Medical Acupuncture

Phantom-limb syndrome can significantly impact on amputees' quality of life and their functional capacity. Conventional treatment approaches have a poor rate of success in alleviating symptoms. Acupuncture has been advocated as an effective alternative treatment; however, there has not been a systematic review of the evidence base for this.

The aim of this review was to determine the effectiveness of acupuncture treatment in the management of phantom-limb syndrome.

This review comprised three phases: (1) an electronic database search to identify potential articles: (2) extraction of data from accepted articles; and (3) rating of internal validity and strength of the evidence provided in the accepted articles.

An Effective Public Health Practice Project quality assessment tool (quantitative studies), a Critical Appraisal Skills Programme quality assessment tool (qualitative studies), and Agency for Health Care Policy and Research guidelines (strength of evidence) were used to assess the evidence.

Level C evidence showed acupuncture treatment reduced phantom-limb pain and sensation (14 studies), improved functional capacity or mobility (5 studies), and reduced levels of analgesic use (3 studies).

Acupuncture therapy has been shown to have a positive effect on the symptoms of phantom-limb syndrome. However, further investigations of superior quality are needed to support these findings and determine the most effective method of acupuncture for this purpose.

The LIFE study was a randomized controlled trial assessing the impact of a self-acupressure intervention, Tapas Acupressure Technique® (TAT®), on weight-loss maintenance. The primary analysis showed no significant difference between TAT and social support (SS) for weight-loss maintenance, while exploratory post hoc tests suggested that, among participants with highest initial weight-loss, those in the TAT condition regained less weight than those in the SS condition.

The aim of the current study was to assess adherence to, and satisfaction with, the experimental self-acupressure intervention in the LIFE weight loss maintenance trial.

This was a secondary analysis of adherence and satisfaction patterns in a large randomized controlled trial.

The study was conducted at a prominent health maintenance organization in the Pacific Northwest.

This study involved 142 obese participants who had lost >10 pounds in a conventional weight-loss program and who were randomized to the experimental acupressure intervention.

The experimental intervention (n=142) arm consisted of instruction and application of a self-acupressure intervention, the Tapas Acupressure Technique^® (TAT^®).

The outcome sought was self-reported satisfaction and frequency of TAT practice

Sixty-six percent of TAT participants attended at least 6 of 8 intervention sessions. More than 80% of participants reported practicing TAT at home, on average, at least 2 days per week. Sixty two percent reported practicing <10 minutes per session, while 27% reported practicing 10–20 minutes per session. Higher satisfaction scores were significantly correlated with less weight regain (p=0.001). Frequency of TAT practice was not significantly associated with changes in weight, stress, insomnia, depression, or quality of life.

These data suggest moderate acceptance of, and adherence to, the TAT intervention. Further research is required to identify and achieve optimal home-practice levels of self-acupressure techniques.

Currently, opioids are the predominately prescribed treatment for wounded warriors being transported by the United States Air Force aeromedical evacuation system.

It is not known whether Battlefield Acupuncture (BFA), a type of ear acupuncture, would be an acceptable and utile therapy for patients and medical staff for pain control in the aeromedical evacuation system. The primary aim of this study was to examine the feasibility of introducing BFA into the aeromedical evacuation system.

This was a feasibility and observational study involving patients with pain who were treated with BFA while being transported by the aeromedical evacuation system from the Landsthul Regional Medical Center (LRMC), in Landstuhl, Germany, to Joint Base Andrews (JBA), in Maryland.

The participants were patients with pain who were being transported from LRMC to JBA and nurses and physicians providing the BFA treatment for these patients.

The intervention was BFA.

The outcome sought was knowledge of the feasibility and acceptability of BFA trial among the medical staff members and the patients.

It was feasible to train nurses without any previous acupuncture knowledge or skills to implement BFA. In addition, medical staff members stated that the trial did not interfere with their preflight duties or during the flight. Patients reported an average pain rating of 4.07 before BFA and pain scores 1 hour post treatment and post flight of 2.17 and 2.76, respectively (p<000.1).

BFA is a feasible acupuncture technique to be performed within the aeromedical evacuation system without interfering with operational medical duties. Significant pain relief was experienced by those patients who elected to receive BFA to relieve their pain.

Myofascial pain syndrome (MPS) is a chronic pain disorder that continues to challenge researchers and clinicians. Current treatments for MPS include trigger-point injections, dry needling, acupuncture, and transcutaneous electrical nerve stimulation. However, it is not known which of these treatment modalities is most effective.

