International Health News Database


Acupuncture and Yoga

by Hans R. Larsen, MSc ChE

Acupuncture may relieve pelvic pain in pregnancy
Hans Larsen GOTHENBURG, SWEDEN. Pelvic girdle pain is common among pregnant women, with one in three affected suffering severe pain. It is thought to be caused by hormones affecting the flexibility of ligaments and muscles in preparation for labour.

A research team from Gothenburg's Institute for the Health of Women and Children investigated the effectiveness of acupuncture to relieve this condition. They compared standard treatment (a home exercise routine), standard treatment plus acupuncture, and standard treatment plus stabilising exercises aimed at improving mobility and strength, each treatment given for six weeks. Participants were 386 women seen at 27 Swedish maternity care centers. They were between 12 and 31 weeks of gestation and experiencing pelvic girdle pain. The women given acupuncture had significantly less pain than the other two groups. This applied to both self-reported pain using a recognized scale and pain assessed by an independent examiner in the morning and in the evening. The stabilising exercise group had more pain than the acupuncture group but less pain than the standard treatment group.

The researchers conclude that treatment with acupuncture and stabilising exercises offers clear advantages and can be seen as a useful addition to standard treatment for pelvic girdle pain during pregnancy. This finding is supported by previous evidence of a beneficial effect of stabilising exercises adapted for pregnancy as well as evidence that acupuncture can have a pain-relieving effect for patients with low back pain. Although acupuncture may well prove helpful in this condition, there was no 'sham acupuncture' group, so the placebo effect may be a factor. Further trials are necessary to rule out the placebo effect, and to establish the ideal method of acupuncture if it is shown to be beneficial.
Elden, H et al. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. British Medical Journal, Vol. 330, April 2005, pp. 761-764

Acupuncture effective in treatment of osteoarthritis of knee
BALTIMORE, MARYLAND & DOS HERMANAS, SPAIN. Osteoarthritis is a major cause of incapacity and deteriorated quality of life in the elderly. It is the most common form of arthritis and occurs most frequently in the knee. Currently, there is no non-surgical cure for the disease and the focus of treatment is the management of pain and functional limitation. Although patient education, physical therapy, exercise, and weight loss are all an important part of intervention, medications are eventually required.

Because medications can cause serious side effects, alternative therapies, such as acupuncture, are receiving attention. While results of various trials suggest that acupuncture may be beneficial in treating the pain associated with knee osteoarthritis, its role is still controversial.

Two recently published studies demonstrate that patients with knee osteoarthritis who receive acupuncture as a complementary (adjunctive) therapy experience better results than those who receive patient education or drug treatment alone.

In one study, researchers at the University of Maryland School of Medicine evaluated 570 elderly patients with knee osteoarthritis to determine whether acupuncture provides greater pain relief and improved function compared with "fake" acupuncture or patient education only. The patients were randomly assigned to either a treatment group that received a total of 23 true acupuncture sessions over 26 weeks, or a control group that received 6 two-hour education sessions over 12 weeks or 23 fake acupuncture sessions over 26 weeks.

Similarly, Spanish researchers evaluated the effectiveness of a 12-week series of acupuncture treatments as a complementary therapy in 97 patients with knee osteoarthritis who were being treated with diclofenac. Like the first study, patients were randomly assigned to receive acupuncture (treatment group) or "fake" acupuncture (control group).

Measurements taken during both studies used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to quantify the pain level and functional disability experienced by the participants. The Maryland researchers found that patients in the acupuncture group, at the end of the study (after 26 weeks), had experienced a 42% reduction in WOMAC pain score as compared to a 19% reduction in the control group. Similarly, a 40% improvement in function score was observed among acupuncture participants versus a 22% improvement in the control group. A global health assessment of the study participants indicated a 15% improvement for acupuncture patients compared to a 7% improvement in the control group. The Spanish researchers found an 82% improvement in WOMAC function score in the patients treated with true acupuncture (and diclofenac) as compared to a 40% improvement in patients treated with sham acupuncture (and diclofenac). Pain scores decreased by 86% in the true acupuncture group versus a decrease of 47% in the sham group. Patients in the true acupuncture group also reported a greater improvement in psychological functioning and consumed 39% less diclofenac tablets than the sham group (85 tablets, on average, versus 139 tablets) over the 12-week trial period.

