Acupuncture Continuing Education
  • low back acupoints

    Acupuncture and cupping are safe and effective treatments for lumbopelvic pain during pregnancy. Researchers conducted an observational study at a hospital-based community antenatal clinic in New Zealand and determined that acupuncture produces significant positive patient outcomes, including reductions in lumbopelvic pain levels. [1] Lumbopelvic pain is in the lower torso, lower back, and pelvic girdle and is frequently experienced by pregnant women. Acupuncture provides an important alternative treatment option because many common prescription drugs and over-the-counter analgesics are not recommended during pregnancy.

  • insomnia back shu

    Emory University and Atlanta VA Medical Center researchers find acupuncture effective for the alleviation of sleep disorders for veterans with PTSD and brain injuries. The research team concludes that acupuncture produces significant improvements in both subjective and objective sleep parameters for veterans with mild traumatic brain injuries (mTBI), including veterans with PTSD (post-traumatic stress disorder). The team notes that “acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.” [1]

  • achilles tendon acupoints

    Acupuncture is an effective treatment modality for Achilles tendon disorders. Two clinical case histories were published by Dr. Hawks demonstrating that acupuncture is “highly effective, with rapid results for both acute and chronic Achilles tendinopathy and was performed easily in an austere environment.” [1] Dr. Hawks works at the Mike O'Callaghan Military Medical Center at Nellis Air Force Base in Nevada and the treatments were administered to personnel while deployed overseas.

  • Acupuncture points

    Acupuncture is effective for the alleviation of musculoskeletal pain, headaches, shoulder pain, and arthritis related pain. Memorial Sloan Kettering Cancer Center (New York, NY) researchers conclude that the analgesic effects of acupuncture are superior to sham controls and the pain relief persists over time. The research team concludes that acupuncture is an effective treatment modality for chronic pain and referral to an acupuncturist is a reasonable treatment option. 

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    Acupoints of the kneeAcupoints of the knee

    Photo: Healthcare Medicine Institute 

    Stanford University researchers conclude that acupuncture reduces and delays the need for opioids after total knee replacement surgery. Over 4.7 million people in the United States have had knee replacement surgery. Conventional post-surgical treatment often includes prescription opioids. [1] The drugs often provide pain relief for patients but are ineffective for some. Further, there is a growing concern that the extended use of prescription opioids leads to addiction, further exacerbating epidemic levels of opiate abuse. As a result, finding drug-free interventions that effectively relieve pain and decrease opiate use has become a public health imperative. 

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    Acupuncture treatment sessionAcupuncture treatment session

     

    Acupuncture benefits sleep. Researchers conducted a rigorous investigation and determined that acupuncture is safe and effective for the relief of insomnia. [1] Specifically, acupuncture improves sleep efficiency, total sleep time, and alleviates overall insomnia severity. Findings from the same study document that acupuncture alleviates depression and anxiety in patients with insomnia. [2] 

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    Major acupuncture points on an acupuncture manikin Major points on an acupuncture manikin

    Photo: Healthcare Medicine Institute 

    University of California School of Medicine researchers have proven that acupuncture lowers blood pressure in subjects with hypertension. [1] The depth and breadth of the research extends across multiple university controlled studies. The investigations also reveal how acupuncture works; the biological mechanisms stimulated by acupuncture are no longer a mystery. 

  • Acupuncture combined with supplementary Traditional Chinese Medicine (TCM) modalities is found effective for the alleviation of chronic neck, shoulder, back, and osteoarthritis pain. Researchers provided acupuncture treatments over the course of eight weekly sessions in a group setting. The researchers confirm that the therapeutic benefits of acupuncture have lasting results. All acupuncture treatments ceased at the eight week data point. A 24 week follow-up confirms that pain levels remain reduced even though no treatments were provided after the eight week data point.

     

    Seated position treatment of the shoulder.

     

    The total therapy package provided to participants included weekly acupuncture, Tui-Na massage, auricular acupoint stimulation, and Gua Sha. The research was conducted by investigators from the Icahn School of Medicine at Mount Sinai (New York), Mount Sinai Beth Israel Medical Center (New York), and the Hunter-Bellevue School of Nursing (New York). The results were published in Pain Medicine, a publication of the American Academy of Pain Medicine. 

  • Acupuncture is more effective than medications for improving sleep quality in survivors of breast cancer. University of Pennsylvania (Philadelphia), Memorial Sloan Kettering Cancer Center (New York), and Memorial University (Newfoundland and Labrador) researchers determined that electroacupuncture outperforms gabapentin for improving sleep latency and efficiency for female breast cancer survivors with hot flashes. In a controlled clinical trial, the researchers conclude that acupuncture improves sleep duration and significantly improves the length of time needed to transition from full wakefulness to restful sleep (sleep latency).

     

    Golden point doll and practitioner

     

    The researchers determined several other benefits provided by acupuncture to breast cancer survivors with hot flashes. Acupuncture reduces sleep disturbances, decreases daytime dysfunction, and improves sleep efficiency. Based on the data, the researchers conclude that acupuncture improves overall sleep quality. In addition, acupuncture does not produce adverse effects associated with gabapentin (e.g., dizziness, fatigue, ataxia) or venlafaxine (e.g., dry mouth, constipation, headaches). The researchers demonstrate that acupuncture produces superior positive patient outcomes without the undesirable adverse effects associated with medications. The research was published in Menopause: The Journal of The North American Menopause Society and was supported, in part, by a grant from the US National Institutes of Health (NIH). 

  • Scientific evidence demonstrates that acupuncture alleviates allergic rhinitis and regulates antibodies.

