Acupunctuur kan pijn verlichten bij
artritis in heup/knie
Uit een grote randomized studie op
patiënten met artritis in knie of heup blijkt dat acupunctuur aangevuld met normale zorg
de pijnklachten kan verminderen en verbetering van de kwaliteit van leven.
http://www.medpagetoday.com/Rheumatology/Arthritis/tb/4393
Witt CM et al. "Acupuncture in
Patients With Osteoarthritis of the Knee or Hip: A Randomized, Controlled Trial With an
Additional Nonrandomized Arm." Arthritis & Rheumatism. 54;11: 3485-93.
Liu T and Liu C. "Acupuncture for Treating Osteoarthritis of the Knee and the
Hip." Arthritis & Rheumatism. 54;11: 3375-77.
Bonghan-buisjes - de fysieke basis
van acupunctuur?
Zuid-Koreaanse onderzoekers denken
recentelijk aanwijzingen gevonden te hebben voor het bestaan van fysieke structuren in de
lichamen van dieren, die corresponderen met de meridianen zoals beschreven in de
acupunctuur. Het gaat om miniscuul dunne "buisjes" die zich bevinden in de huid
en ook waargenomen zijn binnen bloedvaten en bij de belangrijke organen. De structuren
worden Bonghan ducts of Bonghan-buisjes genoemd, naar Bonghan Kim, een Noord-Koreaans
onderzoeker die al in de jaren '60 het bestaan van deze structuren claimde.
Recentelijk hebben drie onafhankelijk
werkende Zuid-Koreaanse onderzoeksgroepen met behulp van verschillende technieken bij
konijnen, varkens en ratten Bonghan-buisjes aangetroffen. In deze semi-transparante,
elastische buisjes bewegen zich, overeenkomstig de theorie van Bonghan Kim,
miniscuulkleine deeltjes die DNA bevatten. Zowel de buisjes als de deeltjes erin konden
zichtbaar gemaakt worden met behulp van moderne fluorescentietechnieken. Volgens de
onderzoekers blijkt uit histologisch onderzoek dat hier sprake is van geheel nieuwe
structuren, die verschillen van de bloedvaten, zenuwbanen en lymfevaten zoals bekend in de
anatomie en fysiologie. In bepaalde Bonghan-buisjes die in bloedvaten werden aangetroffen
werd waargenomen dat de deeltjes erin stroomden in een richting tegengesteld aan die van
het bloed. Als de beweringen van de Koreaanse onderzoekers juist blijken, zal de heersende
visie op het menselijk lichaam op de schop moeten. Wordt ongetwijfeld vervolgd.
Hieronder twee weblinks naar het
Engelstalige tijdschrift van de in Japan gevestigde International Society for Life
Information Science, dat in 2004 een minisymposium aan het onderzoek naar Bonghan-buisjes
wijdde:
http://www.soc.nii.ac.jp/islis/en/journalE/abst222E.htm
http://www.soc.nii.ac.jp/islis/en/journalE/abst231E.htm
Bron: http://www.vanpraaginstituut.nl/
De betekenis van acupunctuur in de
reguliere zorg
Auteur: Dr Kho
Url: http://www.drkho.com/
De behandeling van klachten en ziekten met
naalden (Zhenjiu) vormt een belangrijk onderdeel van de traditionele Chinese geneeswijzen
(TCG). De oudste geschriften van de TCG stammen uit de periode van Keizer Huangdi
(2697-2598 v.Chr).
De Nederlandse heelkundige W. ten Rhijne
introduceerde in 1683 de naam acupunctuur (acus = naald, puncture = prikken). In de TCG
gaat men ervan uit dat er binnen het lichaam een energie (qi) circulatie is. De qi
circuleert langs de denkbeeldige lijnen, die acupunctuurpunten met overeenkomstige
eigenschappen verbinden, de zgn. meridianen. Onder een acupunctuurpunt verstaat men een
scherp cilindrische opening van de bovenste laag van spieromhulsel van het lichaam met een
diameter van 2-8 mm omhuld door een laag bindweefsel waarbinnen een bundel van zenuwcelen
bloedvaten loopt.
Van belang voor de gezondheid is de
noodzaak dat de circulatie van qi ongestoord kan plaatsvinden. Klachten of ziekten
ontstaan volgens de TCG doordat de circulatie van qi in het lichaam op de een of andere
wijze verstoord raakt, waardoor van een evenwichtige qi circulatie niet meer gesproken kan
worden.
De behandeling bestaat uit het opheffen van
die situatie op plaatsen waar de qi circulatie geblokkeerd is.
Naar deze ogenschijnlijk simpele
werkhypothese van acupunctuur is in de laatste decennia's veel onderzoek verricht, zowel
fundamenteel als ook klinisch. Aanleiding hiervoor was de hernieuwde belangstelling voor
acupunctuur in samenhang met de introductie van acupunctuur als verdoving in de zeventiger
jaren van de vorige eeuw.
Kennis van de reguliere geneeskunde van
toen was ontoereikend om het fenomeen acupunctuur-verdoving te kunnen verklaren. Het
vermogen van de acupunctuur om pijn te stillen is vervolgens een onderwerp geworden van
systematische studies. Aldus heeft het fenomeen "acupunctuurverdoving" in de
zeventiger jaren, waarbij patiënten
gedurende verschillende grote ingrepen wakker zijn gebleven - ogenschijnlijk - zonder pijn
te voelen, mede aanleiding gegeven tot het enthousiasme over de studie van pijn en
pijnmechanismen en tot het bereikte resultaat van vandaag.