These results suggest that acupuncture is more effective than drug therapy or patient education therapy alone, and the Maryland researchers conclude that acupuncture may have an important future role in a multidisciplinary approach to knee osteoarthritis treatment. The Spanish researchers recommend additional research to establish the duration of improvement after acupuncture and to establish treatment protocols.
Berman BM, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. 2004 Dec 21;141(12):901-10
Vas J, et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ. 2004 Nov 20;329(7476):1216-19

Acupuncture acts directly on the brain
CHARLESTOWN, MASSACHUSETTS. Although acupuncture has been successfully used for thousands of years in China it is still viewed with considerable skepticism by many Western medical practitioners. One of the main stumbling blocks to greater acceptance is the lack of understanding of how it works. This may all change now with the publication of a seminal report by researchers at the Harvard Medical School. The researchers used functional magnetic resonance imaging (fMRI) to investigate how acupuncture affects brain activity in normal subjects. Thirteen healthy volunteers (ages 27 to 52 years) were involved in the study. They were seated in the MRI scanner and after relaxing had an acupuncture needle inserted in the LI 4 or Hegu point (located on the hand between the thumb and forefinger). The needle was left at rest for two minutes followed by two periods of manipulation (twirling) with a four-minute rest period in between. The researchers noted a highly significant correlation between brain activity and needle manipulation. Needle manipulation caused a pronounced calming of activity (decreased signal intensity) in the deep structures (amygdala, hippocampus, hypothalamus, etc.) of the brain accompanied by an increased signal intensity in the somatosensory cortex. They conclude that "modulation of this neuronal network could constitute the initiating steps by which acupuncture regulates multiple physiological systems and achieves diverse therapeutic effect". [62 references]
Hui, Kathleen, K.S., et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Human Brain Mapping, Vol. 9, 2000, pp. 13-25

Complementary medicine in Australia
MELBOURNE, AUSTRALIA. A team of researchers from the University of Melbourne has released the results of a survey designed to probe the use and knowledge about complementary therapies among general practitioners in the state of Victoria. Nearly half of the doctors had considered practicing one or more complementary therapies and over 80 per cent had referred patients to practitioners of these therapies. Acupuncture, hypnosis, and meditation were the therapies found most acceptable and effective by the GPs and 34 per cent of them had actually taken training in meditation followed by acupuncture at 23 per cent, vitamin and mineral therapy at 23 per cent, hypnosis at 20 per cent, and herbal medicine at 12 per cent. The GPs expressed strong support for the idea that hypnosis, meditation, and chiropracty should be covered by the Australian Medicare system. They considered vitamin and mineral therapy, homeopathy, aromatherapy, reflexology, and herbal medicine to be the least effective of the complementary modalities covered in the survey.

Another survey involving 161 oncologists (cancer specialists) found that almost a quarter of them had considerable knowledge about the use of meditation, relaxation, visual imagery, antioxidant therapy, high-dose vitamin C therapy, and microwave/Tronado therapy in the treatment of cancer. Very few knew anything about cellular therapy, magnetotherapy, and psychic surgery. Most oncologists (69-82 per cent) thought that meditation, relaxation, and visual imagery would be helpful in both curative and palliative (symptom relief) treatment of cancer. Acupuncture and hypnotherapy were also deemed helpful whereas coffee enemas, diet therapy (Gerson/macrobiotic), Iscador/mistletoe therapy, ozone therapy, and psychic surgery were considered to be ineffective and often harmful. The oncologists often over-estimated their patients' use of complementary therapies. For example, only 0.5 per cent of cancer patients in a recent survey reported using aromatherapy while the oncologists estimated that 15 per cent used this therapy. The use of herbal therapies and shark cartilage was also vastly over-estimated at 45 per cent and 15 per cent respectively versus an actual use of 10 per cent and 4 per cent respectively.
Pirotta, Marie V., et al. Complementary therapies: have they become accepted in general practice? Medical Journal of Australia, Vol. 172, February 7, 2000, pp. 105-09
Newell, Sallie and Sanson-Fisher, Rob W. Australian oncologists' self- reported knowledge and attitudes about non-traditional therapies used by cancer patients. Medical Journal of Australia, Vol. 172, February 7, 2000, pp. 110-13
Lewith, George T. Complementary and alternative medicine: an educational, attitudinal and research challenge. Medical Journal of Australia, Vol. 172, February 7, 2000, pp. 102-03 (editorial)

