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Evidence Based                                                          Clinic

1.1 Osteoarthritis


Osteoarthritis (OA) is the most common form of arthritis and is a major cause of disability among older adults. The joints most commonly affected by OA are the knees, hips, hands, and spine. Current there is not cure for osteoarthritis. Guidelines published by the American College of Rheumatology recommended focusing on the relief of pain and stiffness and maintenance or improvement in functional status. While pharmacological interventions (such as anti-inflammation drugs) are associated with a variety of side-effects, acupuncture therapy has been evaluated by a number of clinical trials to be safe and effective for the management of OA.


The first systemic review (published in 2001) of seven randomized controlled trial with a total of 393 patients in US, has demonstrated that acupuncture was significantly more effective to reduce pain in OA patients than control treatment (reference 1).  In a paper published on Lancet in 2005, acupuncture treatment for 8 weeks was shown to reduce pain and improve joint function significantly more than no acupuncture treatments in patients with osteoarthritis of the knee (reference 2). A recent paper (published in 2010) reviewed sixteen clinical trials (acupuncture for peripheral joint osteoarthritis) involving 3498 people, also concluded that acupuncture treatment showed statistically significant improvement in OA pain and joint function (reference 3). 


Please inquery more detailed evidences for osteoarthritis interventions in Oriental Medicine during your visit.


References

1.     Acupuncture for osteoarthritis of the knee: a systematic review. Ezzo J, Hadhazy V, Birch S, Lao L, Kaplan G, Hochberg M, Berman B. Arthritis Rheum. 2001 Apr; 44(4):819-25.

 

2.     Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther HU, Melchart D, Willich SN. Lancet. 2005 Jul 9-15; 366 (9480):136-43.

 

3.     Acupuncture for peripheral joint osteoarthritis. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM. Cochrane Database Syst Rev. 2010 Jan 20; (1).

 

 

1.2 Chronic shoulder pain

 

Chronic shoulder pain and/or stiffness (frozen shoulder) could be caused by rotator cuff disorders including tendonitis and bursitis, biceps tendonitis, subacromial bursitis, glenohumeral,

osteoarthritis, impingement syndrome, and adhesive capsulitis. The goals of therapy usually are to relieve pain and stiffness and to improve function. The common treatments for should pain are nonsteroidal anti-inflammatory drugs (NSAIDs), subacromial injections of glucocorticosteroids, physiotherapy, and acupuncture; while surgery is usually the last option.  

 

The effectiveness of acupuncture treatment on chronic should pain has been shown in numerous case reports during the practice of ancient and contemporary acupuncturists. A number of modern scientically well-designed clinical trials have also demonstrated that acupuncture may be an alternative intervention. A paper published in Pain journal in 2010 reported that in the German randomized acupuncture Trial (comprised 424 outpatients with chronic shoulder pain), statistically greater improvement of shoulder mobility (abduction and arm-above-head test) was shown in the acupuncture treatment group when compared with the control group (immediately after treatment and after 3 months) (reference 1). Interestingly, it was reported that the improvement on should pain between subacromical corticosteroid injection and acupuncture

treatment was similar among 117 patients with subacromial impingement syndrome (reference 2). In addition, for patients diagnosed with osteoarthritis or rotator cuff tendonitis and a total Shoulder Pain and Disability Index (SPADI) score of >30, acupuncture treatment for 6 weeks was reported to be significantly improved the SPADI score (reference 3). 

 

References

1.      German Randomized Acupuncture Trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Molsberger AF, Schneider T, Gotthardt H, Drabik A. Pain. 2010 Oct; 151(1):146-54. 

 

2.      Subacromial corticosteroid injection or acupuncture with home exercises when treating patients with subacromial impingement in primary care--a randomized clinical trial. Johansson K, Bergström A, Schröder K, Foldevi M. Fam Pract. 2011 Aug; 28(4):355-65. 

 

3.      Efficacy of acupuncture as a treatment for chronic shoulder pain. Lathia AT, Jung SM, Chen LX. J Altern Complement Med. 2009 Jun; 15(6):613-8.

 

 

3.   Allergic rhinitis

 

Allergic rhinitis (AR) is a symptomatic nose disorder resulting from an immunological reaction to allergen exposure. Its symptoms include rhinorrhea, nasal itching, obstruction, and sneezing, all of which may cause sleep disturbances and impaired daytime concentration in individuals with AR. Current major strategies for the management of AR include the avoidance of exposure to allergens and pharmacological treatments. Treatments for AR include antihistamines, intranasal glucocorticosteroids, antileukotrienes, and specific immunotherapies. However, these treatments are associated with certain undesirable side effects, and frequently do not provide complete symptomatic relief. Despite advances in conventional therapy, a remarkable number of patients with AR are turning to complementary medicine for relief. The lifetime prevalence of CAM use in Europe patients with AR ranges from 27% to 46% (reference 1). The prevalence of acupuncture, a form of CAM, in AR patients is estimated to be between 17% and 19% (reference 2). Other forms are herbal decoction and patch, summer acupoint application.

