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What is FACT?
Focus on Alternative and Complementary Therapies is
an evidence-based journal that is a single point of reference for
current information
on complementary and alternative medicine (CAM) from around the
world. Current literature is summarised and commented on by members
of the
FACT international editorial board, reviewing topics as diverse
as herbal medicines, vitamins, minerals and supplements, homoeopathy,
acupuncture and manipulative therapies, and giving readers a
concise and objective view of the value of such therapies currently
available.
FACT also contains news, short reports, focus articles and debates
on CAM.
The full text of FACT is available by
subscription. For further information visit the Pharmaceutical
Press website |
Two studies on stimulating a specific acupoint (P6) as a preventative
measure against post-operative nausea and vomiting (PONV) are discussed
in the September issue of FACT. The first study, from the University
of Heidelberg, involved needle acupuncture on 212 women for 20 minutes,
either before or after induction of anaesthesia for gynaecological or
breast surgery, compared with a placebo. The second study, from the University
of Toronto, involved the use of acupressure wristbands with a bead touching
the acupoint, or placebo wristbands, on 152 cardiac surgery patients.
The Heidelberg study found that the incidence of vomiting was reduced
by 18.5 per cent in women who received acupuncture and underwent gynaecological
surgery. The timing of the intervention appeared to have no effect. In
the Toronto study, the reports of nausea, vomiting, pain scores and analgesic
and antiemetic requirements were similar in placebo and acupressure groups;
however, analysis by gender suggested that acupressure might be an effective
treatment for women.
FACT comments that before these studies it had been suggested that stimulation
of acupoint P6 is effective in reducing the incidence of PONV. The Heidelberg
results are in line with these previous findings, which also often focused
on gynaecological surgery, since this is associated with high rates of
PONV.
The negative results of the Toronto study may reflect either a lesser
effect of the acupressure in men or men being less likely to report PONV.
The subgroup analysis of women gave a positive result, suggesting an
antiemetic effect in women only, but the sample size was small.
FACT concludes that the overall pattern of results is consistent with
prior studies and highlights the need for additional research to refine
our understanding of the antiemetic effects of acupoint stimulation.
Acupuncture for knee osteoarthritis?
A study from Birmingham has examined the effects of (1) acupuncture,
(2) acupuncture plus standard care and (3) standard care alone followed
by acupuncture, as therapy for knee osteoarthritis. The study reports
that all groups showed significant improvements in pain and stiffness
scores. These benefits were stated to have been maintained for one
month after the course of acupuncture.
Discussing the results, FACT is cautious of the all-encompassing positive
results of the study, and looks to compare the three groups of treatment
for further clarification. FACT reveals that groups (1) and (2) are better
off than group (3) at five weeks after treatment, but not any longer
at the final visit and concludes that the five weeks’ result could
be the product of the small sample size.
Replying to FACT’s comments, the authors stated that the statistical
analysis takes account of the small sample size. The authors note that
they have now carried out a further, patient-blinded trial to shed further
light on acupuncture for knee osteoarthritis.
Acupuncture for post-stroke spasticity
Researchers in Germany have investigated acupuncture as a treatment
to reduce spasticity after a stroke in 25 patients. The patients received
either two acupuncture sessions per week for four weeks, or the same
treatment schedule but using a placebo “Streitberger needle”.
Patients were measured for improvements in spasticity, pain and walking
speed.
The authors of the study found no beneficial effects of acupuncture
and concluded that acupuncture may not be helpful to patients with
chronic
post-stroke spasticity.
FACT notes that, although in the 1990s it was suggested that acupuncture
might indeed enhance post-stroke spasticity, unfortunately these positive
results have not been replicated more recently. FACT says that there
could be one or more reasons for the discrepancy between past and present
studies. For example, post-stroke spasticity often resolves fairly quickly,
although not often completely, after the stroke and this process could
be enhanced by more care and attention. Thus, patients receiving acupuncture
during this time could be benefiting from a placebo effect. In addition,
since electrical current was often used in early trials, it could have
been this and not the acupuncture that resulted in reduced spasticity.
In relation to the present study, however, FACT remarks that the question
of acupuncture for post-stroke spasticity is not yet resolved. The patients
suffered from chronic post-stroke spasticity from strokes five years
before the trial, on average; it is possible that acupuncture is beneficial
in early stages after a stroke, but ineffectual in chronic stages.
Placebo effect in migraine?
In a recent study, over 400 patients with chronic headache (predominantly
migraine) were allocated to receive up to 12 acupuncture treatments
over three months or a control intervention offering usual care. Patients
were tested for headache score, health status and use of medication.
A secondary study investigated the cost effectiveness of the treatment.
At the end of the study, headache scores were lower in the acupuncture
group. Additionally, compared with controls, the acupuncture group used
15 per cent less medication, made 25 per cent fewer visits to GPs and
took 15 per cent fewer day off sick. The cost of acupuncture over a year
was higher (£403) than for controls (£207) due to the acupuncture
practitioners’ costs.
The authors concluded that “Acupuncture for chronic headache improves
health related quality of life at a small additional cost; it is relatively
cost effective compared with a number of other interventions provided
by the NHS.”
Since the results were published, whether or not such a trial is scientifically
convincing has been a major topic of debate. FACT commented that the
studies were well-done pragmatic trials but that, from a scientific perspective,
the lack of a control group and blinding (the patients knew whether or
not they were receiving acupuncture) were shortcomings. However, the
trial was a good representation of what actually happens in health care.
FACT concludes that the trial provided valid and important information. |
The
Pharmaceutical Journal