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Integrative Acupuncture

June 22, 2012 Written by JP       [Font too small?]

Acupuncture is a healing modality that has the potential to further the cause of integrative medicine, a form of care that combines alternative/complementary practices with allopathic or conventional treatment. For one thing, there’s an enormous amount of scientific research that has been and is being conducted on acupuncture. In addition, acupuncture is widely accepted as very safe and unlikely to conflict with allopathic treatment when applied by a knowledgeable practitioner. Finally, acupuncture is rarely advocated as a sole therapeutic option. Medications, physical therapy and even surgery can be used as adjuncts. All of these points tend to facilitate a greatly likelihood of acceptance and/or cooperation among physicians who aren’t generally holistically minded.

Of late, three studies have crossed my desk which I want all of my patient and physician readers to know about. Every one of these trials took place at a respected institute of learning (Massachusetts General Hospital, University of Milan and University of Munich), was peer reviewed and well designed. The results of these interventions and many others should be considered as part of the growing paradigm of integrative medicine.

The first trial, conducted at Massachusetts General Hospital, reports that an 8 week course of acupuncture dramatically reduces depression in patients with major depressive disorder. In the study, a 30 minute session of acupuncture was administered once or twice-weekly. The once weekly treatment group registered the greatest benefits – a reduction in depression symptoms, as indicated by a decline in Hamilton-D 17 scores, from 19.1 to 9.9. The authors of the research note the response rate as 62% with only occasional “mild soreness/pain” and “mild bleeding” at the needle site as side effects.

Atrial fibrillation (AF), a common form of heart arrhythmia, appears to respond to acupuncture as well. Italian scientists tested acupuncture treatment versus medication (amiodarone) in patients with persistent AF. The acupuncture volunteers received once-weekly treatment over a 10 week period in the Neiguan, Shenmen and Xinshu acupoint regions. The conclusion of the trial revealed that, “acupuncture of the Neiguan spot was associated with an antiarrhythmic effect” and “strongly suggest that acupuncture may be an effective non-invasive and safe antiarrhythmic tool in the management of these patients”.

Atopic dermatitis is a chronic skin condition characterized by irritated and scaly patches of skin. In many cases, it’s conventionally managed with the use of antihistamine medications that help control itching. A study published in the April 2012 issue of the journal Allergy tested the hypothesis that acupuncture may provide a viable alternative to cetirizine, an antihistamine drug. Much to the surprise of the investigators, patients receiving acupuncture demonstrated a more pronounced reduction in “flare size” and “itch intensity” than those given the medication or a placebo.

Atopic dermatitis is certainly uncomfortable, but isn’t considered a serious health threat. Therefore, the use of alternative therapies is rarely discouraged in earnest. Atrial fibrillation and major depressive disorder are different stories. In both instances, proper medical supervision is essential. However, the inclusion of complementary therapies as part of a comprehensive treatment program can be of great, additive value – if the information is available for consideration. So, as patients, hopefully you’ll make it a point to respectfully demand a more integrative approach in your own health care. And, for the physicians out there, hopefully you will keep an open mind and look for ways to improve the care you provide by offering natural and safe solutions when they’re available and evidence based.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - A Pilot Study of Acupuncture Monotherapy in Patients with Major (link)

Study 2 - Acupuncture for Paroxysmal and Persistent Atrial Fibrillation (link)

Study 3 - Acupuncture Compared with Oral Antihistamine for Type I(link)

Acupuncture Treatment May Help Manage Heart Arrhythmias


Source: World J Cardiol. 2012 March 26; 4(3): 60–65. (link)

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Posted in Alternative Therapies, Heart Health, Mental Health

12 Comments & Updates to “Integrative Acupuncture”

  1. Sylvia S. Says:

    Sounds promising and will stay tuned for hopefully more encouraging reports about this!

  2. JP Says:

    Thank you, Sylvia! :)

    Be well!

    JP

  3. Iggy Dalrymple Says:

    While I haven’t tried integrative acupuncture I have had some success with acupuncture. Once it worked for my asthma. Fifteen years later when the asthma returned, the acupuncture failed to help. It worked for tennis elbow, rotator cuff, and sciatica, but failed to help my lower back pain. Now I’ve read that “auricular acupuncture” frequently helps lower back pain, so next trip to Tallahassee I’ll try auricular.

  4. JP Says:

    Hi Iggy,

    Ah, yes, ear acupuncture. Please let us know how that works out for you. Lately, I’ve been reading some intriguing studies about it – links below.

