Lahey Clinic Acupuncture - Evidence Based Guidelines

Lahey Clinic
Acupuncture - Evidence Based Guidelines
Jonathan Ammen, M.Ed., M.Ac., Lic.Ac.
Acupuncture has been used increasingly in the United States and Europe since the 1960’s. Though
acupuncture has historically been used for a wider range of illnesses this paper focuses on those for
which a scientific evidence base has been established. Since the NIH Consensus Conference on
Acupuncture in 1997 there has been great interest in acupuncture research. As of 2010, hundreds of
mechanism studies and efficacy RCTs, have been completed. Likely mechanisms of action have
been identified but are not discussed here and the evidence base for acupuncture efficacy is
growing. Though efficacy research results are promising, the strength of evidence in some studies is
limited by study design and sample size. Also, the puzzle of identifying satisfactory scientific
controls when researching a medical procedure is only partially solved1. Our understanding of
placebo controls has in fact been expanded through some acupuncture studies.2,3
With mounting evidence of acupuncture’s efficacy it is gradually being integrated into conventional
healthcare. In most of the United States acupuncturists are licensed after three years of post
graduate education with internship and passage of board certification examinations. In
Massachusetts, acupuncturists are licensed by the Registration Board in Medicine as an independent
medical specialty. Patients may access care with or without a physician’s referral. Lahey Clinic
began offering acupuncture within the Community Group Practices in 1999 and in 2010 at the
Sophia Gordon Cancer Center in Burlington. At Lahey, acupuncture is integrated with conventional
care.
A summary of the evidence for acupuncture efficacy is presented in table form below. The tables
result from a review of the scientific evidence for acupuncture’s safety & efficacy, citations are
generally limited to randomized controlled trials. Some information from case series or pilot studies
is included only for conditions with which acupuncture has a long history of empirical success. The
author is informed as an acupuncture researcher4,5,6, educator and by 30 years of clinical practice.
Questions about acupuncture in relation to a patient?
Jonathan B. Ammen, Lic.Ac.
[email protected]
Direct Line: 781 259 1165
1
(c) 2010 Jonathan Ammen updated 11/16/2010
Acupuncture - Evidence Based Guidelines
Acupuncture is well tolerated and has an excellent safety record in adults7,8 and children.9
General Medicine - Acupuncture is effective for patients with:
Condition
Low back pain10,11
Chronic Shoulder Pain
Post surgical pain15
Headache16 including migraine17,18
Lateral epicondyle pain19
Knee pain and function due to osteoarthritis20
Fibromyalgia pain fatigue and anxiety21
Dysmenorrhea22,23, infertility24,25 polycystic ovary syndrome26
Menopausal hot flashes27,28
Depression,29,30 depression during pregnancy31
Poor exercise tolerance in heart patients32
Bronchial asthma33,dyspnea34
Chronic obstructive Pulmonary Disease (COPD)35
Sleep apnea36
Findings, Recommendations & Comments
Am College of Phys & Am Pain Soc - use for chronic or
subacute low back pain.12 N Am Spine Soc - better relief and
functional improvement than no treatment, add to other
treatments for greater benefit than other treatments alone.13
Effective therapy in chronic shoulder pain. 15 treatments over 6
weeks are more effective than therapy with NSAIDs and
physiotherapy. Therapeutic effect lasts for 3 mos.14
Comparable to 0.1 mg/kg IV morphine
May enable reduction of medication
May enable reduction of medication
May be combined with physical therapy
As part of comprehensive treatment approach
Commonly used in Asia for wide range of GYN complaints
Promising results, better placebo controls needed.
One meta-analysis found acupuncture similar to antidepressants
in major depressive disorder and post stroke depression.
Ambulated 6 min walk distance was remarkably increased but
no change in Cardiac ejection fraction or peak oxygen uptake.
Improved lung function & reduced anxiety, acupuncture as an
adjunct may enable medication reduction. Safe in children.
Improved dyspnea on exercise.
Apnea index, respiratory events & micro-arousals decreased.
Hematology/Oncology - Acupuncture is effective for patients with:
Condition
Nausea & Vomiting of chemotherapy, pregnancy37 & perioperative38,39
Weight loss.40
Pain
Oral & facial pain41,42,43
Cancer related pain, may enable reduced analgesic use. 44,45,46
Post Surgical pain47,48
Neck dissection pain, dysfunction & xerostomia.49
Joint pain & stiffness from aromatase inhibitors.50
Pain & limited ROM post axillary lymphadenectomy51
Immune Support
Other cancer or cancer treatment symptoms
xerostomia associated with radiotherapy.56
Dysphonia57
Inflammation associated with radiotherapy
Vasomotor59,60 and depressive symptoms associated with antiestrogen therapy61,
Vasomotor symptoms in men treated for prostate cancer.63
Weight loss, cough, chest pain, fever64
Fatigue associated with chemotherapy.65
Postoperative lymphedema 66
Anxiety, depression,67 post traumatic stress PTSD68
Findings, Recommendations & Comments
Strong evidence
Weight gain
Post- surgical, myofascial pain, swallowing pain
Clear benefit even when patients already under stable analgesic
treatment. One trial – equal or better analgesia than
conventional drugs over long term.
Opiates may be reduced by peri-operative acupuncture.
Significant reduction in symptoms versus usual care.
Effective and well tolerated management strategy
Treatment in this study begun 1 day post surgery.
May enhance platelet count & prevented leukocyte decrease
after radiation or chemotherapy.52, 53 Enhancement of leukocyte
phagocytosis.54 Increased IL-2 level and NK cell activity55
Concurrent or after radiotherapy.
Improved voice range, voice quality, and quality-of-life.
rectitis58 studied, other tissues may be extrapolated.
Equivalent to and more durable than Effexor62 also increased
well being, energy, and in some cases libido.
Frequency of and distress from hot flashes reduced, effect
persisted 9 months.
Weight gain, symptom relief, fewer side effects.
Improvements in general & physical fatigue, activity &
motivation
Initiate treatment soon after surgery.
Safe and effective management, PTSD symptom reductions
maintained at least 3 months.
2
(c) 2010 Jonathan Ammen updated 11/16/2010
Endnotes:
1
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(c) 2010 Jonathan Ammen updated 11/16/2010
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