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| Chronic Pain • Holist Nurs Pract. 2005 September/October;19(5):217-221. |
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September 1, 2005 |
| Author / Title |
Use of Acupuncture for Chronic Pain: Optimizing Clinical Practice. / Eshkevari L, Heath J. |
| Abstract |
Increasingly, individuals are turning to complementary therapies to reduce or cope with chronic pain. Acupuncture, one of the oldest complementary therapies, originated from China more than 2500 years ago. It has steadily gained popularity in the United States over the last few decades as a modality for pain relief among both practitioners and patients. A 1997 National Institutes of Health consensus conference concluded that acupuncture needling releases endorphins and other neurotransmitters in the brain and should be considered as an appropriate pain treatment option. This article will provide an overview about acupuncture principles, discuss current clinical evidence, and identify acupuncture resources to optimize practice for chronic pain management. |
| Conclusion |
This article will provide an overview about acupuncture principles, discuss current clinical evidence, and identify acupuncture resources to optimize practice for chronic pain management. |
| Local |
Department of Anesthesia Pain Services, Georgetown University Hospital, and the Nurse Anesthesia Program (Ms Eshkevari), and the Acute Care Nurse Practitioner and Critical Care Clinical Nurse Specialist Program (Ms Heath), Georgetown University, School of Nursing and Health Studies, Washington, DC. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16145331&query_hl=21 |
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| Chronic Pain • Clin J Pain. 2005 Sep-Oct;21(5):406-11. |
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September 1, 2005 |
| Author / Title |
A Comparison of Physician and Nonphysician Acupuncture Treatment For Chronic Low Back Pain / Kalauokalani D, Cherkin DC, Sherman KJ. |
| Abstract |
BACKGROUND:: Although up to a third of the 10,000 acupuncturists in the United States are medical doctors, little is known about the acupuncture techniques they use or how their practices compare with those of nonphysician licensed acupuncturists. This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupuncture. PURPOSE:: This study describes how a random sample of physician acupuncturists in the United States diagnose and treat chronic low back pain and contrasts their practices with those of nonphysician licensed acupuncturists. METHODS:: A total of 464 questionnaires were mailed to physician acupuncturists randomly sampled from 3 sources: web-based Yellow Pages, American Academy of Medical Acupuncturists (AAMA) membership, and Pain Clinics associated with American College of Graduate Medical Education-approved fellowship programs. Responses (n = 137, 30%) were analyzed using descriptive statistics. The results of this survey were compared with data published from a similar survey of nonphysician licensed acupuncturists in Washington State. RESULTS:: Physicians who perform acupuncture use a mixture of styles and emphasize neuroanatomic approaches to needle placement. Most physicians received training in French Energetic acupuncture. In contrast, most nonphysician licensed acupuncturists use a traditional Chinese medicine approach to needle placement. Despite this apparent difference in their predominant styles of acupuncture, there was a high correlation between physician and nonphysician licensed acupuncturist acupoint selection to treat low back pain. In addition to acupuncture needling, physicians use other medical treatments, whereas nonphysician licensed acupuncturists' employ a variety of traditional Chinese medicine adjuncts to needling. CONCLUSION:: This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain. |
| Conclusion |
This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain. |
| Local |
Department of Anesthesia and Pain Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA. dkalauokalani@ucdavis.edu |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16093746&query_hl=1 |
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| Chronic Pain • Eur J Pain. 2005 Aug 8 |
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August 1, 2005 |
| Author / Title |
Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. / Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. |
| Abstract |
This large scale computer-assisted telephone survey was undertaken to explore the prevalence, severity, treatment and impact of chronic pain in 15 European countries and Israel. Screening interviews identified respondents aged 18 years with chronic pain for in-depth interviews. 19% of 46,394 respondents willing to participate (refusal rate 46%) had suffered pain for 6 months, had experienced pain in the last month and several times during the last week. Their pain intensity was 5 on a 10-point Numeric Rating Scale (NRS) (1=no pain, 10=worst pain imaginable) during last episode of pain. In-depth interviews with 4839 respondents with chronic pain (about 300 per country) showed: 66% had moderate pain (NRS=5-7), 34% had severe pain (NRS=8-10), 46% had constant pain, 54% had intermittent pain. 59% had suffered with pain for two to 15 years, 21% had been diagnosed with depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job and 13% had changed jobs because of their pain. 60% visited their doctor about their pain 2-9 times in the last six months. Only 2% were currently treated by a pain management specialist. One-third of the chronic pain sufferers were currently not being treated. Two-thirds used non-medication treatments, e.g,. massage (30%), physical therapy (21%), acupuncture (13%). Almost half were taking non-prescription analgesics; 'over the counter' (OTC) NSAIDs (55%), paracetamol (43%), weak opioids (13%). Two-thirds were taking prescription medicines: NSAIDs (44%), weak opioids (23%), paracetamol (18%), COX-2 inhibitors (1-36%), and strong opioids (5%). Forty percent had inadequate management of their pain. Interesting differences between countries were observed, possibly reflecting differences in cultural background and local traditions in managing chronic pain. Conclusions: Chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Very few were managed by pain specialists and nearly half received inadequate pain management. Although differences were observed between the 16 countries, we have documented that chronic pain is a major health care problem in Europe that needs to be taken more seriously. |
