Functional Medicine "The only way to make sense out of change is to plunge into it, move with it, and join the dance!" - Alan Watts The Institute for Functional Medicine is truly enlightening evidence based medicine, that looks deeply at real data to come to conclusions about the root cause of disease so we can effectively heal individuals. Please join us in the movement, and tell them I sent you! (It is best to start with AFMCP) Please contact me if at sarah@cascadewellness.com you have any questions at all! Acupuncture for painTraditional East Asian medicine is the oldest continually practiced literate medicine used world wide. With the foundation of thousands of years of recorded biological observation, traditional East Asian medicine has survived and thrived due to the effectiveness of its thorough methods (World Health Organization, 2003). There are controlled studies showing measurable changes in fMRI, as well as chemical changes such as; local release of adenosin, release of beta-endorphins and other opioid peptides, with acupuncture point stimulation compared to placebo, so it is no surprise that controlled clinical trials show statistically significant changes above placebo in spite of the methodological difficulty of studying a skin-penetrating therapy based on an non-equatable language (Fang, et al., 2004; Goldman, et al., 2010; Hui, 2005; Han, 2004; Zhang, et al., 2003). Osteoarthritis of the Knee Longer trials on knee pain show benefit while shorter trials show conflicting results. This is congruent with traditional Chinese medicine theory because knee pain can be an indication of chronic overall weakness in some people, which makes resolution more difficult. This is not always the case, and I find in practice that knee pain can also respond very quickly. Berman, et al. (2004) showed that a prolonged treatment regime (26 weeks) of frequent acupuncture (starting with 2 treatments a week and tapering to once weekly) for osteoarthritis of the knee in a 570 patient randomized controlled trial was more effective than sham acupuncture and control. Improvement of function but not pain was seen at 8 weeks, and improvement in pain and function was superior in the acupuncture group compared to the placebo group and control group at longer intervals. Suarez-Almazor, et al. (2009) studied acupuncture for osteoarthritis of the knee and included provider communication as a variable for 8 weeks which showed more benefit with communication style than with acupuncture vs. sham acupuncture. This short 8 week trial used a standardized acupuncture treatment, which effectively eliminates traditional East Asian medicine, including the diagnosis and point selection process. The standard treatment was compared to sham acupuncture, which could still stimulate an acupuncture channel no matter where you place a needle, and not surprisingly both groups got some relief from pain. It is fascinating how much communication style can impact a medical encounter but this is hardly evidence against traditional East Asian medicine. Chronic Shoulder Pain A German controlled clinical trial of 424 participants recently showed benefit for chronic shoulder pain compared to placebo and conventional orthopedic management alone with 15 treatments over 6 weeks. Improvement in function (abduction and arm-above-head test) and pain were observed compared to placebo and conventional treatment after the 6 weeks of treatment, and in 3 months, showing the lasting benefits of acupuncture. Headaches A 401 participant study of patients with chronic headache, predominantly migraine, showed an overall reduction in headaches of 22 equivalent days per year, as well as 25% fewer visits to practitioners, and 15% fewer sick days in the acupuncture group. It was concluded that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine (Vickers, et al., 2004). A new Duke University systematic review of 31 trials on headache showed that acupuncture had a 62 % effective rate while medications had a 45 % effective rate, with sham acupuncture showing less effectiveness than traditional acupuncture (Sun, Y., Gan, T. J., 2010). The challenge of studying acupuncture Most studies compare “acupuncture” to an allopathic diagnosis. Initially, the term “acupuncture” is a misnomer because what is really being studied is a specific set of points rather than an entire system of medicine. You wouldn’t run a trial on statins and call it “allopathic medicine for heart fire” because you would be comparing two entirely different systems of medicine that do not equate because not only is the language different but also the entire context and framework. The issue of placebo control in acupuncture is almost as impractical as a placebo massage. The fascial network of nerves is easily stimulated anywhere on the body so no blinded placebo needling will go without effect, which shows in the unusually high placebo effect in these studies. Yet there are studies showing statistically significant benefit as well as physiological changes when true acupuncture points are used compared to placebo or sham needling. Just think what we might find in well designed trials that attempt to truly harness the diagnostic power of traditional East Asian medicine. For more studies on acupuncture and a complete list of conditions effectively treated please visit Sarah's site CascdeWellness.com References Berman, M. B., Lao, L., Langenberg, P., Wen, L. L., Gilpin, A. M. K., Hochberg, M. C. (2004). Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Annals of Internal Medicine, 141, 901-910. Fang, J. L., Krings, T., Weidemann, J., Meister, I.G., Thron, A. (2004). Functional MRI in healthly subjects during acupuncture: Different effects of needle rotation in real and false acupoints. Neuroradiology, 46(5), 359-62. Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 13, 883-888. Han, J. S. (2004). Acupuncture and endorphins. Neuroscience Letters, 6;361(1-3), 258-61. Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., Kennedy, D. N., Makris, N. (2005). The integrated response of the human cerebro-cerebellare and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-96. Molsberger, A. F., Schneider, T., Gotthardt, H., & Drabik, A. (2009). German randomized acupuncture trial for chronic shoulder pain (GRASP) – A pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. International Association for the Study of Pain, 151, 146-154. doi 10.1016/j.pain.2010.06.036 Suarez-Almazor, M. E., Looney, C., YanFang, L., Cox, V., PietzArthritis Care & Research, 62(9), 1229-36. doi 10.1002/acr Anesthesia & Analgesia, 107(6), 2038-2047. doi 10.1213/ ane.0b013e318187c76a Retrieved from http://www.anesthesia-analgesia.org/content/107/6/2038.long World Health Organization (2003). Acupuncture: Review and analysis of reports on controlled clinical trials. Retrieved from http://apps.who.int/medicinedocs/en/d/Js4926e/ Zhang, W. T., Jin, Z., Cui, G. H., Zhang, K.L., Zhang, L., Zeng, Y.W., ... Han, J. S. (2003). Relations between brain network activation and alalgesic effect induced by low vs. high frequency electrical acupoint stimulation in different subjects: A functional magnetic resonance imaging study. Brain Research, 982(2), 168-78. |