Nova Scotia Medical Society approves alternative medicine section
HALIFAX, CANADA. The board of the Medical Society of Nova Scotia recently approved a new section of the Society which will consist of physicians who use unconventional therapies in their practices. The new Complementary Medicine Section, a first in Canada, has 17 charter members and is open to doctors involved with environmental medicine, homeopathy, acupuncture, electroacupuncture, nutrition counselling, chelation therapy, biofeedback, osteopathy, and herbal therapy. The formation of the new section was spearheaded by Dr. William LaValley who specializes in homeopathy and electroacupuncture and who, up until a year ago, was under investigation by the Provincial Medical Board for his use of unconventional practices. It is estimated that 34 per cent of Americans and 20 per cent of Canadians now use some form of alternative medicine.
Robb, Nancy. Some MDs displeased as MSNS board gives nod to complementary medicine section. Canadian Medical Association Journal, Vol. 150, No. 9, May 1, 1994, pp. 1462-65

Complementary medicine: Full speed ahead in Europe
LONDON, ENGLAND. The use of complementary medicine (alternative medicine, unconventional treatments) is growing by leaps and bounds in Europe. It is estimated that 49 per cent of French people and 46 per cent of Germans now use some form of complementary medicine to treat their illnesses. In France the number of people using homoeopathy grew from 16 per cent of the population in 1982 to 36 per cent in 1992. Unconventional therapies vary in popularity from country to country. In Denmark reflexology is the most popular modality, in Belgium, France and the Netherlands it is homoeopathy while in Sweden, the U.K. and the United States osteopatic and chiropractic therapies are the most popular. Acupuncture is also very popular in most European countries. The market for homoeopathic remedies is growing by 20 per cent per year in Britain and by 30 per cent a year in Greece and Portugal. The market for herbal medicines is also expanding rapidly. Conventional medical doctors are, to an increasing extent, becoming involved in complementary medicine. In Belgium 84 per cent of all homoeopathy and 74 per cent of all acupuncture treatments are carried out by conventional practitioners. In the Netherlands 47 per cent of medical doctors now use some form of complementary therapy. In Germany 77 per cent of pain clinics use acupuncture. The European Council has just issued a directive covering the manufacture, inspection, marketing, and labelling of homoeopathic remedies. A proposal now before the European parliament would cover alternative treatments under "medicare", would include complementary medicines in the European pharmacopeia, and would provide a research budget of $15 million per year for five years. Switzerland has proposed a major research program into unconventional medicine and the governments of Denmark, Finland, Germany, Hungary, Italy, Norway, Slovenia, Spain and the U.K. have now joined this effort.
Fisher, Peter and Ward, Adam. Complementary medicine in Europe. British Medical Journal, Vol. 309, July 9, 1994, pp. 107-11

Acupuncture effective in combatting nausea
LONDON, UNITED KINGDOM. Exerting manual pressure on the Neiguan or P-6 acupuncture point (located about three finger-widths above the wrist on the inner arm) has long been a popular measure for alleviating nausea and motion sickness. Now British researchers report on a study designed to evaluate the scientific validity of this therapy. They reviewed the results of 33 clinical trials involving the use of stimulation of P-6 by needles, acupressure or electricity. The conditions being treated involved nausea or vomiting in connection with pregnancy, chemotherapy or surgery. In four of the trials acupuncture was administered under anesthesia and was found to be ineffective. In 27 of the remaining studies acupuncture was found to have a positive effect.
Vickers, A.J. Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. Journal of the Royal Society of Medicine, Vol. 89, 1996, pp. 303-11

Acupuncture helps smokers to quit
OSLO, NORWAY. Researchers at the University of Oslo have just released a study showing that acupuncture can be highly effective in helping motivated smokers to quit or at least markedly reduce their tobacco consumption. Their experiment involved 46 men and women with an average age of 39 years (mean). They had been smoking about 20 cigarettes a day for about 20 years. At the start of the study the participants were randomly split into two groups. The treatment group (TG) received acupuncture and acupressure treatments using acupuncture points which had previously been found useful for inducing smoking cessation. The control group received treatment using points with no anti- smoking effect. The active treatment involved electroacupuncture at the Lieque and Kongzui points, ear acupuncture at Shenmen and two points relating to the mouth and lungs, and ear acupressure at Shenmen and points relating to the mouth, lungs, and trachea. The control treatment involved points related to the knees, neck, shoulder, and lumbar vertebra. After receiving acupuncture treatments twice a week for three weeks the subjects in the TG reduced their cigarette consumption by 75 per cent versus a 39 per cent reduction in the control group. Among the participants in the active treatment group, 31 per cent had completely quit smoking at the end of the three weeks while none of the subjects in the control group had quit. The researchers conclude that acupuncture treatment involving the proper points may help motivated smokers to quit or at least reduce their cigarette consumption drastically.
He, Dong, et al. Effects of acupuncture on smoking cessation or reduction for motivated smokers. Preventive Medicine, Vol. 26, March/April 1997, pp. 208- 14

