Meta-analysis: acupuncture for osteoarthritis of the knee.

[Guest guest]

Ann Intern Med. 2007 Jun 19;146(12):868-77. Related

Articles, Links

 

 

Meta-analysis: acupuncture for osteoarthritis of the

knee.

 

Manheimer E, Linde K, Lao L, Bouter LM, Berman BM.

 

Center for Integrative Medicine, University of

Maryland School of Medicine, Kernan Hospital Mansion,

Baltimore, Maryland 21207, USA.

 

BACKGROUND: Knee osteoarthritis is a major cause of

pain and functional limitation. PURPOSE: To evaluate

the effects of acupuncture for treating knee

osteoarthritis. DATA SOURCES: Cochrane Central

Register of Controlled Trials, MEDLINE, and EMBASE

databases to January 2007. No language restrictions

were applied. STUDY SELECTION: Randomized trials

longer than 6 weeks in duration that compared needle

acupuncture with a sham, usual care, or waiting list

control group for patients with knee osteoarthritis.

DATA EXTRACTION: Two authors independently agreed on

eligibility, assessed methodological quality and

acupuncture adequacy, and extracted outcome data on

pain and function measures. DATA SYNTHESIS: Eleven

trials met the selection criteria, and 9 reported

sufficient data for pooling. Standardized mean

differences were calculated by using differences in

improvements from baseline between patients assigned

to acupuncture and those assigned to control groups.

Compared with patients in waiting list control groups,

patients who received acupuncture reported clinically

relevant short-term improvements in pain (standardized

mean difference, -0.96 [95% CI, -1.21 to -0.70]) and

function (standardized mean difference, -0.93 [CI,

-1.16 to -0.69]). Patients who received acupuncture

also reported clinically relevant short- and long-term

improvements in pain and function compared with

patients in usual care control groups. Compared with a

sham control, acupuncture provided clinically

irrelevant short-term improvements in pain

(standardized mean difference, -0.35 [CI, -0.55 to

-0.15]) and function (standardized mean difference,

-0.35 [CI, -0.56 to -0.14]) and clinically irrelevant

long-term improvements in pain (standardized mean

difference, -0.13 [CI, -0.24 to -0.01]) and function

(standardized mean difference, -0.14 [CI, -0.26 to

-0.03]). LIMITATION: Sham-controlled trials had

heterogeneous results that were probably due to the

variability of acupuncture and sham protocols, patient

samples, and settings. CONCLUSIONS: Sham-controlled

trials show clinically irrelevant short-term benefits

of acupuncture for treating knee osteoarthritis.

Waiting list-controlled trials suggest clinically

relevant benefits, some of which may be due to placebo

or expectation effects.

 

Publication Types:

Research Support, N.I.H., Extramural

 

PMID: 17577006 [PubMed - in process]

 

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2: Circulation. 2007 Jun 19;115(24):3048-9. Related

Articles, Links

 

 

Acupuncture for blood pressure lowering: needling the

truth.

 

Turnbull F, Patel A.

 

Publication Types:

Comment

Editorial

 

PMID: 17576882 [PubMed - in process]

 

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3: Neurosci Lett. 2007 Jun 2; [Epub ahead of print]

Related Articles, Links

 

 

Activation of the hypothalamus characterizes the

response to acupuncture stimulation in heroin addicts.

 

Liu S, Zhou W, Ruan X, Li R, Lee T, Weng X, Hu J, Yang

G.

 

Ningbo Addiction Research and Treatment Center, Ningbo

315010, China.

 

Acupuncture stimulation elicited a composite of

sensations termed deqi that is related to clinical

efficacy. Neurobiological studies have identified the

hypothalamus as an important component in mediating

the deqi. Functional changes in hypothalamus persist

after abstinence in addicts. We investigated the

activation in the hypothalamus associated with

acupuncture stimulation in healthy volunteers and

heroin addicts by fMRI. Cortisol level and

psychophysical responses, including the deqi sensation

(an acupuncture effect of needle-manipulation),

anxiety, and sharp pain, were also assessed. The

activation of the hypothalamus was more robust in the

addicts than that in the healthy subjects during

acupuncture stimulation. The deqi scores of the heroin

addicts were significantly higher than those of the

healthy subjects during acupuncture treatment. An

acupuncture sensation scale predicted the activation

of the hypothalamus associated with the deqi

sensation.