 

In a recent randomized controlled trial of 5,237 patients with allergic rhinitis, 15 acupuncture sessions during a period of 3 months significantly improved the scores of Rhinitis Quality of Life Questionnaire (RQLQ), when compared with the control group. Similarly, quality-of-life improvements were more pronounced in the acupuncture vs the control group (P <.001) (reference 3).  In another multicenter, randomized, parallel-controlled study of 238 participants, active acupuncture treatment demonstrated a significantly greater effect on symptoms of allergic rhinitis than either sham acupuncture or no active treatment. The difference in the total nasal symptom score (TNSS) was significantly reduced in the active acupuncture group compared with the sham acupuncture (reference 4). Interestingly, both summer acupoint application (reference 5) and herbal medicine were reported to significantly improve the symptoms of RA (reference 6). The possible mechanisms responsible for the safe and effective CAM treatment may be through a complex neuro-endocrino-immunological network of actions. Such function include the inhibition of the release or the activity of mast cell mediators (such as histamine), inhibition the induction of inflammation reaction by chemical agents, and down regulation of serum (immunoglobulin E) IgE levels or the activity of lymphocyte and/or macrophage (reference 7).

 

Reference 

1.     Patient use of traditional and complementary therapies in treating rhinosinusitis before consulting an otolaryngologist. Krouse, J.H., Krouse, H.J., 1999. Laryngoscope 109, 1223-1227.

 

2.     Alternative medicine in allergies prevalence, patterns of use, and costs. Schäfer, T., Riehle, A., Wichmann, H.E., Ring, J., 2002. Allergy 57, 694–700.

 

3.     Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial. Brinkhaus B, Witt CM, Jena S, Liecker B, Wegscheider K, Willich SN. Ann Allergy Asthma Immunol. 2008 Nov;101 (5):535-43. 

 

4.     A multicenter, randomized, controlled trial testing the effects of acupuncture on allergic rhinitis. Choi SM, Park JE, Li SS, Jung H, Zi M, Kim TH, Jung S, Kim A, Shin M, Sul JU, Hong Z, Jiping Z, Lee S, Liyun H, Kang K, Baoyan L. Allergy. 2013 Mar;68(3):365-74. 

 

5.     Influencing factors on efficacy of summer acupoint application treatment for allergic rhinitis: a retrospective study. Peng J, Wu X, Hu J, Fang Y, Zi M, Liu B. J Tradit Chin Med. 2012 Sep; 32(3):377-81.

 

6.     Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial. Brinkhaus B, Hummelsberger J, Kohnen R, Seufert J, Hempen CH, Leonhardy H, Nögel R, Joos S, Hahn E, Schuppan D. Allergy. 2004 Sep;59(9):953-60.

 

7.     Mechanism of traditional Chinese medicine in the treatment of allergic rhinitis. Guo H, Liu MP. Chin Med J
(Engl). 2013 Feb;126(4):756-60. 

 

 

4. Depression

 

Depression is a serious mental disorder affecting around 8 - 20% of the population world widely. Although selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, are first-line medications for various depressive disorders, there still remains a large portion of depressed patients who do not fully response. There is also a high incidence of side effects associated with the clinical use of SSRIs. As an ancient therapeutic technique, acupuncture has been well confirmed to be a generally safe and tolerated therapy for many neuropsychiatric disorders including depression. 

 

Contemporary clinical studies have also illustrated the significant effectiveness of acupuncture on depressive disorders.  A recent systemic review and meta-analysis, retrieved 207 clinical studies of acupuncture for various depression and included 1,998 major depressive depression (MDD) and 1,680 post-stroke depression (PSD) patients, concluded that the efficacy of

acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, and acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD (reference 1). Most recent clinical trials also reported that acupuncture augmented the antidepressant efficacy (reference 2), accelerate the clinical response to SSRIs (reference 3), and effectively treated antidepressant partial and non-responders (reference 4).

