Spring Newsletter - March 2009

SAR 2010 Conference - March 19-21
Translational Research:  Bridging Science, Practice & Community

By creating dynamic bridges between laboratory experiments, clinical trials and clinical practice, the goal of translational research is to address the complexity of research evidence at all levels of scientific inquiry. The conference will explore effective strategies for advancing translational research as it applies to acupuncture and will focus on addressing paradoxes emerging from the research evidence in this field to date.
 
March 19-21, 2010
Sheraton Hotel, Chapel Hill, North Carolina

For updates on the conference, visit our website.


AAAOM Spring Conference

SAR Board members will teach several workshops at the AAAOM Conference in April.  Vitaly Napadow and Richard Harris will be teaching a workshop entitled "Neuroimaging in Acupuncture Research. Misha Cohen will present "The Role of Chinese Herbal Research" along with colleague Caylie See. The AAAOM conference will be held April 23-26 in Hyatt Capitol Park, Sacramento, California.
 
The Role of Acupuncture and Oriental Medicine in Healthcare Reform in the US.

This document is an adaptation from a document that was drafted to explore the potential role of acupuncture and Oriental medicine (AOM) in the United States health care system and was written as a collaborative effort between the Society for Acupuncture Research (SAR) and the American Association of Acupuncture and Oriental Medicine (AAAOM). The motivation for this effort originates from President Barak Obama's call for healthcare reform in the United States and more specifically for seeking cost effective solutions to the current healthcare dilemma.

The purpose of this document is to explore the potential role of acupuncture and Oriental medicine (AOM) in the United States healthcare system. The motivation for this effort originates from President Barak Obama's call for healthcare reform in the United States and more specifically for seeking cost effective solutions to the current healthcare dilemma.  This document is an adaptation from a collaborative effort between the Society for Acupuncture Research (SAR) and the American Association of Acupuncture and Oriental Medicine (AAAOM).

Oriental medicine, including acupuncture and herbal medicine, serves over a billion people globally. In addition to the growing integration of acupuncture into established healthcare settings and the private practice delivery model common in Western countries, people who cannot afford more expensive forms of medicine, use AOM. Acupuncture is safely and effectively practiced in hospitals and community clinics, in refugee camps and rural health clinics, in Europe, North America, Africa and Latin America. The importance of including AOM in a health care reform program seeking to safeguard and improve public health, cannot be overestimated.

The potential impact of integrating AOM into the U.S. Health care system can be exemplified by its cost-effectiveness and safety record. Acupuncture requires minimal equipment> only needles, isopropyl alcohol or antimicrobial solution, cotton balls, and a biohazard container are essential materials. Needles range in price from $3.00 to $11.00 per box of 100. If the average acupuncture treatment uses 8-20 needles, the total estimated cost in materials is less than $2.00 per session. Licensed acupuncturist fees for services range from $60-$100 per treatment, a range largely determined by locale, with costs generally higher in urban populations. A new model of community-based treatments can lower the costs by providing treatments in a group setting. 

Acupuncture effects seem to be cumulative, with sustained symptom relief for weeks to months following treatment. Research in chronic pain has shown that 8-12 treatments are effective in the sustained alleviation of many pain syndromes (Berman et al. 2004, Witt et al. 2006). Therefore, the up-front cost of seeing a licensed acupuncturist may outweigh the cost of multiple visits to the allopathic doctor.  Furthermore, since many prescription medications often have side effects which drive patients to seek additional health care, acupuncture can be a money-saving option.  Recent studies entitled, "Quality of life and cost-effectiveness of acupuncture in patients with osteoarthritis," "Cost-effectiveness of acupuncture treatment in patients with headache pain," and Cost Effectiveness analysis of a randomized trial of acupuncture for chronic headache in primary care (Reinhold T, Witt CM, Jena S, Brinkhaus B, Willich S, 2007; Wonderling D, Vickers AJ. Grieve R, McCarney R, 2004) demonstrate the cost-effectiveness of this intervention: while the initial up-front cost may be slightly higher, this is offset by the improved quality of life, reduced use of prescription medications, reduction of days missed from work, and, in comparison with conventional treatment methods, is actually cheaper. For example, the Medical Expenditure Panel Survey (MEPS) wrote Statistical Brief # 115 reviewing the annual cost of headaches in the U.S. Their study concluded that in 2003 dollars the average cost of treating headaches (doctor visits and prescription medications) was $566. An estimated 3.5% of the population, or 7.5 million people, experience chronic tension and/or migraine headaches, which equates to roughly $4.25 billion dollars spent per year. This figure does not include over-the-counter medications for headache relief.