 

PMID: 17574746 [PubMed - as supplied by publisher]

 

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4: J Nerv Ment Dis. 2007 Jun;195(6):504-513. Related

Articles, Links

 

 

Acupuncture for Posttraumatic Stress Disorder: A

Randomized Controlled Pilot Trial.

 

Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag

R.

 

*Department of Psychiatry and Behavioral Sciences and

Family and Geriatric Medicine, University of

Louisville School of Medicine, Louisville, Kentucky;

†Department of Family and Community Medicine,

University of New Mexico School of Medicine,

Albuquerque, New Mexico; and ‡The Oregon College of

Oriental Medicine, Portland, Oregon.

 

The purpose of the study was to evaluate the potential

efficacy and acceptability of acupuncture for

posttraumatic stress disorder (PTSD). People diagnosed

with PTSD were randomized to either an empirically

developed acupuncture treatment (ACU), a group

cognitive-behavioral therapy (CBT), or a wait-list

control (WLC). The primary outcome measure was

self-reported PTSD symptoms at baseline, end

treatment, and 3-month follow-up. Repeated measures

MANOVA was used to detect predicted Group X Time

effects in both intent-to-treat (ITT) and treatment

completion models. Compared with the WLC condition in

the ITT model, acupuncture provided large treatment

effects for PTSD (F [1, 46] = 12.60; p < 0.01; Cohen's

d = 1.29), similar in magnitude to group CBT (F [1,

47] = 12.45; p < 0.01; d = 1.42) (ACU vs. CBT, d =

0.29). Symptom reductions at end treatment were

maintained at 3-month follow-up for both

interventions. Acupuncture may be an efficacious and

acceptable nonexposure treatment option for PTSD.

Larger trials with additional controls and methods are

warranted to replicate and extend these findings.

 

PMID: 17568299 [PubMed - as supplied by publisher]

 

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5: Aust Fam Physician. 2007 Jun;36(6):447-8. Related

Articles, Links

 

 

Acupuncture in musculoskeletal disorders - is there a

point?

 

Pirotta M.

 

Department of General Practice, University of

Melbourne, Victoria, Australia.

m.pirotta

 

Several surveys have identified that Australian

general practitioners have largely accepted

acupuncture as part of their armamentarium. About a

quarter of GPs have been trained in acupuncture and

the majority of those surveyed agreed that acupuncture

was effective and that they had referred patients for

the therapy. Acupuncture is an integral part of

traditional Chinese medicine and has thousands of

years of history of use. While acupuncture presents

some challenges to test in randomised controlled

trials, such as inadequate placebos and difficulty

achieving blinding of both researchers and

participants, many trials of increasingly high

standard have been published; for example, the

Cochrane Collaboration has over 120 reviews and

protocols relating to acupuncture. This article

presents some recent evidence about the use of

acupuncture to treat musculoskeletal conditions.

 

PMID: 17565404 [PubMed - in process]

 

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6: J Neurosurg Spine. 2007 Jun;6(6):567-9. Related

Articles, Links

 

 

Acupuncture needles causing lumbar cerebrospinal fluid

fistula. Case report.

 

Ulloth JE, Haines SJ.

 

Department of Neurosurgery, University of Minnesota,

Minneapolis, Minnesota 55455, USA.

 

Acupuncture is a frequently used adjuvant treatment

for chronic pain conditions. The authors report the

case of a patient in whom the delayed migration of

embedded acupuncture needles into the lumbar spinal

canal caused the formation of a cerebrospinal fluid

fistula and spine-related headache. The needles were

safely removed surgically and the patient improved

clinically.

 

PMID: 17561747 [PubMed - in process]

 

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7: Res Vet Sci. 2007 Jun 6; [Epub ahead of print]

Related Articles, Links

 

 

A proposed transpositional acupoint system in a mouse

and rat model.

