Summer Newsletter - August 2012


SAR Announcement

SAR’s 2013 International Research Conference (April 18-21, 2013, Ann Arbor, MI)
Join us for SAR’s international research conference in Ann Arbor MI on April 18-21 in 2013.  Important research findings from the three years since our previous 2010 conference in Chapel Hill will be presented and discussed.  Thematically the 2013 conference will emphasize the role of acupuncture in 21st century health care and the importance of translational applications within this field of research. To-date, the primary co-sponsors of the conference will be the University of Michigan Department of Anesthesiology and the University of Michigan Program in Integrative Medicine. Our conference includes three keynote lectures, which directly address current topics in acupuncture research. In addition, a special panel discussion will address the conference theme, the impact of acupuncture research on 21st century health care. Additional symposia will (1) highlight the findings of SAR’s latest White Paper on clinical and basic research comparisons of electrical and manual acupuncture (see below), and (2) explore context and patient-practitioner effects in acupuncture research. Original presentations in three main areas: clinical trials, basic science, and research methodology will be solicited from members of the national and international acupuncture research communities. Click here for a PDF version of the Call for Abstracts(abstract submission deadline is September 10, 2012).  To foster interdisciplinary dialogue and collaboration, the conference will also include interactive workshops focusing on comparative effectiveness research and objective outcomes in clinical trials.  For conference sponsorship information, contact Richard Harris at reharris@med.umich.edu.  For more information about the conference, visit www.sar2013conference.org

 

UPCOMING EVENTS

International Scientific Acupuncture and Meridian Symposium (iSAMS) 2012 Conference: October 5-7, 2012, Sydney, Australia
iSAMS is an international conference that aims to showcase the “cutting edge” of acupuncture research.  This year’s theme is “Moving Acupuncture Research Forward – Issues and Solutions” and there will be several streamed themes highlighting the different methods and approaches associated with acupuncture research, including clinical, mechanistic, public health, integrative and qualitative.  For more information, visit:  http://www.isams.org

International Congress for Educators in Complementary & Integrative Medicine (ICE-CIM 2012)October 24 - 26, 2012 in Washington, DC
ICE-CIM’s goal is to advance the field of complementary and integrative medicine education through the sharing of best practices in the development, implementation, evaluation,
  and dissemination of curricula and teaching methods; the strengthening of existing partnerships; and the development of new collaborations. For more information, visit: http://www.icecim.org/

The 8th annual International Congress of Complementary Medicine Research - ICCMR 2013 (April 11-13, 2013; London)
ICCMR 2013 - will focus on the global sustainability of healthcare for long term conditions such as diabetes, chronic pain, cardiovascular disease, psychological problems, neurodegenerative conditions and arthritis.
The congress will promote discussion on the generalisability of self-care techniques such as yoga and Tai-chi.  The event is designed for academic researchers interested in the efficacy and application of traditional, complementary and integrative therapies; practitioners of traditional, complementary and integrative therapies; mainstream medical researchers and practitioners; and others interested in the congress program.  For more information, visit:  http://www.iccmr2013.org

International Congress on Naturopathic Medicine (ICNM) (July 7-9, 2013, Paris, France)
ICNM is designed to be a premier gathering in 2013 for the most influential and inspiring multi-disciplinary Naturopathic Physicians, Therapists, Professors and Health Care Professionals from around the world, dedicated to improving patient care and defining the future of alternative healthcare. The Scientific Committee is elaborating a large and mature program with internationally distinguished faculty members, researchers and specialists in line with our commitment to innovation, expertise and excellence in complementary medicine.  The United-States will be the Honoring Country at the ICNM 2013.  For further information about the ICNM Congress, visit www.icnmcongress.com.

 

PRIOR EVENT SUMMARY

SAR presented its latest white paper findings in Portland, OR in May 2012 during the third International Research Congress on Integrative Medicine and Health (IRCIMH) (http://imconsortium-congress2012.org).  SAR’s session was entitled, “Acupuncture, Research and The Challenge of Heterogeneity: What Can We Learn from Comparing Manual vs. Electrical Acupuncture” and was well-attended (~100 people).  SAR board members presented findings from SAR’s 2012 Think Tank/White Paper conference, where the SAR Board engaged in a critical review of the basic and clinical research evidence to-date on manual and electrical acupuncture, from which the following perspective was identified: Despite substantial growth in the field of acupuncture research in the last decade, significant challenges remain in drawing overall conclusions from the available data. One important factor contributing to this lack of clarity is the indiscriminate use of the term “acupuncture” which does not differentiate between diverse interventions and techniques. In particular, potential differences between the two most common modes of needle stimulation, manual and electrical, are poorly understood and largely unaddressed.” The SAR Board systematically evaluated the published literature on manual and electrical acupuncture and explored a bi-directional translation of research findings between these two specific forms of acupuncture therapy.  The White Paper will also be submitted for publication to a biomedical journal.

