Acupuncture eases a side effect of radiation

NEW YORK, 09 may 2009- When people with head or neck cancer are treated with radiation, a common side effect is dry mouth, and now researchers have shown that the problem can be relieved by acupuncture.

Excessive dryness of the mouth is technically termed xerostomia. Dr. Mark Chambers and colleagues from The University of Texas M. D. Anderson Cancer Center, Houston, conducted a pilot study to see if radiation-induced xerostomia resulting from radiation therapy for cancer in the head and neck region can be reversed using acupuncture.

Among 19 patients treated twice weekly for 4 weeks, scores on a standard xerostomia assessment scale improved significantly at the end of acupuncture treatment, as well as at 8 weeks after the start of treatment, the researchers report in the medical journal Head and Neck.

However, significant increases in average saliva volume or saliva output were not apparent, they note.

Nonetheless, at week 5 and week 8, there were significant improvements in total quality-of-life scores, as well as improvements in physical well-being at week 8.

"This pilot study demonstrates that acupuncture can improve the subjective symptoms of dry mouth in patients with radiation-induced xerostomia as early as two weeks after starting treatment, and the benefits can remain at least one month after treatment ends," the authors conclude.

"These results are very promising," Chambers told Reuters Health. "However, further research is needed." The team is planning formal clinical trials in China and in the US.

SOURCE: Head and Neck, April 17, of 2009.

Acupuncture eases radiation-induced dry mouth in cancer patients

M. D. Anderson research shows improved quality of life and well being after needle-based therapy

HOUSTON,22 april 2009 -- Twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer, researchers from The University of Texas M. D. Anderson Cancer Center report in the current online issue of Head & Neck.

Xerostomia develops after the salivary glands have been exposed to repeated doses of therapeutic radiation. People who have cancers of the head and neck typically receive large cumulative doses, rendering the salivary glands incapable of producing adequate saliva, said Mark S. Chambers, M.S., D.M.D., a professor in the Department of Dental Oncology. Saliva substitutes, lozenges and chewing gum bring only temporary relief, and the commonly prescribed medication, pilocarpine, has short-lived benefits and bothersome side effects of its own.

"The quality of life in patients with radiation-induced xerostomia is profoundly impaired," said Chambers, the study's senior author. "Symptoms can include altered taste acuity, dental decay, infections of the tissues of the mouth, and difficulty with speaking, eating and swallowing. Conventional treatments have been less than optimal, providing short-term response at best."

M. Kay Garcia, LAc, Dr.P.H., a clinical nurse specialist and acupuncturist in M. D. Anderson's Integrative Medicine Program and the study's first author, noted that patients with xerostomia may also develop nutritional deficits that can become irreversible.

Garcia, Chambers and their team of researchers conducted a pilot study to determine whether acupuncture could reverse xerostomia. Acupuncture therapy is based on the ancient Chinese practice of inserting and manipulating very thin needles at precise points on the body to relieve pain or otherwise restore health. In traditional Chinese medicine, stimulating these points is believed to improve the flow of vital energy through the body. Contemporary theories about acupuncture's benefits include the suggestion that needle manipulation stimulates natural substances that dilate blood vessels and increase blood flow to different areas of the body.

The M. D. Anderson study included 19 patients with xerostomia who had completed radiation therapy at least four weeks earlier. The patients were given two acupuncture treatments each week for four weeks. The acupuncture points used in the treatment were located on the ears, chin, index finger, forearm and lateral surface of the leg. All patients were tested for saliva flow and asked to complete self-assessments and questionnaires related to their symptoms and quality of life before the first treatment, after completion of four weeks of acupuncture, and again four weeks later.

The twice weekly acupuncture treatments produced highly statistically significant improvements in symptoms. Measurement tools included: the Xerostomia Inventory, asking patients to rate the dryness of their mouth and other related symptoms; and the Patient Benefit Questionnaire, inquiring about issues such as mouth and tongue discomfort; difficulties in speaking, eating and sleeping; and use of oral comfort aids. A quality-of-life assessment conducted at weeks five and eight showed significant improvements over quality-of-life scores recorded at the outset of the study.

"In this pilot study, patients with severe xerostomia who underwent acupuncture showed improvements in physical well-being and in subjective symptoms," Dr. Chambers said. "Although the patient population was small, the positive results are encouraging and warrant a larger trial to assess patients over a longer period of time."

Garcia said that a phase III, placebo-controlled trial is planned and is currently under review. She also noted that in other studies, the M. D. Anderson researchers are examining whether acupuncture can prevent xerostomia in patients treated for head and neck cancer, not just treat it.

"Recently, we completed a study at Fudan University Cancer Hospital in Shanghai, China that compared acupuncture to usual care to prevent xerostomia. We have now started a two-arm placebo-controlled pilot trial in Shanghai. In the prevention trials, acupuncture is performed on the same day as the radiation treatments," Garcia said.

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In addition to Chambers and Garcia, other authors on the all-M. D. Anderson study include: Joseph S. Chiang, M.D. and Thomas Rahlfs, M.D., Department of Anesthesiology and Pain Medicine; Lorenzo Cohen, Ph.D. and Qi Wei, M.S., Department of Behavioral Science/Integrative Medicine; Meide Liu, LAc, Place of Wellness; J. Lynn Palmer, Ph.D., Department of Palliative Care and Rehabilitation Medicine Research; David I. Rosenthal, M.D., Department of Radiation Oncology; and Samuel Tung, M.S. and Congjun Wang, Ph.D., Department of Radiation Physics.

