the balance of forces. Curr Opin Cell Biol 10: 232–239.CrossRef,PubMed,CAS,Web of Science® Times Cited: 250Chiquet M. 1999. Regulation of extracellular matrix gene expression by mechanical stress. Matrix Biol 18: 417–426.CrossRef,PubMed,CAS,Web of Science® Times Cited: 182Ciczek LSW, Szopinski J, Skrzypulec V. 1985. Investigations of morphological structures of acupuncture points and meridians. J Trad Chin Med 5: 289–292.Comunetti A, Laage S, Schiessl N, Kistler A. 1995. Characterization of human skin conductance at acupuncture points. Experientia51: 328–331.CrossRef,PubMed,CAS,Web of Science® Times Cited: 15Dung HC. 1984. Anatomical features contributing to the formation of acupuncture points. Am J Acupunct 12: 139–143.Web of Science® Times Cited: 19Giancotti FG, Ruoslahti E. 1999. Integrin signaling. Science 285: 1028–1032.CrossRef,PubMed,CAS,Web of Science® Times Cited: 2066Gunn CC, Ditchburn FG, King MH, Renwick GJ. 1976. Acupuncture loci: A proposal for their classification according to their relationship to known neural structures. Am J Chin Med 4: 183–195.CrossRef,PubMed,CASHo MW, Knight DP. 1998. The acupuncture system and the liquid crystalline collagen fibers of the connective tissues. Am J Chin Med26: 251–263.CrossRef,PubMed,CAS,Web of Science® Times Cited: 15Huan ZY, Rose K. 2001. A brief history of Qi. Brookline, MA: Paradigm Publications.Kaptchuk TJ. 2000. The web that has no weaver. 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Acupuncture.Com - Myalgic Encephalomyelitis (ME)

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For thousands of years, Chinese medicine practitioners have believed that blockages in the body's "life energy" (chi) are responsible for illness and disease. Acupuncture and other traditional Chinese treatments seek to restore the natural flow of chi and return the body to harmony.

 

You don't have to believe in the ancient theory to believe in the power of acupuncture. Many Western researchers contend that acupuncture's benefits can be explained in their terms. Acupuncture needles may stimulate nerve endings under the skin, sending impulses to the brain that result in the release of pain-easing endorphins and other hormones.

 

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Acupuncture and moxibustion for stress-related disorders - "good for musculoskeletal symptoms" ... "effect on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the wh...

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Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally.

 

This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders.

 

The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy.

 

Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.

 

Keywords: Acupuncture, Moxibustion, Stress, Fibromyalgia, Functional gastrointestinal disorder, Irritable bowel syndrome, Autonomic nervous system, Hypothalamo-pituitary adrenal axis, Sawada-style holistic therapy

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Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms | NCCAM

Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms | NCCAM | Acupuncture for CFS and ME | Scoop.it

 

Although acupuncture has long been used to treat pain, the underlying cellular and molecular mechanisms are not fully understood.

 

Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms

Although acupuncture has long been used to treat pain, the underlying cellular and molecular mechanisms are not fully understood. The process appears to involve the brain’s ability to produce opioids (pain-reducing chemicals) that bind to neurons in distinct regions of the brain, and the ability of neurons to produce receptors for these endogenous opioids—specifically, μ-opioid receptors (MORs). Recent clinical trials have indicated that both traditional (actual) and simulated (sham/placebo) acupuncture decrease pain, but other studies have suggested that the neural mechanisms involved may be different.

To investigate these neural mechanisms, NCCAM-funded researchers at the University of Michigan randomly assigned 20 women diagnosed with fibromyalgia (a chronic pain condition) to receive either traditional acupuncture or simulated acupuncture treatments in 9 sessions over 4 weeks. (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture mimics this procedure, but without piercing the skin or using specific points. Participants did not know which treatment they were receiving.) At the initial session and again at the ninth, the women had positron emission tomography scans to analyze MOR binding potential in the brain, and they completed a questionnaire to assess pain intensity.

Traditional acupuncture increased MOR binding potential, in both the short term (right after the first treatment) and the long term (after 4 weeks), in several regions of the brain that process pain. Simulated acupuncture generally resulted in slight reductions in MOR-binding potential. Both traditional and simulated acupuncture groups experienced similar, significant reductions in clinical pain. In the traditional acupuncture group, greater long-term increases in MOR-binding potential were associated with greater reductions in pain.