 

Tai Chi for Chronic Pain Conditions:  What's New in Research?

In this newsletter issue, we mix it up a bit by highlighting advances in a branch of East Asian medicine complementary to acupuncture––Tai Chi.  Paralleling the exponential growth in acupuncture research for chronic pain conditions has been significant development in the evaluation of Tai Chi for pain.  Below we provide a brief summary of highlights from studies published during this past year.

1. Fibromylagia

Recent sound randomized trials have evaluated Tai Chi for fibromyalgia. 

Following a promising and provocative trial published in 2010 in the New England Journal of Medicine supporting Tai Chi’s efficacy for managing symptoms in fibromyalgia patients (http://www.ncbi.nlm.nih.gov/pubmed/20818876), a number of additional studies have been conducted in a variety of countries and populations that have added further support for Tai Chi’s effectiveness and safety in treating fibromyalgia.   

One new RCT conducted in Oregon, USA that included 101 subjects reported that, compared to an educational control group, 12 weeks of Tai Chi resulted in greater and clinically relevant improvements in FM symptoms including pain and physical function including mobility.   

Jones KD, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F.  A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients.  Clin Rheumatol. 2012. May 13. [Epub ahead of print]  (http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/22581278)

Two additional non-controlled studies conducted in Spain, one evaluating women and a second studying men, also support Tai Chi’s effectiveness and safety in this population.

Romero-Zurita A, Carbonell-Baeza A, Aparicio VA, Ruiz JR, Tercedor P, Delgado-Fernández M. Effectiveness of a tai-chi training and detraining on functional capacity, symptomatology and psychological outcomes in women with fibromyalgia. Evid Based Complement Alternat Med. 2012;2012:614196. Epub 2012 May 9. (http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/22649476)

Carbonell-Baeza A, Romero A, Aparicio VA, Tercedor P, Delgado-Fernández M, Ruiz JR. T'ai-Chi intervention in men with fibromyalgia: a multiple-patient case report. J Altern Complement Med. 2011 Mar;17(3):187-9. Epub 2011 Feb 25. (http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/21348799)

2.  Back pain

Despite the prevalence and burden of chronic low back pain, and the need for new therapies for rehabilitation, until recently, no RCTs conducted in the West had rigorously evaluated Tai Chi for this condition.  A recent study conducted in Australia randomized 160 individuals with persistent nonspecific low back pain to receive either 10-week of Tai Chi  or a waitlist control that received usual health care.  The study reported that Tai chi exercise reduced bothersomeness of back symptoms by 1.7 points on a 0-10 scale, reduced pain intensity by 1.3 points on a 0-10 scale, and improved self-report disability by 2.6 points on the 0-24 Roland-Morris Disability Questionnaire scale. These results were considered a worthwhile treatment effect by researchers and participants, and the authors concluded that tai chi can be considered a safe and effective intervention for those experiencing long-term low back pain symptoms.

Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res. 2011 Nov;63(11):1576-83. doi: 10.1002/acr.20594.   (http://www.ncbi.nlm.nih.gov/pubmed/22034119)

3.  Systematic Reviews

Two recent systematic reviews of Tai Chi for pain conditions include comprehensive review of Tai Chi for a number of other pain conditions, including osteoarthritis, rheumatoid arthritis, and headache pain.

Wang, C. Tai chi and rheumatic diseases. Rheum Dis Clin North Am. 2011 Feb;37(1):19-32. Epub 2010 Dec 4. http://www.ncbi.nlm.nih.gov/pubmed/21220083

and

Peng PW. Tai Chi and Chronic Pain. Reg Anesth Pain Med. 2012 May 17. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/22609642]

 

GENERAL RESEARCH HIGHLIGHTS

 “Sleep Quality of Obese Workers of a Teaching Hospital: Acupuncture as a Complementary Therapy”

Summary:
Stemming from known negative physiological and psychological effects of poor Circadean sleep-wake rhythms, researchers demonstrate that auriculoacupuncture and electroacupuncture may be effective in improving sleep disorders and their related symptoms in obese hospital workers.