    Acupuncture alleviates nasal and eye itching, sneezing, and runny nose for patients with allergic rhinitis. Researchers confirm that acupuncture successfully downregulates IgE (immunoglobulin E), an antibody active in hypersensitivity reactions, while simultaneously reducing symptoms of allergic rhinitis. In a highly controlled investigation published in the Annals of Allergy, Asthma & Immunology, university researchers present the first study to prove that acupuncture downregulates allergen specific IgE for dust mites.

     

    Yintang needled with filiform needle on female model 

     

    Researchers from Stanford, RMIT, Griffith, and Western Sydney Universities conclude that acupuncture alleviates persistent allergic rhinitis. Important subjective and objective measures support the conclusion. Allergy symptoms and overall quality of life scores significantly improved as a result of acupuncture therapy. Moreover, symptoms and quality of life scores continued to improve, measured four weeks after completion of acupuncture treatments.

    In objective measures, acupuncture significantly decreased IgE levels for patients with allergic rhinitis. Total IgE and allergen specific IgE for dust mites were significantly downregulated, including measurements taken four weeks after completion of acupuncture therapy. Sham acupuncture did not downregulate either of the IgE levels.

  • Stanford University doctors conclude that acupuncture during surgery reduces pain. Research published in The Laryngoscope finds acupuncture effective for reducing pain and improving restoration of a normal diet postoperatively when acupuncture is applied during surgery. A doctor examines a tonsil. Doctors from the Stanford University School of Medicine conclude that acupuncture is “feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively.”

    The research was conducted by doctors from two Stanford University School of Medicine (Palo Alto, California) departments, the Department of Otolaryngology-Head and Neck Surgery and the Department of Anesthesia.

    A randomized-controlled investigation of acupuncture’s benefits to pediatric tonsillectomy patients reveals that acupuncture patients “experienced significantly less pain at various postoperative time points as compared to the control cohort, and also that the onset of analgesia in the acupuncture cohort began by 36 hours postoperatively, whereas the control group did not reach significant analgesia until 84 hours postoperatively.”

    Postoperative oral intake improved for patients receiving acupuncture during the tonsillectomy operation. The researchers note, “Oral intake was significantly more improved in the acupuncture group than the control group (P = 0.01).” They add that “the acupuncture group had significantly increased oral intake starting at 24 hours and lasting through all remaining time points examined, whereas the control group had significantly increased oral intake starting at 72 hours postoperatively.” 

  • A Stanford University study finds acupuncture safe and cost-effective for relieving pain in children. Dr. Golianu, MD (Department of Anesthesiology, Stanford University), et. al., note research confirming that acupuncture is “useful in chronic pain conditions” adding that it may be clinically valuable in an integrative medical setting. A child is in a health care clinic in this photo. The research documents acupuncture’s ability to stimulate natural pain killers within the body, dynorphins and endorphins, along with several other important biological responses involved in pain management. The researchers cited multiple findings of acupuncture successfully relieving headaches, migraines, abdominal pain, fibromyalgia, pelvic pain, Complex Regional Pain Syndrome (CRPS), acute post-operative pain, and post-operative delirium.

    Children Accept Acupuncture
    The Stanford University research team cites findings that “53% of children were initially apprehensive of acupuncture needles, following their first needle 64% felt it did not hurt, and furthermore would recommend it to someone else.” In adolescents, 67% report acupuncture as “pleasant” and 70% report that acupuncture reduced pain levels. The receptivity to acupuncture may be due, in part, to acupuncture’s ability to induce deep relaxation in patients combined with lasting analgesic effects.

    The researchers note that, “Acupuncture can be a useful adjuvant in the care of pediatric patients with painful conditions, both in the chronic and acute setting.” Citing Lin, et. al., young children and adolescents experienced significant pain relief from acupuncture treatments. The children also found acupuncture “highly acceptable.” On safety, the research confirms “that acupuncture is safe when performed by appropriately trained practitioners.” In the United States, acupuncturists are licensed medical professionals with medical board oversight in most states.

    Headaches
    The researchers note that acupuncture decreases headache frequency and severity across several controlled studies. In addition, acupuncture reduces the need for medications and is proven effective in treating migraines. The research team cites a randomized trial of children with migraines finding acupuncture effective in reducing the intensity and frequency of migraines. Another pediatric study meeting the review standards of the research team finds cold laser acupuncture effective for reducing the frequency of migraines and tension headaches.

    Abdominal Pain
    The researchers cited findings showing acupuncture in adults effective for treating IBS, irritable bowel syndrome, “a comparative effectiveness trial of acupuncture compared to two antispasmodics (pinaverium bromide and trimebutin maleate) showed acupuncture as more effective than these standard therapies for IBS.” A pediatric study found acupuncture effective for the treatment of intermittent abdominal pain. Given the prevalence of abdominal pain in children, the researchers recommend further studies investigating the “dose or frequency and duration of acupuncture treatment required.”

    Fibromyalgia and Arthritis
    The research team did not find randomized controlled pediatric studies on the treatment of fibromyalgia. However, adult studies find acupuncture “superior to standard care alone.” In addition, “Acupuncture was found to change cortical responses to painful stimuli in fibromyalgia patients, suggesting a complex inhibitory modulation may be active in the central nervous system in fibromyalgia patients.” The same scenario was found in the case of juvenile arthritis. No pediatric studies have been conducted but adult studies find acupuncture effective for the treatment of osteoarthritis. For fibromyalgia and arthritis, the research team recommends specific investigations on the effects of acupuncture on children. 