The researchers concluded that, in fibromyalgia patients, different mechanisms appear to be involved in the analgesic effects of traditional acupuncture and simulated acupuncture. By increasing MOR-binding potential, traditional acupuncture appears to help the brain use endogenous opioids more effectively. The slight reduction in MOR-binding potential suggests that simulated acupuncture increases the brain’s production of opioids. The researchers recommend additional studies to determine whether these differences are related to skin penetration of the acupuncture needles, point location, or both.

ReferencesHarris RE, Zubieta J-K, Scott DJ, et al. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs). NeuroImage. 2009; 47(3):1077–1085.Additional ResourcesAcupuncture for Pain Publication Date: September 6, 2009

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FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Becoming an Expert Patient Article 6

FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Becoming an Expert Patient Article 6 | Acupuncture for CFS and ME | Scoop.it

Private complementary therapies

Many complementary therapies are now available on the NHS, in some areas at least, including physiotherapy, hydrotherapy, acupuncture, myofascial release and hypnotherapy. However, the NHS cannot afford to provide these on a long-term basis, so it is common to have to pay for some privately.

Going private for this kind of treatment also has the advantage that you get to choose where you go and who treats who, whereas with the NHS, it can be pot-luck as to whether you get, e.g. a physiotherapist, with any experience of Fibro.

There are a number of complementary therapies, such as heat/cold therapies, baths and aromatherapy that you can do yourself at home (although you should be careful of aromatherapy and try to get expert advice as to what is safe for you to use). Some books that may be helpful include: Leon Chaitow's Fibromyalgia and Muscle Pain: Your Self-treatment Guide; Jacob Teitelbaum's Pain Free 1-2-3; and Clair Davies'The Trigger Point Therapy Workbook: Your Self-Treatment for Pain Relief . These are all available from the FibroAction a-store and are often to be found in local libraries, where you can borrow them for free.

When you are looking for a new complementary therapist of any kind, take your time and be careful in who you choose.

Make sure that they are suitably qualified and try to actually check out how good their qualifications are. It is very easy for someone to do a course, that may not be good at all, or may not be relevant, and then impress potential clients with the qualification or even letters after their name. The title of "Dr" is especially confusing and you should be careful to not assume that this means they are a medical doctor - if you are seeing someone for massage, then them being a Doctor of Divinity or having a PhD in Physics really isn't relevant! The internet is a huge help in this manner. So check out what their qualifications actually are and, if possible, where they have trained and how long their training took - for example, having done an intensive and long massage course at a reputable advanced massage school is far better than having done a 12 week once a week evening class. This is especially important if they are recently qualified: you don't want to be a learning exercise for someone with poor training and little experience!

Similarly, check out which professional bodies they belong to and try to check out the professional bodies. Having to renew qualifications or do continued training in order to be eligible for membership, having scrutiny of members and having a complaints procedure are all signs of a good professional body.

Getting personal recommendations is a great way to find new complementary practitioners, but do take into account whether the person who recommended them has Fibro. A massage therapist that someone with a sports injury and no Fibro finds helpful may not be as helpful for someone with Fibro. Local support group members may know of someone with real experience of Fibro.

Talk to the practitioner before they do anything, preferably before you book a paying appointment. You may end up paying them a lot of money over a long period of time so don't be embarrassed to almost interview them. Ask them if they have experience of people with Fibro and how they help them. Be careful of people who misunderstand the condition, whether that is thinking it is a psychological problem or one that can be cured. In depth knowledge of Fibro is not essential, but it is helpful, particularly for any practitioner that will be hands-on, like a physiotherapist or massage therapist. However, if you feel that they are really taking on board what you tell them about hypersensitivity, exercise intolerance, etc, then that is also a good sign.

To find a complementary practitioner or hydrotherapy pool near you, ask your local support group and your GP. Looking in the local paper may be helpful, as may looking on the internet - you may get many of your questions answered without even having to call. Other support groups, for people with ME/CFS, Arthritis or Neurological Conditions may also be able to direct you. If you have a local branch of theNeurological Alliance then they be able to help you as they will deal with a lot of local support groups.