Research study comprised 37 individuals who were subjected to one electroacupuncture and one auriculoacupuncture session per week over eight weeks, respectively. The Pittsburgh Sleep Quality Index (PSQI) was used to measure participants’ quality of sleep before and after the eight week intervention. All sleep quality scores fell under one of three categories: “disorder”, “bad”, or “good”.   

Prior to the intervention, five workers qualified as having “good” sleep quality, while 14 qualified for sleep “disorder” status. After the eight week acupuncture sessions, nine workers fell under “good” status, while two subjects continued experiencing “disorder” sleep quality. The median PSQI score results, along with statistical consideration of socio-demographic variables, indicate potential for CAM to improve quality of life for this specific population.

Citation:

Haddad et al. Sleep Quality of Obese Workers of a Teaching Hospital: Acupuncture as a Complementary Therapy. Rev ESC Enferm USP. 2012 Feb; 46(1):82-88

 

“Immediate Effects of Acupuncture on Biceps Brachii Muscle Function in Healthy and Post Stroke Subjects”

Summary:
Stroke can result in functional impairments, such as chronic hemiparesis (weakness on one side of the body/reduced muscle strength). Building from this knowledge, researchers investigate the effects of localized manual acupuncture on neuromuscular function in healthy and post-stroke patients.

The study considered two parallel groups, one healthy subjects group and one post-stroke patients group. Surface electromyography (sEMG) was used to measure bicep myoelectric activity, or the electrical properties of bicep muscle tissue, before and after stimulation of acupoints Quchi LI11 and Tianquan PC2.

Findings reveal the healthy subjects group received sufficient stimuli to promote immediate MU gross recruitment changes. In contrast, post-stroke subjects did not exhibit significant reduction on myoelectric activity post treatments, meaning that the TCM manual acupuncture intervention used in this study may not be effective in promoting immediate, significant changes in muscle activity for post-stroke patients. Researchers suggest a large-sample study to confirm or refute preliminary results for the post-stroke group.

 

Citation:

Ana Paula S Fragoso, Arthur S Ferreira. Immediate Effects of Acupuncture on Biceps Brachii Muscle Function in Healthy and Post Stroke Subjects. Chinese Medicine 2012, 7:7

 

“Management of frozen shoulder: a systematic review and cost-effectiveness analysis”

Summary:
Authors identify a need to evaluate clinical- and cost-effectiveness for idiopathic frozen shoulder. Though a lack of available data was identified as a primary limitation to the study, the review included thirty-one clinical effectiveness studies and one economic evaluation.
 

Research results point to a lack of high quality clinical evidence due to acupuncture studies scarcely meeting inclusion criteria for systematic review. Authors conclude that there is insufficient evidence to comment on the effectiveness of acupuncture for primary frozen shoulder.

Citation:

Maund E, Craig D, Suekarran S, Neilson AR, Wright K, Brealey S, et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012;16 (11).

 

“The antinociceptive effect of electroacupuncture at different depths of acupoint at different depths of acupoints and under the needling surface”

Summary:
Study aims to examine changes in intensity and duration of eclectroacupuncture (EA) according to the depth of acupuncture stimulation. Methodologically, the study utilizes the rat tail-flick test as the primary measurement instrument, localizing treatment to Zusanli (ST36) and Sanynjiao (SP6) acupoints. Verum group subjects received one of five acupuncture needle types in their intervention, while control group subjects received injections of saline, 1% or 2.5% formalin into ST36.

Research findings reveal that EA efficacy is dependent on the spatial distribution of the electric current density under the needling surface. Debunking notions that acupoint and depth of needling are the sole factors in determining EA efficacy.

Citation:

Silva et al.: The antinociceptive effect of electroacupuncture at different depths of acupoint at different depths of acupoints and under the needling surface. Chinese Medicine 2012, 7:3    

 

“Management of primary chronic headache in the general population: the Akershus study of chronic headache”

Summary:
Due to overuse of acute headache medication in selected populations, researchers identify a need to evaluate the context of patients seeking acute headache treatment.