  • A Stanford University study finds acupuncture effective for reducing the need for sedative medications for neonates and infants undergoing treatments in the intensive care unit. Dr. Golianu, MD (Department of Anesthesiology, Stanford University), Christina Almgren, PNP (Stanford Children’s Health, Stanford University), et. al., note that high doses of opioids and benzodiazepines are often required for neonates and infants for the purposes of pain management and sedation. Cessation from medications lead to withdrawal symptoms and irritability. The researchers cite acupuncture’s documented ability to reduce pain, irritability and withdrawal symptoms in adults. Infants benefit from acupoint therapy at Stanford.

    The research team applied acupuncture in the pediatric setting to see if the therapeutic effects known to help adults also applies to neonates and infants. They concluded that the pediatric patients “tolerated acupuncture well and required a decreased amount of pain medication for treating agitation and withdrawal.” The study concludes, “Acupuncture may be a useful adjunct for managing agitation and withdrawal in neonates and infants in the intensive care unit, and may lead to a decreased need for sedative medications.” Acupuncture points used in the study were Yin Tang, ST36, and PC6 plus acupuncture point protocols developed by the National Acupuncture Detoxification Association.

    In a related study, doctors from the University of Washington School of Medicine (Seattle, Washington) conclude, “Our experience suggests that acupuncture therapy is a safe, non-pharmacological option for prevention of emergence delirium in children undergoing general anesthesia.” The doctors note that delirium occurs in approximately 12 - 50% of pediatric patients receiving general anesthesia. They add that pharmaceutical drugs used to manage delirium often produce unwanted adverse effects including “sedation and longer recovery time from anesthesia.”

    The study came up with some very interesting findings. All children in the study receiving intravenous anesthesia plus acupuncture required less quantities of propofol, an amnestic-hypnotic drug. A total of 83% of patients did not get delirium. An additional 17% had relatively mild cases of delirium and were able to “communicate the source of distress.” The acupuncture points used in the study were SP8, HT7, and LR3. Needle stimulation was applied to the three acupuncture points. Magnet therapy was applied to ear Shenmen. No complications occurred demonstrating that acupuncture is both safe and effective in the prevention of pediatric emergence delirium. 

  • New research from the University of Maryland School of Medicine concludes that acupuncture increases pregnancy rates for women receiving IVF at medical clinics that otherwise have low success rates with the fertility procedure. Acupuncture enhances success IVF procedures. The study was a systematic review of 16 clinical trials with a total of 4,021 subjects. Acupuncture was compared with IVF as a standalone treatment and also with IVF combined with simulated-sham acupuncture. The researchers discovered some very interesting results.

    Across the 16 separate and independent clinical trials, acupuncture was successful in increasing pregnancy rates in clinics with a lower than 32% IVF success rate. On the other hand, acupuncture did not enhance the IVF procedure in clinics wit a higher than 32% success rate. Lead author Eric Manheimer notes that this may be due to the fact that acupuncture and other fertility enhancement procedures have a lessened clinical value for IVF when the pregnancy rates are already high. The study concludes that in cases where pregnancy rates are low, acupuncture offers a significant clinical benefit to those receiving IVF by increasing the pregnancy rate.

    Another recent study concludes that acupuncture and moxibustion significantly increase pregnancy rates for women receiving IVF fertility treatments. The study investigated infertile women who had at least 2 unsuccessful IVF fertility treatments. True acupuncture, sham acupuncture and a control group were compared. The acupuncture group showed a significantly higher clinical success rate the IVF procedure than both the sham acupuncture and control groups. The acupuncture group had a 35.7% success rate whereas the sham group had a 10.7% success rate and the control group had a 7.1% success rate. These findings are consistent with the University of Maryland Study in that acupuncture has been shown to significantly increase IVF success rates for individuals and clinics with a prior history of failed IVF procedures respectively.

    This second study investigated both acupuncture and moxibustion for the enhancement of IVF success rates. Acupuncture points on the Conception Vessel, Governing Vessel and Urination Bladder Channel were chosen: UB18, UB22, UB23, UB52, CV3, CV4, CV5, CV7 and GV4. Acupuncture needling was administered on the first and seventh days during which ovulation was medically induced. Acupuncture was also administered on the day prior to medical intervention of the ovary and on the day after the embryo transfer.

    Yet another study presented conclusive evidence showing that acupuncture is more effective than clomifene (Clomid, Omifin) for the treatment of infertility. Acupuncture had a 76.8% success rate for the induction of ovulation and clomifene demonstrated a 48.1% success rate. More than this, an important study discovered that acupuncture increases live birth rates. Women receiving IVF treatments had significantly higher live birth rates if acupuncture was applied on the day of embryo transfer. Researchers from the University of Washington (Seattle), Oregon College of Oriental Medicine (Portland) and the Northwest Center for Reproductive Sciences (Kirkland, Washington) applied acupuncture prior to the IVF procedure to GV20, CV6, ST29, SP8, P6, and LV2 along with auricular points: uterus, endocrine, shenmen, brain. Afterwards, acupuncture points LI4, SP10, ST36, SP6 and K3 were applied along with the same auricular points. Notably, prior to IVF the uterus and endocrine points were applied to the right ear and the shenmen and brain auricular acupuncture points were applied to the left ear. After the IVF procedure, the auricular points were applied to the opposite ears.

    Another study study also concluded that acupuncture increases live birth rates for women who get IVF treatments. Scientists sought to measure the histological mechanisms by which acupuncture exerts its effective action. They were successful in discovering that acupuncture increases blood and embryo levels of HLA-G, a protein that is predictive of higher pregnancy and live birth rates when in higher concentrations.  It is important to note that this biochemical research concluded that acupuncture increased both pregnancy rates and live birth rates.

