Nadia Ellis

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

Abstract Objective To determine the effects of a policy of “use acupuncture” on headache, health status, days off sick, and use of resources in patients with chronic headache compared with a policy of “avoid acupuncture.” Design Randomised, controlled trial. Setting General practices in England and Wales. Participants 401 patients with chronic headache, predominantly migraine. Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care. Main outcome measures Headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. Use of resources was assessed every three months. Results Headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). The adjusted difference between means is 4.6 (95% confidence interval 2.2 to 7.0; P = 0.0002). This result is robust to sensitivity analysis incorporating imputation for missing data. Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2). Conclusions Acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. Expansion of NHS acupuncture services should be considered.

Acupuncture for migraine and headache in primary care: a protocol for a pragmatic, randomized trial

UNLABELLED This paper presents the protocol for a randomized trial of acupuncture for migraine and headache. SUBJECTS Four hundred patients with migraine or headache will be recruited from GP practices. INCLUSION CRITERIA Eighteen to 65 years old, contractable by telephone, onset at least 1 year prior at age less than 50, two headaches per month in the previous 6 months, adequate data completion and headache severity during pre-randomization baseline. EXCLUSION CRITERIA Pregnancy or malignancy, cluster headache, serious pathological aetiology, cranial neuralgia, acupuncture treatment in the past year. DESIGN Following a 4-week baseline, patients will be allocated to acupuncture or control by minimized randomization. Up to 12 acupuncture treatments will be provided by advanced members of the Acupuncture Association of Chartered Physiotherapists. The type of acupuncture given will be recorded. STUDY MEASURES: Outcome will be assessed by headache diary, medication diary and SF36 at 3 months and 1 year. Resource use and days off sick will be assessed by quarterly questionnaire. Adverse events will be monitored by self-report. The primary outcome measure will be the change in mean daily headache score between baseline and the 1 year follow-up. An economic evaluation will also be undertaken.

Trigger point acupuncture

One of the main problems which is met by a physiotherapist in clinical practice is musculo-skeletal pain. There are many ways in which this can be addressed.

A pilot study to evaluate the effect of acupuncture on nocturia in the elderly

Abstract A single blind trial design was used involving the population of two long stay care of the elderly homes in the Southampton area. The trial included 3 males and 17 females. One group of 11 received acupuncture and a control group of 9 received mock transcutaneous electrical nerve stimulation. Measurements were carried out before commencement of treatment, and after 1 week and 2 weeks, when treatment was completed. The comparison between the two groups showed a significant reduction after one week (p = 0.008) and 2 weeks (p = 0.004) in favour of the acupuncture group, using the Mann-Whitney test.

The history of traditional Chinese medicine

The existence of traditional Chinese medicine (TCM) can be traced through written scripts as far back as 3000 years. One of the earliest text books on the subject is the Huang Ti Nei Ching or The Yellow Emperor’s Manual of Corporeal Medicine. The first part called the Su Wen is written in a question and answer format between the legendary Emperor Huang Ti and his minister Chi-Po. This book can be dated back to the 2nd century bc although the practice of acupuncture and moxabustion is believed to be much older. Moxabustion is the name given to heat which is applied to the skin by burning the dried leaves of the herb Artemisia vulgaris (mugwort). Acupuncture and moxabustion are of equal importance in TCM and it is believed that moxabustion predated acupuncture as a treatment.

The basis of traditional Chinese medicine

The concept of yin and yang is that all matter consists of both negative and positive components. It is based on the philosophy of Tao. The essential nature of Tao was described in the 5th Century bc by Laotse in the Tao te king. The Tao is an abstract force that creates all things and brings about the polarity between yin and yang from an unstructured primal state. All things in nature develop within this field of tension between yin and yang. Examples of yin and yang are listed in Table 2.1.

Musculo-skeletal problems

Palpation of the superficial and deep structures is an important aspect of diagnosis. If there is superficial tenderness and heat, then according to TCM the tendino-muscular meridian (TM) would be considered over-active relative to the main meridian which lies deeper in the tissues. Similarly if there is tenderness on deep palpation and pain on joint movement then the TM is considered to be under-active relative to the main meridian.

Transcutaneous electrical nerve stimulation (TENS)

This modality has been known to be used as far back as 2000 years ago. Records have been found dating back to Roman times which describe the touching of an electrical fish as being efficacious in painful conditions.

Technique of treating acupoints with needles and non-invasive procedures

The treatment area should be uncluttered so as to avoid dust. The treatment table can be covered with a disposable sheet or have a surface that can be washed after each treatment is finished. Inserting needles into the skin is an invasive procedure and the same careful precautions as would be taken when giving an injection should be observed.

Current practice in China

Since the Revolution in 1949 there has been active encouragement for TCM in China. Government support has enabled research to be undertaken. Much work has been done in the laboratory to validate the effect of acupuncture on pain (Han and Teranius, 1982). There are also a large volume of papers on the therapeutic effects of acupuncture on many medical conditions (O’Connor and Bensky, 1975). However, these are mainly discriptive studies and not in the form of ‘trials’ using control groups. Other ways of using acupuncture have also been developed, which are not always strictly based on TCM.