 

Yin CS, Jeong HS, Park HJ, Baik Y, Yoon MH, Choi CB,

Koh HG.

 

Acupuncture and Meridian Science Research Center,

Institute of Oriental Medicine, Kyung Hee University,

1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Republic

of Korea.

 

In acupuncture, the specificity of the point and the

reproducibility of the location of the point are

prerequisite to the specificity and reproducibility of

research involving acupuncture stimulation. The

transpositional method, which locates animal acupoints

(AAs) on the surface of animal skin corresponding to

the anatomic site of a human acupoint, has been

generally adopted for research modeling. However,

there remains a lack of consensus on the specific

location of AA among researchers. The potential

problems that the discrepancy in acupoint locating

methods causes include the attempt to compare research

results. This report is a conceptual study that calls

attention to the problems of inconsistency in AA

location, and proposes a transpositional 121 AA system

in a mouse and rat model. Further discussion, and the

establishment of reproducible transpositional AA

systems, will prompt further quantitative research and

exchange of scientific ideas.

 

PMID: 17559895 [PubMed - as supplied by publisher]

 

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8: BMC Syst Biol. 2007 Jun 5;1(1):25 [Epub ahead of

print] Related Articles, Links

 

 

Dynamic morphometric characterization of local

connective tissue network structure in humans using

ultrasound.

 

Langevin HM, Rizzo DM, Fox JR, Badger GJ, Wu J,

Konofagou EE, Stevens-Tuttle D, Bouffard NA, Krag MH.

 

ABSTRACT: BACKGROUND: In humans, connective tissue

forms a complex, interconnected network throughout the

body that may have mechanosensory, regulatory and

signaling functions. Understanding these potentially

important phenomena requires non-invasive measurements

of collagen network structure that can be performed in

live animals or humans. The goals of this study were

to establish that 1) ultrasound images accurately

represent connective tissue architecture and 2)

ultrasound can be used to quantify dynamic changes in

local connective tissue structure in vivo. We

performed ultrasound and histology examinations of the

same tissue in two subjects undergoing surgery: in one

subject, we examined the relationship of ultrasound to

histological images in three dimensions; in the other,

we examined the effect of a localized tissue

perturbation using a previously developed robotic

acupuncture needling technique. In ten additional

non-surgical subjects, we quantified changes in tissue

spatial organization over time during needle rotation

vs. no rotation using ultrasound and semi-variogram

analyses. RESULTS: 3-D renditions of ultrasound images

showed longitudinal echogenic sheets that matched with

collagenous sheets seen in histological preparations.

Rank correlations between serial 2-D ultrasound and

corresponding histology images resulted in high

positive correlations for semi-variogram ranges

computed parallel (r=0.79, p<0.001) and perpendicular

(r=0.63, p<0.001) to the surface of the skin,

indicating concordance in spatial structure between

the two data sets. Needle rotation caused tissue

displacement in the area surrounding the needle that

was mapped spatially with ultrasound elastography and

corresponded to collagen bundles winding around the

needle on histological sections. In semi-variograms

corresponding to each ultrasound frame, the shape of

the semi-variogram curve changed markedly across

successive frames during needle rotation but not in

the absence of rotation. The direction of this change

was heterogeneous across subjects. However, the

frame-to-frame variability was 10-fold (p<0.001)

greater with rotation than with no rotation indicating

changes in tissue structure during rotation.

CONCLUSION: The combination of ultrasound and

semi-variogram analyses allows quantitative assessment

of dynamic changes in the structure of human

connective tissue in vivo.

 

PMID: 17550618 [PubMed - as supplied by publisher]

 

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9: Evid Based Complement Alternat Med. 2007

Jun;4(2):233-240. Epub 2006 Oct 31. Related Articles,

Links

 

 

Potential Synergism between Hypnosis and

Acupuncture-Is the Whole More Than the Sum of Its

Parts?

 

Schiff E, Gurgevich S, Caspi O.

 

Bnai Zion Medical Center, Internal Medicine Division

Haifa, Israel, University of Arizona, Program in

Integrative Medicine Arizona, USA and The Recanati

Center for Medicine and Research and the Section for

Integrative Medicine, Rabin Medical Center (Beilinson

Campus) and the Tel-Aviv University Sackler Faculty of

Medicine Israel.