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Acupuncture - the most effective form of CAM for musculoskeletal conditions - The Journal of Chinese Medicine

Acupuncture - the most effective form of CAM for musculoskeletal conditions

Acupuncture is the most effective CAM for treating musculoskeletal conditions and one of only a few therapies that is supported by current medical evidence, according to a report commissioned by the charity Arthritis Research UK. The report, which examined trial data on 25 therapies, was aimed at helping people with musculoskeletal conditions and healthcare professionals choose safe and effective therapies. Very little evidence was found in support of commonly-used therapies such as copper or magnets for musculoskeletal disorders. The therapies that were shown to be the most effective were: acupuncture for osteoarthritis, low back pain and fibromyalgia, massage for fibromyalgia and low back pain, tai chi for osteoarthritis and yoga for back pain. (Practitioner-based complementary and alternative therapies for the treatment of rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain. www.arthritisresearchuk.org/news/press-releases/2013/march/january/new-report-on-complementary-therapies-for-arthritis-reveals-lack-of-scientific-evidence.aspx

 

Acupuncture is the most effective CAM for treating musculoskeletal conditions and one of only a few therapies that is supported by current medical evidence, according to a report commissioned by the charity Arthritis Research UK....

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FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Traditional Chinese Acupuncture affects mu Opioid Receptors differently to Sham Acupuncture

FibroAction - Raising Awareness of Fibromyalgia Syndrome in the UK - Traditional Chinese Acupuncture affects mu Opioid Receptors differently to Sham Acupuncture | Acupuncture for CFS and ME | Scoop.it

JUN15

Traditional Chinese Acupuncture affects mu Opioid Receptors differently to Sham Acupuncture

 

A team of researchers at the University of Michigan, including FibroAction Professional Advisory Board member, Daniel Clauw MD, have used Positron emission tomography to determine that traditional chinese acupuncture activates certain pain relieving systems in the body better than sham acupuncture.

Controversy remains regarding the mechanisms of acupuncture analgesia or pain relief. A prevailing theory, largely unproven in humans, is that it involves the activation of endogenous opioid antinociceptive systems and mu-opioid receptors - i.e. the body's natural pain-killing mechanisms. This is also a neurotransmitter system that mediates the effects of placebo-induced analgesia. This overlap in potential mechanisms may explain the lack of differentiation between traditional acupuncture and either non-traditional or sham acupuncture in multiple controlled clinical trials. In other words, the systems that acupuncture activates to relieve pain are the same systems activated by the placebo effect of pain relief, which would explain why it is so hard to prove that traditional chinese acupuncture works better than the placebo of sham acupuncture.

The researchers compared both short-and long-term effects of traditional Chinese acupuncture versus sham acupuncture treatment on the binding availability of mu-opioid receptors in chronic pain patients diagnosed with fibromyalgia syndrome.

Patients were randomized to receive either traditional Chinese acupuncture or sham acupuncture treatment over the course of four weeks.

Positron emission tomography (PET) with (11)C-carfentanil was performed once during the first treatment session and then repeated a month later following the eighth treatment.

The researchers found that acupuncture therapy evoked short-term increases in mu-opioid receptor binding potential, in multiple pain and sensory processing regions including the cingulate (dorsal and subgenual), insula, caudate, thalamus, and amygdala. Acupuncture therapy also evoked long-term increases in mu-opioid receptor binding potential in some of the same structures including the cingulate (dorsal and perigenual), caudate, and amygdala.

These short-and long-term effects were absent in the sham group where small reductions were observed, an effect more consistent with previous placebo PET studies.

Long-term increases in mu-Opioid receptor binding potential following traditional Chinese acupuncture were also associated with greater reductions in clinical pain.

In conclusion:

"These findings suggest that divergent [mu-Opioid receptor] processes may mediate clinically relevant analgesic effects for acupuncture and sham acupuncture."

References:

Harris RE, Zubieta JK, Scott DJ, Napadow V, Gracely RH, Clauw DJ. Traditional Chinese Acupuncture and Placebo (Sham) Acupuncture Are Differentiated by Their Effects on mu-Opioid Receptors (MORs). Neuroimage. 2009 Jun 4. [Epub ahead of print]

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Pain - Fibromyalgia Tender Points (see page 359 and see p355 for acupuncture information)

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5 Reasons You Should Try Acupuncture

