Acupuncture in Medicine

Although substantial data have supported the effectiveness of acupuncture for treating knee osteoarthritis (OA), the number of points used has varied. The objective of this study was to compare the effectiveness of six and two acupuncture points in the treatment of knee OA.

A randomised trial of knee OA patients was conducted. Patients were randomly allocated into two groups of 35. The “six point group” received treatment at six acupuncture points, ST35, EX-LE4 (Neixiyan), ST36, SP9, SP10 and ST34, while the “two point group” received treatment at just the first pair of points, ST35 and EX-LE4. Both groups received twice weekly electroacupuncture on 10 occasions. Electrical stimulation was carried out at low-frequency of 3 Hz to all points, with the intensity as high as tolerable. Both groups were allowed to take a 200 mg celecoxib capsule per day for intolerable pain. Patients were assessed at baseline, week 5, week 9 and week 13, using a Thai language version of the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Global assessment of change after 10 treatments was also recorded.

Acupuncture at both six and two acupuncture points was associated with significant improvement. Mean total WOMAC score at weeks 5 and 13 of patients in both groups showed no significant difference statistically (p = 0.75 and p = 0.51). Moreover, the number of celecoxib capsules taken, global assessment of global change and body weight change of both groups also showed no statistical difference.

This evidence suggests that electroacupuncture to two local points may be sufficient to treat knee OA, but in view of some limitations to this study further research is necessary before this can be stated conclusively.

Acupuncture has potential value in producing analgesia in the postoperative period, but previous trials have inconsistent results. We aimed to study the effect of electroacupuncture on pain and nausea and the requirement for postoperative analgesia via patient-controlled analgesia.

107 patients who were undergoing abdominal hysterectomy or laparascopic cholecystectomy were randomised to receive either electroacupuncture (n = 56) or no additional treatment (n = 46) during the operative period. We measured the use of patient-controlled analgesia and time in recovery as well as pain, postoperative nausea and vomiting, and sedation. 102 patients were included in the analysis. The majority of patients were female: the laparoscopic cholecystectomy group included 10 males. Adhesive dressings were placed over all acupuncture points in both groups, to ensure blinding of patients and assessors during the recovery period.

The electroacupuncture group had a longer duration of operation but the difference was not statistically significant. There were no significant differences between the groups for the requirement for patient-controlled analgesia or total time in recovery. Pain scores were marginally lower in the acupuncture group, but not significantly, and there were no differences between the groups in nausea or sedation scores.

Electroacupuncture at 10 Hz given under general anaesthetic has no effect on postoperative nausea or analgesic requirement. Future studies should investigate acupuncture given before or after surgery.

Exacerbation of chronic obstructive pulmonary disease (COPD) is a common reason for hospital admission, and adjunctive non-pharmacological treatments would be welcomed. A pilot study was undertaken to assess the feasibility of conducting a study of acupuncture during an acute exacerbation of COPD. We also examined the credibility of a sham device in this setting and assessed the effect of acupuncture on breathlessness and anxiety.

A prospective, randomised, patient- and assessor-blinded, sham controlled study was conducted on three consecutive days in a district general hospital. Credibility of both acupuncture and the Park sham device were assessed using the Borkovec and Nau questionnaire. Dyspnoea was measured on the modified Borg score and a 10 cm visual analogue scale, while anxiety was measured on a 10 cm visual analogue scale.

11 patients were recruited and nine completed the study. There were no adverse events with either intervention. Acupuncture was well tolerated and credibility scores were similar before and after real and sham acupuncture. Symptoms improved after both treatments, with no significant difference between groups.

In this pilot study acupuncture was well tolerated by subjects experiencing an acute exacerbation of COPD. Acupuncture treatment and the Park sham device were both credible. Although recruitment was slow, a further trial with a larger sample size is feasible and recommended.

Concerns have been expressed about potential toxicity of the smoke produced by the burning of moxa in traditional Chinese medicine. With the advent of strict anti-smoking legislation in the UK, it was decided to test the volatiles produced by moxibustion and compare them with current agreed safe exposure levels.

Moxa, in the form of cigar shaped moxa “sticks” or “rolls”, was tested under International Organization for Standardization conditions in a tobacco testing laboratory, and the quantities of a number of pre-determined volatiles measured. The smoke tested was “sidestream smoke”, the smoke which arises from the burning tip of the moxa. The test results were then scaled up to reflect normal use and to provide direct comparisons with agreed national safety standards for both short- and long-term exposure levels.

Levels of only two volatiles produced were equivalent or greater than the safe exposure levels, as was the carbon monoxide level reported, both as a consequence of using worst case assumptions for comparison. Under normal operating conditions neither volatile nor carbon monoxide would present a safety hazard. One group of chemicals tested, the aromatic amines, with known carcinogenic properties have no agreed safety levels. Results for these in the study compared favourably with background levels reported in urban environments.

There are no immediate concerns arising from the continued use of moxa as a therapeutic modality in traditional Chinese medicine. Further testing may be required to establish whether current recommendations for ventilation and cleansing of treatment room surfaces may need to be revised. Stronger recommendations may also be necessary on the inadvisability of using moxa on broken skin.

The Gateway Clinic is a specialist NHS service in South London providing acupuncture and Chinese medicine. The clinic receives a diverse range of referrals from an expanding population of local general practitioners (GPs).

This study explores the referral behaviour of GPs and other primary care users of the Gateway Clinic.

A pragmatic mixed-methods approach was used, combining mapping of GPs’ usage of the Gateway as taken from the clinic's database between the years 2000 and 2005, a questionnaire survey of the referring primary care practitioners in 2005, and data, including a thematic analysis of the interview transcripts from semi-structured interviews of a purposive sample of those GPs who refer.

Doctors in the community refer a wide range of health problems to the Gateway Clinic. The most common referrals were musculoskeletal conditions (38–44%), general and unspecified conditions (11–14%), blood and immune system conditions (6–12%), psychological conditions (8–13%), neurological conditions (6–9%), gynaecological conditions (5–6%) and digestive conditions (5–6%). The health problems referred by local healthcare practitioners correlate strongly with the patient profile seen in private acupuncture practice. Between 2000 and 2005 numbers of healthcare practitioners increased by 218% resulting in a 300% increase in patient referrals made to the clinic; the mean frequency of referral per practitioner increased by 71%. Analysis of the qualitative data suggests that positive clinical experience encourages GPs to increase the range of conditions they refer leading to the development of informal referral guidelines.

The Gateway Clinic has become an increasingly popular referral resource. The influences that drive referral to the clinic are multiple and follow “tacit guidelines”. GPs select patients on the basis of their individual clinical experience, informed by positive patient feedback and often only after more conventional medical treatment options have been exhausted.