Internationaal heeft de
wereldgezondheidsorganisatie, de WHO, de bijdrage van de traditionele geneeswijzen binnen
de reguliere gezondheidszorg van vele lidstaten al lang onderkend. In 1991 heeft de World
Health Assembly een belangrijke resolutie, de WHA44.34, aangenomen. Daarin bepleit de WHO
haar lidstaten o.a. de samenwerking tussen de traditionele en de moderne geneeswijzen te
intensiveren, vooral de implementatie van wetenschappelijk al bewezen, veilige en
effectieve traditionele methoden, teneinde de alsmaar stijgende (nationale) kosten van
geneesmiddelen consumptie terug te dringen. Daarnaast beveelt de WHO de lidstaten aan
wetenschappelijk onderzoek op het gebied van de traditionele geneeswijzen te blijven
stimuleren: www.who.int.
Eveneens in de lijn van de WHO
aanbevelingen zij opgemerkt, dat de Amerikaanse Food and Drug Adminstration (FDA) in 1996
acupunctuurnaalden uit de lijst van experimenteel medische instrumenten heeft doorgehaald.
De FDA onderschrijft het gebruik van acupunctuur als een effectieve behandelingsmethode
voor een aantal indicaties, zoals postoperatieve pijnbestrijding na tandheelkundige
ingrepen, misselijkheid en braken na anesthesie en chemotherapie. Voorts wijst de FDA op
dat acupunctuur effectief kan zijn bij de behandeling van diverse klachten zoals
tennisarm, migraine, artritis, periodieke buikkrampen en andere
chronisch pijnlijke condities.
Het valt te bezien op welke wijze de
Nederlandse overheid in de komende jaren bereid zou zijn de WHO resolutie te willen
implementeren, en hoe zij - uit praktisch oogpunt - de WHO aanbevelingen zal overnemen.
Het effectiviteitonderzoek van acupunctuur
zou kunnen betekenen dat de consumptie van geneesmiddelen op een verantwoorde wijze
teruggedrongen wordt. Het spreekt voor zich dat de farmaceutische industrie een dergelijk
onderzoek - in tegenstelling tot het geneesmiddelenonderzoek - noch toejuicht noch
financieel ondersteunt. De
overheid is de meest aangewezen en geëigende instantie het onderzoek te ondersteunen.
Binnen dit context ligt het in de lijn der verwachting dat de universitaire gemeenschap in
de zin van een hiervoor op te richten vakgroep het onderzoek ter hand zal nemen.
INDICATIE
Hoewel het meeste onderzoek in de acupunctuur betrekking heeft op het pijnstillende effect
- de acupunctuur-analgesie (AA) - is het een misvatting te veronderstellen dat acupunctuur
slechts geschikt is om pijnklachten te doen verminderen. Als het belangrijkste onderdeel
van de TCG bestrijkt het indicatiegebied van de acupunctuur niet alleen het verhogen van
de pijndrempel, maar ook de behandeling van diverse andere klachten. Naar de reguliere
geneeskunde vertaald, is het basisprincipe van het Yin-Yang evenwicht van acupunctuur
hetzelfde als het in balans zijnde orthosympatische en het parasympathische zenuwstelsel,
de twee tegenovergestelde componenten van het autonome zenuwstelsel.
Overheerst de ene component dan krijgt men
overeenkomstige klachten. De reguliere geneeskunde vertrouwt op het effect van de
allopathische middelen om het verstoorde evenwicht te herstellen. Acupunctuur tracht door
het benaderen van een bepaalde puntencombinatie hetzelfde te bereiken. Evenals de
reguliere geneeskunde is de TCG een ervaring geneeswijze (practice based). Op basis van de
resultaten van het onderzoek (evidence based) kan men in grote lijnen de indicatie voor
acupunctuur in de navolgende volgorde indelen:
1. als een behandelingsmethode bij acute pijn
2. als een behandelingsmethode bij chronische pijnklachten
3. als geneeswijze
Acupunctuur Analgesie in en buiten China
Allereerst dient de essentiële vraag te worden beantwoord of acupunctuur
daadwerkelijk een analgesie teweeg zou brengen. Aanleiding hiertoe was de introductie van
de acupunctuur als een nieuwe anesthesietechniek in China in 1958: de klassieke
acupunctuuranesthesie (KAA). Patiënten bleven gedurende de ingreep bij bewustzijn. Bij
geselecteerde patiënten kan de KAA eveneens in de westerse operatiekamer worden
toegepast. In diverse experimenten bij mensen in verschillende laboratoria kon vervolgens
het analgetische effect van de acupunctuur ondubbelzinnig worden aangetoond. Dierproeven
hebben bovendien het effect van de acupunctuur op verhoging van de pijndrempel bevestigd.
De conclusie ligt voor de hand dat KAA reproduceerbaar is en dat de acupunctuur in staat
is de pijndrempel te verhogen.
Bestrijding van acute pijn
De tweede essentiële vraag, die vervolgens aan de orde komt, is op welke wijze
het pijnstillende effect van acupunctuur tot stand kan komen. Anders gezegd: hoe brengt de
acupunctuur het pijnstillende effect tot stand?
Het vermoeden dat er door de stimulatie van
de acupunctuurpunten opiaatachtige stoffen in toenemende hoeveelheden worden geproduceerd
werd bevestigd na de ontdekking van de morfinereceptoren in de hersenen in 1972 en na het
identificeren van lichaamseigen pijnstillende stoffen in 1975. Talloze experimenten laten
voorts ondubbelzinnig zien langs welke structuren van het perifere en centrale
zenuwstelsel (CZS) de door ingebrachte acupunctuurnaalden opgewekte stimulatie-impulsen de
pijnremmende-systemen kunnen activeren: hetzij rechtstreeks hetzij door de vrijmaking van
verschillende chemische stoffen in de hersenen, de zogenaamde neuronmodulatoren.