    References:
    Manheimer, Eric, Daniëlle van der Windt, Ke Cheng, Kristen Stafford, Jianping Liu, Jayne Tierney, Lixing Lao, Brian M. Berman, Patricia Langenberg, and Lex M. Bouter. "The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis." Human reproduction update (2013).

    di Villahermosa, Daniela Isoyama Manca, Lara Guercio dos Santos, Mariana Balthazar Nogueira, Fabia Lima Vilarino, and Caio Parente Barbosa. "Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial." Acupuncture in Medicine (2013).

    Journal of Acupuncture and Tuina Science, 2012, 10(2), R246.3. Teng Hui, Liu Yu-lei, Wang Jun-ling, Xie Ying. Department of Traditional Chinese Medicine, Shenzhen Maternal and Child Healthcare Hospital, Guangdong, China.

    Johansson, Julia, et al. "Acupuncture for ovulation induction in polycystic ovary syndrome: A randomized controlled trial." American Journal of Physiology-Endocrinology And Metabolism (2013).

    Hullender Rubin, Lee E., Michael S. Opsahl, Lisa Taylor-Swanson, and Deborah L. Ackerman. "Acupuncture and In Vitro Fertilization: A Retrospective Chart Review." The Journal of Alternative and Complementary Medicine (2013).


    Exploration of clinical regularities in acupuncture-moxibustion treatment for infertility. Qin-feng Huang. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE. Volume 10, Number 2. (2012), 72-76, DOI: 10.1007/s11726-012-0574-0.

    Fertil Steril. 2005 Jan;83(1):30-6. Secretion of human leukocyte antigen-G by human embryos is associated with a higher in vitro fertilization pregnancy rate. Yie SM, Balakier H, Motamedi G, Librach CL.

  • The executive editor at Harvard Men’s Health Watch has published on the efficacy of acupuncture for the treatment of chronic pain. He cited research from the Archives of Internal Medicine and has Dr. Chen of Massachusetts General Hospital, a Harvard affiliated hospital, on record as supporting the beneficial effects of acupuncture. Dr. Chen, an anesthesiologist, noted that acupuncture is beneficial and has a low incidence of adverse effects. Many doctors have long supported the use of acupuncture as an effective procedure.

    Electroacupuncture is demonstrated here. ElectroacupunctureOne influential and early supporter in the west was Dr. Henry Sigerist, M.D., D.Litt., LL.D. who served as the Director of the Johns Hopkins Institute of the History of Medicine. He was inspired by Chinese Medicine in part by Mr. J. W. Lindau, an organic chemist who began the translation of the Neijing Su Wen, one of the most important works of Chinese Medicine. Dr. Sigerist then suggested that Dr. Veith take up the task of finishing the project after Mr. Lindau died. Dr. Veith succeeded and published the first English version of the great work. More recently, Maoshing Ni, Ph.D. also released an important and influential translation of the Neijing Su Wen.

    Another great supporter of acupuncture techniques in the USA was Dr. Janet Travell, M.D. She was a medical researcher and personal physician to Presidents John F. Kennedy and Lyndon B. Johnson. JFK is the first known sitting US President to receive acupuncture for the control of pain. Specifically, JFK required treatments for pain related to injuries sustained during World War II. Dr. Travell was an Emeritus Clinical Professor of Medicine at George Washington University and also taught at Cornell University. She published extensively on the use of trigger point therapy, a westernized acupuncture procedure, to control pain.

    This latest article written by Daniel Pendick, Executive Editor of Harvard Men’s Health Watch, underscores the existence of quality research showing that acupuncture is successful in the treatment of pain. The research concluded that, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.” This research reflects a co-emerging trend seen in the expansion of acupuncture health insurance benefits. In 2014, all small group and individual health insurance plans in both California and Maryland will be required to include acupuncture as a covered benefit.

    Reference:
    Vickers, Andrew J., et al. "Acupuncture for chronic pain: individual patient data meta-analysis." Deutsche Zeitschrift für Akupunktur 55.4 (2012): 24-25.
    1        Memorial Sloan-Kettering Cancer Center, New York, New York
    2        Dana-Farber Cancer Institute, Boston, Massachusetts
    3        Complementary and Integrated Medicine Research Unit, Southampton Medical School, Southampton, England
    4        Complementary Medicine Research Group, University of York, York, England
    5        Arthritis Research UK Primary Care Centre, Keele University, Newcastle-under-Lyme, Staffordshire, England
    6        Group Health Research Institute, Seattle, Washington
    7        University Medical Center Charité and Institute for Social Medicine, Epidemiology and Health Economics, Berlin
    8        Institute of General Practice, Technische Universität München

  • Acupuncture helps patients receiving chemotherapy for the treatment of ovarian cancer. A massive study of over 20,000 patients was conducted by top researchers from the Harvard Medical School, Massachusetts General Hospital (Boston), The New England School of Acupuncture (Newton) and the Dana-Farber Cancer Institute. The researchers discovered that social function scores significantly improved in the acupuncture group.

    Acupuncture helps cancer patients. Acupuncture for ChemoThe investigation was initially presented to The Society for Integrative Oncology's 6th International Conference in New York City. One important feature of the study is the large sample size. Other important features of the study were that it was a randomized, sham-controlled trial. The acupuncture results were tabulated against a control group that received sham, simulated, acupuncture. The true acupuncture group social functions scores were significantly better than the sham group thereby ruling out the placebo effect.

    Reference:
    Weidong Lu, Ursula A. Matulonis, Julie E. Dunn, Hang Lee, Anne Doherty-Gilman, Elizabeth Dean-Clower, Annekathryn Goodman, Roger B. Davis, Julie Buring, Peter Wayne, David S. Rosenthal, and Richard T. Penson. Medical Acupuncture. -Not available-, ahead of print. doi:10.1089/acu.2012.0904.