Alternative therapies gain status in Germany
BERLIN, GERMANY. Homeopathy and acupuncture have long been considered medically acceptable therapies in Germany and are covered by the standard health insurance. Other newer alternative therapies such as ozone therapy have not been accepted by the medical establishment and are not covered. This is all about to change due to a new law just passed by the German Parliament. Until now new treatments were evaluated for acceptability by a committee of medical specialists "according to the current state of scientific knowledge." The new law changes this wording to read "according to the current state of scientific knowledge in that particular form of therapy." This essentially means that new alternative therapies will be evaluated by practitioners of those therapies rather than by medical doctors. Medical doctors are aghast at the new law, but medical insurance specialists point out that the German public clearly wants access to alternative treatments and that "no German government can afford to cut them from the list of approved treatments."
Charles, Dan. German law embraces alternative medicine. New Scientist, June 28, 1997, p. 6

Acupuncture cures chronic hiccups
INNSBRUCK, AUSTRIA. Chronic hiccups is a fairly common disorder, yet little is known about its cause and conventional treatment with surgery or drugs is largely ineffective. Now Dr. Andreas Schlager, MD of the Univerity of Innsbruck reports the use of Korean hand acupuncture to successfully treat a case of persistent hiccups in a 70-year-old patient. The patient who also suffered from coronary heart disease, reflux esophagitis, and hiatal hernia had experienced uncontrollable hiccups for three months. When examined he was hiccuping continuously throughout the day. Dr. Schlager treated the patient with Korean hand acupuncture at points K-F3 (located on the palm side of the hand in the middle of the distal phalanx of the fifth finger) and K-A12 (on the palm above the third metcarpal bone). For the first two treatments Dr. Schlager used regular acupuncture needles in 30-minute sessions. This was followed by continuous acupressure applied to K-F3 for 24 hours a day using special discs with raised dots fastened with adhesive tape. The hiccups stopped completely after the second treatment. A further preventive treatment was applied for three days using laser acupuncture for 60 seconds at each point. Three months later the patient underwent gastroscopy and the hiccups recurred. Two sessions of Korean hand acupuncture stopped them again and no further episodes have occurred since (now 12 months ago). Says Dr. Schlager "Korean hand acupuncture should be the treatment of choice for chronic hiccups before applying other methods."
Schlager, Andreas. Korean hand acupuncture in the treatment of chronic hiccups. American Journal of Gastroenterology, Vol. 93, November 1998, pp. 2312-13 (letter to the editor)

Acupuncture prevents breech birth
NANCHANG, CHINA. The threat of a breech birth (buttocks rather than the head appear first in the birth canal) is particularly high among women having their first child. A breech birth can often be avoided by external manipulation (ECV) prior to labor, but in some cases necessitates the use of cesarean delivery with the accompanying dangers and discomforts for both mother and child. A team of Chinese and Italian researchers reports that moxibustion (stimulation of acupuncture points with burning herbal preparations containing moxa [Artemisia vulgaris, mugwort]) can markedly reduce the risk of breech birth by increasing fetal movement and can actually turn the fetus around so that a normal head-first birth (cephalic presentation) is achieved. Their study involved 260 women in their 33 week of a first pregnancy who had all had an ultrasound diagnosis of breech presentation. Half the women were given a daily 30-minute treatment with moxibustion (self-administered at home) for one or two weeks while the other half served as a control group. The moxibustion was aimed at stimulating acupuncture point BL 67 (Zhiyin, located beside the outer corner of the fifth toenail). During the 35th week of pregnancy 75.4 per cent of the fetuses in the moxibustion group had changed to the cephalic (head-first) position as compared to only 47.7 per cent in the control group. The fetuses in the moxibustion group also showed greater mobility with an average of 48.45 movements per hour as compared to 35.35 in the control group. Twenty-four of the women in the control group and one in the moxibustion group later underwent ECV to turn the fetus around. Despite the greater use of ECV in the control group the number of babies delivered head-first was still significantly higher (75.4 per cent) in the moxibustion group than in the control group (62.3 per cent). The researchers conclude that moxibustion performed for one or two weeks starting in the 33-week of pregnancy is an effective and safe method for converting breech presentations in first-time pregnancies.
Cardini, Francesco and Weixin, Huang. Moxibustion for correction of breech presentation. Journal of the American Medical Association, Vol. 280, November 11, 1998, pp. 1580-84