Other studies reporting the cost-effectiveness of acupuncture include: Acupuncture for severe angina pectoris (Ballegaard S, Johannessen A, Karpatschof B, Nyboe J, 1999); Acupuncture for persistent low back pain (Wonderling D, Vickers AJ, Grieve R, McCarney R, 2004); and Transcutaneous Electric Nerve Stimulation for carpel tunnel syndrome; (Ratcliffe J, Thomas KJ, MacPherson H, Brazier J, 2006; Naeser MA, Hahn KK, Lieberman BE, Branco KF 2002). The Carpal tunnel syndrome study showed a significant cost-savings: in 2002 dollars, one case of CTS without surgical intervention costs an estimated $5,246, versus an estimated $1,000, based on 15 visits at $65 per visit. This represents a savings of $4,000 per patient. In Table 3 from the Branco & Naeser's 1999 paper in the Journal of Alternative and Complementary Medicine, the cost for CTS surgery was $21,000 per patient, which would average $12,000 per patient for Western intervention ($5,000 without surgery). Using the calculation above, the savings in real dollars, using laser acupuncture would average $11,000 per patient. There were one million cases of CTS in 1999, which would equate to $11 billion savings. It should be noted other methods of acupuncture are effective in treating CTS, but for the purposes of this paper we are citing this source to emphasize our point.

Studies have shown that acupuncture is extremely safe when administered by a licensed professional trained in anatomy and the skill set required for needling. The ratio of treatments to adverse incidents is statistically extremely low. For instance, a York study included 574 acupuncturists giving 34,407 treatments with 43 minor adverse effects. The majority of these were a mild bruising or bleeding at the needled site. Two point eight percent of patients reported a temporary worsening of symptoms following treatment, but 86% of this same group had improvement after the initial aggravation. In general, the most commonly reported reactions consisted of patients feeling either more relaxed or more energized, indicating an overall positive response to the experience. Another study of 31,822 treatments reported that of the 48 reported minor incidents, none was serious, and 70% of the cases showed improvement of conditions following treatment. (McPherson, et al. 2001; White, et al. 2001). Because acupuncture is a minimally invasive option for many conditions and has no negative interactions with concurrent prescription drugs, acupuncture produces no serious side effects, and it may simultaneously alleviate symptoms while reducing the need for prescription drugs.

Acupuncture can be integrated into existing healthcare settings. Currently, the evidence suggests the inclusion of acupuncture for post-surgical healing, neurological rehabilitation, pain management onsite and offsite, in oncology as an adjunct for the side effects of chemotherapy and radiation, as well as an adjunct in the treatment of anxiety and depression. Acupuncture can also be utilized as support for outpatient services, treating an array of symptoms of many conditions.

In light of the current financial crisis that the United States and other countries are experiencing, acupuncture may function as cost-effective alternative to conventional medical practices.  The outlook is surprisingly optimistic given the enthusiasm of President Obama's call for healthcare reform.  The time to act is upon us.


New Board Member, Joe Audette

Joseph F. Audette, M.A., M.D. 
Asst Professor, Harvard Medical School
Chief of Pain Medicine,
Harvard Vanguard Medical Associates 

Joseph F. Audette, M.D., earned his medical degree at Harvard Medical School in 1991, completed a residency in Physical Medicine & Rehabilitation at Columbia Presbyterian Hospital in New York in 1995, and is board certified in PM&R and Pain Management. While in New York, he trained in acupuncture at the Tristate School of Traditional Chinese Acupuncture. He has recently been hired as the new Chief of Pain Medicine at Harvard Vanguard in Boston, which is a large multi-specialty medical group practice providing care to more than 450,000 adult and pediatric patients across eastern Massachusetts. His research interests include Acupuncture, Myofascial and Chronic Pain and he has lectured internationally on these topics. He is currently working in collaboration with Vitaly Napadow, PhD, LicAp. on an NIH funded grant titled Brain Plasticity in Carpal Tunnel Syndrome and its Response to Acupuncture.  He is also the co-director with David Euler, LicAp. and Kiiko Matsumoto, LicAp. of the Harvard CME course Structural Acupuncture for Physicians.  Welcome, Joe!