 

Reference

1.      The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. J Affect Disord. 2010 Jul; 124(1-2):9-21. 

 

2.      Dense cranial electroacupuncture stimulation for major depressive disorder--a single-blind, randomized, controlled study. Zhang ZJ, Ng R, Man SC, Li TY, Wong W, Tan QR, Wong HK, Chung KF, Wong MT, Tsang WK, Yip KC, Ziea E, Wong VT. PLoS One. 2012;7(1):e29651

 

3.      A 6-week randomized controlled trial with 4-week follow-up of acupuncture combined with paroxetine in patients with major depressive disorder. Qu SS, Huang Y, Zhang ZJ, Chen JQ, Lin RY, Wang CQ, Li GL, Wong HK, Zhao CH, Pan JY, Guo SC, Zhang YC. J Psychiatr Res. 2013 Jun; 47(6):726-32. 

 

4.      A pilot study of acupuncture augmentation therapy in antidepressant partial and non-responders with major depressive disorder. Yeung AS, Ameral VE, Chuzi SE, Fava M, Mischoulon D. J Affect Disord. 2011 Apr;
130(1-2):285-9. 

 

 

5. Insomnia

 

Insomnia is a common sleeping disorder manifesting as insufficient sleep time and/or reduced sleep quality. It significantly affects the quality of life, study, and work of patients. Insomnia has been traditionally treated with benzodiazepines and hypnotics, which have been shown to be associated with many adverse effects. 

 

Insomnia has been reported to be effective and safe treated by acupuncture in multiple clinical studies, including primary insomnia (reference 1 and 2); residual insomnia associated with major depressive disorder (reference 3); insomnia in stroke patients (reference 4);  insomnia of malignant tumor patients (reference 5);  and in postmenopausal women with insomnia (reference 6). 

 

 

Reference

1.      Curative effect of acupuncture and moxibustion on insomnia: a randomized clinical trial.  Gao X, Xu C,
Wang P, Ren S, Zhou Y, Yang X, Gao L. J Tradit Chin Med. 2013 Aug;33(4):428-32.

 

2.      A comparison between acupuncture versus zolpidem in the treatment of primary insomnia. Tu JH, Chung WC, Yang CY, Tzeng DS. Asian J Psychiatr. 2012 Sep;5(3):231-5. 

 

3.      Electroacupuncture for residual insomnia associated with major depressive disorder: a randomized controlled trial. Yeung WF, Chung KF, Tso KC, Zhang SP, Zhang ZJ, Ho LM. Sleep. 2011 Jun 1; 34(6):807-15.  

 

4.      Intradermal acupuncture on shen-men and nei-kuan acupoints improves insomnia in stroke patients by reducing the sympathetic nervous activity: a randomized clinical trial. Lee SY, Baek YH, Park SU, Moon SK, Park JM, Kim YS, Jung WS. Am J Chin Med. 2009;37(6):1013-21.

 

5.      Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality.  Feng Y, Wang XY, Li SD, Zhang Y, Wang HM, Li M, Cao K, Ye YF, Zhang Z. J Tradit Chin Med. 2011 Sep; 31(3):199-202

 

6.      The relationship of subjective sleep quality and cardiac autonomic nervous system in postmenopausal women with insomnia under auricular acupressure. Kung YY, Yang CC, Chiu JH, Kuo TB. Menopause. 2011 Jun;18(6):638-45. 


 

6. Side effects associated with cancer treatment 

 

It was reported that more than 40% of cancer patients used some type of complementary and alternative medicine (CAM) therapies (reference 1). A National Institutes of Health consensus panel recognized the efficacy and safety of acupuncture for pain, nausea, vomiting, xerostomia, and other symptoms associated with various cancer treatment techniques (reference 2). 

 

For the management of pain associated with cancer treatments, a number of clinical trials have reported a significant improvement utilizing acupuncture treatment, including pain associated with cancer patients with a history of neck dissection (reference 3), aromatase inhibitors induced arthralgias (joints pain) (reference 4), and chemotherapy induced peripheral neuropathic pain (reference 5). It’s reported that approximately 60%–70% of patients experienced nausea during abdominal or pelvic radiation (reference 6), emesis and nausea are also common side-effects of some chemotherapies such as anthracycline. A randomized clinic trial including 215 cancer patients with radiotherapy-induced nausea, reported that nearly all acupuncture treated patients experience that the treatment was effective for nausea (reference 7). For chemotherapy-related nausea and emesis, electro-acupuncture was shown to be well-tolerated and effective in a study of 317 patients (reference 8).

 

Acupuncture treatment was also demonstrated to effectively manage radiation-induced xerostomia in cancer patients. In a clinic study including 145 patients with chronic radiation-induced xerostomia >18 months after treatments, eight sessions of weekly group acupuncture compared with group oral care education provide significantly better relief of xerostomia in patients (reference 9). 