    Author Information:
    1 Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, Boston, MA.
    2 The New England School of Acupuncture, Newton, MA.
    3 Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
    4 Biostatistics Center, Massachusetts General Hospital, Boston, MA.
    5 Department of Gynecologic Oncology & Medicine, Massachusetts General Hospital, Boston, MA.
    6 Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.

  • Acupuncture relieves cancer pain due to medication side effects according to new research conducted at the University of Maryland School of Medicine in Baltimore. Treatment for multiple myeloma (MM), cancer of plasma cells that affects bone marrow, is treated with the pharmaceutical drug bortezomib. Peripheral neuropathy, damage to peripheral nerves, is a common side effect causing pain in cancer patients taking bortezomib. The new research finds that acupuncture is effective for relieving peripheral neuropathy pain due to bortezomib intake in cancer patients. This finding affects cancer treatments in that bortezomib induced pain is a dose-limiting factor. The researchers conclude, “Acupuncture is a viable treatment option for MM patients experiencing painful BIPN (bortezomib-induced peripheral neuropathy).”

    Acupuncture Prescription
    Patients were given acupuncture at a rate of 1-2 times per week or once every two weeks dependent upon clinical pain reduction responses. Acupuncture needles were retained for a total of 25 minutes per treatment. Points used in the study were: auricular shen men, auricular point zero, two auricular points where electro-dermal signals were detected, LI4 (Hegu), TB5 (Waiguan), LI11 (Quchi) , ST40 (Fenglong) and Bafeng. All patients experienced pain reduction immediately following the first acupuncture visit. No adverse reactions were associated with the acupuncture treatments and patients experienced long lasting pain relief.

    About HealthCMi:
    Healthcare Medicine Institute authors and presenters provide acupuncture continuing education for acupuncture CEUs online and publish the HealthCMi internet news service.

    Reference:
    Ting Bao, Lixing Lao, Michelle Medeiros, Ruixin Zhang, Susan G. Dorsey, and Ashraf Badros. Medical Acupuncture. September 2012, 24(3): 181-187. doi:10.1089/acu.2011.0868. The University of Maryland School of Medicine, Baltimore, Maryland. The University of Maryland School of Nursing, Baltimore, Maryland.

  • New research concludes that acupuncture is an effective monotherapy for major depressive disorder. Researchers from the Depression Clinical Research Program at Massachusetts General Hospital (Boston) cited prior research as the basis for this investigation. The researchers note, “We have previously shown that a standardized acupuncture augmentation was effective for antidepressant partial responders with major depressive disorder (MDD).” In a follow-up investigation, the researchers examined the safety and efficacy of acupuncture for the treatment of depression as a standalone therapy.

    Patients in the study received 8 weeks of acupuncture, 1-2 times per week, with every treatment lasting 30 minutes. A choice of 5 acupuncture points were included in the study. Manual stimulation was applied every 10 minutes to the acupuncture points and electroacupuncture at 2 Hz was applied to acupoints on the head. Based on the results, the researchers concluded that, “Standardized acupuncture treatment was safe, well-tolerated and effective, suggesting good feasibility in outpatient settings.”

    More Research
    Prior research at Massachusetts General Hospital (Boston) demonstrated that acupuncture is effective in the treatment of clinical depression for patients who are non-responsive to conventional pharmaceutical antidepressant therapies. The study researched the ability of acupuncture to augment conventional antidepressant therapy and concluded that acupuncture is an effective adjunct to antidepressants for both partial and non-responders.

    Other recent research demonstrates that electroacupuncture has an antidepressant effect and prevents atrophy of brain cells. Researchers measured that electroacupuncture prevents atrophy of glial cells in the hippocampus, a portion of the brain. The researches note that there is mounting data showing that major depressive disorder is linked to glia cell atrophy. The researchers posit that the antidepressant effect of electroacupuncture may be due to its ability to prevent “glial atrophy in the hippocampus.” In the study, electroacupuncture was applied to acupoints Du20 (BaiHui) and AnMian at a rate of once per day for a period of three weeks. The antidepressant effects were quantified and the protective effects of electroacupuncture on brain cells was measured by “immunohistochemistry, Western blot analysis and reverse transcription-polymerase chain reaction.”

    Additional new research concludes that acupuncture is effective in relieving depression and increases the therapeutic effect of fluoxetine (Prozac, Sarafem, Fontex). In the study, electroacupuncture was applied to acupuncture points: Baihui (DU20), Yintang (EX-HN3), Sishencong (EX-HN1), Toulinqi (GB15), Shuaigu (GB8), Taiyang (EX-HN5), Touwei (ST8). The researchers demonstrated that electroacupuncture produces a “rapid effect in alleviating depressive symptoms in both clinician-rated (HAMD-17) and self-rated (SDS) measures of depression.” The investigators conclude that electroacupuncture is effective in augmenting the antidepressant effects of fluoxetine for the treatment of moderate and severe major depressive disorder.


    References:
    A pilot study of acupuncture monotherapy in patients with major depressive disorder
    David Mischoulon, Charlotte D. Brill, Victoria E. Ameral, Maurizio Fava, Albert S. Yeung. Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts. 21 April 2012.

    Albert S. Yeunga, Victoria E. Amerala, Sarah E. Chuzia, Maurizio Favaa and David Mischoulon. A pilot study of acupuncture augmentation therapy in antidepressant partial and non-responders with major depressive disorder. Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.

    Glia atrophy in the hippocampus of chronic unpredictable stress-induced depression model rats is reversed by electroacupuncture treatment. Qiong Liua, Bing Lia, Hai-Yan Zhua, Yan-Qing Wanga, Jin Yu and Gen-Cheng Wu. Journal of Affective Disorders, Volume 128, Issue 3, February 2011, Pages 309-313.