    Tomorrow, Mrs. HF is going in for her first acupuncture session – acupoints and type to be determineed. I’m hoping it’ll be a most positive experience. Fingers crossed!

    http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2011.05232.x/abstract

    http://www.springerlink.com/content/r11t743220hvv211/

    http://www.ncbi.nlm.nih.gov/pubmed/21223673

    Be well!

    JP

  5. JP Says:

    Yoga is another natural option for atrial fibrillation:

    http://www.sciencedirect.com/science/article/pii/S0735109713000442

    Be well!

    JP

  6. JP Says:

    Update: Lemon balm extract may also protect against heart palpitations …

    http://www.sciencedirect.com/science/article/pii/S0378874115000781

    J Ethnopharmacol. 2015 Feb 10. pii: S0378-8741(15)00078-1. doi: 10.1016/j.jep.2015.02.007. [Epub ahead of print]

    Heart palpitation relief with Melissa officinalis leaf extract: Double blind, randomized, placebo controlled trial of efficacy and safety.

    ETHNOPHARMACOLOGICAL RELEVANCE:

    In Traditional Iranian Medicine (TIM), Melissa officinalis L. is commonly regarded as an effective therapy for heart palpitations.

    OBJECTIVE:

    Heart palpitation is a common complaint that is often benign and associated with a marked distress that makes the condition difficult to treat. Herbal medicines provide an alternative to conventional drugs for treating various kinds of diseases. This study was done as a double blind randomized placebo-controlled clinical trial to evaluate the efficacy and safety of the dried extract of M. officinalis on adults suffering from benign palpitations.

    MATERIALS AND METHODS:

    Eligible volunteers were randomly assigned as outpatients to a fourteen day treatment with 500mg twice a day of lyophilized aqueous extract of M. officinalis leaves (or placebo). Participants in the tests, physicians and researchers were blind to group assignments. Both primary and secondary outcomes were patient-reported. Primary outcomes were obtained from two measures: mean frequency of palpitation episodes per week, derived from patients’ diaries, and mean intensity of palpitation estimated through Visual Analogue Scale (VAS) in a self-report questionnaire. Psychiatric symptoms (somatization, anxiety and insomnia, social dysfunction and severe depression) were evaluated as secondary outcomes by General Health Questionnaire-28(GHQ-28), before and after intervention.

    RESULTS:

    Fifty-five volunteers out of seventy-one recruited study subjects completed the trial. Results showed that 14-days of treatment with lyophilized aqueous extract of M. officinalis leaves reduced frequency of palpitation episodes and significantly reduced the number of anxious patients in comparison to the placebo (P=0.0001, P=0.004resp.). Also, M. officinalis extract showed no indication of any serious side effects.

    CONCLUSION:

    Lyophilized aqueous extract of Melissa officinalis leaves may be a proper and safe herbal drug for the treatment of benign palpitations.

    Be well!

    JP

  7. JP Says:

    Update 05/12/15:

    http://www.hindawi.com/journals/ecam/2015/143858/

    Evid Based Complement Alternat Med. 2015;2015:143858.

    Acupuncture therapy is more effective than artificial tears for dry eye syndrome: evidence based on a meta-analysis.

    Background. The efficacy of acupuncture in dry eye syndrome patients remains controversial. Methods. Pubmed, Ovid, Cochrane libraries, CNKI, Wanfang, and CQVIP databases were electronically searched until October 1, 2014. Outcomes including tear break-up time (BUT), Schirmer I test (SIT), and cornea fluorescein staining (CFS) were analyzed. A meta-analysis was performed using both fixed- and random-effects models based on heterogeneity across studies. Results. Seven studies were included in this study; 198 and 185 patients were randomly treated with acupuncture and artificial tears, respectively. The overall BUT of patients in acupuncture group was significantly longer than that of the artificial tears group after treatment (P < 0.00001). The SIT was significantly higher in the acupuncture group than that in the artificial tears group after treatment (P = 0.001). The CFS of patients in acupuncture group was significantly improved compared to that in artificial group (P < 0.0001). Conclusions. Acupuncture therapy is effective for the dry eye patients, partly better than artificial tear treatment.

    Be well!

    JP

  8. JP Says:

    Update 06/11/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26060503

    Evid Based Complement Alternat Med. 2015;2015:920353.

    Acupuncture for Frequent Migraine: A Randomized, Patient/Assessor Blinded, Controlled Trial with One-Year Follow-Up.

