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advantages + disadvantages

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Did You Know?

According to the Chinese scholar and physician Huangfu Mi (c. 215-282 AD), using needles as a means of therapy was used in China over 5000 years ago during the Bronze Age.

Acupuncture is an ancient Chinese therapy that involves the use of needles. Acupuncture has been practiced in China, Japan, Korea, and other Asian countries since several centuries. In acupuncture, specific points or acupoints of the human body are stimulated by inserting and manipulating thin metallic needles that have a diameter ranging between 0.18 mm to 0.51 mm. Handling of these needles can be done either by hand or by electrical stimulation.

In US, acupuncture is mostly practiced for treating musculoskeletal pain, depression, and stress. According to a survey conducted in 2002, it is estimated that more than 8 million Americans have opted for acupuncture at some point or the other in their lives. Let's find out more about the advantages and disadvantages of acupuncture through this Buzzle article.

Advantages of Acupuncture

The WHO (World Health Organization) has reported that acupuncture is an effective treatment for therapeutic purposes. According to traditional Chinese medicine (TCM), the main idea behind acupuncture is to restore and maintain health by working on vital energy or (Qi) points of the body. It is widely used by acupuncturists (practitioner), dentists, physicians, and other health practitioners for relieving pain and several other health related problems.

One of the most important advantages of acupuncture is that, there are rarely any side effects if it is carried out by a registered and well-trained practitioner. The NIH (National Institutes of Health) has reported that acupuncture has lower adverse effects as compared to prescribed medications and other medical procedures that are followed for treating similar conditions.

Acupuncture can be performed in any age group such as children, adults, and elderly people. Usually it does not hurt and is done without interfering with other ongoing treatments and medications. Even, people with compromised immune systems can benefit from acupuncture treatment.

The GERAC or the German Acupuncture Trials, was the largest study ever conducted to find out about the effectiveness of acupuncture. GERAC trials of 2001 revealed that acupuncture worked better than the established and common practices of medicine and therapy, however, it did not reveal the desired effects when pitted against sham acupuncture. The positive results of the trial lead to the inclusion of acupuncture in the German statutory health insurances by German Joint Federal Committee. However, this type of holistic therapy was restricted to lower back and knee pain therapy.

In 2012, a major meta-analysis was conducted on 17,922 patients in order to find out the effectiveness of acupuncture, on four chronic types of pain that include headache, back and neck ache, shoulder pain, and osteoarthritis. The trials revealed that pure acupuncture was indeed more effective than sham acupuncture and was not a mere placebo.

Acupuncture is especially effective in alleviating chronic pain and was recommended in 2008 by the Osteoarthritis Research Society International for treating pain symptoms of osteoarthritis affecting the knee.

Acupuncture has been researched enough times to reveal that it induces the nerves in the spinal cord and brain to release pain relieving neurotransmitters. A research conducted in 1999 went on to report that acupuncture causes the pituitary glands to release endorphins. It was found that the individuals who went through acupuncture for reducing recurrent pain had elevated levels of endorphin in the cerebrospinal fluid.

In 2003, the World Health Organization also recognized the efficacy of acupuncture and mentioned an extensive list of diseases and disorders that can and could be treated with the help of acupuncture.

Many people have reported that they experienced relief from headache, back pain, joint pain, insomnia, stress, and fatigue after completing prescribed acupuncture sessions. It is also claimed that acupuncture helps restore energy and increases the overall stamina of the patient.

It has been suggested that acupuncture is an effective treatment for various health conditions such as, dental pain, asthma, nausea, infertility, and migraine. However, more research needs to be done in order to validate these claims as well as to identify the various acupuncture points of the body and understand its effects on the brain during treatment.

Disadvantages of Acupuncture

Acupuncture is safe as far as the procedure is practiced by a licensed acupuncturist and the needles used are sterile. The U.S. Food and Drug Administration (FDA) has set certain standards for acupuncture needles, which must be adhered to. It has been recommended that needles should be labeled and sealed properly in order to prevent tampering, contamination, and misuse.

Some of the points to be kept in mind while undergoing acupuncture treatment are - the practitioner should swab the treatment site with skin disinfectant before inserting the needles. The needles should be used only once per patient and should be disposed properly.

Every person responds differently to acupuncture and hence, the effectiveness of this technique varies from person to person. While some may be required to undergo more sessions in order to experience long-lasting relief, others may be satisfied with the results in merely a few sittings.

The patient may experience mild soreness in the pierced areas of the body after the treatment. However, this discomfort usually subsides after a day or two.

Some experience more pain than others while undergoing acupuncture. On the other hand, some people with sensitive skin may develop rashes or eruptions as a result of the body reacting against the acupuncture procedure.

Acupuncture may also cause drowsiness, loss of appetite, weakness, or induce sleep. This practice is not a sure-shot method and will not magically cure ailments that require modern medical intervention. The only help that acupuncture may provide, is temporary relief from pain.

Acupuncture is often not covered by health insurance providers and is thus a risky bargain for those who seek treatment for their health ailments. The practice of acupuncture does not provide any guarantees or proof that its patients will be completely healed. The entire procedure can also turn out to be extremely expensive after the follow-up treatments are taken into account.

Acupuncture must not cause bleeding when the needles are pierced into the skin. If this happens, the procedure is not being practiced correctly and must be stopped immediately.

Infection and injury to tissue may occur in rare cases, when the procedure is performed incorrectly.

Always make sure that the acupuncturist is registered and qualified enough to perform acupuncture. Improper placement of needles by an unqualified practitioner that can lead to bleeding, swelling, and pain in the treatment site. While acupuncture may not have many side effects, if it does not yield any benefits either, the practice would prove futile for the patient.

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Advantages and Disadvantages of Acupuncture

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Acupuncture is an important part of traditional Chinese medicine and has been practiced for thousands of years. Even though acupuncture is used for treating many health problems, the credibility of this ancient medical practice is still questioned by many skeptics.

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general strengths and weaknesses - availability/rational

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general strengths and weaknesses - availability/rational

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Amy Harris

Based in western New York, Amy Harris began writing for Demand Media and Great Lakes Brewing News in 2010. Harris holds a Bachelor of Science in Mathematics from Penn State University; she taught high school math for several years and has also worked in the field of instructional design.

In the United States, acupuncture is an integral part of complementary and alternative medicine, incorporating techniques from Chinese, Japanese and Korean traditions. Some Westerners are skeptical of the practice, while others swear by it, reporting a plethora of beneficial effects. When properly performed, acupuncture is a safe practice; however, inform your physician of any alternative medicine procedures you pursue, and don't discontinue any prescription medications before speaking to your doctor.

Acupuncture involves the insertion of needles about as slender as a human hair into the skin on specific locations of the body. The acupuncturist may simply leave the needles in for a period of time, or may manipulate them with his hands or via electrical stimulation. Different people experience acupuncture in different ways. Many report no discomfort whatsoever during needle insertion, while others report pain. Some people feel a burst of energy following the treatment, while others become relaxed. Follow-up treatments typically occur over a time span of several weeks or months.

Among the oldest healing practices in the world, acupuncture dates back thousands of years. It stems from ancient Chinese medicine and didn't spread to the United States until the latter half of the 20th century. Acupuncture practitioners and patients believe that the procedure promotes the vital flow of energy through all areas of the body.Researchers speculate that acupuncture may aid in the release of the body's natural painkillers as well as chemicals regulating blood pressure.

A primary reason that people seek acupuncture is to cope with pain. The practice can help mitigate symptoms of various types of pain, including back, neck, joint and dental pain as well as migraines, fibromyalgia and arthritis. It may reduce nausea after patients undergo surgery or receive chemotherapy, as well as aid in smoking cessation and coping with the bothersome symptoms of allergies and menopause. Some couples even seek acupuncture as a means of increasing fertility. However, acupuncture isn't a diagnostic procedure - that is, it cannot diagnose a disease, injury or other condition, but is instead a means of coping with known maladies.

Unlike undergoing surgery or even completing a drug regimen, acupuncture is a noninvasive treatment, with little to no side effects or recovery time. It may therefore reduce dependence on medications as well as the need for unpleasant medical procedures. Acupuncture is suitable for almost all people, regardless of physical condition, with the possible exception of those suffering from bleeding disorders or taking blood thinners. The practice takes a holistic approach in attempting to eliminate the root cause of the malady, rather than simply mitigating the symptoms.

Some patients report minor soreness for a period of time immediately following treatment, although it is rarely a cause for concern. In many cases, acupuncture cannot possibly cure the physical ailment, as in the case of broken bones; at best, it can aid in alleviating the accompanying pain in such circumstances. Acupuncture typically involves regularly scheduled follow-up treatments, which may prove a hassle for some patients. Treatments can be costly and often aren't covered by health insurance providers, and results aren't guaranteed, possibly leading some patients to believe they've wasted their time and money. And although acupuncture produces little to no side effects when delivered properly by a licensed acupuncturist, unqualified practitioners can deliver substandard care, resulting in pain from improper needle placement and even infections from unsterilized needles.

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Advantages & Disadvantages of Acupuncture

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In the United States, acupuncture is an integral part of complementary and alternative medicine, incorporating techniques from Chinese, Japanese and Korean traditions. Some Westerners are skeptical of the practice, while others swear by it, reporting a plethora of beneficial effects. When properly performed, acupuncture is a safe practice; however,...

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Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.
It is used in many NHS GP practices, as well as in most pain clinics and hospices in the UK.

Acupuncture is often seen as a form of complementary or alternative medicine (CAM).

How acupuncture works

Western medical acupuncture is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles.

This results in the body producing natural substances, such as pain-relieving endorphins. It's likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.

A course of acupuncture usually creates longer lasting pain relief than when a single treatment is used.

Traditional acupuncture is based on the belief that an energy, or "life force", flows through the body in channels called meridians. This life force is known as Qi (pronounced "chee").

Practitioners who use acupuncture in the traditional way believe that when Qi does not flow freely through the body, this can cause illness. They also believe acupuncture can restore the flow of Qi, and so restore health.

Uses of acupuncture

Acupuncture practitioners - sometimes called acupuncturists - use acupuncture to treat a wide range of health conditions. However, the use of acupuncture is not always based on rigorous scientific evidence.

The National Institute for Health and Care Excellence (NICE) provides guidelines for the NHS on the use of treatments and care of patients.

Currently, NICE only recommends considering acupuncture as a treatment option for:

Acupuncture is also often used to treat other musculoskeletal conditions (of the bones and muscles) and pain conditions, including:

joint pain

dental pain

postoperative pain

However, the evidence on the effectiveness of acupuncture compared with other treatments is unclear.

Acupuncture on the NHS

Acupuncture is sometimes available on the NHS, most often from GP surgeries or physiotherapists, although access is limited.

Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners.

If you're being treated by an acupuncture practitioner for a health condition or are considering having acupuncture, it's advisable to discuss this with your GP.

How acupuncture is performed

An initial acupuncture session usually lasts 20 minutes to 1 hour and involves an assessment of your general health, medical history and a physical examination, followed by insertion of the acupuncture needles.

Courses of treatment often involve several separate sessions, but this can vary.