    Zhang Z-J, Ng R, Man SC, Li TYJ, Wong W, et al. (2012) Dense Cranial Electroacupuncture Stimulation for Major Depressive Disorder—A Single-Blind, Randomized, Controlled Study. PLoS ONE 7(1): e29651. doi:10.1371/journal.pone.0029651.

    About HealthCMi: The Healthcare Medicine Institute provides acupuncture CEU continuing education credit for licensed acupuncturists. The HealthCMi news division provides up-to-date research and acupuncture continuing education news.

  • A collaborative investigation between researchers from the University of Maryland School of Medicine (Baltimore) and the Shanghai University of Traditional Chinese Medicine concludes that, “Recent clinical trial and systematic review results clearly show acupuncture to be more beneficial Acupuncture CEUs OnlineAcupuncture Researchthan conventional standard care for many pain conditions….” Published in Medical Acupuncture, the review notes that basic science research has identified several mechanisms by which acupuncture exerts its effectiveness in the treatment of pathological conditions. The authors note that “an extensive body of acupuncture research has been published, much of it with important clinical implications.” In addition, the authors note that there is a trend towards acupuncture becoming accepted by the mainstream in the United States, citing a national survey showing a growth in acupuncture utilization.

    Recent Research Topics
    The modern research continues to pour in. Below is a short list of some of the research that has sparked recent interest. The list is by no means exhaustive and new research continues to map the neurophysiological mechanisms of acupuncture.

    Liver Fibrosis
    A recent sham-controlled study measured the mechanisms by which acupuncture prevents liver fibrosis. Acupuncture demonstrated changes to hepatocyte arrangement and relief from necrosis and hepatic pseudo-lobular formation. Also, MMP-9 protein expression levels of hematopoietic stem cells (HSC) were “upregulated remarkably” by the use of acupuncture.

    Brain Waves
    Magnetoencephalography (MEG) demonstrated that acupuncture induces specific responses to brain waves. Researchers discovered that, “Significantly increased delta power and decreased alpha as well as beta power in bilateral frontal ROIs (brain Regions of Interest) were observed following stimulation at ST36.”

    Fertility
    A recent study measured the biochemical mechanisms by which acupuncture increases IVF success rates. In a randomized controlled study, it was concluded that, “Acupuncture could improve the poor receptive state of (the) endometrium due to mifepristone by promoting Th2 cytokines secretion and inhibiting Th1 cytokines to improve blastocyst implantation.”

    Oxygen at Points
    New research has discovered that oxygen levels are higher at acupuncture points. The researchers note that their investigation may “verify the physical existence of acupuncture points….”

    Osteoporosis
    New research demonstrates that acupuncture improves bone metabolism for the prevention of osteoporosis. Blood analysis measured increases in levels of BGP (bone gla protein) from acupuncture treatment.

    MRI Investigation
    Researchers from MIT (Massachusetts Institute of Technology, Cambridge) and the University of Michigan (Ann Arbor) utilized MRI research to demonstrate that autonomic nervous system (ANS) responses to acupuncture emanate from “distinct subregions” of “brain circuitry.” True acupuncture activated the secondary somatosensory cortex (S2), insula and the mid-cingulate cortex. The heart rate (HR) deceleration and skin conductance response (SCR) “magnitude of response was greater following real acupuncture” than with sham acupuncture.

    Laser Acupuncture
    Researchers concluded that laser acupuncture “can modulate physiological and neurovegetative parameters after stimulating the Baihui (DU20) acupuncture point” and that there was a “clear on/off-effect when the laser was activated/deactivated.”

    Muscle Building
    Acupuncture builds and preserves muscle mass. The research measured that acupuncture “recovered the skeletal muscle mass” and “ameliorated skeletal muscle atrophy by reducing mRNA expressions of the E3 ubiquitin ligases atrogin-1 and MuRF1.” Acupuncture also “increased the mRNA expressions of Akt1 and TRPV4.”

    Pain Relief
    Researchers from the University of Rochester Medical Center in New York stated, “acupuncture releases a natural pain-relieving molecule into the body…. Adenosine is a key to reducing pain during acupuncture treatment.”

    References:
    Shifen Xu and Lixing Lao. Medical Acupuncture. March 2012, 24(1): 10-14. doi:10.1089/acu.2011.0831.

    Differential spectral power alteration following acupuncture at different designated places revealed by magnetoencephalography (Proceedings Paper). Youbo You; Lijun Bai; Ruwei Dai; Ting Xue; Chongguang Zhong; Zhenyu Liu; Hu Wang; Yuanyuan Feng; Wenjuan Wei; Jie Tian. 14 April 2012. 


    Proceedings Vol. 8317. Medical Imaging 2012: Biomedical Applications in Molecular, Structural, and Functional Imaging, Robert C. Molthen; John B. Weaver, Editors.

    Acupuncture Research. Inhibitory Effect of Acupuncture on Hepatic Extracellular Matrix Production in Carbon Tetrachloride-induced Liver Fibrosis Rats. 2012-01.

    T. G. Wegmann, H. Lin, L. Guilbert, and T. R. Mosmann, “Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?” Immunology Today, vol. 14, no. 7, pp. 353–356, 1993.


    Minyoung Hong, Sarah S. Park, Yejin Ha, et al., “Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 106762, 7 pages, 2012. doi:10.1155/2012/106762.

    Zhongguo Zhen Jiu. 2012 Jan;32(1):13-6. Observation on influence of bone metabolism biochemical indices of senile osteoporosis treated with distant acupuncture and nearby tuina]. Wang T, Pang L, Huang H, Wang WY. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China.