 

Both hypnosis and acupuncture have gained credibility

over the years in their effectiveness for treating

various health conditions. Currently, each of these

treatments is administered in distinct settings and

separate times. That is, even if patients receive both

treatments as part of a multidimensional therapeutic

program, they would typically receive them separately

rather than simultaneously at the same session. This

separation however might be undesirable since, at

least theoretically, hypnosis and acupuncture could

potentially augment each other if administered

concomitantly. In this article we outline the

rationale for this hypothesis and discuss the

potential ramifications of its implementation.

 

PMID: 17549241 [PubMed - as supplied by publisher]

 

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10: Circulation. 2007 Jun 19;115(24):3121-9. Epub 2007

Jun 4. Related Articles, Links

 

 

Randomized trial of acupuncture to lower blood

pressure.

 

Flachskampf FA, Gallasch J, Gefeller O, Gan J, Mao J,

Pfahlberg AB, Wortmann A, Klinghammer L, Pflederer W,

Daniel WG.

 

Med Klinik 2, Universitätsklinikum Erlangen, Ulmenweg

18, 91054 Erlangen, Germany.

frank.flachskampf

 

BACKGROUND: Arterial hypertension is a prime cause of

morbidity and mortality in the general population.

Pharmacological treatment has limitations resulting

from drug side effects, costs, and patient compliance.

Thus, we investigated whether traditional Chinese

medicine acupuncture is able to lower blood pressure.

METHODS AND RESULTS: We randomized 160 outpatients

(age, 58+/-8 years; 78 men) with uncomplicated

arterial hypertension in a single-blind fashion to a

6-week course of active acupuncture or sham

acupuncture (22 sessions of 30 minutes' duration).

Seventy-eight percent were receiving antihypertensive

medication, which remained unchanged. Primary outcome

parameters were mean 24-hour ambulatory blood pressure

levels after the treatment course and 3 and 6 months

later. One hundred forty patients finished the

treatment course (72 with active treatment, 68 with

sham treatment). There was a significant (P<0.001)

difference in posttreatment blood pressures adjusted

for baseline values between the active and sham

acupuncture groups at the end of treatment. For the

primary outcome, the difference between treatment

groups amounted to 6.4 mm Hg (95% CI, 3.5 to 9.2) and

3.7 mm Hg (95% CI, 1.6 to 5.8) for 24-hour systolic

and diastolic blood pressures, respectively. In the

active acupuncture group, mean 24-hour ambulatory

systolic and diastolic blood pressures decreased

significantly after treatment by 5.4 mm Hg (95% CI,

3.2 to 7.6) and 3.0 mm Hg (95% CI, 1.5 to 4.6),

respectively. At 3 and 6 months, mean systolic and

diastolic blood pressures returned to pretreatment

levels in the active treatment group. CONCLUSIONS:

Acupuncture according to traditional Chinese medicine,

but not sham acupuncture, after 6 weeks of treatment

significantly lowered mean 24-hour ambulatory blood

pressures; the effect disappeared after cessation of

acupuncture treatment.

 

Publication Types:

Research Support, Non-U.S. Gov't

 

PMID: 17548730 [PubMed - in process]

 

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11: Complement Ther Med. 2007 Jun;15(2):109-14. Epub

2006 Oct 27. Related Articles, Links

 

 

Effect of Acu-TENS on recovery heart rate after

treadmill running exercise in subjects with normal

health.

 

Cheung LC, Jones AY.

 

Department of Physiotherapy, Alice Ho Mui Ling

Nethersole Hospital, Hong Kong.

 

OBJECTIVE: This study aims to investigate the effect

of transcutaneous electrical nerve stimulation,

applied at bilateral acupuncture points PC6

(Acu-TENS), on recovery heart rate (HR) in healthy

subjects after treadmill running exercise. DESIGN: A

single blinded, randomized controlled trial. SETTING:

Laboratory with healthy male subjects (n=28).