Insertion of the needles

The needles are inserted into specific places on the body, which practitioners call acupuncture points.

During the session, you'll usually be asked to sit or lie down. You may also be asked to remove some clothes so the practitioner can access certain parts of your body.

The needles used are very fine and are usually a few centimetres long. They should be single-use, pre-sterilised needles that are disposed of immediately after use.

Acupuncture practitioners choose specific points to place the needles based on your condition. Several points may be used during a typical session, depending on the number of symptoms you have.

The needles may be inserted just under the skin, or deeper so they reach muscle. Once the needles are in place, they may be left in position for a length of time lasting from a few minutes up to around 30 minutes.

You may feel a tingling or a dull ache when the needles are inserted but you should not experience any significant pain. If you do, let your practitioner know straight away.

Acupuncture safety and regulation

There's no statutory regulation of acupuncture in England.

If you choose to have acupuncture, it is recommended that you check the acupuncture practitioner is either a regulated healthcare professional such as a doctor, nurse or physiotherapist or a member of a national acupuncture organisation.

You can find an accredited register of acupuncture practitioners on the Professional Standards Authority for Health and Social Care website.

When it's done by a qualified practitioner, acupuncture is generally very safe. Rarely, some people experience mild, short-term side effects such as:

pain where the needles puncture the skin

bleeding or bruising where the needles puncture the skin

drowsiness

feeling sick

feeling dizzy or faint

worsening of pre-existing symptoms

If you have a bleeding disorder, such as haemophilia, or are taking anticoagulants, talk to your GP before you have acupuncture.

Acupuncture is also not usually advised if you have a metal allergy or an infection in the area where needles may be inserted.

It's generally safe to have acupuncture when you're pregnant. However, let your acupuncture practitioner know if you're pregnant because certain acupuncture points cannot be used safely during pregnancy.

Read more about the safety of complementary therapies in pregnancy.

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Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes. It is used in many NHS GP practices, as well as in most pain clinics and hospices in the UK.

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alcoholism

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This briefing paper summarises the evidence for the effectiveness of acupuncture in substance misuse - drugs, smoking and alcohol, restricting itself mainly to controlled clinical studies. Although research on the effectiveness of acupuncture for drug misuse is still at an early stage, the evidence is encouraging. Sufficient early trial and empirical findings suggest that there are positive treatment effects.

Indeed, the use of acupuncture is popular and the method documented as quick, safe and potentially valuable as an addition to addiction services (1,2). However, methodological weaknesses in most of the research leave the specific effects of the treatment still open to question. The evidence with respect to alcohol addiction is much less substantial, though on the whole positive; for smoking, the many trials have served to highlight how different interpretations of the same data can result in conflicting conclusions. Further research is essential, and a consensus needs to be reached on how trials should be conducted and how acupuncture can be best incorporated into comprehensive substance abuse programmes.

The Evidence Series of Briefing Papers aims to provide a review of the key papers in the literature, which provide evidence of the effectiveness of acupuncture in the treatment of specific conditions. The sources of evidence will be clearly identified ranging from clinical trials, outcome studies and case studies. In particular this series of briefing papers will seek to present, discuss and critically evaluate the evidence.

Introduction

Both traditional whole body acupuncture and auricular acupuncture have been used to treat people who have problems with addictions to drugs, alcohol and cigarettes. The use of auricular acupuncture in treating acute drug withdrawal is relatively recent, with Wen and Cheung in Hong Kong in 1973 (3,4,5) first describing the effects of acupuncture in alleviating the severity of opiate withdrawal symptoms. The practical application of acupuncture in the traditional drug treatment setting evolved at New York's City Lincoln Hospital during the 1970's.(6) As a result, many acupuncture programs based on the Lincoln protocol were established world wide in a variety of settings. The work was extended to the treatment of other substance misuse disorders such as addiction to cigarettes and alcohol. The Lincoln protocol is relatively simple. Five small needles (shenmen, 'sympathetic' 'kidney', 'liver' and 'lung' on each ear) (7) are inserted at points regarded as specific for chemical dependency (8,9). Many acupuncturists do not restrict themselves to ear points, but use certain body points as well. The technique aims to relieve withdrawal symptoms and craving and to improve general relaxation and mental and physical functioning. Treatments last 30-40 minutes and client progress is monitored by regular urine analysis. Acupuncture treatment offers the client support during acute and post acute withdrawal through the relief of classic symptoms. Up to 50 people can be treated in one hour and the programme has claimed considerable success in retaining difficult to treat drug users i.e. out of 1,500 crack clients between 1986-1988, more than 80% were retained after their first treatment (Lincoln Hospital unpublished 1988). In 1985, the National Acupuncture Detoxification Association (NADA) was formed. The organisation was to assist practitioners to acquire the skills to develop Drug and Alcohol programmes. The NADA approach, incorporating auricular acupuncture, was introduced into the UK by John Tindall and is currently used in various drug agencies, particularly in London e.g. Core Trust, Angel Drug Project, City Roads and the Stockwell Project. In October 1991, the National Institute on Drug Abuse sponsored a technical review to discuss the efficacy of acupuncture for the treatment of substance abuse (10). The current status of research and directions for future study were discussed. It was agreed that although potentially useful, studies provided equivocal results because of design, sample size and other factors and that further research was needed. However, it was felt that acupuncture was a safe, effective and inexpensive treatment for addictive diseases, being easily administered and producing significant results.

Literature Search

A search was made on ARRCBASE and Medline using the key words addict*, detox*, substance abuse, substance dependence, narcotic dependence, alcohol, smoking and tobacco and further literature was retrieved from the references identified in the publications obtained. In all, 100 references were identified concerning use of acupuncture and substance misuse. ARRCBASE is a specialist acupuncture database built up by the Acupuncture Research Resource Centre. The database contains articles relevant to Chinese Medicine and acupuncture from the British Library's AMED (Alternative Medicine Database) and the American Medline databases. Of the references retrieved, papers were excluded for one of the following reasons: they were in a foreign language, were predominantly related to treatment and not treatment evaluation, they did not involve insertion of needles (11-14) and one article (15) was published twice. Studies were included in the evidence review if they met the following criteria: human subjects addicted to either drugs (13 studies included), cigarette smoking (20 studies included) or alcohol (4 studies included), a reference/control group was used (i.e. controlled trial design), and needles, press needles, staples or electro acupuncture were used in the acupuncture treatment. In addition, a total of 27 review articles were retrieved which commented on various studies. Selected studies are summarised in tables 1 (drugs), 2 (tobacco) and 3 (alcohol).

Drug Misuse

Introduction

Drug treatment can be divided into the stages of detoxification, rehabilitation and relapse prevention. Acupuncture has been used for all stages of drug treatment. Detoxification refers to the initial phase when a client is experiencing the direct effects of drug tolerance associated with chronic drug use. The therapeutic goals are to counteract the effects of drug withdrawal and return the individual to a relatively 'neutral' or 'normal physiological state. This stage usually requires approximately 3 to 7 days of treatment (2). Rehabilitation is the second stage of treatment for substance dependence and begins after detoxification. This involves a combination of procedures designed to educate the patient about the negative effects of drugs and alcohol, motivate the individual to admit the substance abuse is a problem and to develop effective strategies for sustained behavioural change. This stage varies in duration and treatment setting from 15-90 days or more. Relapse prevention is the third stage of treatment and begins near the rehabilitation phase. The goals are to maintain the gains achieved in earlier phases of treatment and to develop strategies for resisting the temptation to use drugs in the future (10). The greatest challenge in the treatment of substance abuse is relapse (its prevention and management) (1). There is much anecdotal evidence in the literature for acupuncture's success in almost all drug addicted clients at almost all stages of treatment. For detoxification, acupuncture has been used to relieve physical symptoms of withdrawal. During the rehabilitation phase, acupuncture is used to reduce dysphoria and induce a general state of relaxation. For relapse prevention, it has been used to encourage relaxation and relieve or prevent symptoms of drug craving (10).

Specific Studies

In Wen's initial studies on acupuncture and substance abuse, opium addicts receiving electro acupuncture as post surgical analgesia experienced relief from withdrawal symptoms (3,4). Subsequent studies used electro acupuncture and naloxone (analgesic medication) and the patient adjusted the stimulation themselves (16). At one-year follow up, 51% of the subjects in the treatment group were drug free. The number of treatments varied according to the needs and responses of the individual patients and relief of withdrawal symptoms was commonly found. The research methods, however, lacked rigour. Pomerantz reported five successful replications of Wen's findings (17). Smith's research in the late 1970's resulted in establishing the standard for treatment due to his reported clinical experience with many cases (8).

Cocaine

In a six-week, single-blind study of acupuncture for cocaine dependence in methadone maintained patients, 40 patients were randomly assigned to receive daily acupuncture at three auricular sites and one body site (Li4), or at control sites within 2-3 mm of the four active sites (18). Cocaine use decreased significantly for patients in both groups. The only statistical difference between the two types of needle puncture was on ratings of cravings and calculations suggested that very large sample sizes would be required to detect treatment differences. In a prior study, Margolin et al (1993) had used a single-blind study design (n=48) to compare the sensations experienced when needles were inserted into sham and real auricular acupuncture points (19). Both ears were needled, one in sham sites and the other in active sites for cocaine addiction. Subjects completed a questionnaire rating the sensations in the ear and identifying which ear had received real acupuncture. Real points were perceived as more painful than sham points but this outcome was just as likely to have arisen by chance. The effect of auricular acupuncture in reducing cocaine/crack craving and consumption was examined via a single-blind, placebo trial of 150 people seeking treatment (20) for cocaine addiction. Lipton et al (1994) suggested that counselling should have been included in order to affect the psychosocial factors that may lead to relapse. Patients were randomly assigned to experimental or placebo acupuncture treatments which were provided in an outpatient setting for one month. Placebo treatments involved needle insertion at points not used for drug treatment. Outcome measures included reported drug use, attendance, urine drug screens and an Addiction Severity Index measured at each treatment session. Within a two-week period, the treatment group had significantly lower levels of cocaine in their blood relative to the control group. Treatment retention was the same for both. Another randomised controlled trial was carried out in 1995 on 98 subjects abusing cocaine (21). The long-term effects of the five needle NADA protocol was superior to the effects of a one needle auricular treatment. The study also demonstrated the benefits of using an integrated treatment approach within such a programme. Otto et al, in 1998, conducted a single-blind study of auricular acupuncture with 36 cocaine dependent in-patients in a substance abuse treatment unit, to determine whether the treatment could help reduce craving, increase treatment retention and prevent relapse (22). There was regular assessment of both treatment and control groups, but the study failed to show a significant difference even though the group receiving acupuncture remained in treatment longer than those who received no acupuncture. In 1999, the treatment of cocaine addiction using a single-blind, randomised, placebo- controlled design was evaluated using two linked but concurrent studies. The first one randomised 236 residential clients into three groups, true acupuncture, sham acupuncture and conventional treatment without acupuncture (23). The treatment group received acupuncture at three points considered to be specific for substance abuse. Control subjects were treated with three non-specific sham points. The second study randomised 202 day patients into one of three dose levels of true acupuncture (28,16 or 8 treatments). Subjects received acupuncture at five rather than three specific ear points. Sham points were not used in the second study. The data failed to show any significant treatment differences between the three groups in the first study and no differences among the three dose levels of true acupuncture in the second study. However, relative to pre-treatment usage, groups in both studies reported a significant decrease in cocaine consumption.

