Acupuncture Therapy
اسلاید 1: www.tabaye.ir
اسلاید 2: By Marissa GraceLatin: Acus (needle) PuncturaValues Assessment: Continuum…….
اسلاید 3: Cognitive ObjectivesList 3 stated benefits of acupuncture. Define sham acupuncture.Describe what Qi is. Identify the most significant adverse effect related to safety and explain what it was related to. Explain which treatment application (Back pain, OA of the Knee, or PONV) has the most evidence of benefits based on results, strengths and limitations.
اسلاید 4: OriginsTrace back more than 2000 years in China6th Century spread to Korea and Japan 8th and 10th Century trade into Vietnam 16th Century Western France by Jesuit missionaries 1972- Visit to China from President Nixon-Member of US Press Corps with emergency appendectomy received acupuncture. Experienced shared with New York Time
اسلاید 5: Stated Benefits N/V after chemotherapyBack PainOsteoarthirtisPreop surgery painAddictionStrokeHeadacheMenstrual CrampsTennis elbowFibromyalgiaAsthmaCarpal Tunnel
اسلاید 6: Techniques and PracticesSham acupunctureOkibari - Japanese style MoxibustionCuppingElectroacupuncture (EA)
اسلاید 7: NeedlesNeedles made of flint, thorns of plants, bamboo slivers or bone Very fine and flexible about 1/2in (0.6cm) to 1 ½ in (38cm)Attract or disburse energy along meridiansFDA approved needles by use of licensed practitioners in 1996. Sterile, non toxic, single use only
اسلاید 8: Tools of the Trade http://www.lhasaoms.com/
اسلاید 9: Traditional Chinese Medicine Qi: Life force, vital energy behind all physiological processes. warms body, pathogen protection, promotes growthMeridian network system Disruption of flow results in illnessMechanism of Qi still mysterious
اسلاید 10: Traditional Chinese MedicineMeridiansTerm for each of 20 pathways through body for flow of qi, accessed through acupuncture points 12 main and 8 secondaryUp to 2000 points along meridian complex Points regulate different areas of the body
اسلاید 11: TheoryStimulation of the nervous system to release chemicals in the muscles, spinal cord, and brain. Beta-endorphinAnalgesia. Placebo effect.
اسلاید 12: Is acupuncture safe? A systemic review of case reports Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83 Method202 cases reported (40% from US) from 1965-1999, First hand reports included, case reports
اسلاید 13: Is acupuncture safe? A systemic review of case reports Lao L, et al. Alt Therapy in Health and Med Jan/Feb 2003:9,1:72-83 Results Infection: Hepatitis 80% (94cases/35 years)Needles not cleans/ repeated use/ inadequate sterilizationInternal Organ/tissue injuryFewer complications after 1988: no further Hepatitis reports.20% of practitioners with no recognized qualifications
اسلاید 14: Acupuncture for back pain: A meta-analysis of randomized controlled trials. Ernst, Arch of internal Med. 1998;158:20:2235-2241MethodsRandomized controlled trials of acupuncture of back pain in humans377 subjects, mostly with chronic poor prognosis back pain Consulted by 6 experienced acupuncturists12 studies included (9 suitable for meta-analysis)ConclusionInsufficient evidence to state whether superior to placeboLong term effect of back pain with acupuncture uncertain
اسلاید 15: Acupuncture for back pain: A meta-analysis of randomized controlled trials. Ernst, Arch of internal Med. 1998;158:20:2235-2241
اسلاید 16: Randomized trial comparing traditional medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of internal medicine. 2001; 161, 8: 1081-1088. DesignOnly 17% of invited Washington State Group Health HMO patients participated (262 patients, age 20-70 years). Ten acupuncture or massage visits in a 10 week period. 95% of patients w/ Follow-up after 4, 10, and 52 weeks. Symptoms and dysfunctions assessed Results F/U with 95% of participantsmassage is an effective short-term treatment for chronic low back pain with benefits to last at least 1 year
اسلاید 17: Randomized trial comparing traditional medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Cherkin DC, Eisenberg D, Sherman KJ et al. Archives of internal medicine. 2001; 161, 8: 1081-1088. Results If acupuncture has a positive effect it seems to be during the first 4 weeks with limited improvement thereafter. Strengths- randomized design, involvement of therapist with protocol development, and high compliance rate. Limitations -absence of control group, restriction of single form of acupuncture (TCM), possibility of atypical therapists, use of protocols that excluded treatments often used by some TCM acupuncturist.
اسلاید 18: OsteoarthritisOA most prevalent form of arthritisCommon site is knee joint and a leading cause of disability in the elderly Acupuncture for OA is a therapeutic approach common in Asian societies
اسلاید 19: A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee Berman BM, et. al. Rheumatology 1999;38: 346-354Design73 patients from the Baltimore area (average age 65 years). Inclusion criteria ≥ 50 older Dx of OA ≥ 6 months, moderate pain in knee most days in the last month, taking analgesic or anti-inflammatory agents for pain control at least one month.protocol included TCM treatment for Bi syndrome which uses local and distal points on channels that cross the area of pain
اسلاید 20: A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee Berman BM, et. al. Rheumatology 1999;38: 346-354Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)The patient’s scores were determined at 0, 4, 8 and 12 weeks during trial. Resultsthe acupuncture group with about 34% ↓ on WOMAC at week 4 and 42% at week 8. There were no significant changes in the control group from baseline to week 12. Limitations noted lack of placebo control group.
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اسلاید 22: Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004 DesignReduce pain/improve function among patients with knee OA as compared to both sham acupuncture and education control groups 8 week intense acupuncture treatment, followed by an 18 week tapering regime 570 participantsAssessments conducted at baseline, 4, 8, 14, and 26 weeks
اسلاید 23: Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Berman BM, Lao L, Langenberg P, et al. Annals of Internal Medicine. 2004 ResultsTrue acupuncture groups improvement from baseline was significantly greater than the sham control group at weeks 8 (P=0.01), 14 (P=0.04), 26 (P=0.009) Most believe they received true acupuncture at both times, suggesting the sham acupuncture to be a credible blinding strategy At 4 weeks 67% of the true acupuncture group and 58% of sham believed they were receiving true acupuncture (P=0.06) and at 26 weeks 75% in acupuncture group and 58% in sham (P=0.003).
اسلاید 24: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta-analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.DesignStimulation of wrist at pericardium (P6)Systemic review 24 randomized controlled trials (1679 patients)Nonphamacologic- acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation and acupressureMeasured incidence of nausea, vomiting or both after surgery 0-6h (early) or 0-48h (late)
اسلاید 25: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta-analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.Results Pediatric studies failed to show significant benefit.Antiemetic use in preventing early or late PONV in adults was comparable to the non-pharmacologic techniques. Significant reduction of early vomiting in nonpharm. group compared with placebo w/in 6h of surgery for adults.
اسلاید 26: The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV): A meta-analysis Lee A, Done M. Anesthesia and analgesia. 1999. 88:6: 1362-1369.LimitationsCombining different non-pharmacologic techniques. May have different effects to prevent PONVOptimal methods of applying techniques unknown. Length of treatment (5min- 7days)No statistical heterogeneityConclusionsFurther RCT with better study methodology needed in adults. Mechanism for prevention of PONV not established.
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اسلاید 28: Values Assessment: Continuum……./ Questions????
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