INTERVENTIONS: Each subject participated in three

separate protocols in random order. PROTOCOL A: The

subject followed the Bruce protocol and ran on a

treadmill until their HR reached 70% of their maximum

(220-age). At this 'target' HR, the subject adopted

the supine position and Acu-TENS to bilateral PC6 was

commenced. PROTOCOL B: Identical to protocol A except

that Acu-TENS was applied in the supine position for

45min prior to, but not after exercise. PROTOCOL C:

Identical to protocol A except that placebo Acu-TENS

was applied. MAIN OUTCOME MEASURES: Heart rate was

recorded before and at 30s intervals after exercise

until it returned to the pre-exercise baseline. The

time for HR to return to baseline was compared for

each protocol. RESULTS: Acu-TENS applied to bilateral

PC6 resulted in a faster return to pre-exercise HR

compared to placebo. Time required for HR to return to

pre-exercise level in protocols A-C was 5.5+/-3.0;

4.8+/-3.3; 9.4+/-3.7min, respectively (p<0.001). There

was no statistical difference in HR recovery time

between protocols A and B. Subjects expressed the

lowest rate of perceived exertion score (RPE) at 70%

maximum HR with protocol B. CONCLUSION: This study

suggests that Acu-TENS applied to PC6 may facilitate

HR recovery after high intensity treadmill exercise.

 

PMID: 17544861 [PubMed - in process]

 

--

 

12: Complement Ther Med. 2007 Jun;15(2):101-8. Epub

2006 Nov 3. Related Articles, Links

 

 

Exploring acupuncturists' perceptions of treating

patients with rheumatoid arthritis.

 

Hughes JG, Goldbart J, Fairhurst E, Knowles K.

 

Division of Primary Care, University of Liverpool,

Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.

 

AIMS: To outline acupuncturists' perceptions of

treating patients with rheumatoid arthritis (RA),

exploring the impact of practitioner affiliation to a

traditional or western theoretical base. METHODS:

Qualitative study utilising Grounded Theory Method.

Nineteen acupuncturists were chosen via theoretical

sampling. In-depth semi-structured interviews were

tape-recorded and transcribed. Field notes were also

taken. Emerging categories and themes were identified.

RESULTS: Inter-affiliatory differences were identified

in the treatments administered and the scope and

emphasis of intended therapeutic effects. Limited

divergence was found between acupuncturists'

perceptions of treatment outcomes. Factors perceived

as impacting on treatment outcomes were identified.

CONCLUSIONS: Clinical trials of acupuncture in RA may

have failed to administer a treatment which reflects

that administered in clinical practice. Outcome

measures employed in clinical trials of acupuncture in

RA, as well as established outcome indices for RA, may

lack the necessary breadth to accurately assess

acupuncture's efficacy. Acupuncturist affiliation has

demonstrable implications for the practice and

research of acupuncture.

 

PMID: 17544860 [PubMed - in process]

 

--

 

13: Complement Ther Med. 2007 Jun;15(2):92-100. Epub

2006 Dec 11. Related Articles, Links

 

 

Acupuncture as a complex intervention for depression:

A consensus method to develop a standardised treatment

protocol for a randomised controlled trial.

 

Macpherson H, Schroer S.

 

Department of Health Sciences, University of York,

United Kingdom; Foundation for Traditional Chinese

Medicine, York, United Kingdom.

 

OBJECTIVE: To standardise a complex intervention by

defining the characteristic (specific) components of

treatment for a randomised controlled trial of

acupuncture as an intervention for individuals who

have been diagnosed with depression using a consensus

method. METHODS: A nominal group technique was used.

Potential components of the acupuncture intervention

were generated from the literature, experts and

participants. These were categorised as constant or

variable, the latter including active management

techniques (such as providing relevant explanations),

auxiliary techniques (such as auricular acupuncture),

and other aspects of patient care (such as offering

life-style and dietary advice), all of which were

underpinned by defined theoretical frameworks.