    Objectives. This study aimed to evaluate the efficacy and safety of manual acupuncture as a prophylaxis for frequent migraine. Methods. Fifty frequent migraineurs were randomly allocated to receive 16 sessions of either real acupuncture (RA = 26) or sham acupuncture (SA = 24) during 20 weeks. The primary outcomes were days with migraine over four weeks, duration, and intensity of migraine and the number of responders with more than 50% reduction of migraine days. The secondary outcomes were the relief medication, quality of migraine, quality of life, and pressure pain thresholds. Results. The two groups were comparable at baseline. At the end of the treatment, when compared with the SA group, the RA group reported significant less migraine days (RA: 5.2 ± 5.0; SA: 10.1 ± 7.1; P = 0.008), less severe migraine (RA: 2.18 ± 1.05; SA: 2.93 ± 0.61; P = 0.004), more responders (RA: 19 versus SA: 7), and increased pressure pain thresholds. No other group difference was found. Group differences were maintained at the end of the three-month follow-up, but not at the one-year follow-up. No severe adverse event was reported. Blinding was successful. Discussion. Manual acupuncture was an effective and safe treatment for short-term relief of frequent migraine in adults. Larger trials are warranted.

    Be well!

    JP

  9. JP Says:

    Updated 1/23/16:

    http://www.ncbi.nlm.nih.gov/pubmed/26795764

    Acupunct Med. 2016 Jan 21.

    Randomised controlled trial of contralateral manual acupuncture for the relief of chronic shoulder pain.

    OBJECTIVE: To explore the effects of contralateral manual acupuncture (MA) on patients with chronic shoulder pain.

    METHODS: Eighty patients with chronic shoulder pain were randomly allocated to receive contralateral MA (n=38) for 4 weeks or to remain on a waiting list while receiving conventional orthopaedic therapy (n=42). Visual analogue scale (VAS) scores were taken as the primary outcome measure and used for a priori power calculation. Secondary outcome measures for the assessment of shoulder mobility and quality of life included the Jobe test, the Constant-Murley (CM) score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the 36 item Short Form Health Survey (SF-36).

    RESULTS: Intention-to-treat (ITT) analysis demonstrated significant pain relief with contralateral acupuncture, with mean differences in VAS scores compared to the waiting list group of -19.4 (-28.0 to -10.8) at 2 weeks, -40.4 (-49.0 to -31.8) at 4 weeks, -41.1 (-49.7 to -32.5) at 8 weeks, and -40.9 (-49.5 to -32.3) at 16 weeks. CM and DASH scores were also improved at all time points (p<0.01). Shoulder mobility, physical functioning, social functioning and mental health components of the SF-36 were also improved by contralateral acupuncture at 8 weeks. No significant adverse effects were observed.

    CONCLUSIONS: These results demonstrate beneficial effects of contralateral acupuncture in the treatment of chronic shoulder pain, both in terms of pain and function. Future research is required to compare directly the effects of local and contralateral acupuncture and to quantify the specific and non-specific effects.

    Be well!

    JP

  10. JP Says:

    Updated 05/26/16:

    http://www.ncbi.nlm.nih.gov/pubmed/26964157

    Zhongguo Zhen Jiu. 2015 Dec;35(12):1209-13.

    [Moderate and severe persistent allergic rhinitis treated with acupuncture: a randomized controlled trial].

    OBJECTIVE: To observe the clinical efficacy and safety on moderate and severe persistent allergic rhinitis treated with acupuncture.

    METHODS: Sixty-six patients of moderate and severe persistent allergic rhinitis were randomized into an acupuncture group (34 cases) and a western medication group (32 cases). In the acupuncture, group, acupuncture was applied to Dazhui (GV 14), Feishu (BL 13), Pishu (BL 20), Ganshu (BL 18) and Shenshu (BL 23) in the prone, retained for 20 min; then in the supine, at Baihui (GV 20), Yintang (GV 29), yingxiang (LI20) Taichong (LR 3) and Hegu (LI 4), retained for 20 min. Acupuncture was given once every two days, three times a week, continuously for 8 weeks. In the western medication group, cetirizine hydrochloride was taken orally, 10 mg each time, once every day, continuously for 8 weeks. Separately, before treatment, after the treatment of 1 and 2 months and in 1 month after treatment, the total nasal symptom score (TNSS), the scores in the emotion rating scale for Ganzangxiang of TCM (ERSG) and the rhinoconjunctivitis quality of life questionnaire (RQLQ) were observed in the patients of the two groups. The clinical efficacy was compared between the two groups.