Yoga alleviates carpal tunnel syndrome
PHILADELPHIA, PENNSYLVANIA. Carpal tunnel syndrome (CTS) is becoming an increasingly common problem in the workplace resulting in considerable suffering, lost time from work, and increased medical expenses. The syndrome is caused by excessive repetitive movements of hands and wrists and manifests itself by severe pain and loss of strength in the hand (grip strength). Researchers at the University of Pennsylvania School of Medicine now report that yoga exercises can be highly effective in alleviating CTS. Their trial involved 42 patients diagnosed with CTS who were randomized into two groups. The first group participated in a twice-weekly yoga program consisting of 11 postures designed for stretching, strengthening and balancing each joint in the upper body along with relaxation. The members of the other group were fitted with a wrist splint to supplement their current treatment. After eight weeks the patients were re-evaluated. The yoga group had achieved a very significant 42 per cent decrease in pain score and a 15 per cent increase in grip strength. There were no significant changes in pain or grip strength in the wrist splint group. Many of the patients in the yoga group reported that their improvement remained four weeks after completion of the treatment program.
Garfinkel, Marian S., et al. Yoga-based intervention for carpal tunnel syndrome. Journal of the American Medical Association, Vol. 280, November 11, 1998, pp. 1601-03

Acupuncture goes mainstream
TORRANCE, CALIFORNIA. The merits of acupuncture were debated at a recent Consensus Development Conference held by the National Institutes of Health (NIH). The assembled medical doctors and other practitioners agreed that there now is evidence that acupuncture is effective in the treatment of postoperative and chemotherapy-induced nausea, nausea associated with pregnancy, and pain following dental surgery. The panel also concluded that acupuncture may be effective in stroke rehabilitation and in the treatment of addiction, headaches, menstrual cramps, fibromyalgia, low-back pain, asthma, carpal tunnel syndrome, and tennis elbow. The volume of acupuncture research being done by Western practitioners is steadily increasing. NIH is funding a three-year, US$ one million study to evaluate the effects of acupuncture on osteoarthritis of the knee. Other grants have been awarded for the study of acupuncture in the treatment of back pain, dental pain, and depression. In the United Kingdom, the National Health Services is funding a two and a half year study on the use of acupuncture in the management of headaches. With an increasing number of health insurance plans now paying for acupuncture treatments it would appear that this 3000 year old medical technology is finally entering the mainstream of Western medicine.
Hsu, Dora T. and Diehl, David L. The West gets the point. The Lancet, Vol. 352 (suppl IV), 1998, p. 1

Tai Chi benefits heart surgery patients
TAIPEI, TAIWAN. Tai Chi Chaun (TCC) is an ancient Chinese martial art which, in recent years, has become very popular in the West as a means of improving and maintaining health. TCC is an ideal low-cost exercise as it does not require any special equipment and can be performed anywhere. Recent studies have shown that TCC, despite its relatively low intensity, improves aerobic capacity and is effective in reducing anxiety, tension, and mood disturbances. Now researchers at the National Taiwan University Hospital report that patients recovering from coronary artery bypass surgery also benefit from regular TCC exercises. The study involved 20 men aged 53 to 64 years who had undergone bypass surgery and who had completed the standard phase II cardiac rehabilitation program (bicycling three times weekly for three months at 50-60 per cent of heart rate range). Nine of the men were assigned to the TCC group and the remaining eleven acted as the control group. The TCC group, led by a qualified instructor, performed TCC exercises every morning (20 minutes of warm-up exercises, 24 minutes of TCC, and 10 minutes of cool-down exercises). Each set of TCC included 108 classical postures and provided an exercise intensity of 48-57 per cent of heart rate range. The control group walked three times a week for 50 minutes in a nearby park at a speed which resulted in a heart rate range of 50-60 per cent. The aerobic fitness of both groups was measured at the start of the study and one year later using a standard bicycle ergometer. At the end of one year the average peak VO2 (a measurement of aerobic fitness) had increased by 10.3 per cent in the TCC group, but had decreased slightly in the control group. The peak work rate also increased in the TCC group by about 11.9 per cent (from 135 to 151 watt) while it decreased slightly in the control group (from 131 to 128 watt). The researchers conclude that TCC improves cardiac fitness in bypass patients. They also note that the TCC program seemed more attractive to the participants than the walking program. The members of the TCC group attended an average of 3.8 times weekly as compared to an attendance rate of only 1.7 times weekly in the control group.
Lan, Ching, et al. The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery. Medicine and Science in Sports and Exercise, Vol. 31, May 1999, pp. 634-38

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