Participants were selected on the basis of their

experience and training, to encompass a diverse range

of styles of traditional acupuncture practice in the

UK, and all rated components in two rounds. RESULTS:

Fifteen practitioners rated 52 variable components in

the first round and 55 in the second. There was group

support for 16 active management components, three

auxiliary techniques and five areas of life-style

support, all driven by eight theoretical diagnostic

and treatment frameworks. For the 39 components that

were rated twice, group support increased between

rounds from 75 to 79% (z=-2.2, p=0.03), while the

absolute average deviation from the median dropped

from 1.04 to 0.83 (z=-2.5, p=0.011). CONCLUSION:

Standardising the characteristic components of a

complex intervention for a randomised controlled trial

of acupuncture for depression using a consensus

approach is feasible. The method can be generalised to

other clinical situations and other treatment

modalities.

 

PMID: 17544859 [PubMed - in process]

 

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14: Schmerz. 2007 May 26; [Epub ahead of print]

Related Articles, Links

 

 

[Evidence for laser acupuncture in cases of orthopedic

diseases : A systematic review.]

 

[Article in German]

 

Schüller BK, Neugebauer EA.

 

Institut für Forschung in der operativen Medizin

(IFOM), Fakultät für Medizin der Universität

Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln,

Deutschland, sekretariat-neugebauer.

 

BACKGROUND AND OBJECTIVES: The aim of this review is

to evaluate the evidence for laser acupuncture in

selected orthopaedic diseases. MATERIAL AND METHODS:

Randomized controlled studies, meta-analyses and

systematic reviews were identified by a systematic

search strategy in Medline and the Cochrane library.

The studies were evaluated using the quality criteria

of the Oxford Centre of Evidence Based Medicine.

RESULTS: For the selected orthopedic diseases (medial

and lateral epicondylitis, myofascial pain syndrome of

the neck, back and shoulder and osteoarthritis),

meta-analyses, systematic reviews and eight randomized

controlled studies were found. All other published

studies used laser therapy without consideration of

classical acupuncture points. All studies had

significant drawbacks in methodological quality and

the number of patients included. In more recent

trials, improvement towards higher methodological

quality was obvious. Although current evidence is

equivocal, positive effects can be assumed in

myofascial pain syndromes of the neck, back and

shoulder. Laser acupuncture is advantageous in terms

of side effects compared to classical acupuncture

techniques. CONCLUSION: Better, well designed

randomized studies with higher power are mandatory in

orthopedic diseases.

 

PMID: 17530300 [PubMed - as supplied by publisher]

 

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15: Climacteric. 2007 Jun;10(3):264; author reply

264-5. Related Articles, Links

 

 

Effects of acupuncture and estrogens on hot flushes.

 

Dören M.

 

Publication Types:

Comment

Letter

 

PMID: 17487655 [PubMed - in process]

 

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16: Auton Neurosci. 2007 May 30;133(2):158-69. Epub

2007 Feb 22. Related Articles, Links

 

 

Specific acupuncture sensation correlates with EEGs

and autonomic changes in human subjects.

 

Sakai S, Hori E, Umeno K, Kitabayashi N, Ono T,

Nishijo H.

 

System Emotional Science, Graduate School of Medicine,

University of Toyama, Toyama 930-0194, Japan.

 

Sympathetic overactivation is suggested to be

associated with chronic pain syndrome, and acupuncture

is frequently applied in therapy for this syndrome.

Furthermore, the forebrain including the various

cerebral cortices has been implicated in inhibitory

and facilitatory control of pain as well as autonomic

functions. We investigated relationships among

specific sensations induced by acupuncture

manipulation, effects on sympathetic and

parasympathetic autonomic functions, and EEG changes.

An acupuncture needle was inserted into the right

trapezius muscle of the subjects, and acupuncture

manipulation was repeated to induce specific

acupuncture sensation repeatedly while the needle was

left in the muscle. Acupuncture manipulation

significantly decreased heart rate (HR), and increased

systolic blood pressure (SBP). Spectral analysis

indicated that acupuncture manipulation significantly

decreased low frequency components (LF) of both HR

variability (HRV) and SBP variability (SBPV), and

significantly reduced ratio of LF to high frequency

component (HF) of HRV (LF/HF, index of sympathetic

activity). Furthermore, there was a significant

negative correlation between changes in LF/HF ratio of

HRV and the number of specific acupuncture sensations

reported, and a significant positive correlation

between HF of HRV and the number of acupuncture

sensations. Analyses of EEG data indicated that

acupuncture manipulation non-specifically increased

power of all spectral bands except the gamma band.