Zowel de opiaatachtige- evenals de
niet-opiaatachtige antipijnsystemen zijn betrokken bij het tot stand komen van acupunctuur
analgesie (AA). Door de stimulatiefrequentie te veranderen kunnen bovendien de gewenste
lichaamseigen pijnstillende stoffen (ß-endorfinen, dynorfinen en/of enkefalinen) in
het CZS worden vrijgemaakt. Daarmee is een aspect van de acupunctuur - de
acupunctuur-analgesie - zowel rationeel als wetenschappelijk verklaarbaar. De
systematische, grondige en uitputtende wijze waarop AA wetenschappelijk is onderzocht is
uniek te noemen voor een behandelingsmethode die alternatief is. Zelfs in de reguliere
geneeskunde is het niet voorgekomen dat een bepaalde behandeltechniek op een dergelijk
systematische wijze is onderzocht. Men kan stellen dat de AA, mits juist wordt toegepast,
thans een definitieve plaats heeft binnen de reguliere geneeskunde, en vooral in het
vakgebied anesthesiologie, bij de bestrijding van acute pijn.
Bestrijding van chronische pijn
Het activeren van lichaamseigen pijnremmende systemen kan een acute pijnconditie
snel bestrijden. Het is echter niet eenvoudig te verklaren op welke wijze kortdurende en
herhaalde stimulatie van acupunctuurpunten in een behandelingsfrequentie van een of twee
keer in de week de chronische pijn voor weken, maanden of zelfs voor altijd doet
verdwijnen. Activatie van de opiaatachtige pijnremmende systemen spelen zeker een rol bij
verlichting van chronische pijn, hoewel de werking van de lichaamseigen
pijnstillende stoffen slechts kort is. Er moet dus meer aan de hand zijn gezien het
aanhoudende en langdurige effect. Bij herhaalde toediening van een locale verdoving treedt
overigens het identieke fenomeen.
De chronische pijn verdwijnt langdurig dan
op grond van de werking van de toegediende locale verdoving kan worden verklaard. In beide
gevallen zou de plooibaarheid of de plasticiteit van de zenuwcellen reden kunnen zijn
waarom chronische pijn langdurig wegblijft na herhaalde acupunctuur
behandeling of na herhaalde toediening van een locale verdoving.
Toepassing acupunctuur als
geneeswijze
Vele klachten of ziekten die niets met pijn te maken te hebben worden genoemd om
met acupunctuur te worden behandeld. Doel hiervan is herstel van de niet in balans zijnde
componenten van het autonome zenuwstelsel, een verbetering van de (lokale) doorbloeding en
het minimaliseren van de ongunstige invloed van emotionele factoren. Meer en meer
onderzoekscentra in het westen, o.a. het Zweedse Karolinska Instituut voeren de
effectiviteitstudies uit. Immers, alleen op deze wijze zou kunnen blijken of acupunctuur
bij de behandeling van bepaalde klachten dan wel ziekten waardevol kan zijn.
Aangetoond is voorts dat onder andere:
a. de overlevingsduur van een minder
doorbloed spiertransplantaat na acupunctuurbehandeling toeneemt
b. acupunctuur in vergelijking met allopatische middelen even effectief is bij de
behandeling van misselijkheid en braken, veroorzaakt door anesthesie en operatie, bij
vroege zwangerschap en of door chemotherapie.
c. acupunctuur effectief is gebleken bij de behandeling van incontinentie als gevolg van
de blaas instabiliteit.
Indien uit meerdere studies geconcludeerd
is dat acupunctuur effectief is bij behandeling van bepaalde klachten is de volgende stap
aan de orde, namelijk op welke wijze is het effect tot stand is gekomen. Daarvoor dient
men dezelfde systematische wegen te bewandelen als bij het ontrafelen van hoe het
pijnstillende effect van acupunctuur bij bestrijding van acute pijn geschiedt.
Samengevat kan het volgende worden
geconstateerd. Na duizenden jaar ontwikkeling van acupunctuur als onderdeel van de
traditionele Chinese geneeswijze, is deze geneeswijze uitgegroeid tot een belangrijke
behandelmethode zowel in China als in het Westen. Door een systematisch onderzoek is men
achter gekomen op welke wijze een manuele stimulatie van een in de huid ingestoken
acupunctuurnaald het pijnstillende effect teweeg kan brengen. Meer en meer effecten
studies laten zien dat
acupunctuur waardevol kan zijn bij de behandeling van klachten en/of ziekten. Het wordt
ingezien dat de traditionele Chinese geneeskunde een verrijking van de reguliere
geneeskunde kan betekenen.
Engelse versie
THE SIGNIFICANCE OF ACUPUNCTURE IN
CONVENTIONAL HEALTHCARE
The treatment of complaints and illnesses
with needles (Zhenjiu) is part of the traditional Chinese medicine (TCM). The oldest
written records of TCM date back to the period of Emperor Huangdi (2697-2598 BC). The name
“acupuncture” (acus = needle, puncture = pricking) was introduced in
1683 by the Dutch surgeon W. ten Rhijne. TCM assumes that there is a circulation of energy
(qi) within the body. Qi flows along imaginary lines, the so-called meridians, which link
acupuncture points with similar properties. It is supposed that underneath each
acupuncture point there is a sharp cylindrical perforation of the superficial fascia of
the body with a diameter of 2-8 mm, covered by a sheet of connective tissue in which a
neurovascular bundle runs. In the interest of health, an unimpeded flow of qi is
necessary.
According to TCM, conditions or illnesses
result from an interruption of the flow of qi in the body, making a balanced of the qi
circulation no longer possible. The treatment consists of attempting to end the situation
in places where the flow of qi is impeded.