Heroin

One of the first trials was carried out by Wen and Teo and compared drug abstinence in an ear acupuncture group and a methadone group. The acupuncture group was nearly twice as likely to be free of drugs at one year but no statistics were provided (16). Man and Chuang in 1980 employed controlled trial methodology to compare electro acupuncture and methadone, but failed to say whether assignment to the two treatments was randomised (24). Withdrawal symptoms were assessed, but with an 83% dropout rate follow up assessment was abandoned. In an electroacupuncture study by Newmeyer et al subjects were allowed to pick the treatment they wanted; acupuncture or medication or both.(25) A questionnaire profiling subjects' mood states was given several times during the trial. There were fewer withdrawal symptoms in the acupuncture group related to pain and psychological states such as depression, irritability or anxiety. There was also less evidence of drug use in the urine screens in this group. Clark's opiate detoxification trial compared acupuncture with methadone and failed to produce a significant difference between the two groups, although the acupuncture group was more likely to have drug free urine at 90 day follow up (26). Geijer (1987) compared treatment outcomes with 65 incarcerated, opiate addicted individuals randomly assigned to methadone detoxification with acupuncture or methadone alone. (31) Significantly fewer withdrawal symptoms were reported by the acupuncture group, who also reported they smoked less (98% compared with 35% of the methadone only group). Note that no placebo acupuncture control condition was used and the reduced withdrawal symptoms could have been due to a placebo effect. A controlled study of detoxification for addiction to heroin randomly assigned 100 addicted persons in a single-blind design (27) to the standard auricular acupuncture treatment used for addiction, or to a sham acupuncture treatment with points that were geographically close to the standard points. Attrition was high for both groups (only 20 subjects completed the study), but those assigned to the standard acupuncture treatment attended the acupuncture clinic more days, reported less heroin use, had less evidence of drug use in urine drug screens and stayed in treatment longer than those assigned to sham treatment. Self-reports of frequency of drug use suggested that those with lighter habits (those using heroin once daily or less) found the treatment modality more helpful. Although this was an encouraging preliminary study, the sample size was small and the self-report nature of the outcome measures precludes any definitive conclusions.

Multi-substance abuse

Patients with substance abuse problems admitted to a psychiatric unit over an 11-month period were offered auricular acupuncture (28). Out of 77 patients offered the treatment, 30 refused or had fewer than four treatments (control groups) and 47 had acupuncture five or more times (treatment group). The treatment group did significantly better than the control groups with 75% compliance with psychiatric/substance abuse treatment versus 20% respectively. Average inpatient stay was 22 days for the treatment group compared with 16 days for the control group. The treatment group were also more likely to stay in follow up treatment for at least four months than the control group i.e. 58% vs 26%. This study obviously has an inherent bias, due to the choice of the control group.

Review And Meta-Analysis

Ter Riet, (29) in 1990, identified 5 controlled clinical studies on heroin use (16,24,25,30, 31). Although four reported positive results (16,25,30,31), their methodological quality was rated as poor and it was felt that the research did not support the efficacy of acupuncture in the treatment of substance misuse. Reported shortcomings were: the reference groups did not all receive sham acupuncture, the patients were not blinded to the treatment, nor were they randomly allocated to their treatment groups.

Conclusion

Since Wen and Cheung's initial reports, numerous descriptive studies citing the effectiveness of acupuncture and/or electro acupuncture as a detoxification treatment for opiate addiction have appeared in the literature (32-45). Much of this research, including Wen and Cheung's (3-5) has been severely criticised in previous reviews for a variety of methodological reasons: the lack of adequate experimental controls and comparison groups (10,14,46,47), the appropriateness of selecting a placebo and the double-blind procedure (10). Following the meta analysis of Ter Riet et al 1990 (29), Brewington et al 1994 (48) conducted a comprehensive review of acupuncture treatment of substance misuse and concluded that the findings did support a role of acupuncture as an aid to treatment of substances abusers. Their review included anecdotal reports, animal studies, studies of human heroin, cocaine and alcohol users in which some form of placebo was used, comparisons of acupuncture with methadone detoxification in opiate addicts and, studies of acupuncture analgesic effects. Although acupuncture has been incorporated as a treatment component in various drug addiction programmes for over 20 years, its efficacy has not been demonstrated in large-scale controlled trials. The critical issues to be addressed in such trials include the choice of appropriate controls, point location for needle insertion, degree of blinding and bias checks. Margolin et al 1998 have discussed these issues in their article on planning a randomised, controlled trial of acupuncture for cocaine addiction (86). However, the above studies indicate that acupuncture may produce a significant effect in terms of treatment retention when compared with sham or placebo procedures, and also that lighter users may respond better than heavy ones in attending the clinic more frequently, and over a longer time period. The limitation for many of these studies was the high attrition rate for all groups and the lack of resources to carry out long term follow up of cases. Additional research is needed to determine how best acupuncture can be incorporated into comprehensive substance abuse treatment programmes.

Smoking Cessation

Introduction

Smoking is the largest single cause of preventable death in industrialised countries (49). People who stop smoking live longer than those who continue to smoke and their risk of developing lung cancer, heart disease, stroke and respiratory illness decreases. Cigarette smoking however remains a difficult habit to break, with many smokers trying several times before they can successfully stop. As a result, assistance is sought from a wide variety of professionals. Acupuncture is a popular treatment for smoking cessation and is believed to reduce associated withdrawal symptoms. The use of acupuncture originated from the work described above on drug addicts in Hong Kong, but the data on effectiveness are contradictory. Uncontrolled studies have suggested an effect on smoking cessation (53,50) and some investigators claim very high (61-95%) rates of success (37, 50), but often this is not based on sound methodological assessment.

Specific studies

Many of the studies on smoking cessation are not comparable (1). Protocols vary as to the location and number of needles, the frequency and duration of treatments, the method used (staples, needles, lasers, electrical stimulation) and the definition of placebo - which may itself produce treatment effects. Disregard of the severity of smoking behaviour and motivational characteristics and the lack of long term follow up and small sample sizes, are the other criticisms that have been made. In a 1977 study 92 subjects who had smoked more than 15 cigarettes for three years were randomised into two groups, either with an indwelling needle in an 'active point' (lung) for one week or an indwelling needle in an 'inactive' auricular point (kidney) for one week (51). At one week those receiving acupuncture at the 'active' site were more likely to have abstained but at a three months follow up abstinence was not sustained. In the same year, Lacroix and Besancon also used bilateral facial acupuncture, in this case, weekly for three weeks, and compared it with sham acupuncture (52). The method of randomisation was not stated in their paper, but they demonstrated a significant effect, with 74% of the acupuncture group stopping smoking compared with 29% of controls. No long- term follow up was reported. Parker and Mok, also in 1977, compared electroacupuncture stimulation to 'effective' auricular points (shenmen and lung) with 'inactive' points (shoulder and eye) over a three week period (53). Although there were indications that the group receiving active treatment were more likely to decrease their cigarette consumption the differences failed to achieve significance. Tan et al (1978) (54), treating patients three times a week, reported a significant decrease in cigarette smoking with laser acupuncture in a controlled trial. In a study of 58 smokers, by MacHovec et al (1978) (55), acupuncture (using a sutured bead on the ear lobe at the acupuncture site for an indefinite time) was compared with hypnosis in individual and group sessions. Self reported smoking cessation was higher for both acupuncture and hypnosis groups compared with controls. Employed self-retained ear seeds. At six months, 25% of the subjects receiving correct site treatment were abstinent, compared with 0% with placebo points. 75% of the experimental group showed improvement (i.e. reduced use or abstinence) six months after treatment compared with 25% of the placebo group. Note that this study did not state whether subjects were randomised, nor did it present any tests of statistical significance. A randomised trial was carried out by Lagrue in 154 smokers (56). Facial acupuncture was repeated after one week, and was compared with sham acupuncture. Although there was no significant difference between the two groups in the number of subjects achieving abstinence, there was 80% reduction in consumption at one week. Lamontagne et al in 1980(57) compared two types of acupuncture therapy, one aimed at smoking withdrawal and the other aimed at enhancing relaxation, which made up the control group in a randomised trial. There was a decrease in cigarette use in the acupuncture group but the effect did not continue for one, three and six month follow up. This was a poor choice of acupuncture control procedure, since the anti-smoking effect of 'relaxation' treatment cannot be ruled out. In the first part of a two part study by Martin et al (58) 132 smokers either received three weeks of indwelling needles in 'effective' auricular points (lung and hunger) plus 20 minutes electro acupuncture to hand and ear sites, or 'ineffective' auricular points (elbow and eye). In the second part of the study 128 smokers were randomised into those receiving the 'effective' auricular points and the same 'ineffective' points. After three weeks there was no significant difference between the groups neither in either study, nor at six months follow up. In 1982, Steiner et al carried out a randomised controlled trial in 23 subjects - people who had been smoking over 20 cigarettes/day for two consecutive years (59). Acupuncture to genuine body and ear points was given over a two-week period and compared to sham acupuncture. No significant difference in immediate cessation was observed between the two groups. Although 80% of the experimental group reported a decreased desire to smoke after treatment compared with 50% of the placebo group, the difference was not statistically significant. Again, the small sample size with this study limited its value. The study by Cottraux in the following year recruited 558 subjects who had smoked 10 or more cigarettes for two years into a study, which compared behavioural therapy, facial acupuncture, placebo capsules and a waiting list control (60). Those in the acupuncture and behavioural therapy groups were significantly more likely to stop smoking at 15 day follow up than the placebo group, but this difference did not carry over to the 9 and 12 month follow up period. In a randomised controlled trial of 130 smokers, acupuncture (auricular and whole body) and conventional medical treatment were compared (61). Abstinence and reduction in smoking were assessed over a 12 month follow up. There was no significant difference between the two groups for either outcome. A similar conclusion was reached by Vandevenne et al, who recruited 200 self referred smokers for a randomised controlled trial where acupuncture (three auricular and two body points) and sham acupuncture were compared (63). There were no differences in immediate cessation or at 1 year follow up. Gillams (62) used an indwelling needle (replaced every week) in 81 subjects who had been smoking more than 50 cigarettes for five years. A group of subjects with an indwelling needle in the auricular point for the lung was used for a period of four weeks, and was compared with a group with a needle placed in an 'inactive' point. Group therapy was given each week to both. At three month follow up again there was no significant difference between the groups, but this is perhaps not surprising given the 'hardened' smokers that were used. A study by Clavel in 1985 (64) demonstrated that subjects treated with either acupuncture or nicotine gum showed a better response than a control group. However, there was no difference between the two active treatments, probably as a result of insufficient numbers. Both were effective in helping smokers to stop, and although about half of these in each group subsequently relapsed, there were still significantly more ex-smokers in the treatment groups than the control at 13 months. In a later trial, Clavel (65) failed to show the efficacy of acupuncture compared with a sham control: both groups produced cessation rates after one month of the order of 22-23%. This was a large study of 996 subjects comparing the use of nicotine chewing gum and acupuncture in a randomised controlled set-up (65). The gum treatment was significantly more effective than it's control (26 v 19%). In a later 2x2 factorial design study, the same authors failed to show a difference in cessation rates between acupuncture and control and nicotine gum and control at 12 month follow up (66). In 1991, Leung's controlled trial compared behavioural therapy with indwelling needles in auricular points in 95 subjects who had smoked for least one year. (67) Subjects were followed up at one, three and six months. The behavioural group was significantly more likely to have stopped smoking than the acupuncture or control group, but the acupuncture group was more likely to have reduced the number of cigarettes smoked. The effects of acupuncture on smoking reduction/cessation and the specificity of points were investigated in 46 healthy men and women volunteers who wanted to stop smoking (68). Subjects were randomly assigned to one of two groups. One group was given effective acupuncture treatment (the test group) and the other given acupuncture treatment at points assumed to have no effect on smoking cessation (control group). Clinical outcomes measured included serum cotinine and serum thiocyanate, the most commonly used physiological indicators of a smoking habit. The daily cigarette consumption fell during the treatment period in both groups but the reduction was significantly greater in the test group. Altogether 31% of those in the test group had quit smoking completely at the end of the treatment compared with none in the control group. For the test group the concentrations of cotinine and thiocynate were reduced significantly after the treatment period. For both groups the taste of tobacco worsened during the treatment period, but the effect was more pronounced for the test group than for the control group. The desire to smoke fell significantly in both groups after treatment, and the reduction was larger for the test group than for the control group. The study suggests that acupuncture may help motivated smokers to reduce their smoking or even quit altogether. In a recent electro acupuncture study, White et al (69) observed no significant difference between the mean reduction in withdrawal symptom scores of two groups between day one and day 14 (39% in the acupuncture group and 42% in the control). At nine months, only three of those quitting at 14 days were still not smoking. The authors concluded that electro acupuncture did not have a specific effect in reducing nicotine withdrawal symptoms. In another randomised placebo-controlled trial in 1998, 78 smokers were given a single treatment of electro acupuncture using needles at either an active or a placebo site plus self retained ear seeds for two weeks, in a general practice setting (70). The active treatment group were more likely to have stopped smoking than the placebo group at six months.