5 Reasons You Should Try Acupuncture | Acupuncture for CFS and ME | Scoop.it

Years ago I watched Kiiko Matsumoto treat a hemiplegic patient who two years prior was knocked on her head by an ocean wave and lost sensation in the left side of her body. As Kiiko buzzed around the patient placing needles and pressing points, the patient reported, teary-eyed, that she could feel both her arms and hands. From that day on, I’ve been a firm believer in acupuncture’s healing potential. Most patients try acupuncture as a last resort when their doctors have declared their discomfort unfixable or psychosomatic, or prescription drugs have caused collateral damage. Some give it a try when their insurance plans cover a certain number of visits. Others have found community acupuncture offers a way to make regular treatments affordable. If you still haven’t tried acupuncture and are curious whether it’s worth your time and money, here are five encouraging reasons to give it a chance: 1. It's personalized healthcare. No two acupuncture patients receive the same treatment for the same disease or discomfort. Acupuncturists treat patients, not diseases. They are trained to take in every detail of you, from the sound of your voice to the quality of your skin to the sparkle in your eyes. They care about your whole story, past and present. They see your body as a network of interdependent parts: muscle, bone, fascia, organs, blood and body fluids, as well as more subtle layers like meridians and qi. They see what is deficient and what is stuck, mentally as well as physically, and make adjustments like a traffic cop, facilitating the body’s own healing ability.  2. It’s nothing to be afraid of. Sure, you may feel the needles and their immediate effects, but you needn’t be anxious. If you're suffering aches and pains on a daily basis, that chronic pain far outweighs any momentary mini pinch of a hair-thin sterile acupuncture needle.  3. It has lovely side effects.
You may go to acupuncture to cure your neck and shoulder pain, and find that the pain diminishes. Meanwhile, yourstress level, sleep quality, digestion, and overall mood improve too. 4. It gets to the root.
Acupuncture treatments are deeply healing because they focus not only on the patient’s current condition, but investigate why their symptoms are manifesting and aim to treat the underlying root cause.  5. It works. Acupuncture has been around since before recorded history. The earliest written record comes from a few hundred years before the common era. If it didn’t work, it certainly wouldn’t have lasted thousands of years and spread through hundreds of Asian medical lineages.   Scientists try to understand how acupuncture works from a biomedical perspective. Some refer to its effects on fascia, the connective tissue that surrounds all our muscles and organs. Some point to acupuncture’s ability to stimulate the limbic system and autonomic nervous system.  Some scientists claim in their studies that acupuncture is sometimes as effective as “sham acupuncture.” While they attempt to fit a versatile and non-linear medicine into a formulaic model with double-blind studies, the clinical experience of everyday practitioners and patients agrees with thousands of years of history — acupuncture works! For an official list by the World Health Organization on what acupuncture treats, click here.


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Acupuncture for Pain | NCCAM - including fibromyalgia

Acupuncture for Pain | NCCAM - including fibromyalgia | Acupuncture for CFS and ME | Scoop.it
Basic information on pain and acupuncture, including summaries of scientific research on acupuncture for specific kinds of pain, and sources for additional information. From the U.S. National Institutes of Health.

 

FibromyalgiaAgency for Healthcare Research and Quality. Technology Assessment: Acupuncture for Fibromyalgia.Rockville, MD: Agency for Healthcare Research and Quality; 2003.Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Annals of Internal Medicine. 2005;143(1):10–21.Harris RE, Gracely RH, McLean SA, et al. Comparison of clinical and evoked pain measures in fibromyalgia. The Journal of Pain: Official Journal of the American Pain Society. 2006;7(7):521–527.Harris RE, Tian X, Williams DA, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. Journal of Alternative and Complementary Medicine. 2005;11(4):663–671.Mayhew E, Ernst E. Acupuncture for fibromyalgia—a systematic review of randomized clinical trials.Rheumatology (Oxford). 2007;46(5):801–804.

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Acupuncture for treating fibromyalgia - The Cochrane Library - Deare - Wiley Online Library

Acupuncture for treating fibromyalgia - The Cochrane Library - Deare - Wiley Online Library | Acupuncture for CFS and ME | Scoop.it

Authors' conclusions 

 

Implications for practice

Due to the weaknesses of the included studies, the implications for practice are limited. Overall, there is a low to moderate-quality level of evidence that formula acupuncture for the treatment of fibromyalgia is safe. There is a moderate level of evidence that acupuncture is not better than sham controls. Electro-acupuncture is found to be consistently better than sham interventions in improving pain, global well-being, sleep, stiffness and fatigue. The effect of acupuncture was not maintained at six to seven months after treatment. The same level of evidence supports acupuncture as an adjunct therapy to medication and exercise or acupuncture when compared with a medication and exercise control. When comparing acupuncture with medication or a wait list, there is low quality evidence in favour of acupuncture but this needs more rigorous and methodologically sound studies.