Much research has been conducted into the
apparently simple working hypothesis of acupuncture in recent decades, both fundamental
and clinical. This was initiated by renewed interest in acupuncture in conjunction with
the introduction of acupuncture as an anaesthetic in the seventies of the last century.
The scientific world was left with a
dilemma, because such a phenomenon could not be explained by the current physiological
knowledge. In fact, its use as an anaesthetic has challenged the scientific community
which in turn triggered and accelerated basic pain and analgesic research to the progress
and achievements of the past decades.
On the international level, the World
Health Organization (WHO), has long ago recognized the contribution of traditional
medicine to conventional health care systems of its member states. In 1991 the World
Health Assembly adopted an important resolution, the WHA44.34. With the aim of helping to
reduce national drug costs, it urgues member states to ensure that the contribution of
scientifically proven traditional medicine is fully exploited. In addition, the WHO
recommends the continuation of
scientific research on traditional medicine. It must also be noticed, that in the line of
WHO recommendations, the United States Food and Drug Administration (FDA) removed
acupuncture needles from the list of experimental medical instruments in 1996. The FDA
endorses the use of acupuncture as an effective treatment for a number of indications,
e.g. postoperative pain from dental surgery, nausea and vomiting from anaesthesia and
chemotherapy. Furthermore, the FDA points out that acupuncture can be effective in the
treatment of tennis elbow, migraine, arthritis, returning stomach cramps and other
chronically painful conditions.
It remains to be seen in which way the
Dutch government is willing and capable of implementing the WHO resolution over the coming
years, and how - from a practical point of view - it will adopt the recommendations of the
WHO. It is to be expected that the a faculty of traditional medicine will be founded
within academic community which will then be responsible for further reseacrh in the field
of traditional medicine.
INDICATION
Even though most research on acupuncture is
related to its ability to reduce pain, the so-called acupuncture analgesia (AA), it is a
mistaken idea to assume that acupuncture is only suitable to lessen pain. Raising the pain
threshold is not the most important part of acupuncture as TCM, but treatment of other
conditions are part of it as well. Translated into Western medicine, the basic principle
of Yin-Yang balance is more or less the same as a equilibrium of autonomic nervous system,
i.e. sympathetic and parasympathetic nervous systems. Should sympathetic nervous system be
dominant, typical and related complaints will exist accordingly. Western medicine uses
allopathic drugs to restore the disrupted balance between sympathetic and parasympathetic
nervous systems. Acupuncture attempts to accomplish the same result by puncturing a
certain combination of acupoints. Its homeostatic influence on the autonomic nervous
system serves nowadays as a work hypothesis for its use to
treat complaints ans illnesses.
Like Western medicine, acupuncture is
practice based. On the other hand, the use of acupuncture as anaesthetic is based on
findings and results of research (evidence
based). Taken into account both aspects, one can place the indication of acupuncture into
the following categories:
1. as a method to treat acute pain
2. as a method to treat benign chronic pain
3. as a method to treat a number of
complaints and illness
Acupuncture Analgesia inside and
outside China
The first essential question to be answered
is whether acupuncture can actually bring about analgesia (AA=acupuncture analgesia). This
was provoked by the introduction of acupuncture as a new anaesthetic technique in China in
1958, the classical acupuncture anaesthesia (CAA). Patients remained conscious during the
operation. CAA could also be applied to selected patients in Western operating theaters,
e.g. Austria, Italy, UK and USA. The analgesic effect could subsequently be demonstrated
unequivocally in a series of experiments on people in different laboratories. In addition,
tests on animals confirmed the raising of the pain threshold. The conclusion that CAA can
be reproduced is obvious.
Mechanisms of acupuncture analgesia
The second essential question which is
subsequently raised is, how acupuncture can produce analgesia. In terms of neurophysiology
and neurochemistry, which neural pathways and which chemical substances are possibly
involved if one stimulate an inserted needle into a acupoint? The supposition that first
manually and later electrically stimulation of acupuncture points leads to the increased
production of opiate-like substances was confirmed after the discovery of morphine
receptors in the brains in 1972, and after the identification of painthreeshold increasing
substances produced by the body in 1975. Furthermore, countless experiments unambiguously
show along which structures of the peripheral and central nervous system (CNS) the pain
inhibition pathways can be activated as a result of the insertion of acupuncture needles:
either
directly or by way of the release of various chemical substances in the brains, the
so-called neuro modulators. Both the opiate-like and the non-opiate-like anti-pain
inhibition systems are involved in the analgesia produced by acupucnture. In addition, by
changing the frequency of the stimulation in term of low (< 10Hz) or high (>100Hz),
the corresponding endogenous opioids (B-endorphins, enkephalins or dynorphins) can be
released into the CNS. The evidence provides us a rational and
scientific explanation of one aspect of acupuncture: the acupuncture analgesia. The
systematic, thorough and exhausting way which AA has been researched can be called unique
for a treatment method which is alternative. Not even in conventional Western medicine has
any form of treatment been researched this systematically.
It can be stated that AA, provided it is
applied properly, has recently obtained a firm place in conventional Western medicine, and
particularly in the field of anaesthesia, with the relief of acute pain.
Relief of chronic pain
The activation of pain-relieving systems of the body itself can relieve an acute
pain condition quickly. However, there is no simple explanation in which way brief and
repeated stimulation of acupuncture points in a treatment frequency of once or twice a
week can make the pain disappear for a period of weeks, months, or even forever. The
activation of opiate-like pain-inhibition systems certainly do play a role in the relieve
of chronic pain, even though the working of the substances made by the body is only brief.
There must, therefore, be more to it considering the maintained and long-lasting effect.
An identical phenomenon occurs in case of repeated application of a local anaesthetic, by
the way.