Review And Meta-Analysis

There have been several reviews and meta-analyses carried out in this field, usually analysing many of the same papers but in a different way using different acceptance criteria. A review by Schwartz (1988) (71) used seven studies to analyse a real versus sham acupuncture model involving a total of over 5000 patients, and gave cumulative results, which suggested that real acupuncture works 25% of the time. Sham acupuncture was almost equally effective; cessation rates between 20% and 25% (percentages of people abstinent for 6 months). A meta analysis by Ter Riet et al (1990) (29) noted that the negative outcomes (51,53,56,57,58,59,60,61,62,63,72,74) exceeded by far the number of positive outcomes (52,55,73). The studies with negative outcomes were graded as methodologically superior, indeed they concluded that the more rigorous the methodology, the more likely it was to have a negative outcome, though on the whole the research was of poor quality. A criticism is that the authors were not experts in acupuncture and may therefore have included studies that were unsatisfactory from an acupuncture point of view. In addition, their main conclusion was not that acupuncture did not work, rather that when studies involving real acupuncture and sham acupuncture were analysed, little difference could be detected between the 'real treatment' and 'placebo'. Also, they failed to consider the specificity of the point selection. A review in 1995 argued that trials in which control subjects were needled in inappropriate sites underestimated the effects of acupuncture, since needling anywhere could trigger the release of endorphins, which aid the relief of withdrawal symptoms (75). Lewith concluded that acupuncture is as effective as nicotine replacement therapy but that the site of needle insertion does not seem to be important. He stated that the real versus sham acupuncture model is an inappropriate one to investigate the value of acupuncture in the context of smoking cessation, and that a formal meta analysis is fraught with difficulties in combining the results of disparate studies, which use different time points and techniques. He emphasised that the effects of acupuncture are equal to that of the best studies demonstrating withdrawal from smoking with a variety of nicotine replacement treatments. A more recent review in 1997 was carried out by authors experienced in acupuncture and trial methodology, and based on a synthesis of best evidence (76). This method (77,78) employs the greatest internal and external validity using well-specified criteria. It favours effect size over statistical significance. In this review studies were included if they met the following criteria; single-blind controlled design i.e. controls receive sham acupuncture, pre-allocation concealment of randomisation, appropriate choice of control points, more than 25 subjects in each group. The outcome measure was complete sustained cessation of smoking both immediately after treatment and at the longest follow up period. Sixteen controlled trials were identified (51,52,53,54,56,57,59,60,61,62, 63,66,74). In two cases, two separate studies were reported. The analysis did not find that the 'active' types of acupuncture used were more effective than 'placebo' or 'sham' for smoking cessation. However, they also concluded that sham acupuncture was an inappropriate control, as it was likely to have some physiological effects similar to real acupuncture. If significant differences are to be shown, acupuncture trials should have larger sample sizes. Practitioner blinding was another problem identified although the study by Lagrue (52) did manage to achieve this. The authors of the review suggested that research should now be concentrated on: Is electro acupuncture more successful than simple needle acupuncture? Are other treatment schedules (e.g. different end points, repeated attendances) more effective? Does acupuncture reduce the withdrawal symptoms associated with smoking cessation? In 1998 (amended, 1999) a Cochrane review summarised the data on acupuncture for smoking cessation (79), including a total of 20 trials (51,52,53,56,57,58,59,60,61,62,63,64, 65,66,67,68,69,70,72,74). The authors suggested that acupuncture was not superior compared with sham points for smoking cessation for any time point considered in the review (early after treatment, at six or at 12 months), though three studies produced strongly positive results (52,68,70). Similarly when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point. Acupuncture appeared to be superior to 'no intervention' at early follow up but this difference was not sustained. The results with different techniques did not show any one particular method (i.e. auricular acupuncture or whole body acupuncture) to be superior to control intervention. The review concluded that acupuncture appears to act only as a placebo in smoking cessation. Future research should concentrate on using adequate stimulation and investigating whether acupuncture can lead to a reduction in nicotine withdrawal symptoms.

Conclusion

Although acupuncture has been claimed to be of enormous value in aiding smoking cessation it is likely that this assumption is based on some of the early studies involving hard drug addiction rather than smoking. Different types of acupuncture treatments can be used, the most common being the placement of a small semi-permanent needle into an acupuncture point on the ear. Sometimes this is preceded by electro-stimulation to promote endorphin release, or body acupuncture. There is however, no physiological evidence that acupuncture relieves withdrawal symptoms. The studies described do not demonstrate that acupuncture alone aids smoking cessation but it is thought that it can be a useful technique through which this can be promoted (75). Acupuncture may act as a 'placebo procedure' to help the smoker handle the addictive component of smoking, while it is suggested that, for sustained abstinence, the psychosocial aspects of smoking must be addressed. Hence counselling or behavioural therapy may be needed alongside acupuncture and, as with any smoking cessation method, motivation to quit is necessary for continued abstinence. Whilst this is the mainstream position amongst medical researchers there have been alternative interpretations of the evidence. Some authors have not agreed with the choice of control points used by some investigators. The 'shoulder', 'kidney' and 'eye' points are not thought to be inactive by some, and others have stated that the 'elbow' and the 'eye' points may be effective as they are innervated by the vagus nerve. Further, it has been suggested that the site of needle insertion in general is unimportant, with a non-specific triggering of endorphin release, which may help withdrawal from a number of addictions including smoking (75). It therefore follows that a real-versus sham model is an inappropriate manner in which to investigate the value of acupuncture in the context of smoking cessation. (It also follows that a simple, formulaic procedure may be just as effective as anything else). Re- analysing the trial results simply as acupuncture (whether 'active' or 'sham') versus no acupuncture indicates that its effectiveness in smoking cessation is of the order of 20-30% - as good as the recommended nicotine replacement methods (and similar to results from uncontrolled studies (87)). This size of effect holds only for the short term, but it is perhaps not unreasonable to consider initial cessation and long-term abstinence as two different outcomes, requiring different strategies. The latter may require follow-up acupuncture sessions and a more individualised regime, a proposition as yet untested by controlled research trials. Most studies have involved rather minimal amounts of treatment, while the most intensive/continuous one has produced the most compelling results (68). Thus it seems that many more questions need to be answered before the degree of effectiveness of acupuncture for smoking can be established.

Alcohol

Introduction

Alcoholism is a major health problem in society and its effects range from being a cause of road traffic accidents to increased risk of stroke and mental health problems. There have however, been few controlled trials carried out to valuate the effectiveness of acupuncture to treat people who have problems with alcoholism.

Specific Studies

Four controlled trials on the use of acupuncture in the treatment of alcohol misuse were identified (81,82,83,84). A randomised trial on 54 hardcore alcoholic recidivists was carried out to investigate whether sobriety could be achieved, and episodes of drinking and detoxification centre admissions reduced, as a result of therapy (81). Specific points for substance misuse were compared to non-specific points. Patients in the treatment group expressed less need for alcohol, and had fewer drinking episodes and admissions to the detoxification centre during the study than control patients. The majority of treated patients felt that acupuncture had a definite impact on their desire to drink, whereas, only a few control patients noted this effect. A second placebo controlled study by Bullock in the USA investigated 80 severe recidivist alcoholics who received acupuncture either at points specific for the treatment of substance abuse (treatment group) or at non specific points (control group) (82). A total of 21 out of 40 of the treatment group completed the programme compared with 1 of the 40 controls. Significant treatment effects persisted at the end of the six-month follow-up and more control patients expressed a moderate to strong need for alcohol, and they had more than twice the number of both drinking episodes and admissions to a detoxification centre. The difference in effect size between true and sham acupuncture ranged from 24-36% depending on the measure used and the stage of treatment. Worner et al (83) described a replication of Bullock's study (82). A total of 56 alcoholics, one third of whom had also reported illicit drug use were examined. Clients were allocated to one of three treatment groups, specific acupuncture, sham transdermal stimulation or standard care. They used rates of completion of treatment and detoxification as outcome measures. Results showed no significant differences across a number of criteria between the three groups. Once again this study suffered from small sample sizes (20 per group). More recently Rampes et al in the UK carried out a 6-week single-blind randomised controlled trial to determine the effectiveness of auricular acupuncture in reducing the craving for alcohol (83). Groups were randomised to specific electro acupuncture treatment, non-specific electro acupuncture treatment or normal treatment. A significant reduction in craving was observed for both acupuncture groups and a 44% increase in craving for controls at week 8. By week 24, there were no such differences between the groups. Numbers in each arm of the study were however, small.

Review And Meta Analysis

Ter Riet's analysis (29) of two of the above studies (81,82) concluded that they were of insufficient quality and therefore interpretation was not meaningful. Although the results suggested that acupuncture may be helpful in breaking the cycle of alcohol misuse, the number of subjects was small (less than 50 per group) and the high dropout rate in the placebo group could have biased the results. In addition, the results were not validated with biochemical measures and self reported data on alcohol consumption. Following Rampes article (84), Ter Riet carried out a second analysis based on the criteria used in the previous one and confirmed that the study did not provide evidence that electro- acupuncture was efficacious in the treatment of addiction to alcohol (85).