Evidence suggests that treatment sessions should be twice per week, over four weeks, with each session lasting for 25 minutes. Electro-acupuncture seems to provide a number of benefits for fibromyalgia participants. Practitioners should consider electro-acupuncture with 2 to 5 Hz electrical stimulation and acupuncture points could include ST36 and LI4. Optimal needling depth, point selection and needle stimulation are yet to be identified. 

Like any treatment for chronic pain, maintenance acupuncture treatment is likely to be required for long-term benefit for fibromyalgia. How frequent the treatment should be is unknown.

 

Implications for research

We recommend a number of ways in which to address the weaknesses identified in the included studies. To further test the usefulness of acupuncture in treating fibromyalgia, researchers need to develop Chinese medicine diagnostic and subgroup differentiation criteria. The suitability of any sham acupuncture needs to be tested in this population prior to any further studies. In regards to the safety profile, a clear definition of what adverse events are associated with acupuncture is needed. Future studies testing the efficacy of acupuncture should use an adequate sample size, apply electro-acupuncture and assess the long-term results. Use of a disease-specific tool, such as the Fibromyalgia Impact Questionnaire, and accurate reporting of treatment using the Standards for Reporting Interventions in Controlled studies of Acupuncture (STRICTA) guidelines would be desirable. Future studies also need to assess how often acupuncture should be delivered to maintain its long-term benefit and the cost-effectiveness of such a treatment plan.

 

 

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The National Institutes of Health (NIH) Consensus Development Program: Acupuncture and neuro-endocrine function research

The National Institutes of Health (NIH) Consensus Development Program: Acupuncture and neuro-endocrine function research | Acupuncture for CFS and ME | Scoop.it

Conclusions

 

Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.

 

However, promising results have emerged, for example, efficacy of acupuncture in adult post-operative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma for which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.

 

Further research is likely to uncover additional areas where acupuncture interventions will be useful.

 

Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function. Although much needs to be accomplished, the emergence of plausible mechanisms for the therapeutic effects of acupuncture is encouraging.

 

The introduction of acupuncture into the choice of treatment modalities readily available to the public is in its early stages. Issues of training, licensure, and reimbursement remain to be clarified. There is sufficient evidence, however, of its potential value to conventional medicine to encourage further studies.

 

There is sufficient evidence of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.


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Study: Alternative Medical Interventions Used in the Treatment and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia - including acupuncture | Abstract

Study: Alternative Medical Interventions Used in the Treatment and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia - including acupuncture | Abstract | Acupuncture for CFS and ME | Scoop.it

"alternative treatments, acupuncture and several types of meditative practice show the most promise for future scientific investigation."


Reference:


Nicole S. Porter, Leonard A. Jason, Aaron Boulton, Nancy Bothne, and Blair Coleman. The Journal of Alternative and Complementary Medicine. March 2010, 16(3): 235-249. doi:10.1089/acm.2008.0376.

 

Published in Volume: 16 Issue 3: March 2, 2010


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Fibromyalgia Treatment - Acupuncture as Fibromyalgia Treatment - Acupuncture as Chronic Fatigue Syndrome Treatment

Fibromyalgia Treatment - Acupuncture as Fibromyalgia Treatment - Acupuncture as Chronic Fatigue Syndrome Treatment | Acupuncture for CFS and ME | Scoop.it
Learn about acupuncture treatments for fibromyalgia and chronic fatigue syndrome, how Chinese acupuncture works, how to find a qualified acupuncturist in your area, and what to expect during acupuncture treatments for fibromyalgia.

 

"

According to experts, both Eastern and Western, the potential benefits of acupuncture include:

Less painBetter sleepRelaxationPossible immune system boostBetter overall health

Research released in 2008 showed that after 20 acupuncture treatments, people with FMS had significant improvements in pain and quality of life that lasted for 3 months after treatment was stopped, with a gradual decline in those areas until all benefit was gone after 2 years.

Acupuncture can be much safer than other therapies, especially if you're combining several different treatments. Benefits as a complementary therapy include:

No negative interactions with other treatments, including drugsExtremely mild side effectsLow risk"
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