New Board Member, Robert Davis

Robert Davis, MS, L.Ac.
Vermont Oriental Medical Clinic, PLC
President, Stromatec, Inc.
South Burlington, VT

Robert Davis received an MS in acupuncture and Oriental medicine from Southwest Acupuncture College, Santa Fe in 1999. He is board certified in acupuncture and Chinese herbal medicine and maintains a clinical practice in South Burlington, Vermont. He served as the President of the Vermont Association of Acupuncture and Oriental Medicine from 2001 - 2006. He is currently the President of Stromatec, Inc., a biotech R&D company providing quantitative tools and "know how" to researchers and clinicians in the areas of acupuncture needling techniques and connective tissue physiology and pathology. He has served as the Principle Investigator for three National Institute of Health research grants. Welcome, Robert!


SAR Research Highlight

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institute of Health (NIH) has recently awarded a 5-year R01 grant to two of SAR's board members, Vitaly Napadow and Joseph Audette. The aims of this grant, entitled "Brain Processing in Carpal Tunnel Syndrome (CTS) and its Response to Acupuncture" will be to utilize functional MRI (fMRI) to explore acupuncture-induced neuroplasticity in CTS and the correlation of this plasticity to clinical outcomes. This study exemplifies both NCCAM's and SAR's recent emphasis on translational research, by embedding basic science evaluation via fMRI within a clinical trial design. 

CTS, the most common entrapment neuropathy, is exceeded only by low back pain as a cause of employee absenteeism. Maladaptive neuroplasticity in the brain of CTS patients was noted in the investigators' pilot study (1,2), and included altered primary somatosensory cortex (SI) somatotopy and primary sensorimotor hyperactivation. Drs. Napadow and Audette hypothesize that the disability and pain associated with CTS is not only a consequence of the peripheral nerve lesion but also relates to the observed, altered sensory processing in the brain. Acupuncture has shown potential as a conservative treatment option for CTS, but its mechanisms of action are unknown. The study investigators believe that acupuncture, which was demonstrated in the pilot study to engage different brain regions in CTS patients compared to healthy controls (3), may function as a somatosensory conditioning stimulus and reverse CTS-associated maladaptive neuroplasticity. This grant will fund a larger study which will assess changes in brain activity that accompany the dysfunction in the wrist, as well as how different acupuncture protocols directed at different bodily locations might modify both local nerve health and brain function to refine acupuncture utility for CTS and advance rehabilitation options in CTS care.

References

  1. Napadow V, Kettner N, Ryan A, Kwong KK, Audette J, Hui KKS. Somatosensory Cortical Plasticity in Carpal Tunnel Syndrome - a Cross-sectional fMRI Evaluation. Neuroimage. 2006, Jun 31(2):520-30.
  2. Napadow V, Liu J, Li M, Kettner N, Ryan A, Kwong KK, Hui KKS, Audette J. Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture. Hum Brain Mapp. 2007, Mar;28(3):159-71.
  3. Napadow V, N Kettner, J Liu, M Li, KK Kwong, M Vangel, N Makris, J Audette, Hui KKS. Hypothalamus and Amygdala Response to Acupuncture Stimuli in Carpal Tunnel Syndrome. Pain. 2007, 130(3):254-66.

Upcoming Research Conferences

*  SAR Board members will present workshops at the AAAOM Spring conference.

*  The SAR Board has submitted a workshop proposal to the North American Research Conference in CAM sponsored by the Consortium of Academic Centers of Integrative Medicine (CACHIM) to be held in Minneapolis, MN next spring. The workshop title "Paradoxes in Acupuncture Research: Strategies for Moving Forward" will present the review of the literature and findings that provide support to the White paper mentioned above.

*  SAR 2010
The University of North Carolina School of Medicine at Chapel Hill, academic home of SAR Board member Jongabe Park, has graciously offered to co-sponsor SAR's next International Conference,
March 19-21, 2010

 

Information and links were accurate at the time the newsletter was published.

 


 
 
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