Conclusion

Although the studies that evaluated the use of acupuncture in treating people with alcohol problems have been limited, they have on the whole provided positive results. (Indeed, Meyer (88), in a very recent review, contends that it is only Bullock et al's alcohol studies that provide good evidence of efficacy in any area of substance abuse). There have been high dropout rates: future studies should focus on the reasons for this, and thus limit loss to follow up. The studies considered in this section are very different from each other. For example Worner et al (83) used several body points in addition to 2 ear points, Bullock used 3 ear points and a hand point (81,82). Worner used sham acupuncture but Bullock did not. Worner had a standard-care-only treatment group; Bullock's attended minimal AA style group meetings. The frequency and duration of acupuncture differed, as did the length of treatment. The sample sizes were small in both studies. Comparison of these two studies typifies the problems in summarising substance abuse acupuncture research in general. The treatments are not comparable; the study design, analysis and sample sizes differ in significant ways. The methodological inadequacies make it difficult to interpret the results, which are thought to be inconclusive when considered in the reviews and meta-analyses of the medical literature. Grateful acknowledgement is made to Nicola Robinson and Mark Bovey for their work in preparing this briefing paper.

{/tab} {tab title=References}

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Table 1. Drug misuse and acupuncture: the evidence for effectiveness

Study

Sample size

Method

Control

Follow up

Outcome Measures

Results

Stats

1

Wen & Cheung
1973
(Opium Heroin)

40

No control

12 mths

Withdrawal symptoms
Urine analysis

Relief of withdrawal symptoms
51% drug free (A)

P<0.05

2

Avants, Margolin et
al 1995
(Cocaine)

40

Ear acupuncture (A)
+ 1 body site
6 week course

Placebo (C)

6 wks

3

Lipton et al 1994
(Cocaine)

150

Ear acupuncture (A)

Sham points (C)

1 mth

Urine analysis
Treatment retention

P<0.05

4

Konefal et al 1995
(Various
substances)

98

1 needle (ear) (C)

16 wks

Urine analysis

P not
stated

5

Otto et al 1998
(Cocaine)

36

Ear acupuncture (A)
12 wk programme

Sham points (C)

12 mths

Craving
Treatment retention

No reduction in craving
High drop out rate - only 4
completed whole course

NS

6

236

202

Ear acupuncture (A)
8 wks (28 times)

3 different dosage
regimes in 8 wks:
28,16 or 8 treatments

P= 0.007

NS

7

Wen & Teo 1975
(Heroin)

35

Ear Acupuncture (A)

Methadone (M)

12 months

Drug abstinence

51% (A) 29% (M) free of drugs
at l year

None
provided

8

Man and Chuang 1980
(Opiates)

35

Methadone (M)

Discontinued

Urine analysis
Withdrawal symptoms
Craving

Only 3 patients in each group
completed the study
83% drop out

No
analysis

9

Newmeyer et al 1984
(Heroin)

132

Electro-acupuncture (A)
Electro-acupuncture &
medication

Medication (M)

6 mths

Not
provided

10

Geijer 1987 (Opiates)

65

Acupuncture (A)
+ Methadone

Methadone (M)
No placebo
control

Unknown

Withdrawal symptoms
Reduction in drug use

Reduction in withdrawal symptoms
in acupuncture group
98% (A) 35% (C)

P<0.05

11

Clark 1990
(Opiates)

84

Ear acupuncture (A)

Methadone (M)

90 days

Urine analysis.

12

Washburn et al
1993
(Heroin)

100

Ear acupuncture (A)

Sham points (C)

3 wks

13

77

Ear acupuncture (A)
(>5 treatments)

12mths

Continuation of treatment
Compliance with treatment
Discharge rate
Acceptance of staff's
discharge recommendations
Remained in FU for at least 4 mths
Average inpatient stay
Immediate relapse

*A acupuncture M methadone C control NS = (statistically) non-significant

Table 2. Smoking cessation and acupuncture: the evidence for effectiveness

Study

Sample size

Method

Control

Follow up

Outcome Measures

Results

Stats

1

Lacroix &
Besancon 1977

117

Facial acupuncture (A)
1 per wk x 3 wks

Sham points (C)

3 wks

Abstinence

74% (A) 29% (C) immediate
cessation

P<0.01

2

Gilbey 1977

92

Ear acupuncture with
press needle (self
stimulated) (A)

Sham points - press
needle (C)

3 mths

Smoking cessation

36% (A) 33% (C) immediate
20% (A) 15% (C) at follow up

NS

3

Parker & Mok
1977

41

Electro-acupuncture (A)
Press needle (A)
2 per wk x 3 wks

Sham electroacupuncture
(C)
Sham acupuncture (C)

6 wks

Decrease in cigarette
smoking

NS

4

Tan & Huang
1978

104

Laser acupuncture (A)
3 per wk x 2 wks

Laser probe near skin (C)

None

Decrease in cigarette
smoking

75-100% reduction in smoking in
acupuncture group

Sig

5

MacHovec &
Man 1978

58

Sutured plastic bead at
acupuncture site (A)
Single treatment

Hypnosis
Group hypnosis
Sham points (C)

6 mths

Abstinence
Improvement

25% (A) 0% (C)
75% (A) 25% (C)

None given

6

Lagrue et al 1980

154

Facial acupuncture (A)
1 per wk x 2 wks

Sham points (C)

None

Abstinence
Reduction in smoking

44% (A) 40% (C) immediate
cessation
80% reduction at 1 wk

NS

7

Lamontagne et al
1980

75

Ear acupuncture (A)
1 per wk x 2 wks

Acupuncture for
relaxation (C)

6 mths

Reduction in smoking

29% (A) 36% (C) immediate
cessation
8% (A) 16% (C) at follow up

P<0.05

8

Martin & Waite
1981

260

Indwelling ear needles +
electro-acupuncture (A)
1 treatment

Sham ear points (C)

6 mths

Abstinence and reduction

16% (A) 27% (C) immediate
cessation
12% (A) 10% (C) at follow up

NS

9

Steiner et al 1982

32

Ear and body acupuncture
(A)
2 per wk x 2 wks

Sham acupuncture (C)

4 wks

Abstinence
Decrease in desire to smoke

Immediate cessation:
9% (A) 9% (C)
80% (A) 50% (C)

NS
NS

10

Cottraux et al
1983

558

Facial acupuncture (A)
3 per wk x 1 wk

Behaviour therapy
Untreated control (C)
Placebo capsule x 3

12
mths

Abstinence

21% (A) 8% (C) at 2 wks
16% (A) 7% (C) at follow up

P<0.05
NS

11

Labadie 1983

130

Ear and whole body
acupuncture (A)
1 treatment (possibly more)

Drugs (tranquillisers,
detox agents) (C)

12
mths

Cessation at follow up
Reduction in smoking

32% (A) 31% (C)
16% (A) 11% (C)

NS

12

Gillams et al 1984

81

Press needle + group therapy
(A)
1 per wk x 4 wks

Press needle in wrong
point + group therapy
(C)

3 mths

Abstinence

32% (A) 30% (C) immediate
cessation
18% (A) 15% (C) at follow up

NS

13

Vandevenne et al
1985

200

Face and body points (A)
4 treatments over 3 wks

Sham points (C)

1 yr

Abstinence

37% (A) 33% (C) immediate
cessation
20% (A) 15% (C) at follow up

NS

14

Clavel et al 1985

651

Facial acupuncture (A)
1 treatment only
Nicotine gum (G)

Sham points (C)
+ Group therapy

13mths

Cessation rate
Carbon monoxide

P=0.0001
P=0.002

15

Clavel and
Paoletti 1990

996

Acupuncture (A)
Nicotine gum (G)
3 treatments over 1 mth

Sham points (C)
Placebo gum (C)

1 mth

Cessation rate

22% (A) 23% (C)
26% (G) 19% (C)

NS
P<0.05

16

Leung 1991

95

Press needles (A)

Behavioural therapy (B)
Control group (C)

6mths

Abstinence
Daily consumption

16% (A) 33% (B) 4% (C)
2% (A) 35% (B) 90% (C)

P<0.001
P<0.001

17

He et al 1997

46

Sham points (C)

Serum cotinine/thiocyanate
Taste/desire
Smoking cessation

Both reduced
Worse/less
31% (A) 0% (C)

P<0.001
<.05/<.001
P<0.002

18

White et al
1998

76

Electro-ear acupuncture (A)
on days 1, 3 and 7

Sham points (C)

9 mths

Cessation
Reduction in withdrawal
symptoms

No difference (A) and (C) at 9
mths
39% (A) 42% (C) at 2 wks

NS
NS

Waite & Clough
1998

78

Electro-acupuncture
+ ear seeds (A)
2 wks

Placebo site
+ ear seeds (C)

6 mths

Smoking cessation

12.5% (A) 0% (C) ceased
smoking at 6 mths

P=0.055

* A acupuncture AS sham acupuncture C control NS = (statistically) non-significant

Table 3. Alcohol misuse and acupuncture: the evidence for effectiveness

Study

Sample size

Method

Control

Follow up

Outcome Measures

Results

Stats

1

Bullock et al 1987

54

Acupuncture
2½ mth period

Sham points

2½ mths

Programme attendance
Self reported need for
alcohol

P<0.05

2

Bullock et al 1989

80

Acupuncture
2months (A)

Sham points (C)

6 mths

Number of completed
treatment programmes
Number feeling indifferent
to alcohol at 6 mths
Number of drinking
episodes at 6 mths
Number abstinent at 6 mths
Admissions to detox unit
Job applications made

More completions:
21/40 (A) 1/40 (C) self reported
Less need for alcohol:
22 (A) 10(C)
Fewer drinking:
100 (A) 241 (C)
Greater abstinence: 12 (A) 4(C)
Fewer admissions: 0.69 (A) 1.56 (C)
75% (A) 45%(C)

3

Worner 1992

56

Acupuncture
(body and ear)
3mths (A)

Transdermal
stimulation
Standard care (C)

6mths

Figures not reported

NS

4

Rampes et al 1997

59

Sham points (AS)
Standard care (C)

6 mths

NS
NS
NS

* A acupuncture AS sham acupuncture C control NS = (statistically) non-significant

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Substance abuse and acupuncture: the evidence for effectiveness

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This briefing paper summarises the evidence for the effectiveness of acupuncture in substance misuse - drugs, smoking and alcohol, restricting itself mainly to controlled clinical studies. Although research on the effectiveness of acupuncture for drug misuse is still at an early stage, the evidence is encouraging.

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alcoholism

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Background

Approximately 3.3 million deaths worldwide are attributed to alcohol dependency per year [ 1]. The prevalence of alcohol dependency in the UK in 2010 was estimated at 5.9% of the population (8.7% of men and 3.2% of women), compared with 4% in Europe [ 1, 2]. A dependent drinker who stops drinking will experience alcohol withdrawal syndrome; this is a distressing and life-threatening condition with symptoms that range in severity, including tremors, agitation, paroxysmal sweats, fever, nausea, and seizures [ 3]. These symptoms typically occur within the first 24 h of stopping drinking and can last a number of weeks [ 4].