The immediate effects of trigger-point acupuncture in myofascial pain and heart rate variability (HRV) were assessed.

Eight female patients with a mean age of 26.4±9.3 years, who had MPS participated in this study.

The trapezius and rhomboid muscles were examined for myofascial trigger points. The painful myofascial trigger points were identified by palpation, and trigger-point acupuncture was performed.

Pain level and HRV were the primary outcomes measured. Baseline and post-treatment pain assessment was performed using a visual analogue scale. HRV was analyzed using electrocardiographic signs that were recorded throughout the treatment protocol.

Acupuncture at trigger points significantly decreased pain scores from 7.1±1.7 to 3.6±1.6 (p=0.00028), while it had no significant effect on HRV.

These preliminary results suggest that myofascial trigger-point acupuncture can be an effective method for relieving MPS-related pain.

Appropriate safety measures need to be implemented during acupuncture treatment to ensure protection of both patients and practitioners.

The aim of this article is share information about the safety culture of the Acupuncture Services in the Pain Management Centre of Singapore General Hospital (SGH).

Acupuncture-related adverse events are prevented by adopting stringent standards of safety culture and practice with rigorous auditing in the following aspects: patient and staff education; an infection-control protocol; standardization of treatment services delivered by accredited Traditional Chinese Medicine (TCM) physicians; obtaining consent for procedures; proper procedure documentation and record-keeping; and discharge advice and follow-up plans.

Over the past 14 years, the SGH Acupuncture Services maintains zero incident and adverse-event rates for a total of 68,504 acupuncture treatment sessions. The total number of patients increased from 1822 (1998–2002) to 2195 (2008–2011), and daily patient numbers increased from 10 (1998–2002) to >25 (2008–2011) patients. Besides clinical work, four articles were published in peer-reviewed scientific journals, and four research projects are still ongoing.

Through robust safety practice and culture with continuing education and staff professional development, the SGH Acupuncture Services ensures minimal adverse events and infection rates while delivering competent clinical services. The authors wish to share their experience with other TCM practitioners, in the hope that some aspects of this report can be incorporated into their every day practices—safe, standardized, and evidence-based TCM.

Trigger finger, or flexor tendon tenosynovitis, is a relatively common condition, and it is considered to be somewhat refractory to conventional treatment in persons with diabetes.

This article first reviews relevant literature and then presents a case of trigger digits in a male with diabetes. The authors' treatment—using acupuncture, osteopathic manipulation, and topical nonsteroidal anti-inflammatory drugs—is described.

The patient was treated with acupuncture once weekly for eight sessions. Osteopathic manipulation included myofascial release, muscle energy, and manipulation and articulation of the carpal bones. Topical Voltaren gel was also prescribed.

Resolution of trigger finger symptoms was sought.

Significant improvement was demonstrated and, at 1 year post-treatment, the patient remained asymptomatic.

This case report suggests that physical modalities such as acupuncture and osteopathic manipulation can be useful in the treatment of flexor tendon tenosynovitis. Randomized controlled trials are indicated.

In some studies acupuncture seems to work better than placebo in irritable bowel syndrome; yet, in others, acupuncture seems to work no better than sham versions of acupuncture or placebo. In the experience of the current author, acupuncture has been effective—both for symptomatic relief and for prevention of recurrences, if points are carefully chosen according to the presenting symptoms and the patterns of Disharmony.

The aim of this case study is to describe the development of a system of point selection, for both symptom reduction and correction of Disharmonies that originally lead to the development of IBS.

Three cases are described. These were females (ages 49, 78, and 74). Each patient was examined individually to determine her pattern of Disharmony and the relevant points were treated. Chong Mai was used in all of these cases. This meridian was chosen because of its regulatory effects on all symptoms of IBS and related Disharmonies. Other points were then added as required.

Acupuncture provided significant relief in all three cases during the initial treatment period of 8 weeks; but it was necessary for the patients to have additional treatments periodically to maintain their relief from IBS symptoms. The third patient had a poor prognosis with respect to obtaining complete relief, because of the long duration of her constipation.

While the available evidence for the beneficial effects of acupuncture in IBS is equivocal, in the author's experience, stimulating Chong Mai and points according to the presenting symptoms and Disharmony patterns, demonstrated empirically that acupuncture can be used with success in most cases.