 

Cancer-related fatigue is a serious clinical issue. There are multiple clinical studies showing that acupuncture is an effective intervention for managing the symptom of CRF and improving patients’ quality of life (reference 10 and 11). Women taking tamoxifen experience hot flashes and night sweats have also showed significant improvement using acupuncture treatment (reference 12).  

 

Reference

1.     Lee MM, Lin SS, Wrensch MR, Adler SR, Eisenberg D. Alternative therapies used by women with breast cancer in four ethnic populations. J Natl Cancer Inst 2000;92(1):42e47. 

 

2.     NIH-Consensus Conference. Acupuncture. JAMA 1998;280(17):1518e1524.

 

3.     Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha AR, Shah J, Vickers AJ. J Clin Oncol. 2010 May 20;28(15):2565-70

 

4.     Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. Crew KD, Capodice JL, Greenlee H, Brafman L, Fuentes D, Awad D, Yann Tsai W, Hershman DL. J Clin Oncol. 2010 Mar 1;28(7):1154-60.

 

5.     Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropathy. Donald GK, Tobin I, Stringer J. Acupunct Med. 2011 Sep; 29(3):230-3.

 

6.     Management of radiation-induced nausea and vomiting. Abdelsayed GG. Exp Hematol 2007; 35 (Suppl 1): 34–36.

 

7.     Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea--a randomized controlled study. Enblom A, Johnsson A, Hammar M, Onelöv E, Steineck G, Börjeson S. Ann Oncol. 2012 May; 23(5):1353-61.

 

8.     Electroacupuncture for refractory acute emesis caused by chemotherapy. Choo SP, Kong KH, Lim WT, Gao F, Chua K, Leong SS. J Altern Complement Med. 2006 Dec;12(10):963-9.

 

9.     ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V; ARIX Steering Committee. Ann Oncol. 2013 Mar; 24(3):776-83. 

 

10.  Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. Molassiotis A, Bardy J, Finnegan-John J, Mackereth P, Ryder DW, Filshie J, Ream E, Richardson A. J Clin
Oncol. 2012 Dec 20; 30(36):4470-6. 

 

11.  Patient education integrated with acupuncture for relief of cancer related fatigue randomized controlled feasibility study. Johnston MF, Hays RD, Subramanian SK, Elashoff RM, Axe EK, Li JJ, Kim I, Vargas RB, Lee J, Yang L, Hui KK. BMC Complement Altern Med. 2011 Jun 25;11:49. 

 

12.  Using traditional acupuncture for breast cancer-related hot flashes and night sweats. de Valois BA, Young TE, Robinson N, McCourt C, Maher EJ. J Altern Complement Med. 2010 Oct; 16(10):1047-57.



7. Supportive cancer care and Herbal (Kampo) medicine

 

Clinical trials to date have demonstrated that cancer treatments based on Western Medicine are currently the most efficient treatments; also medical diagnosis based on Western Medicine is essential to determine the exact degree of progression and malignancy of cancer. Meanwhile, Oriental Medicine including Kampo medicine is obtaining its scientific rationale in supportive cancer care.

 

Currently more than 70% of Japanese physicians prescribe Kampo medicines in daily clinical practices (reference 1). Kampo medicine is considered a government-regulated prescription drug and currently 148 formulas are listed on the Japanese national insurance program.A great amount of clinical studies have reported the beneficial effectiveness of some Kampo extracts in supportive cancer care, including prevention of chemotherapy induced diarrhea (reference 2) and peripheral neuropathy (reference 3), and significantly improved cancer survivorship (reference 4).

 

Reference

1.     The clinical use of Kampo medicines (traditional Japanese herbal treatments) for controlling cancer patients' symptoms in Japan: a national cross-sectional survey. Iwase S, Yamaguchi T, Miyaji T, Terawaki K, Inui A, Uezono Y. BMC Complement Altern Med. 2012 Nov 20; 12:222.

 

2.     The Kampo medicine, Goshajinkigan, prevents neuropathy in patients treated by FOLFOX regimen. Nishioka M, Shimada M, Kurita N, Iwata T, Morimoto S, Yoshikawa K, Higashijima J, Miyatani T, Kono T. Int J Clin Oncol. 2011 Aug; 16(4):322-7. 

 

3.     Significance of Kampo, traditional Japanese medicine, in supportive care of cancer patients. Yamakawa J, Motoo Y, Moriya J, Ogawa M, Uenishi H, Akazawa S, Sasagawa T, Nishio M, Kobayashi J. Evid Based Complement Alternat Med. 2013

 

4.     Can Kampo therapy prolong the life of cancer patients? Takegawa Y, Ikushima H, Ozaki K, Furutani S, Kawanaka T, Kudoh T, Harada M. J Med Invest. 2008 Feb; 55(1-2):99-105

 

 

 

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