In England, treatment for alcohol dependency is received by a minority (6%) of an estimated 1 million people aged 16-65 years who are alcohol dependent [ 2]. The UK National Institute for Health and Care Excellence (NICE) reports that non-pharmacological treatments are an important therapeutic option for people with alcohol-related problems, and that acupuncture is valued by service users with alcohol-related problems [ 2]; however, NICE acknowledges that the evidence base for the effectiveness of acupuncture is weak [ 2].

A preliminary search of the field identified two reviews specifically related to acupuncture as an intervention for alcohol disorders [ 5, 6]. The review by Kunz et al. [ 5] included 14 studies investigating the effectiveness of auricular acupuncture in the treatment of withdrawal from substances (opiate, cocaine, and alcohol). The authors decided not to conduct a meta-analysis owing to potential systematic and selection biases. The findings for the review were inconclusive and the effectiveness of auricular acupuncture as an intervention for withdrawal was not determined. The included studies lacked rigorous methodology, resulting in reduced internal validity. In this review, Chinese language studies were excluded.

A subsequent review by Cho and Whang [ 6] included 11 studies and did not limit acupuncture techniques to auricular acupuncture [ 6]. A meta-analysis for treatment completion rates identified no statistically significant difference between acupuncture and either sham or no acupuncture groups. The results were equivocal and the included studies lacked rigorous methodology. However, the review included languages other than English, which increased its robustness.

An updated review is needed, using rigorous review methods. In the present review, we refined the search for acupuncture as a treatment for alcohol craving and withdrawal symptoms in alcohol-dependent individuals. We included randomised controlled studies (RCTs) published in both the English and Chinese literature, and conduct meta-analyses on the main outcome measures. Therefore, the present review expands on the existing research in this area to provide fresh and relevant evidence from all RCTs to establish whether acupuncture is effective in reducing alcohol craving and withdrawal symptoms.

Methods

Eligibility of studies for this systematic review

Inclusion and exclusion criteria were pre-specified (Table ).

Search method

The following English language databases were searched up to June 2015: AMED (OvidSP) (from 1985), the Cochrane Library, EMBASE (OVID) (from 1946), MEDLINE (OVID) (from 1946), PsycINFO (from 1987), and PubMed (from 1970); and the following Chinese language database were searched up to June 2015: CNKI (from 1994), Sino-med (from 1960), VIP (from 1989), and WanFang (from 1998). Table presents the keywords used, and Appendix S1 (Additional file 1) provides the MeSH terms and keywords used in the Medline (OVID) search.

Study selection

CS screened the Western databases; titles and abstracts were analysed to exclude irrelevant and duplicate studies. CW screened the Chinese literature using the same criteria. All relevant studies were retrieved as full reports for detailed evaluation. Any study that did not satisfy the inclusion criteria was excluded.

Data extraction

Data were extracted by CS on study design, participant characteristics, results, and statistical information. Translations of the full Chinese reports were undertaken by TZ at the University of York; these translations were clarified by CS, with further clarification from CW.

Quality assessment

The included RCTs were assessed for bias and scored using the Cochrane Risk of Bias tool [ 7], and for methodological quality using the Jadad Scale [ 8].

Narrative synthesis

A narrative synthesis was performed to provide a basis for assessing each RCTs contribution to the research question in terms of interpretation, synthesis, and triangulation regarding the quantitative data.

Quantitative synthesis

Meta-analyses produced the overall effect estimates for the two primary outcomes related to craving and withdrawal symptoms. Continuous outcomes (Visual Analogue Scale and Likert-scaled options used to assess craving and Alcohol Withdrawal Syndrome Scale, the Mainz Alcohol Withdrawal Scale, and the Clinical Institute Withdrawal Assessment for withdrawal) were presented as the standardised mean difference (SMD) with 95% confidence intervals (CI). As each RCT did not use the same acupuncture technique, we could not assume that acupuncture in each RCT was estimating the same effect, therefore we used a random-effects model for meta-analyses. For RCTs containing either two acupuncture groups or two sham acupuncture groups, both arms were combined for the analyses. Analyses of data on craving and withdrawal outcomes at the end of the intervention phase were performed using Comprehensive Meta-Analysis Version 2 software (Biostat Inc, Englewood, NJ, USA). Forest plots were drawn using our own routines in Stata (Stata Corp, College Station, TX, USA)

Assessment of heterogeneity

Clinical heterogeneity was explored through the narrative synthesis, identifying any variations in participants and interventions. Clinical heterogeneity was present in each meta-analysis owing to differences in the acupuncture techniques used and participant status (inpatient or outpatient) in the experimental interventions. Statistical heterogeneity was investigated for I ² statistics above 50%, i.e. demonstrative of moderate heterogeneity [ 9]. Secondary analyses based on variations in RCT characteristics were used to explore potential sources of heterogeneity.

Discussion

Major findings

Our review comprised 15 RCTs with 1378 patients from eight countries published in either Chinese or English. Our findings provide the first clear evidence that acupuncture might be considered an effective intervention for alcohol dependence. This evidence of significant effectiveness was observed in our two primary analyses, one showing a reduction in alcohol craving and one showing a reduction in withdrawal symptoms. In all three of our secondary analyses, we found significant reductions in alcohol craving: comparing acupuncture versus sham acupuncture; comparing acupuncture with controls in only those RCTs conducted in Western countries; and in those RCTs that recruited males only. We note that the effect size of acupuncture when all RCTs are combined is slightly larger than when compared with sham acupuncture RCTs or with Western-based RCTs, and is slightly smaller when compared with male-only RCTs. While the overall effect estimate favoured acupuncture for all analyses, some of the individual RCTs found non-significant effects of acupuncture on alcohol dependence. By pooling the data across RCTs, we increased the overall power, which led to the conclusion that acupuncture was an effective intervention.

The present review has identified pre-specified secondary analyses to explore reasons for potential heterogeneity and aid interpretation. The I ² value for acupuncture versus all controls for alcohol craving was 83.8%; this value reduced slightly for the analysis of acupuncture versus sham acupuncture in alcohol craving (77.4%). An analysis of alcohol craving in Western-based RCTs showed increased heterogeneity (89.1%). An analysis of acupuncture for male-only participants for alcohol craving substantially reduced the heterogeneity (55.1%). Interpreting these values with reference to the 50% threshold [ 9] indicates that the results must be treated with caution.

Strengths and limitations

The included RCTs were rigorously assessed using two quality assessments. The included RCTs were not all of a high standard, with 10 of the 15 RCTs scoring two or less on the Jadad scale. Moreover, only eight RCTs contained sufficient statistical information on outcomes for meta-analysis; this limited the scope for comparing acupuncture with some controls. For example, because of a lack of sufficient quantitative outcome data we were unable compare acupuncture with treatment-as-usual. While we have combined changes in continuous outcomes using standardised mean differences for the purposes of conducting the meta-analyses, the individual measures of craving and withdrawal symptoms may have different measurement characteristics, which would lead to an increase in heterogeneity. Furthermore, most of the included RCTs contained a small sample size. These factors resulted in a small number of participants being included in the final analyses. The present review did not include a sufficient number of RCTs to address publication bias.

The majority of the included RCTs were conducted in a hospital setting; therefore, generalisation of the results to community settings must be done with caution. The clinical heterogeneity associated with the different acupuncture techniques limits our ability to identify which technique was more effective for treatment of alcohol disorders. Acupuncture treatments also varied in duration, frequency, and the acupuncture points used, making it difficult to assess the key characteristics that might be associated with the effectiveness of the intervention. Whilst some RCTs combined auricular acupuncture and body acupuncture as part of the same treatment, most RCTs involved either auricular or body acupuncture. Given the potential variation in modes of action, combining these two modalities (either within RCTs or between RCTs), will add to the clinical heterogeneity. Sham acupuncture also varied across RCTs. Moreover, sham acupuncture cannot be considered a physiologically inert intervention, thereby potentially leading to an underestimate of the effect of the acupuncture.

Comparisons with previous systematic reviews

The present review included an increased number of RCTs (n = 15) compared with the previous reviews of Kunz et al. [ 5] (n = 6) and Cho and Whang [ 6] (n = 11). Kunz et al. [ 5] did not conduct a meta-analysis, and reported that there was insufficient evidence to conclude whether auricular acupuncture is an effective intervention in the treatment of alcohol and substance abuse. Cho and Whang conducted a meta-analysis of acupuncture versus sham acupuncture for treatment completion rates, reporting no significant differences [ 6] but no meta-analysis was conducted by them for craving because of insufficient data. By contrast, our study found sufficient data to conduct a meta-analysis of craving with six trials included [ 10, 14- 16, 18, 23]. Moreover, the present review is the first to provide a meta-analysis of withdrawal symptoms, albeit based on only two RCTs [ 11, 24]. The results we present here therefore represent an update of the evidence, with the caveat that our results are based on a small number of RCTs with variable risks of bias.

Implications for research and practice

Non-pharmacological treatments are an important therapeutic option for people with alcohol-related problems, and there is some evidence that acupuncture is valued by service users [ 2]. Recommendations for future studies to improve the quality and statistical power of the next review on this topic include:

Larger sample sizes Further RCTs with larger sample sizes are needed. An increased sample size increases power statistically, enhancing a meta-analysis. Large sample sizes also provide the opportunity to explore potential moderators and mediators of response.

Relevant statistical information reported Summary statistics on outcomes should be reported to a high standard so that these data can be included, thereby enhancing the robustness of the meta-analyses. An assessment for publication bias could also be conducted using a funnel plot.

Female participants More studies should recruit female as well as male participants, so that results can be better generalised to the female population of problem drinkers.

Longer-term follow ups for at least 1 year are recommended, along with parallel cost-effectiveness analyses.

Increase methodological quality Future studies should follow STRICTA recommendations [ 26], which are guidelines specifically aimed at producing high quality reporting of acupuncture interventions, and the Consolidated Standards of Reporting Trials (CONSORT) statement [ 27], which are guidelines on study design and reporting to reduce potential bias and increase methodological quality.

Contributor Information

# data[].attributes.attachment_link.title
Acupuncture as an intervention to reduce alcohol dependency: a systematic review and meta-analysis

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Acupuncture has been widely used as a treatment for alcohol dependence. An updated and rigorously conducted systematic review is needed to establish the extent and quality of the evidence on the effectiveness of acupuncture as an intervention for reducing ...

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study for depression

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Abstract

Objective To summarise the existing evidence on acupuncture as a therapy for depression.

Methods RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted independently by two authors. The methodological quality was assessed. Pre and post means and SDs for depression specific measures were extracted, when available, for meta-analysis.

Results Seven randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication, weighted mean difference −0.43(95% CI −5.61 to 4.76). There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs.

Conclusion The evidence from controlled trials is insufficient to conclude whether acupuncture is an effective treatment for depression, but justifies further trials of electroacupuncture.

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The effectiveness of acupuncture for depression - a systematic review of randomised controlled trials

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Objective To summarise the existing evidence on acupuncture as a therapy for depression. Methods RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted independently by two authors. The methodological quality was assessed.