| Conclusion |
Chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Very few were managed by pain specialists and nearly half received inadequate pain management. Although differences were observed between the 16 countries, we have documented that chronic pain is a major health care problem in Europe that needs to be taken more seriously. |
| Local |
University of Oslo, Faculty of Medicine, Faculty Division Rikshospitalet, Department of Anaesthesiology, Rikshospitalet University Hospital, NO-0027 Oslo, Norway. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16095934&query_hl=1 |
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| Chronic Pain • Clin J Pain. 2003 Nov-Dec;19(6):364-70. |
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November 1, 2003 |
| Author / Title |
Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. / Kerr DP, Walsh DM, Baxter D. |
| Abstract |
OBJECTIVE: To assess the efficacy of acupuncture in the treatment of chronic low back pain. METHODS: Patients (n = 60) with chronic low back pain were recruited and randomly allocated to either Acupuncture therapy or Placebo transcutaneous electrical nerve stimulation (TENS) groups. Patients were treated weekly for 6 weeks, and blinded assessments were carried out pre- and post-treatment using the McGill Pain Questionnaire (MPQ) and visual analog scales (VAS) for pain, the Short-form 36 quality-of-life questionnaire, and a simple range of motion measurement. A total of 46 patients completed the trial and were followed up at 6 months. RESULTS: Analysis of results using t tests showed that in both groups there were significant pre-post improvements for all scores, except for MPQ scores in the Placebo-TENS group. There was no significant difference between the 2 groups for any of the outcome measures at the end of treatment. Results from the 6-month follow-up would suggest that the response was better in the acupuncture group. DISCUSSION: Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups. |
| Conclusion |
Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups. |
| Local |
Rehabilatation Sciences Research Group, School of Rehabilitation Sciences, University of Ulser at Jordanstown, County Antrim, Northern Ireland. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14600536&query_hl=7 |
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| Chronic Pain • Pain. 2000 May;86(1-2):119-32. |
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May 1, 2000 |
| Author / Title |
Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. / Smith LA, Oldman AD, McQuay HJ, Moore RA. |
| Abstract |
The objectives of the study were (1) to carry out a systematic review to assess the analgesic efficacy and the adverse effects of acupuncture compared with placebo for back and neck pain and (2) to develop a new tool, the Oxford Pain Validity Scale (OPVS), to measure validity of findings from randomized controlled trials (RCTs), and to enable ranking of trial findings according to validity within qualitative reviews. Published RCTs (of acupuncture at both traditional and non-traditional points) were identified from systematic searching of bibliographic databases (e.g. MEDLINE) and reference lists of retrieved reports. Pain outcome data were extracted with preference given to standardized outcomes such as pain intensity. Information on adverse effects was also extracted. All included trials were scored using a five-item 0-16 point validity scale (OPVS). The individual RCTs were ranked according to their OPVS score to enable more weight to be placed on the trials of greater validity when drawing an overall conclusion about the efficacy of acupuncture for relieving neck and back pain. Statistical analyses were carried out on the OPVS scores to assess the relationship between trial finding (positive or negative) and validity. Thirteen RCTs met the inclusion criteria. Five trials concluded that acupuncture was effective, and eight concluded that it was not effective for relieving back or neck pain. There was no obvious difference between the findings of trials using traditional and non-traditional points. Using the new OPVS scale, the validity scores of the included trials ranged from 4 to 14. There was no significant relationship between OPVS score and trial finding (positive versus negative). Authors' conclusions did not always agree with their data. We drew our own conclusions (positive/negative) based on the data presented in the reports. Re-analysis using our conclusions showed a significant relationship between OPVS score and trial finding, with higher validity scores associated with negative findings. OPVS is a useful tool for assessing the validity of trials in qualitative reviews. With acupuncture for chronic back and neck pain, we found that the most valid trials tended to be negative. There is no convincing evidence for the analgesic efficacy of acupuncture for back or neck pain. |
| Conclusion |
With acupuncture for chronic back and neck pain, we found that the most valid trials tended to be negative. There is no convincing evidence for the analgesic efficacy of acupuncture for back or neck pain. |
| Local |
Pain Research, Nuffield Department of Anaesthetics, University of Oxford, The Churchill, Oxford Radcliffe Hospital, Headington, UK. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10779669&query_hl=7 |
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