    Napadow, V., Lee, J., Kim, J., Cina, S., Maeda, Y., Barbieri, R., Harris, R. E., Kettner, N. and Park, K. (2012), Brain correlates of phasic autonomic response to acupuncture stimulation: An event-related fMRI study. Hum. Brain Mapp.. doi: 10.1002/hbm.22091.

    Author Information: Massachusetts General Hospital, Charlestown, Massachusetts. 
Department of Radiology, Logan College of Chiropractic, Chesterfield, Missouri. Kyung Hee University, Yongin, Korea. 
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts. 
Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. 
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.

    Evidence-Based Complementary and Alternative Medicine. V 2012, ID402590. Sino-European Transcontinental Basic and Clinical High-Tech Acupuncture Studies—Part 3: Violet Laser Stimulation in Anesthetized Rats. Xin-Yan Gao, Gerhard Litscher, Kun Liu, and Bing Zhu.

    Biochemical and Biophysical Research Communications. Volume 410, Issue 3, 8 July 2011, Pages 434–439. Acupuncture ameliorated skeletal muscle atrophy induced by hindlimb suspension in mice. Akiko Ondaa, Qibin Jiaob, Yasuharu Naganoc, Takayuki Akimotod, Toshikazu Miyamotoe, Susumu Minamisawab, Toru Fukubayashia.
    Goldman N, Chen M, Fujita T, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010.

  • New research demonstrates that magnetic acupressure reduces severe pain associated with bone marrow aspiration and biopsy (BMAB). Doctors and researchers from the Johns Hopkins University School of Medicine and the University of Maryland School of Medicine (Baltimore) evaluated pain levels of cancer patients undergoing BMAB. The randomized study compared two groups, one receiving acupressure at acupuncture point LI4 (Hegu) and another group receiving sham acupressure at a non-acupuncture point on the arm. Median pain scores were similar but severe pain decreased dramatically for those receiving magnetic acupressure at the real acupuncture point.

    The researchers cite the minimal training and expense needed to train someone to apply magnetic acupressure at acupuncture point LI4. Unlike acupuncture, which requires years of post-graduate training, acupressure at a single acupuncture point can be taught quickly and easily. No patients experienced any significant toxicities associated with the acupressure procedures.

    The acupuncture point used in the acupressure study was LI4 (Hegu, Joining Valley). It is located on the hand between the thumb and index finger. Naturally, training is necessary to ensure that the precise location of the acupuncture point is identified by those applying acupressure. In Chinese medicine, LI4 has long been known for its pain relieving properties. LI4 is also commonly used by acupuncturists for disorders of the face, eyes, nose, mouth and ear; including the treatment of pain. Proper stimulation of LI4 is effective in relieving headaches, pain of the eyes, toothaches, jaw pain, and pain of the limbs and bones.

    bonemarrowbiopsy

    Reference:
    The Analgesic Effect of Magnetic Acupressure in Cancer Patients Undergoing Bone Marrow Aspiration and Biopsy: A Randomized, Blinded, Controlled Trial. Ting Bao, MD; Xiaobu Ye, MD, MS; Janice Skinner CRNP; Bing Cao, MS; Joy Fisher MA, CCRP; Suzanne Nesbit PharmD, BCPS; and Stuart A. Grossman, MD. Journal of Pain and Symptom Management. Volume 41, Issue 6, June 2011, Pages 995-1002. The University of Maryland Marlene and Stewart Greenebaum Cancer Center and the Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland. The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.

  • A report from the National Institutes of Health (NIH) reports “that many well-designed studies have found that acupuncture can help with certain conditions, such as back pain, knee pain, headaches and osteoarthritis.” Research includes various scientific approaches to validating and measuring the effects of acupuncture including MRI studies, biochemical and bioelectric analysis and clinical trials. The NIH also reports, “Studies have found it to be very safe, with few side effects.”

    In the report, researchers at the NIH question whether or not attempting placebo controlled trials is an effective approach to measuring the efficacy of acupuncture. Dr. K. J. Sherman, an NIH researcher at Group Health Research Institute in Seattle, Washington notes, “I don’t really think you can come up with a great placebo needling.” Dr. R. E. Harris, an NIH researcher at the Chronic Pain and Fatigue Research Center in Ann Arbor, Michigan notes, “It’s hard to design placebo-controlled studies of acupuncture when we don’t understand what the active component of the intervention is.”

    NIH researchers also question the validity of sham acupuncture control groups. Dr. Harris’s research was able to prove that although sham acupuncture (using non-acupuncture points for a control group) and true acupuncture reduce pain in fibromyalgia patients, they “do it by different mechanisms.” Dr. Harris’s research showed that differing mechanisms by which the pain relief was achieved was measured at the molecular level. This suggests that sham acupuncture may superficially cause pain reduction but that it is not scientifically achieved by the same mechanisms as true acupuncture. Dr. Richard L. Nahin of the NIH’s National Center for Complementary and Alternative Medicine states, “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. But while both treatments turn on areas of the brain, they turn on different areas of the brain.” Dr. Sherman notes, “there’s no place on the back, if you have back pain, where you can say you have a great control, so I don’t think that’s a really solid idea.” The researchers recommend acupuncture as a treatment modality but suggest that future research needs to reconsider attempts to use placebo and sham control groups.

    acupunctceusyy

    Reference:
    Contie, Defibaugh, Ewsichek, Latham and Wein. Understanding Acupuncture Time To Try It? NIH News in Health. February 2011.

  • The NIH (National Institutes of Health) has awarded funding for the study of the safety, effectiveness, and functions of herbs including Da Suan (garlic), Dang Gui, Qing Hao (Artemisia), Gan Cao (licorice), and Shan Yao (yam). Acupuncturists have used these substances for over a thousand years but now three divisions of the NIH have funded research to better understand the role of these herbs.