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effectiveness - studies included (DEPRESSION)

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Depression is a common mental health problem that affects people of all genders, ages, and backgrounds. About two thirds of adults will at some time experience depression severe enough to interfere with their normal activities (Mintel/YouGov, 2006, Stewart et al, 2004).
Women are twice as likely as men to become depressed (Stewart et al, 2004) partly due to hormone changes occurring pre-menstrually, at menopause, during pregnancy or after childbirth. Depression is estimated to cost the UK £7.5 billion a year in medication, benefits and lost working days (McCrone et al, 2008). The World Health Organization predicts that by 2020 depression will be second only to chronic heart disease as an international health burden (WHO, 2008

Although everyone occasionally experiences low mood, these feelings usually pass after a couple of days. When a person has clinical depression, these problems can become chronic or recurrent, interfering with daily life. Depression causes symptoms such as low mood, loss of interest in enjoyable activities, anxiety, irritability low self-esteem, disturbed sleep or appetite, weight change, tiredness, lack of motivation, concentration or libido, physical pain, and suicidal thoughts.

Depression is likely to result from a combination of genetic, biochemical, environmental, and psychological factors. It may be triggered by stressful events, such as bereavement, illness, relationship problems or financial difficulties.

References

Mintel/YouGov. Depression poll commissioned by the British Association for Counselling and Psychotherapy. 2006 Apr.

Stewart DE, Gucciardi E, Grace SL; Depression. BMC Women's Health. 2004 Aug 25;4 Suppl 1:S19.

McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S. Paying the Price: The cost of mental health care in England to 2026. The King's Fund, May 2008, ISBN 978 1 85717 571 4.

World Health Organization. 2008. http://www.who.int/mental_health/management/depression/definition/en/

How acupuncture can help

Most research on acupuncture for depression has been carried out in China with Western drugs as comparators. Two recent systematic reviews, both drawing on Western and Chinese data, found that acupuncture was similar in effectiveness to anti-depressant medication and not significantly better than sham acupuncture or waiting list controls. However, they reached very different conclusions, one recommending acupuncture (Zhang 2010) and one stating that the evidence was insufficient (Smith 2010). Major issues to consider in respect of the research evidence are a) how trustworthy are Chinese studies (Ernst 2010), b) how valid are sham controlled trials (Schroer 2010), and c) how relevant to normal practice is the acupuncture provided in trials (Schroer 2010). Notions about acupuncture's placebo properties (Ernst 2010) can only be speculative, and with little relevance to decisions about patient benefit. Given that acupuncture appears to be at least as effective as existing conventional drugs, without their level of side effects, it should be considered as one of the therapeutic options, alongside the existing repertoire. Two specific situations, during pregnancy (Manber 2010) and post-stroke (Zhang 2010; Smith 2010), seem to be particularly favourable for incorporating acupuncture treatment. (See table overleaf)

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional wellbeing.

Studies indicate that acupuncture can have a specific positive effect on depression by altering the brain's mood chemistry, increasing production of serotonin (Sprott 1998) and endorphins (Wang 2010). Acupuncture may also benefit depression by acting through other neurochemical pathways, including those involving dopamine (Scott 1997), noradrenaline (Han 1986), cortisol (Han 2004) and neuropeptide Y (Pohl 2002).

Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain which is responsible for anxiety and worry (Hui 2010). Stress-induced changes in behaviour and biochemistry may be reversed (Kim 2009).

Some of the most recent research suggests that depression is associated with dysfunction in the way that parts of the resting brain interact with each other (Broyd 2008); acupuncture has been shown to be capable of changing the 'default mode network' (Dhond 2007), but the effect goes beyond that of expectation/placebo (Hui 2010).

Acupuncture can be safely combined with conventional medical treatments such as anti-depressants, helping to reduce their side effects and enhance their beneficial effects (Zhang 2007).

Acupuncture treatment can also help resolve physical ailments such as chronic pain (Zhao 2008), which may be a contributing cause of depression. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in overcoming depression. Finally, people struggling to cope with depression usually find that coming to see a supportive therapist on a regular basis is helpful in itself.

About traditional acupuncture

Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote and maintain good health. Its benefits are now widely acknowledged all over the world and in the past decade traditional acupuncture has begun to feature more prominently in mainstream healthcare in the UK.

Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is unique to each individual. The traditional acupuncturist's skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective treatment.

The World Health Organisation (WHO) recognises that acupuncture can help resolve specific symptoms or conditions. Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general wellbeing

About the British Acupuncture Council

With over 3000 members, the British Acupuncture Council (BAcC) is the UK's largest professional body for traditional acupuncturists. Membership of the BAcC guarantees excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk

The evidence

Research

Conclusion

Reviews

Ernst E, Lee MS, Choi TY Acupuncture for Depression? A Systematic Review of Systematic Reviews. Eval Health Prof. 2010 Dec 7. [Epub ahead of print]

Schroer S, Adamson J. Acupuncture for Depression: A Critique of the Evidence Base. CNS Neurosci Ther. 2010 Nov 21[Epub ahead of print]

Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Disord. 2008 Dec;111(2-3):125-34.

Leo RJ, Ligot JS Jr. A systematic review of randomized controlled trials of acupuncture in the treatment of depression. J Affect Disord. 2007 Jan;97(1-3):13-22.

Systematic review and meta analysis of acupuncture as a treatment of depression, which analysed the pooled results of nine small randomised controlled trials. Found that; 'acupuncture modalities were as effective as antidepressants employed for treatment of depression'.

Clinical studies

Manber R et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstetrics and Gynecology. 2010; 115(3):511-520.

Randomized controlled study of acupuncture for depression during pregnancy, involving 150 women. Eight weeks of acupuncture at points specifically chosen to treat depression was significantly more effective than either non-specific acupuncture or the average of both control groups (the 2 nd was massage). The response rates were 63% for specific acupuncture, 37.5% sham acupuncture and 50% massage. They concluded that a short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those of standard depression treatments, and hence could be a viable treatment option.

Fu WB, Fan L, Zhu XP, He Q, Wang L, Zhuang LX, Liu YS, Tang CZ, Li YW, Meng CR, Zhang HL, Yan J. Acupuncture for treatment of depressive neurosis: a multi-center randomized controlled study. Zhongguo Zhen Jiu. 2008 Jan;28(1):3-6.

Multi-centre randomized controlled study of acupuncture for depression, involving 440 cases. Found the therapeutic effect of acupuncture on depression to be similar to or better than that of Prozac, with fewer side effects.

Zhang GJ, Shi ZY, Liu S, Gong SH, Liu JQ, Liu JS. Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine. Chin J Integr Med. 2007 Sep;13(3):228-30.

Röschke J, Wolf C, MÃ¼ller MJ, Wagner P, Mann K, Grözinger M, Bech S. The benefit from whole body acupuncture in major depression. J Affect Disord. 2000 Jan-Mar;57(1-3):73-81.

Randomized controlled study of acupuncture used in conjunction with antidepressants to treat depression, involving 70 patients. Concluded that acupuncture plus antidepressants improved the course of depression more than medication alone.

Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol Psychiatr. 2000 Mar;68(3):137-44.

Randomized controlled trial of acupuncture treatment in 43 patients with minor depression. Results indicated that, compared with placebo treatment, acupuncture leads to a significant clinical improvement in depression as well as a marked reduction in anxiety symptoms.

Physiology studies (human and animal)

Studies have shown that acupuncture stimulation, when associated with sensations comprising deqi, evokes deactivation of a limbic-paralimbic-neocortical network, as well as activation of somatosensory brain regions. These networks closely match the default mode network and the anti-correlated task-positive network. The effect of acupuncture on the brain is integrated at multiple levels, down to the brainstem and cerebellum and appears to go beyond either simple placebo or somatosensory needling effects. Needling needs to be done carefully, as very strong or painful sensations can attenuate or even reverse the desired effects. Their results suggest that acupuncture mobilizes the functionally anti-correlated networks of the brain to mediate its actions, and that the effect is dependent on the psychophysical response. They discuss potential clinical application to disease states including chronic pain, major depression, schizophrenia, autism, and Alzheimer's disease.

The effects of acupuncture on the behavioral responses induced by chronic mild stress (CMS) were evaluated in rats by using a maze and a sucrose intake test. C-fos expression in the brain was examined by immunohistochemistry. Acupuncture stimulation at point P6 (3 min) (but not at point SJ5) reversed stress-induced behavioural changes and significantly attenuated c-fos expression in the hypothalamus, suggesting that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.

Dhond RP, Yeh C, Park K, Kettner N, Napadow V. Acupuncture modulates resting state connectivity in default and sensorimotor brain networks. Pain. 2008 Jun;136(3):407-18.

Experimental fMRI study of brain activity before and after acupuncture. Found that verum acupuncture had a persistent effect on the connectivity of different brain areas during its resting-state. Acupuncture increased the extent of regions of the brain active at rest (the 'default mode network') to include areas involved with pain, emotion and memory.

Zhao ZQ, Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.

Review of evidence for neural mechanisms underlying acupuncture analgesia and its ability to treat chronic pain.

Han JS. Electroacupuncture: An alternative to antidepressants for treating affective diseases? Intl J Neurosci 1986;29:79-92.

Review presenting evidence that acupuncture can accelerate synthesis and release of serotonin and noradrenline in the CNS.

Additional Info

Terms and conditions:
Terms and conditions The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its website www.acupuncture.org.uk.

Last modified on Wednesday, 04 February 2015 16:58

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Depression is a common mental health problem that affects people of all genders, ages, and backgrounds. About two thirds of adults will at some time experience depression severe enough to interfere with their normal activities (Mintel/YouGov, 2006, Stewart et al, 2004).

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lots of studies for effectivness of acupuncture (schizophrenia

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Review of Acupuncture for Schizophrenia | ENCOGNITIVE.COM

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There is a paucity of scientific data on the use of acupuncture or low-power laser treatment in schizophrenia. The authors have conducted a literature search, identifying eight papers on the subject: all were significantly flawed, most seriously so. The papers suggest that acupuncture and lowpower laser treatment may be as effective as chlorpromazine in schizophrenia.

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good for effectivness - studies included (Schizophrenia)

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Q: Is acupuncture effective in the treatment of schizophrenia?

A: Although the World Health Organisation lists schizophrenia as one of the conditions which acupuncture can treat, the evidence, such as there is, is not that convincing. Published studies and reviews such as:

http://www.ncbi.nlm.nih.gov/pubmed/22076901

http://www.ncbi.nlm.nih.gov/pubmed/19832819

are very cautious in their conclusions, and very limited in the scope of the outcomes which they measure.

We are mainly concerned, with conditions such as this, that a practitioner may be out of their depth in managing a patient. Although we have not yet set levels and standards of what would count as 'expert' training, mental health is one of a number of areas where we believe practitioners may need additional skills and expertise to embrace treatment of such conditions within their scope of practice. Although the training in western medicine underpinning a Chinese medicine qualification is thorough, this is an area of specialist treatment where even a GP might struggle.