Including a random sample of 30,000 Norwegians, authors design a cross-sectional epidemiological survey seeking to identify and evaluate the utility of health services and medication use for people with primary chronic headaches. Research findings show that over 60% of patients, at some point, used CAM; authors suggest this may be due to a failure to achieve optimal control with medication. 

Study concludes that improved management by health professionals as well as an increased use of prophylactic treatment may alleviate the burden for patients with primary chronic headache.

Citation:

Kristoffersen et al. Management of primary chronic headache in the general population: the Akershus study of chronic headache. J Headache Pain. 2012 March; 13(2): 113-120

 

A new method for quantifying the needling component of acupuncture treatments”

Davis and the colleagues used a new needling sensor tool (Acusensor) to record needling in real time. Calculated parameters included displacement amplitude, displacement frequency, rotation amplitude, rotation frequency, force amplitude and torque amplitude. Data analysis revealed significant differences in the amplitude of displacement and rotation between needling performed by staff from two different acupuncture styles (Chinese and Japanese).  The relationships between displacement and rotation frequencies, as well as between displacement and force amplitudes showed considerable variability across individual acupuncturists and subjects. I think this study presents that needling can be mechanically characterized both in basic and clinical research.

Citation: Davis RTChurchill DLBadger GJDunn JLangevin HM. A new method for quantifying the needling component of acupuncture treatments. Acupunct Med. 2012 Mar 16. [Epub ahead of print])

 

“Radiation-induced dry mouth and acupuncture”

In the journal Cancer, Meng et al reported that adjuvant acupuncture improved symptoms of xerostomia, or dry mouth, caused by head/neck radiation that occurred during treatment for nasopharyngeal carcinoma.  Forty participants received adjuvant acupuncture on the same days as their radiation therapy, three times a week for seven weeks. When compared to the control group (N=46), the acupuncture group’s stimulated whole salivary flow rate was higher at week 7 (p=0.002) and week 11 (p<0.03) of treatment. The higher stimulated whole salivary flow rate lasted until a final measure was taken during a follow up screening that occurred 6 months after the final treatment (acupuncture, 1.57; control, 0.95; p<0.003; group difference 0.62; 95% CI 0.22, 1.01). The acupuncture group also demonstrated improved unstimulated salivary flow starting at week 3 (p=0.004), continuing through week 7 (p<0.0001) and week 11 (p<0.02) when compared to the control. All groups were given a Xerostomia Questionnaire that indicated the level of symptoms they were suffering from after treatment. Lower scores on the questionnaire represent fewer xerostomia symptoms. The acupuncture group reported improved quality of life during treatment as they scored lower on than the control group at week 11 (RR=0.62, 95% CI 0.45, 0.87) and at six-month follow up (RR=0.38, 95% CI 0.19, 0.76).

Meng Z, Garcia MK, Hu C, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer. 2011: epub ahead of print.

“Acupuncture and Polycystic Ovary Syndrome”

Pastore et al compared the effect of true acupuncture (N=40) against sham acupuncture (N=44) on ovulation frequency and luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio in a double blind, randomized, and controlled trial of women diagnosed with polycystic ovary syndrome. Participants received 12 sessions; twice weekly for the first four weeks, then once weekly for four more weeks. The rates of ovulation and reduction in LH to FSH ratio were similar between groups. The mean ovulation rate was 0.37 per month in the true acupuncture group and no different than the sham controlled group (0.40/month, p=0.6). There were no changes in FSH between groups (p=0.077).  When compared to baseline, LH was lowered in both groups at three-month follow up (p=0.04), but more significantly in the sham arm during the intervention (p=0.04). The LH to FSH ratio decreased from 1.9 (1.2) at baseline to 1.4 (1.4) after intervention (p=0.039) and at the three-month follow-up (1.3 (0.7), p=0.001). The same was true in the sham group, the LH to FSH ratio at baseline was 2.2(1.9) and reduced to 1.4(1.1) after intervention (p=0.019) and at the three-month follow-up (1.5 (1.0), p=0.067). There was no difference between the treatment groups in LH to FSH ratio after intervention (0.876) or at three-month follow-up (p=0.276).

Pastore LM, Williams CD, Jenkins J, Patrie JT. True and Sham Acupuncture Produced Similar Frequency of Ovulation and Improved LH to FSH Ratios in Women with Polycystic Ovary Syndrome. Journal of Clinical Endocrinology & Metabolism. 2011;96(10):3143-3150


 
 
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