    The garlic research will map the molecular pathways in which garlic stimulates cell function. Artemisia research will explore its molecular and physiological mechanisms involved in preventing metabolic syndrome which is a risk factor for diabetes and heart disease. The licorice research takes a close look at the impact of licorice on women’s estrogenic hormones. The yam research investigates its effects on bone, uterus, breast tissue, breast cancer metastasis, and brain activity.  The medical benefits of these herbs have been utilized by acupuncturists for their patients for over a thousand years. Now, the NIH supports research and documentation as to how such botanicals achieve clinical results.

    The Office of Dietary Supplements (ODS), the National Center for Complementary and Alternative Medicine (NCCAM), and the National Cancer Institute are taking a closer look to determine the clinical efficacy and mechanisms of action of these Chinese herbs. Five research centers receive the funding and are together known as the Botanical Research Centers (BRC). The research centers are located at Louisiana State University, University of Illinois (Chicago and Urbana-Champaign locations), University of Missouri, and Wake Forest University of Health Sciences. Other partner institutions include Oregon State University, Rutgers University (NJ),  University of Colorado Health Sciences, Brigham and Women’s Hospital (Boston, Massachusetts), John’s Hopkins University (Baltimore, Maryland), and the Bent Creek Institute (Asheville, North Carolina).

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  • Doctors from the University of Maryland School of Medicine, Baltimore and the University of Vermont College of Medicine, Burlington published a case vignette in the New England Journal of Medicine recommending acupuncture for the treatment of lower back pain. The article cites that patients with lower back pain account for over $90 billion in annual health care expenses in the US. The doctors conclude that acupuncture is an effective means for treating lower back pain based partly on a recent study of 6,359 patients published in Spine1. For the lower back pain patient in the case study presented, 10-12 acupuncture treatments over an 8 week period are recommended.

    The doctors cite physiological phenomena that measure the effects of acupuncture. Local anesthesia at needle insertion sites block the the analgesic effects of acupuncture showing that acupuncture is dependent upon neural innervation2. Acupuncture has been proven to cause the release of endogenous opioids in brain-stem, subcortical, and limbic structures3,4. Acupuncture has also been proven to induce the secretion of adrenocorticotropic hormone and cortisol from the pituitary gland thereby creating a systemic anti-inflammatory response5. Functional MRI studies in humans reveal that acupuncture stimulates limbic and basal forebrain areas involved in pain processing6. PET scan MRIs (positron-emission tomography) show that acupuncture increases opioid binding potential in the brain for several days7. Acupuncture has also been proven to mechanically stimulate connective tissues8, release adenosine at the site of needle stimulation9, and increase local blood blow10. The doctors then cite clinical trials showing the efficaciousness of acupuncture in the treatment of thousands of patients10-15.


    Despite this overwhelming evidence proving the mechanisms of action and efficaciousness of acupuncture, skeptics were outraged at the publication of an article supportive of acupuncture in the venerable New England Journal of Medicine. An article recently posted in the Forbes “science business” section stated that the article is “embarrassing” and that acupuncture “infiltrates” the University of Maryland Medical School. In the article, the author calls acupuncture “pseudoscience” and states that it is based on “magical thinking of non-existent life-force.” The skeptic author’s only proof of his theory is that one of the many studies cited in the article found that acupuncture was only 47.6% effective for the treatment of lower back pain and that sham acupuncture was 44.2% effective. Therefore, the author concludes that using “toothpicks” randomly on the human body will have the same pain relieving effects as acupuncture. What the author fails to mention in the Forbes attack article is that conventional western medicine therapy (a combination of drugs, physical therapy, and exercise) was only 27.4% effective in that very same study. Should we therefore abolish western medicine by MDs and call it pseudoscience? Acupuncturists have noted that the success of sham acupuncture noted in that particular study of 1,162 patients in Germany reveals that poorly placed acupuncture needles also derive benefit for the patient.

    The author in the Forbes article does have an agenda, he calls for the elimination of the NCCAM (National Center for Complementary and Alternative Medicine), a division of the NIH (National Institutes of Health). He states that since acupuncture is poorly supported by research, the NCCAM should be abolished. The authors of the New England Journal of Medicine article contend that more research needs to be conducted on the efficacy of acupuncture based on existing and promising research. The authors suggest continuing acupuncture education and research as a means to better serve the public with quality medicine.


    References
    1. Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine 2008;33:E887-E900.
    2. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific ba- sis. Anesth Analg 2008;106:602-10.
    3. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003;26:17-22.
    4. Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996;2:53-60.
    5. Li A, Lao L, Wang Y, et al. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalamus to alleviate edema in a rat model of inflammation. BMC Complement Altern Med 2008;8:20.
    6. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603-16.
    7. Harris RE, Zubieta JK, Scott DJ, Napa- dow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009;47:1077-85.
    8. Langevin HM, Churchill DL, Wu J, et al. Evidence of connective tissue involvement in acupuncture. FASEB J 2002;16:872-4.
    9. Goldman N, Chen M, Fujita T, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010 May 30 (Epub ahead of print).
    10. Sandberg M, Lundeberg T, Lindberg LG, Gerdle B. Effects of acupuncture on skin and muscle blood flow in healthy subjects. Eur J Appl Physiol 2003;90:114-9.
    11. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006;166:450-7.
    12. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, paralel-group trial with 3 groups. Arch Intern Med 2007;167:1892-8. [Erratum, Arch In- tern Med 2007;167:2072.]
    13. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch In- tern Med 2009;169:858-66.
    14. Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333:623.
    15. Witt CM, Jena S, Selim D, et al. Prag- matic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006;164:487-96.

     

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