Low Back Pain Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine. 2013 Nov 15;38(24):2124-38.
Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. The Clinical j ournal of pain. 2013 Feb;29(2):172-85.
Wellington J. Noninvasive and alternative management of chronic low back pain (efficacy and outcomes). Neuromodulation : journal of the International Neuromodulation Society. 2014 Oct;17 Suppl 2:24-30.
Women's Health Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care Claudia M. Witt, MD, MBA, Thomas Reinhold, MSc, Benno Brinkhaus, MD, Stephanie Roll, MSc, Susanne Jena, MSc, Stefan N. Willich, MD, MPH, MBA American Journal of Obstetrics and Gynecology February 2008Volume 198, Issue 2, Pages 166.e1–166.e8 Abstract:http://www.ajog.org/article/S0002-9378(07)00920-9/abstract Full article:http://www.ajog.org/article/S0002-9378(07)00920-9/fulltext Summation: 649 women with dysmenorrhea (painful menstruation) were randomized to acupuncture (15 sessions over three months) or to a control group (no acupuncture) with 201 randomized. The average pain intensity on a 1-10 scale was lower in the acupuncture group (average 3.1) compared to the non-acupuncture group (average 5.4). The acupuncture group had better quality of life with the overall cost of ICER €3,011 per QALY).
Modes of action/mechanisms of acupuncture The two most researched areas of the physiological actions and pathways underpinning acupuncture to date have been the analgesic/antihyperalgesic and anti-inflammatory effects of acupuncture. The following are three excellent reviews of much of the evidence regarding how acupuncture relieves pain and/or inflammation via a multitude of mechanisms of internal signals causing adjustments of bodily resources.
Mechanisms of Acupuncture-Electroacupuncture on Persistent Pain (Review)Ruixin Zhang, Ph.D., Lixing Lao, Ph.D. Ke Ren, Ph.D., and Brian M. Berman, M.D. Anesthesiology. 2014 Feb; 120(2): 482–503 . Full article:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947586/ Summation: This excellent review not only summarizes how studies in the last decade have found that acupuncture and electro-acupuncture cause the production of natural (endogenous) pain modifying substances including opioids, serotonin, and norepinephrine, it also details how recent research is finding the most effective frequencies (Hz ranges) for stimulating the production of these substances. Especially important in this time of an opioid epidemic in North America, recent research found that electro-acupuncture combined with very low dosages of analgesics provided greater relief than the acupuncture or medications alone.
Acupuncture: Emerging evidence for its use as an analgesic (Review)GAO P, GAO X, FU T, XU D, WEN Q. Experimental and Therapeutic Medicine. 2015;9(5):1577-1581. doi:10.3892/etm.2015.2348. Full article:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471669/ Summation: Many studies have looked at how acupuncture causes pain relief (analgesia) and it has been hypothesized that acupuncture acts on various parts of the central nervous system, including the spinal cord, brain stem, cerebral ganglia and cerebral cortex. The complex mechanisms behind just how acupuncture causes these effects include neurohormones and neurotransmitters, such as endogenous opioids and γ-aminobutyric acid, as well as signaling pathways and even the immune response.
Mediators, receptors and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture (Review)John L. McDonald, Allan W. Cripps, and Peter K. Smith Evidence-Based Complementary and Alternative Medicine, vol. 2015, Article ID 975632, 10 pages, 2015. doi:10.1155/2015/975632. Full article:http://www.hindawi.com/journals/ecam/2015/975632/ Summation: Acupuncture has been used for millennia to treat allergic diseases including both intermittent rhinitis and persistent rhinitis. Besides the research on the efficacy and safety of acupuncture treatment for allergic rhinitis, research has also investigated how acupuncture might modulate immune function to exert anti-inflammatory effects. A proposed model has previously hypothesized that acupuncture might downregulate proinflammatory neuropeptides, proinflammatory cytokines, and neurotrophins, modulating transient receptor potential vallinoid (TRPV1), a G-protein coupled receptor which plays a central role in allergic rhinitis. Recent research has been largely supportive of this model. New advances in research include the discovery of a novel cholinergic anti-inflammatory pathway activated by acupuncture. A chemokine-mediated proliferation of opioid-containing macrophages in inflamed tissues, in response to acupuncture, has also been demonstrated for the first time. Further research on the complex cross talk between receptors during inflammation is also helping to elucidate the mediators and signaling pathways activated by acupuncture.
Cost Effectiveness This sampling of studies deal with acupuncture’s cost effectiveness as it answers two important questions at once; if acupuncture can demonstrate cost effectiveness and the larger question of if acupuncture itself is clinically effective. Any therapy demonstrating cost effectiveness could only do so if that therapy was clinically effective.
A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture.Kim SY1, Lee H, Chae Y, Park HJ, Lee H. Acupuncture Med. 2012 Dec;30(4):273-85. doi: 10.1136/acupmed-2012-010178. Epub 2012 Oct 25. Abstract:http://www.ncbi.nlm.nih.gov/pubmed/23099289?dopt=Abstract Full study:http://aim.bmj.com/content/30/4/273.long Summation: 17 studies were included from Europe and Asia that looked at cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis for allergic rhinitis, dysmenorrhea, osteoarthritis, and headache. All cost utility analysis studies showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone. Nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. The cost-effectiveness analysis studies found acupuncture was beneficial at a relatively low cost. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials.Ambrósio EM1, Bloor K, MacPherson H. Complement Ther Med. 2012 Oct;20(5):364-74. doi: 10.1016/j.ctim.2012.05.002. Epub 2012 Jun 6.. Abstract:http://www.ncbi.nlm.nih.gov/pubmed/22863652?dopt=Abstract Full article:http://www.complementarytherapiesinmedicine.com/article/S0965-2299(12)00080-5/fulltext Summation: A UK study using 8 economic evaluation studies, seven cost-utility analyses and one cost-effectiveness analysis covering the conditions of low back pain, neck pain, dysmenorrhoea, migraine and headache, and osteoarthritis. In the UK their National Institute for Health and Clinical Excellence sets a threshold for the cost of a quality adjusted life year (QALY) of £20,000 to £30,000. If a therapy can provide 1 QALY for less than £20,000 to £30,000, it is considered cost effective. In the seven cost-utility analyses, acupuncture was found to be clinically effective but cost more. The cost per quality adjusted life year (QALY) gained ranged from £2527 to £14,976 per QALY well below the threshold. The one cost-effectiveness study indicated that there might be both clinical benefits and cost savings associated with acupuncture for the treatment of migraine headache.
Thanks to the Acupuncture Now Foundation for much of the up to date, relevent information on this site. Below are some further papers for information.
Scharf H, Mansmann U, Streitberger K,et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med 2006;145:12-20.
White P, Lewith G,Prescott P, Conway J . Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med 2004;141:911-9.
Furlan AD, van Tulder MW, Cherkin DC, et al . Acupuncture and dry-needling for low back pain (Cochrane review). Cochrane Database Syst Rev 2005. Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2.
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