One reason for the staying away of
long-lasting chronic pain in both cases could be the plasticity of the nerve cells after
repeated acupuncture treatment or after repeated application of a local anaesthetic. The
short duration of analgesia produced by each acupuncture treatment enables the involved
nerve cells to learn the pain-free condition as normal rather than the recognition and
their fixation to a painful condition. Repeated short duration of analgesia produced by
repeated acupuncture treatments may therefore lead to a normalization of the mistaken
fixation of the nerve cells onto a painful condition. Practically, one will see that the
duration of analgesia increases steadily after each of acupuncture treatment, which may
ultimately result in disappearing of the pain condition.
The use of acupuncture as
therapeutic modality
Many conditions or illnesses which have nothing to do with pain acan effectively
be treated by acupuncture. The objective of this is the restoration of unbalanced
components of the autonomous nervous system, an improvement in the (local) blood flow and
the minimizing of the unfavorable influence of emotional factors. An increasing number of
research laboratories in the West, such as the Swedish Karolinska Institute conduct
effectiveness studies. After all, only in this way will it become
apparent whether acupuncture can be valuable with treatment of certain conditions or
illnesses. Furthermore, among other things it has been shown that:
a. the survivability of transplanted muscle
with impaired blood flow can be increased after acupuncture treatment.
b. that acupuncture is equally effective as allopathic drugg in the treatment of nausea
and vomiting, caused by anaesthesia and surgery, in case of early pregnancy or by
chemotherapy.
c. that acupuncture is an effective treatment method of incontinence resulting from
bladder instability.
Scientific studies should evaluate first
whether acupuncture is an effective method of treatment. Secondly, the unraveling as how
such an effect can be produced. It is, in fact, the same systematic path in every
scientific studies, and similar with the unraveling of the pain-inhibition effect of
acupuncture in the relief of acute pain.
Summary
After thousands of years of development acupuncture has, as part of traditional Chinese
medicine, emerged into an important treatment method in both China as in the West.
Systematic research has revealed in which way an inserted an acupuncture needle can cause
a pain-inhibition effect. An increasing number of effectiveness studies indicate that
acupuncture can be helpful in the treatment of complaints and illnesses. Traditional
Chinese medicine is recognized as an enrichment of conventional medicine.
Acknowledgments
The author would like to thank the foundation of scientific research (SAPOC) in Nijmegen
for it's support in the realization of this article.
Acupunctuur helpt redelijk tegen
nekpijn
Dat blijkt uit een omvangrijke analyse
van bestaande studies. Op de korte termijn vermindert het de klachten met zo'n dertig
procent. De analyse verscheen gisteren in The Cochrane Library, een invloedrijk bestand
voor evidence-based medicine geneeskunde die op wetenschappelijk bewijs gestoeld is. De
auteurs gebruikten de tien studies die van voldoende kwaliteit waren. Over de
lange-termijneffecten van acupunctuur bij nekpijn (langer dan drie maanden na de
behandeling) konden ze geen uitspraak doen omdat er geen goed onderzoek naar is gedaan. De
onafhankelijke Cochrane Collaboration, die analyses van dit type organiseert, vond al
eerder aanwijzingen dat acupunctuur vooral op korte termijn helpt bij pijnklachten, zoals
chronische lage rugpijn, schouderpijn of onverklaarde hoofdpijn. Voor veel andere
aandoeningen, van depressie tot tabaksverslaving of astma, is het nut van acupunctuur niet
aangetoond.
http://www.nrc.nl/wetenschap/article393146.ece
Acupuncture Pins Down Allergy
Relief
At the end of the study period, participants in both groups were rated on their level of
improvement. The first group treated with traditional Chinese medicine patients
demonstrated improvements in allergy symptoms in the eyes and nose, higher levels of
physical activity, and an improved psychological condition compared to patients in the
control group.
http://www.foxnews.com/story/0,2933,263787,00.html
Hypnosis and Acupuncture Show
Promise for Labor Pain
A review of non-drug pain relief therapies suggests that hypnosis and acupuncture may ease
labor pain. “There is too little research to assess how effective many complementary
therapies will be with pain management in labor,” said lead study author Caroline
Smith. Further research is needed, she said, but “the results concerning acupuncture
and hypnosis are encouraging.” In addition to hypnosis and acupuncture, the review
examined the effects of massage, relaxation, aromatherapy, acupressure and white noise on
pain relief. But the review did not turn up enough evidence to determine if any of the
other therapies bring women significant comfort. The meta-analysis compiles data from 14
studies that included more than 1,400 women. Five studies examined hypnosis, while three
studies gauged acupuncture’s effect on pain relief. “More robust research and
more research trials have been undertaken for these two therapies versus the other
treatments,” said Smith, a research fellow at the University of Adelaide in
Australia. The review appears in the current issue of The Cochrane Library, a publication
of The Cochrane Collaboration, an international organization that evaluates research in
all aspects of health care. Systematic reviews draw evidence-based conclusions about
medical practice after considering both the content and quality of existing trials on a
topic.
http://www.hbns.org/getDocument.cfm?documentID=1372
Acupuncture Relieves Pain and Improves
Function in Knee Osteoarthritis
Acupuncture provides pain relief and improves function for people with osteoarthritis
of the knee and serves as an effective complement to standard care. This landmark study
was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and
the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both
components of the National Institutes of Health.