Furthermore, changes in HF (index of parasympathetic

activity) and total power (overall activity of the

autonomic nervous system) of HRV were positively

correlated with changes in theta, alpha, and gamma

power, while changes in LF of SBPV and LF/HF of HRV

were negatively correlated with changes in power of

all spectral bands. These results are consistent with

the suggestion that autonomic changes induced by

manipulation inducing specific acupuncture sensations

might be mediated through the central nervous system,

especially through the forebrain as shown in EEG

changes, and are beneficial to relieve chronic pain by

inhibiting sympathetic nervous activity.

 

PMID: 17321222 [PubMed - in process]

 

--

 

17: Midwifery. 2007 Jun;23(2):184-95. Epub 2006 Oct

18. Related Articles, Links

 

 

A randomised-controlled trial in Sweden of acupuncture

and care interventions for the relief of inflammatory

symptoms of the breast during lactation.

 

Kvist LJ, Louise Hall-Lord M, Rydhstroem H, Wilde

Larsson B.

 

Department of Obstetrics and Gynaecology, Floor 2,

Helsingborg Hospital, Helsingborg, SE-251 87 Sweden;

Faculty of Social and Life Sciences, Karlstad

University, Sweden.

 

OBJECTIVES: to further compare acupuncture treatment

and care interventions for the relief of inflammatory

symptoms of the breast during lactation and to

investigate the relationship between bacteria in the

breast milk and clinical signs and symptoms. DESIGN:

randomised, non-blinded, controlled trial of

acupuncture and care interventions. SETTING: a

midwife-led breast feeding clinic in Sweden.

PARTICIPANTS: 205 mothers with 210 cases of

inflammatory symptoms of the breast during lactation

agreed to participate. The mothers were randomly

assigned to one of three treatment groups, two of

which included acupuncture among the care

interventions and one without acupuncture. All groups

were given essential care. Protocols, which included

scales for erythema, breast tension and pain, were

maintained for each day of contact with the breast

feeding clinic. A Severity Index (SI) for each mother

and each day was created by adding together the scores

on the erythema, breast tension and pain scales. The

range of the SI was 0 (least severe) to 19 (most

severe). FINDINGS: no significant difference was found

in numbers of mothers in the treatment groups, with

the lowest possible score for severity of symptoms on

contact days 3, 4 or 5. No statistically significant

differences were found between the treatment groups

for number of contact days needed until the mother

felt well enough to discontinue contact with the

breast feeding clinic or for number of mothers

prescribed antibiotics. Significant differences were

found in the mean SI scores on contact days 3 and 4

between the non-acupuncture group and the two

acupuncture groups. Mothers with less favourable

outcomes (6 contact days, n=61) were, at first contact

with the midwife, more often given advice on

correction of the baby's attachment to the breast. An

obstetrician was called to examine 20% of the mothers,

and antibiotic treatment was prescribed for 15% of the

study population. The presence of Group B streptococci

in the breast milk was related to less favourable

outcomes. KEY CONCLUSIONS AND IMPLICATIONS FOR

PRACTICE: if acupuncture treatment is acceptable to

the mother, this, together with care interventions

such as correction of breast feeding position and

babies' attachment to the breast, might be a more

expedient and less invasive choice of treatment than

the use of oxytocin nasal spray. Midwives, nurses or

medical practitioners with specialist competence in

breast feeding should be the primary care providers

for mothers with inflammatory symptoms of the breast

during lactation. The use of antibiotics for

inflammatory symptoms of the breast should be closely

monitored in order to help the global community reduce

resistance development among bacterial pathogens.

 

PMID: 17052823 [PubMed - in process]

 

 

 

Dr,M.Fadaie

MBBS,MD,Lic/Ac

Iran Acupucnture discussion group:

tebe_sozani

 

 

 

 

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