By Marissa Grace

Latin: Acus (needle) Punctura

Values Assessment:
Continuum.

Cognitive Objectives

List 3 stated benefits of acupuncture.

Define sham acupuncture.
Describe what Qi is.
Identify the most significant adverse effect
related to safety and explain what it was related
to.
Explain which treatment application (Back pain,
OA of the Knee, or PONV) has the most
evidence of benefits based on results, strengths
and limitations.

Origins

Trace back more than 2000 years in China

6th Century spread to Korea and Japan
8th and 10th Century trade into Vietnam
16th Century Western France by Jesuit
missionaries
1972- Visit to China from President Nixon Member of US Press Corps with emergency
appendectomy received acupuncture.
Experienced shared with New York Time

Stated Benefits
N/V after
chemotherapy
Back Pain
Osteoarthirtis
Preop surgery pain
Addiction
Stroke
Headache
Menstrual Cramps

Tennis elbow
Fibromyalgia
Asthma
Carpal Tunnel

Techniques and Practices

Sham acupuncture
Okibari - Japanese style
Moxibustion
Cupping
Electroacupuncture (EA)

Needles
Needles made of flint, thorns of plants, bamboo
slivers or bone
Very fine and flexible about 1/2in (0.6cm) to 1
in (38cm)
Attract or disburse energy along meridians
FDA approved needles by use of licensed
practitioners in 1996. Sterile, non toxic, single
use only

Tools of the Trade

http://www.lhasaoms.com/

Traditional Chinese Medicine

Qi: Life force, vital energy behind all
physiological processes.
warms body, pathogen protection, promotes
growth
Meridian network system
Disruption of flow results in illness
Mechanism of Qi still mysterious

Traditional Chinese Medicine

Meridians
Term for each of 20 pathways through body
for flow of qi, accessed through acupuncture
points
12 main and 8 secondary
Up to 2000 points along meridian complex
Points regulate different areas of the body

Theory
Stimulation of the nervous system to
release chemicals in the muscles, spinal
cord, and brain.
Beta-endorphin

Analgesia.
Placebo effect.

Is acupuncture safe? A systemic review of case

reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83

Method
202 cases reported (40% from US) from
1965-1999,
First hand reports included, case reports

Is acupuncture safe? A systemic review of case

reports
Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83

Results
Infection: Hepatitis 80% (94cases/35
years)
Needles not cleans/ repeated use/ inadequate
sterilization

Internal Organ/tissue injury

Fewer complications after 1988: no further

Hepatitis reports.
20% of practitioners with no recognized qualifications

Acupuncture for back pain: A meta-analysis

of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241
Methods
Randomized controlled trials of acupuncture of back
pain in humans
377 subjects, mostly with chronic poor prognosis back
pain
Consulted by 6 experienced acupuncturists
12 studies included (9 suitable for meta-analysis)
Conclusion
Insufficient evidence to state whether superior to
placebo
Long term effect of back pain with acupuncture
uncertain

Acupuncture for back pain: A meta-analysis

of randomized controlled trials.
Ernst, Arch of internal Med. 1998;158:20:2235-2241

Randomized trial comparing traditional medical acupuncture,

therapeutic massage, and self-care education for chronic
low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al.
Archives of internal medicine. 2001; 161, 8: 1081-1088.

Design
Only 17% of invited Washington State Group Health
HMO patients participated (262 patients, age 20-70
years).
Ten acupuncture or massage visits in a 10 week period.
95% of patients w/ Follow-up after 4, 10, and 52
weeks.
Symptoms and dysfunctions assessed

Results
F/U with 95% of participants
massage is an effective short-term treatment for chronic
low back pain with benefits to last at least 1 year

Randomized trial comparing traditional medical acupuncture,

therapeutic massage, and self-care education for chronic low
back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of
internal medicine. 2001; 161, 8: 1081-1088.

Results
If acupuncture has a positive effect it seems to
be during the first 4 weeks with limited
improvement thereafter.
Strengths- randomized design, involvement of
therapist with protocol development, and high
compliance rate.
Limitations -absence of control group, restriction
of single form of acupuncture (TCM), possibility
of atypical therapists, use of protocols that
excluded treatments often used by some TCM
acupuncturist.

Osteoarthritis
OA most prevalent form of arthritis
Common site is knee joint and a leading
cause of disability in the elderly
Acupuncture for OA is a therapeutic
approach common in Asian societies

A randomized trial of acupuncture as an adjunctive

therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354

Design

73 patients from the Baltimore area (average

age 65 years).
Inclusion criteria 50 older Dx of OA 6
months, moderate pain in knee most days in
the last month, taking analgesic or antiinflammatory agents for pain control at least
one month.
protocol included TCM treatment for Bi
syndrome which uses local and distal points on
channels that cross the area of pain

A randomized trial of acupuncture as an adjunctive

therapy in osteoarthritis of the knee
Berman BM, et. al. Rheumatology 1999;38: 346-354

Western Ontario and McMaster Universities

Osteoarthritis Index (WOMAC)
The patients scores were determined at 0, 4, 8 and
12 weeks during trial.

Results
the acupuncture group with about 34% on WOMAC
at week 4 and 42% at week 8.
There were no significant changes in the control
group from baseline to week 12.
Limitations noted lack of placebo control group.

Effectiveness of acupuncture as adjunctive therapy in

osteoarthritis of the knee: a randomized, controlled trial.
Berman BM, Lao L, Langenberg P, et al. Annals of Internal
Medicine. 2004

Design
Reduce pain/improve function among patients
with knee OA as compared to both sham
acupuncture and education control groups
8 week intense acupuncture treatment,
followed by an 18 week tapering regime
570 participants
Assessments conducted at baseline, 4, 8, 14,
and 26 weeks

Effectiveness of acupuncture as adjunctive therapy in

osteoarthritis of the knee: a randomized, controlled trial. Berman
BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004

Results
True acupuncture groups improvement from baseline
was significantly greater than the sham control group
at weeks 8 (P=0.01), 14 (P=0.04), 26 (P=0.009)
Most believe they received true acupuncture at both
times, suggesting the sham acupuncture to be a
credible blinding strategy
At 4 weeks 67% of the true acupuncture group and 58% of
sham believed they were receiving true acupuncture
(P=0.06) and at 26 weeks 75% in acupuncture group and
58% in sham (P=0.003).

The use of nonpharmacologic techniques to prevent

postoperative nausea and vomiting (PONV): A metaanalysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.

Design
Stimulation of wrist at pericardium (P6)
Systemic review 24 randomized controlled
trials (1679 patients)
Nonphamacologic- acupuncture, electroacupuncture,
transcutaneous electrical nerve stimulation, acupoint stimulation and
acupressure

Measured incidence of nausea, vomiting or

both after surgery 0-6h (early) or 0-48h (late)

The use of nonpharmacologic techniques to prevent

postoperative nausea and vomiting (PONV): A metaanalysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.

Results
Pediatric studies failed to show significant
benefit.
Antiemetic use in preventing early or late
PONV in adults was comparable to the nonpharmacologic techniques.
Significant reduction of early vomiting in
nonpharm. group compared with placebo w/in
6h of surgery for adults.

The use of nonpharmacologic techniques to prevent

postoperative nausea and vomiting (PONV): A metaanalysis
Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.

Limitations
Combining different non-pharmacologic techniques.
May have different effects to prevent PONV

Optimal methods of applying techniques unknown.

Length of treatment (5min- 7days)
No statistical heterogeneity

Conclusions
Further RCT with better study methodology needed in
adults.
Mechanism for prevention of PONV not established.

Values Assessment:
Continuum./ Questions????