The other concern is that a patient may be looking to reduce essential medication using acupuncture as a replacement, and we remind members frequently that this is something they must not encourage unless the patient has discussed the matter with their primary medical lead and this has been jointly agreed as a possibility.

Having said all of that, there is no doubt that many people who suffer with serious mental illness derive great benefit from the reduction in anxiety which acupuncture can help to achieve, and if the practitioner's own judgement is that they are comfortable treating someone with a serious mental illness, there is no reason why they should not.

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Is acupuncture effective in the treatment of schizophrenia?

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Q: Is acupuncture effective in the treatment of schizophrenia? A: Although the World Health Organisation lists schizophrenia as one of the conditions which acupuncture can treat, the evidence, such as there is, is not that convincing. Published studies and reviews such as: http://www.ncbi.nlm.nih.gov/pubmed/22076901 http://www.ncbi.nlm.nih.gov/pubmed/19832819 are very cautious in their conclusions, and very limited in the scope of the outcomes which they measure.

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effectivness (sz)

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Plain language summary

Although acupuncture or Traditional Chinese Medicine has been practised for over 2000 years in China and the Far East, especially in Korea and Japan, it is a relatively new form of treament for physical and psychological conditions in the West. Acupuncture inserts needles into the skin to stimulate specific points of the body ( acupoints). The aim is to achieve balance and harmony of the body.

Schizophrenia is a serious mental illness and is usually treated using antipsychotic medication. However, although effective, antipsychotic medication can cause side‐effects (such as sleepiness, weight gain and even dribbling). Acupuncture has been shown to have very few negative effects on the individual and could be more socially acceptable and tolerable for people with mental health problems. Acupuncture may also be less expensive than drugs made by pharmaceutical companies, so reducing costs to individuals and health services.

This reviews looks at the effectiveness of various types of acupuncture as treatment for people with schizophrenia. An update search for studies was carried out in 2012 and found 30 studies that randomised participants who were receiving antipsychotic medication to receive additional acupuncture or standard care.

Although some of the studies did favour acupuncture when combined with antipsychotics, the information available was small scale and rated to be very low or low quality by the review authors, so not completely provable and valid. Depression was reduced when combining acupuncture with antipsychotic medication, but again this finding came from small‐scale research, so cannot be clearly shown to be true. The review concludes that people with mental health problems, policy makers and health professionals need much better evidence in order to establish if there are any potential benefits to acupuncture.

This means that the question of whether acupuncture is of benefit to people, and whether it is of greater benefit than antipsychotic medication, remains unanswered. There is not enough information to establish that acupuncture is of benefit or harm to people with mental health problems.

Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness.

Abstract

Background: Acupuncture, with many categories such as traditional acupuncture, electroacupuncture, laser acupuncture, and acupoint injection, has been shown to be relatively safe with few adverse effects. It is accessible and inexpensive, at least in China, and is likely to be widely used there for psychotic symptoms.

Objectives: To review the effects of acupuncture, alone or in combination treatments compared with placebo (or no treatment) or any other treatments for people with schizophrenia or related psychoses.

Search methods: We searched Cochrane Schizophrenia Group's Trials Register (February 2012), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and clinical trials registries. We also inspected references of identified studies and contacted relevant authors for additional information.

Selection criteria: We included all relevant randomised controlled trials involving people with schizophrenia‐like illnesses, comparing acupuncture added to standard dose antipsychotics with standard dose antipsychotics alone, acupuncture added to low dose antipsychotics with standard dose antipsychotics, acupuncture with antipsychotics, acupuncture added to Traditional Chinese Medicine (TCM) drug with TCM drug, acupuncture with TCM drug, electric acupuncture convulsive therapy with electroconvulsive therapy.

Data collection and analysis: We reliably extracted data from all included studies, discussed any disagreement, documented decisions and contacted authors of studies when necessary. We analysed binary outcomes using a standard estimation of risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we calculated mean differences with 95% CI. For homogeneous data we used fixed‐effect model. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE.

Main results: After an update search in 2012 the review now includes 30 studies testing different forms of acupuncture across six different comparisons. All studies were at moderate risk of bias.

When acupuncture plus standard antipsychotic treatment was compared with standard antipsychotic treatment alone, people were at less risk of being 'not improved' (n = 244, 3 RCTs, medium‐term RR 0.40 CI 0.28 to 0.57, very low quality evidence). Mental state findings were mostly consistent with this finding as was time in hospital (n = 120, 1 RCT, days MD ‐16.00 CI ‐19.54 to ‐12.46, moderate quality evidence). If anything, adverse effects were less for the acupuncture group (e.g. central nervous system, insomnia, short‐term, n = 202, 3 RCTs, RR 0.30 CI 0.11 to 0.83, low quality evidence).

When acupuncture was added to low dose antipsychotics and this was compared with standard dose antipsychotic drugs, relapse was less in the experimental group (n = 170, 1 RCT, long‐term RR 0.57 CI 0.37 to 0.89, very low quality evidence) but there was no difference for the outcome of 'not improved'. Again, mental state findings were mostly consistent with the latter. Incidences of extrapyramidal symptoms ‐ akathisia, were less for those in the acupuncture added to low dose antipsychotics group (n = 180, 1 RCT, short‐term RR 0.03 CI 0.00 to 0.49, low quality evidence) ‐ as dry mouth, blurred vision and tachycardia.

When acupuncture was compared with antipsychotic drugs of known efficacy in standard doses, there were equivocal data for outcomes such as 'not improved' using different global state criteria. Traditional acupuncture added to TCM drug had benefit over use of TCM drug alone (n = 360, 2 RCTs, RR no clinically important change 0.11 CI 0.02 to 0.59, low quality evidence), but when traditional acupuncture was compared with TCM drug directly there was no significant difference in the short‐term. However, we found that participants given electroacupuncture were significantly less likely to experience a worsening in global state (n = 88, 1 RCT, short‐term RR 0.52 CI 0.34 to 0.80, low quality evidence).

In the one study that compared electric acupuncture convulsive therapy with electroconvulsive therapy there were significantly different rates of spinal fracture between the groups (n = 68, 1 RCT, short‐term RR 0.33 CI 0.14 to 0.81, low quality evidence). Attrition in all studies was minimal. No studies reported death, engagement with services, satisfaction with treatment, quality of life, or economic outcomes.

Authors' conclusions: Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.

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national center for biotechnology information

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united states national library of medicine

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Acupuncture for schizophrenia - PubMed Health - National Library of Medicine - PubMed Health

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Although acupuncture or Traditional Chinese Medicine has been practised for over 2000 years in China and the Far East, especially in Korea and Japan, it is a relatively new form of treament for physical and psychological conditions in the West. Acupuncture inserts needles into the skin to stimulate specific points of the body (acupoints).

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Scientific Acupuncture Clinic Center --- Compulsive Disorder

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Although the outcomes of this study were not great, it should be remembered that, typically, Western psychotropic medications for OCD are not effective in 20-30% of patients and that all 21 patients in this study were in that hard-to-treat, drug-resistant category.

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Acupuncture strengths and weaknesses for OCD

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Acupuncture strengths and weaknesses for OCD

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Potentials and limitations of cognitive treatments for obsessive-compulsive disorder. - PubMed - NCBI

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Cogn Behav Ther. 2005;34(3):140-7. Comparative Study; Review

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Amy Harris

Based in western New York, Amy Harris began writing for Demand Media and Great Lakes Brewing News in 2010. Harris holds a Bachelor of Science in Mathematics from Penn State University; she taught high school math for several years and has also worked in the field of instructional design.

In the United States, acupuncture is an integral part of complementary and alternative medicine, incorporating techniques from Chinese, Japanese and Korean traditions. Some Westerners are skeptical of the practice, while others swear by it, reporting a plethora of beneficial effects. When properly performed, acupuncture is a safe practice; however, inform your physician of any alternative medicine procedures you pursue, and don't discontinue any prescription medications before speaking to your doctor.

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Acupuncture involves the insertion of needles about as slender as a human hair into the skin on specific locations of the body. The acupuncturist may simply leave the needles in for a period of time, or may manipulate them with his hands or via electrical stimulation. Different people experience acupuncture in different ways. Many report no discomfort whatsoever during needle insertion, while others report pain. Some people feel a burst of energy following the treatment, while others become relaxed. Follow-up treatments typically occur over a time span of several weeks or months.

Among the oldest healing practices in the world, acupuncture dates back thousands of years. It stems from ancient Chinese medicine and didn't spread to the United States until the latter half of the 20th century. Acupuncture practitioners and patients believe that the procedure promotes the vital flow of energy through all areas of the body.Researchers speculate that acupuncture may aid in the release of the body's natural painkillers as well as chemicals regulating blood pressure.

A primary reason that people seek acupuncture is to cope with pain. The practice can help mitigate symptoms of various types of pain, including back, neck, joint and dental pain as well as migraines, fibromyalgia and arthritis. It may reduce nausea after patients undergo surgery or receive chemotherapy, as well as aid in smoking cessation and coping with the bothersome symptoms of allergies and menopause. Some couples even seek acupuncture as a means of increasing fertility. However, acupuncture isn't a diagnostic procedure - that is, it cannot diagnose a disease, injury or other condition, but is instead a means of coping with known maladies.

Unlike undergoing surgery or even completing a drug regimen, acupuncture is a noninvasive treatment, with little to no side effects or recovery time. It may therefore reduce dependence on medications as well as the need for unpleasant medical procedures. Acupuncture is suitable for almost all people, regardless of physical condition, with the possible exception of those suffering from bleeding disorders or taking blood thinners. The practice takes a holistic approach in attempting to eliminate the root cause of the malady, rather than simply mitigating the symptoms.

Some patients report minor soreness for a period of time immediately following treatment, although it is rarely a cause for concern. In many cases, acupuncture cannot possibly cure the physical ailment, as in the case of broken bones; at best, it can aid in alleviating the accompanying pain in such circumstances. Acupuncture typically involves regularly scheduled follow-up treatments, which may prove a hassle for some patients. Treatments can be costly and often aren't covered by health insurance providers, and results aren't guaranteed, possibly leading some patients to believe they've wasted their time and money. And although acupuncture produces little to no side effects when delivered properly by a licensed acupuncturist, unqualified practitioners can deliver substandard care, resulting in pain from improper needle placement and even infections from unsterilized needles.

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Advantages & Disadvantages of Acupuncture

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In the United States, acupuncture is an integral part of complementary and alternative medicine, incorporating techniques from Chinese, Japanese and Korean traditions. Some Westerners are skeptical of the practice, while others swear by it, reporting a plethora of beneficial effects. When properly performed, acupuncture is a safe practice; however,...

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Few well‑established studies have examined the effect of acupuncture on schizophrenia, particularly

traditional Chinese acupuncture; most available studies are case reports from China. Rathbone and
Xia (2007) concluded in their Cochrane review that there is insufficient evidence to recommend the use

of acupuncture for people with schizophrenia..... Then it goes on to list more detail and more studies

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Acupuncture is sometimes available on the NHS

Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners. Initial sessions usually cost £40-70, and further sessions £25-60.

If you're being treated by an acupuncture practitioner for a health condition or are considering having acupuncture, it's advisable to discuss this with your GP.