http://nccam.nih.gov/news/2004/acu-osteo/pressrelease.htm
Acupuncture or neuro-electric stimulation
Traditional Chinese acupuncture is an archaic procedure in which needles are inserted
through the skin over imaginary channels in accord with rules developed from
pre-scientific superstition and numerological beliefs. The needles are manipulated to
supposedly influence an imaginary body energy whose blockage is presumed to create
diseases that are diagnosed and defined in a manner antithetical to modern medical
knowledge. New information from research by Chinese scientists has replaced this mystical
sham medical procedure with a simple, evidence-based, no-needle treatment. This method
stimulates motor points and nerve junctures. Specific electrical currents induce the gene
expression of neurochemicals and activate brain areas important for healing. Here then is
a scientifically based alternative to the metaphysical theories and magical rituals of
traditional Chinese acupuncture.
http://www.csicop.org/si/2003-03/acupuncture.html
Acupuncture - beyond the placebo effect
Researchers at the University of Southampton and University College London have shown
for the first time that the impact of acupuncture goes beyond the acknowledged placebo
effect caused by the patient's own expectation of feeling benefit from the treatment. The
scientists from Southampton, Dr George Lewith and Dr Peter White of the University's
Complementary Medicine Research Unit, have distinguished between the placebo effects
produced by a patient's expectation and the real effects of treatment in a group of
patients with painful osteo-arthritis, by monitoring specific responses in the brain
during treatment.
http://www.soton.ac.uk/mediacentre/news/2005/may/05_71.shtml
Acupuncture treatment may be more
effective than conventional therapy in treating lower back pain
Six months of acupuncture treatment
appears to be more effective than conventional therapy in treating low back pain,
according to a study in the Sept. 24 issue of Archives of Internal Medicine, one of the
JAMA/Archives journals, although the study suggests that both sham acupuncture and
traditional Chinese verum acupuncture appear to be effective in treating low back pain.
“Low back pain is a common, impairing and disabling condition, often long-term, with
an estimated lifetime prevalence of 70 percent to 85 percent,” the authors write as
background information in the article. “It is the second most common pain for which
physician treatment is sought and a major reason for absenteeism and disability.”
Acupuncture is increasingly used as an alternative therapy, but its value as a treatment
for low back pain is still controversial.
Michael Haake, Ph.D., M.D., of the
University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized
clinical trial involving 1,162 patients (average age 50) who had experienced chronic low
back pain for an average of eight years. Patients underwent ten 30-minute sessions
(approximately two sessions per week) of verum acupuncture (387 patients), sham
acupuncture (387 patients) or conventional therapy (388 patients). Verum acupunture
consisted of needling fixed points and additional points to a depth of 5 millimeters to 40
millimeters based on traditional Chinese medicine, while sham acupuncture consisted of
inserting needles superficially (1 millimeter to 3 millimeters) into the lower back
avoiding all known verum points or meridians. Conventional therapy consisted of a
combination of medication, physical therapy and exercise. Five additional sessions were
offered to those who had a partial response to treatment (10 percent to 50 percent pain
reduction).
“A total of 13,475 treatment sessions
were conducted (verum acupuncture, 4,821; sham acupuncture, 4,590; conventional therapy,
4,064),” the authors write. Patients receiving the additional five sessions were 232
(59.9 percent) in the verum group, 209 (54.3 percent) in the sham group and 192 (52.5
percent) in the conventional group.
Response rate was defined as a 33 percent
improvement in pain or a 12 percent improvement in functional ability. “At six
months, response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the
sham acupuncture group and 27.4 percent in the conventional therapy group,” the
authors note. “Differences among groups were as follows: verum vs. sham, 3.4 percent;
verum vs. conventional therapy, 20.2 percent; and sham vs. conventional therapy, 16.8
percent.”
“The superiority of both forms of
acupuncture suggests a common underlying mechanism that may act on pain generation,
transmission of pain signals or processing of pain signals by the central nervous system
and that is stronger than the action mechanism of conventional therapy,” the authors
conclude. “Acupuncture gives physicians a promising and effective treatment option
for chronic low back pain, with few adverse effects or contraindications. The improvements
in all primary and secondary outcome measures were significant and lasted long after
completion of treatment.”
(Arch Intern Med. 2007;167(17):1892-1898
Acupuncture is as effective as
standard drug treatments for migraine
There are several effective drug
treatments available for the prophylaxis of migraine. However, despite poor evidence from
randomised controlled trials, acunpuncture is the most frquently used preventive therapy
for migraine in Germany. In their Article, Hans-Christoph Diener (University
Duisburg-Essen, Germany) and colleagues present the results of the German Acupuncture
Trials (GERAC) migraine study. In this prospective, randomised, multicentre, controlled
clinical trial they showed that the number of days on which a patient suffered from
migraine was significantly reduced after treatment with either acupuncture or standard
therapy. However, the improvement was the same whether the patient was treated with a sham
acupuncture technique, which was done on areas of the skin in which no traditional Chinese
medicine acupuncture points are known; verum acupuncture, which consisted of obligatory
needling points and additional points individually chosen by the physicians on the basis
of traditional Chinese medicine diagnosis for syndromes; or standard migraine prophylactic
treatment. These results are surprising and, since the underlying mechanisms are unknown,
difficult to explain. "Ultimately, one could argue that the efficacy of a treatment,
especially a treatment with almost no adverse events or contraindications, is more
important than the knowledge of the mechanism of action of this particular therapy",
concludes Diener. "The decision whether acupuncture should be used in migraine
prevention remains with the treating physician."
Acupuncture found to lower
elevations in blood pressure
Acupuncture treatments using low levels
of electrical stimulation can lower elevations in blood pressure by as much as 50 percent,
researchers at the Susan Samueli Center for Integrative Medicine at UC Irvine have found.
In tests on rats, the researchers found that electroacupuncture treatments provided
temporary relief from the conditions that raise blood pressure during hypertensive states.
Such treatments, they believe, potentially can become part of a therapeutic regimen for
long-term care of hypertension and other cardiovascular ailments in people. "This
study suggests that acupuncture can be an excellent complement to other medical
treatments, especially for those treating the cardiac system," said Dr. John C.