    RESULTS: (1) For TNSS, the results after 1 and 2 months treatment and in 1 month after treatment were all, reduced as compare with that before treatment separately in the two groups (P < 0.05, P < 0.01) The result after 2 months treatment was lower than that after 1 month treatment in the acupuncture group (P < 0.05). In 1 month after treatment, the result in the acupuncture group was lower than that in the western medication group (P < 0.05). (2) For ERSG, the score after 2 months treatment was lower than that before treatment in the two groups (both P < 0.05). The score after 2 months treatment in the acupuncture group was lower than that in the western medication group (P < 0.05). (3) For RQLQ, the score after 1 month treatment was lower than that before treatment and the score after 2 months treatment was lower than that after 1 month treatment in the two groups (all P < 0.05). The score after 1 and 2 months treatment and in 1 month after treatment in the acupuncture group was lower than that in the western medication group separately (all P < 0.05). (4) The total effective rate was 91.2% (31/34) in the acupuncture group and was 90.6% (29/32) in the western medication group, without significant difference between the two groups (P > 0.05).

    CONCLUSION: Acupuncture is the safe and effective intervention on moderate and severe persistent allergic rhinitis. Compared with the western medicine group, the efficacy in the acupuncture group presents much more advantageous at its durability.

    Be well!

    JP

  11. JP Says:

    Updated 10/05/16:

    http://www.journalofpsychiatricresearch.com/article/S0022-3956(16)30386-7/abstract

    J Psychiatr Res. 2016 Sep 16;84:18-26.

    Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder.

    Major depressive disorder (MDD) is a common disorder with a high prevalence and significant social and economic impacts. Nevertheless, the treatment of MDD is far from satisfactory. Acupuncture treatment has emerged as a promising method for treating MDD. However, the neural mechanism by which acupuncture reduces depressive symptoms is not fully understood. Studies have shown that the corticostriatal reward circuitry is associated with the pathophysiology of MDD; thus, we investigated the corticostriatal resting-state functional connectivity (rsFC) before and after real and sham acupuncture treatments combined with the antidepressant fluoxetine. Forty-six female major depressive patients were assigned to either verum acupuncture plus fluoxetine (n = 22) or sham acupuncture plus fluoxetine (n = 24) treatment for 8 weeks, and resting state functional magnetic resonance imaging (fMRI) data were collected before the first and after the last treatment sessions. The results showed that compared with sham acupuncture, the verum acupuncture group showed: (1) significantly increased rsFC between inferior ventral striatum and medial prefrontal cortex, ventral rostral putamen and amygdala/parahippocampus, as well as dorsal caudate and middle temporal gyrus; (2) significantly decreased rsFC between right ventral rostral putamen and right dorsolateral prefrontal cortex, and right dorsal caudate and bilateral cerebellar tonsil. The increased rsFC between the inferior ventral striatum and medial prefrontal cortex, ventral rostral putamen and amygdala/parahippocampus were significantly positively associated with decreased clinical scores (Montgomery-Åsberg Depression Rating Scale and Self-Rating Depression Scale scores) at the end of the eight-week treatment. Our findings suggest that acupuncture may achieve treatment effects by modulating the corticostriatal reward/motivation circuitry in MDD patients.

    Be well!

    JP

  12. JP Says:

    Updated 2/16/18:

    https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pnx322/4856005?redirectedFrom=fulltext

    Pain Med. 2018 Feb 13.

    Randomized Controlled Trial of Acupuncture for Women with Fibromyalgia: Group Acupuncture with Traditional Chinese Medicine Diagnosis-Based Point Selection.

    Background: Group acupuncture is a growing and cost-effective method for delivering acupuncture in the United States and is the practice model in China. However, group acupuncture has not been tested in a research setting.

    Objective: To test the treatment effect of group acupuncture vs group education in persons with fibromyalgia.

    Design: Random allocation two-group study with repeated measures.

    Setting: Group clinic in an academic health center in Portland, Oregon.

    Subjects: Women with confirmed diagnosis of fibromyalgia (American College of Radiology 1990 criteria) and moderate to severe pain levels.

    Methods: Twenty treatments of a manualized acupuncture treatment based on Traditional Chinese Medicine diagnosis or group education over 10 weeks (both 900 minutes total). Weekly Revised Fibromyalgia Impact Questionnaire (FIQR) and Global Fatigue Index at baseline, five weeks, and 10 weeks and a four-week follow-up were assessed.

    Results: Thirty women were recruited, with 78% reporting symptoms for longer than 10 years. The mean attendance was 810 minutes for acupuncture and 861 minutes for education. FIQR total, FIQR pain, and Global Fatigue Index all had clinically and statistically significant improvement in the group receiving acupuncture at end of treatment and four weeks post-treatment but not in participants receiving group education between groups.

    Conclusions: Compared with education, group acupuncture improved global symptom impact, pain, and fatigue. Furthermore, it was a safe and well-tolerated treatment option, improving a broader proportion of patients than current pharmaceutical options.

    Be well!

    JP

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