Longhurst, director of the Samueli Center and study leader. "The Western world is
waiting for a clear scientific basis for using acupuncture, and we hope that this research
ultimately will lead to the integration of ancient healing practices into modern medical
treatment."
The study appears in the March issue of the
Journal of Applied Physiology.
Acupuncture is a 3,000-year-old form of
Chinese medicine that involves inserting needles at specific points on the body to help
cure disease or relieve pain. In previous studies, Longhurst and his UCI colleagues have
identified at the cellular and molecular level how acupuncture excites brain cells to
release neurotransmitters that either inhibit or heighten cardiovascular activity. They
have found that when an acupuncture needle is inserted at specific sites on the wrist,
inside of the forearm or leg, this triggers the release of opioid chemicals in the brain
that reduce excitatory responses in the cardiovascular system. This decreases the heart's
activity and its need for oxygen, which in turn can lower blood pressure, and promotes
healing for a number of cardiac ailments, such as myocardial ischemia (insufficient blood
flow to the heart) and hypertension.
In this study, the Longhurst team applied
acupuncture to specific points on the forelimb of test rats with artificially elevated
blood pressure rates; these same sites on humans are on the inside of the forearm slightly
above the wrist. The researchers found that acupuncture alone had no effect on blood
pressure.
Next, they added electrical stimulation to
the acupuncture treatment by running an electrical current through the needles. High
frequencies of stimulation also had no effect, but low frequencies lowered increased blood
pressure by as much as 40 to 50 percent. Overall, the researchers found that a 30-minute
treatment reduced blood pressure rates in these test rats by 25 mmHg -- with the effect
lasting almost two hours."This type of electroacupuncture is only effective on
elevated blood pressure levels, such as those present in hypertension, and the treatment
has no impact on standing blood pressure rates," said Longhurst, a cardiologist who
is also the Lawrence K. Dodge Professor in Integrative Biology. "Our goal is to help
establish a standard of acupuncture treatment that can benefit everyone who has
hypertension and other cardiac ailments." Longhurst and his colleagues currently are
testing this electroacupuncture treatment method in an ongoing human study.
Acupuncture better than drugs alone
for osteoarthritis of the knee
Acupuncture as a complementary therapy
to the pharmacological treatment of osteoarthritis of the knee: randomised controlled
trial BMJ Volume 329 pp 1216-9. Acupuncture, as a complementary therapy to drug treatment
for osteoarthritis of the knee, is more effective than drug treatment alone, find
researchers from Spain in this week's BMJ. Osteoarthritis of the knee is common,
affecting almost a tenth of the population aged over 55. The role of acupuncture in
osteoarthritis remains controversial and few studies comparing acupuncture and drug
treatment have been conducted. A total of 88 patients with osteoarthritis of the knee were
randomly divided into two groups, one receiving acupuncture plus diclofenac (an
anti-inflammatory drug) and the other dummy (placebo) acupuncture plus diclofenac.
Treatment lasted 12 weeks and levels of pain, stiffness, and physical function were
monitored using recognised scales. The acupuncture group had a greater reduction in pain
and stiffness, improved physical functioning and quality of life than the placebo group.
Although the 12-week monitoring period may be insufficient to evaluate the effects of
treatment in the medium term, acupuncture as a complementary therapy to drug treatment for
osteoarthritis of the knee is more effective than drug treatment alone, say the authors.
Future research should extend the observation period after treatment in order to evaluate
the duration of the improvement obtained and to establish treatment protocols, they
conclude.
New report indicates acupuncture
provides relief for sufferers of dry mouth
The emergence of acupuncture is
allowing some patients to relieve or significantly reduce dry mouth's debilitating
effects, according to a report in the May/June 2005 issue of General Dentistry, the
Academy of General Dentistry's (AGD) clinical, peer-reviewed journal. Dry mouth (also
known as xerostomia) is a painful condition caused by a decrease in the amount of saliva
in the mouth when salivary glands do not work properly. Saliva is a natural defense for
teeth and plays a major role in preventing tooth decay by rinsing away food particles and
neutralizing harmful acids. A decrease in saliva puts patients at risk for cavities, gum
disease and discomfort since foods that are consumed adhere to the teeth longer. Dry mouth
can be caused by medications like antihistamines, decongestants, antidepressants and
diuretics and can often be treated by the dentist.
The quality of life of patients suffering
from dry mouth is often profoundly impaired. Symptoms include extensive dental decay,
infections of the tissues of the mouth, difficulty in speaking, eating and swallowing,
ulceration or soreness of the mouth, an altered sense of taste and difficulty in wearing
dentures.However, "typical treatment options for dry mouth have been short-term at
best," according to Warren M. Morganstein, DDS, MPH, and associate dean at the
Baltimore College of Dental Surgery, University of Maryland Dental School. "Studies
have found that acupuncture was a viable option to successfully treat dry mouth pain in
patients and provide long-term relief."
After undergoing head and neck radiation
therapy, seven patients with dry mouth were treated using acupuncture. Patients were seen
once a week for four to five weeks, followed by two or three biweekly sessions. Dr.
Morganstein found that eight months after treatment, all patients reported a reduction in
dry mouth symptoms, as well as an increase in saliva flow and the ability to eat and
speak, and improved sleep. In the United States, acupuncture is performed primarily by
licensed, non-physician acupuncturists. Additionally, physicians and a small number of
dentists have been trained in medical acupuncture. Acupuncture is effective in increasing
the amount of saliva and, by doing so, alleviating or decreasing the symptoms of dry
mouth.
Acupuncture relieves pelvic pain
during pregnancy
Effects of acupuncture and stabilising
exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain:
randomised single blind controlled trial BMJ Online First
Acupuncture and strengthening exercises help relieve pelvic girdle pain during pregnancy
and are effective complements to standard treatment, finds a study published online by the
BMJ today.
Pelvic girdle pain is a common complaint among pregnant women worldwide, but no cure
exists. Researchers in Sweden identified 386 pregnant women with pelvic girdle pain. Women
were randomly divided into three groups; one received standard treatment (a pelvic belt
and a home exercise programme), another received standard treatment plus acupuncture, and
the third received standard treatment plus stabilising exercises to improve mobility and
strength. Pain levels were recorded every morning and evening using a recognised scale and
all women were assessed by an independent examiner at the end of the treatment period.
After treatment, both the acupuncture group and the stabilising exercise group had less
pain than the standard group in the morning and in the evening. Reduction of pelvic girdle
pain as assessed by the independent examiner was greatest in the acupuncture group.
Acupuncture or stabilising exercises as an adjunct to standard treatment offers clear
clinical advantages over standard treatment alone for reduction of pain in pregnant women
with pelvic girdle pain, say the authors. Acupuncture was superior to stabilising
exercises in this study, they conclude.
Acupuncture more effective than
massage for chronic neck pain
Randomised trial of acupuncture
compared with conventional massage and "sham" laser acupuncture for treatment of
chronic neck pain Acupuncture is an effective short term treatment for patients with
chronic neck pain, but there is only limited evidence for its long term effects after five
treatments, concludes research in this week's BMJ. A total of 177 patients with chronic
neck pain were randomly allocated to five treatments over three weeks. Fifty-six patients
received needle acupuncture, 60 were given conventional massage, and 61 received
"sham" laser acupuncture (a dummy procedure to control for acupuncture).One week
after treatments, the acupuncture group showed a significantly greater improvement in
motion related pain compared with massage but, surprisingly, not compared with sham laser
acupuncture. However, after three months follow up, there were no significant differences
in mobility and pain between the groups. This is consistent with previous trials that show
that a single treatment approach in chronic pain does not result in long term effects in
the majority of cases, add the authors. We conclude that acupuncture can be an effective
and safe form of treatment for patients with chronic neck pain, say the authors. However,
as neck pain may be a chronic condition, single forms of treatment may not always be
adequate. Future research is necessary to evaluate the optimum number of acupuncture
treatments for the management of these patients.
Acupuncture relieves symptoms of
fibromyalgia, Mayo Clinic study finds
Evidence suggests acupuncture reduces
the symptoms of fibromyalgia, according to a Mayo Clinic study. Fibromyalgia is a disorder
considered disabling by many, and is characterized by chronic, widespread musculoskeletal
pain and symptoms such as fatigue, joint stiffness and sleep disturbance. No cure is known
and available treatments are only partially effective.
Mayo's study involved 50 fibromyalgia
patients enrolled in a randomized, controlled trial to determine if acupuncture improved
their symptoms. Symptoms of patients who received acupuncture significantly improved
compared with the control group, according to the study published in the June issue of
Mayo Clinic Proceedings.
"The results of the study convince me
there is something more than the placebo effect to acupuncture," says David Martin,
M.D., Ph.D., lead author of the acupuncture article and a Mayo Clinic anesthesiologist.
"It affirms a lot of clinical impressions that this complementary medical technique
is helpful for patients." Increasingly, patients are interested in pursuing
complementary medicine techniques in conjunction with their mainstream medical care, Dr.
Martin says. But often, such techniques lack scientific evidence to justify a patient's
expense and time.
The study lends credence to patients'
belief that nontraditional methods may improve their health. In Mayo's trial, patients who
received acupuncture to counter their fibromyalgia symptoms reported improvement in
fatigue and anxiety, among other symptoms. Acupuncture was well tolerated, with minimal
side effects. Mayo's acupuncture study is one of only three randomized and controlled
studies involving fibromyalgia patients. Of the other studies, one found acupuncture to be
helpful, while the other reported it was ineffective for pain relief.
Dr. Martin says Mayo's study demonstrates
that acupuncture is helpful, and also proves physicians can conduct a rigorous, controlled
acupuncture study. Future research could help physicians understand which medical
conditions respond best to acupuncture, how to apply it to best relieve symptoms, and how
long patients can expect to their symptoms to decrease after each treatment.
New relief for morning sickness
Research from the Women’s and
Children’s Hospital and Adelaide University, Department of Obstetrics and Gynaecology
has now shown that acupuncture is an extremely effective treatment for morning sickness in
early pregnancy. A large trial was undertaken involving 593 women who were less than 14
weeks pregnant with symptoms of nausea or vomiting. Twenty-minute sessions of acupuncture
were given weekly for four weeks. Study Coordinator Dr Caroline Smith says, “Around
50 to 80% of all pregnant women experience nausea or vomiting in early pregnancy. As a
result they can have poor quality of life – they feel lousy and may be low in
spirits, anxious and find it hard to do everyday things. “Our results have shown that
as little as one acupuncture treatment can significantly change the way these women feel.
“We found that traditional acupuncture reduced nausea throughout the trial with dry
retching being reduced from the second week. Another type of acupuncture called p6 took
around a week longer to have an effect, “ Dr Smith says. Traditional acupuncture uses
a variety of acupuncture points on the forearm or abdomen, whereas p6 acupuncture involves
only one acupuncture point classically associated with nausea and vomiting. Dr Smith
believes this research is particularly important as it provides good quality evidence for
a complementary therapy. “Women now have an additional option to manage their morning
sickness. They function physically and emotionally much better after both types of
acupuncture. “I hope this exciting evidence that complementary therapy does work,
will open up new opportunities for funding future research in women’s health,”
Dr Smith says.