Acupuncture 'probably ineffective' in treatment of hot flushes

07 april 2009--Acupuncture cannot be shown to have any positive effect on hot flushes during the menopause. This is the conclusion of a systematic review of literature by three groups in Daejon, Busan (South Korea) and Exeter (UK), published in the current edition of the peer-reviewed journal Climacteric.

Many women are concerned by the unfavourable publicity given to HRT use, but still have to deal with the symptoms which can occur during and after the menopause. A significant minority of women look for alternatives to HRT to deal with these symptoms. Often these alternatives are untested, and it can be impossible to balance the risks and benefits of these treatments against the risks and benefits of conventional treatments or the discomfort of untreated menopause.

The researchers reviewed studies on the use of acupuncture for the relief of hot flushes during the menopause. They identified 106 studies in total, which they eventually narrowed down to the six most relevant to the study. These six studies were randomised controlled trials (RCTs), which included testing the effects of real acupuncture against the effect of sham acupuncture. Only one RCT reported favorable effect of acupuncture on the frequency and severity of hot flush after 4 weeks follow-up, while the other five RCTs demonstrated no such effects.

Researchers caution that the quality of good studies is not great, and that because of this the use of acupuncture cannot be completely ruled out. However, the available literature indicates that acupuncture does not seem to be effective in the treatment of menopausal hot flushes.

Lead researcher, Dr Myeong Soo Lee (Korea Institute of Oriental Medicine, South Korea) said

Although the availability of good Randomised Controlled Trials is too small to draw any firm conclusion, in general the evidence from sham-controlled RCTs for the effects of acupuncture for treating menopausal hot flush is not convincing. We would always recommend that women wanting relief from menopausal symptoms consult their clinician before undertaking any course of treatment.

Commenting, Dr David Sturdee (President of the International Menopause Society) said:

There's no doubt that many women need relief from the symptoms associated with the menopause. They need to make sure that the treatment they choose works, and is right for them. I would always recommend that a woman consult her clinician before starting any treatment.

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Please mention Climacteric, the journal of the International Menopause Society, in any story.

Acupuncture stops headaches, but 'faked' treatments work almost as well

21 jan 2009--Headache sufferers can benefit from acupuncture, even though how and where acupuncture needles are inserted may not be important. Two separate systematic reviews by Cochrane Researchers show that acupuncture is an effective treatment for prevention of headaches and migraines. But the results also suggest that faked procedures, in which needles are incorrectly inserted, can be just as effective.
"Much of the clinical benefit of acupuncture might be due to non-specific needling effects and powerful placebo effects, meaning selection of specific needle points may be less important than many practitioners have traditionally argued," says lead researcher of both studies, Klaus Linde, who works at the Centre for Complementary Medicine Research at the Technical University of Munich, Germany.
In each study, the researchers tried to establish whether acupuncture could reduce the occurrence of headaches. One study focused on mild to moderate but frequent 'tension-type' headaches, whilst the other focused on more severe but less frequent headaches usually termed migraines. Together the two studies included 33 trials, involving a total of 6,736 patients.
Overall, following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches compared to those who were given only pain killers. In the migraine study, acupuncture was superior to proven prophylactic drug treatments, but faked treatments were no less effective. In the tension headache study, true acupuncture was actually slightly more effective than faked treatments.
The results indicate that acupuncture could be a used as an alternative for those patients who prefer not to use drug treatments, and additionally may result in fewer side effects. However, Linde says more research is still required, "Doctors need to know how long improvements associated with acupuncture will last and whether better trained acupuncturists really achieve better results than those with basic training only."

ECCO: Acupuncture -- Real or Fake -- Helps Relieve Nausea in Cancer Patients

BARCELONA, Spain, Sept. 27 -- Acupuncture failed to prevent nausea in cancer patients undergoing radiation any better than a sham procedure -- but the vast majority of the patients in both groups thought the needles were effective.
"Both groups of patients reported they believed the treatment has been invasive and effective and they would do it again," Ann Enblom, a physiotherapist and doctoral student at Sweden's Linkoping University, told attendees at the European CanCer Organisation meeting here.
Previous studies have shown that about 63% of patients who undergo cancer radiotherapy suffer from nausea. Compared with that figure, both real and sham acupuncture showed results.
"We found that 37% of our patients who actually had the needles placed in the acupuncture sessions experienced nausea compared with 31% of the patients who had the sham needle procedure," Enblom said, noting that there was no statistically significant difference between those figures.
Enblom and colleagues recruited 237 cancer patients who were undergoing radiation therapy, a procedure that often results in nausea and vomiting that can continue through the course of treatment and beyond. She reported on 110 patients who received acupuncture and 105 patients who received the sham procedure close to, but not at the actual acupuncture site.
The actual acupuncture needles were placed in the wrist, a few centimeters below the palm in the traditional P6 location that Chinese traditional medicine sites as the place the thin needles need to be inserted to prevent nausea.
The sham procedure used a device that causes the needle to retract into the tube once it touches the skin -- much the way trick knives push backwards into the hilt of the knife when someone is "stabbed" on stage. Enblom said almost all the patients receiving the sham procedure thought they had actually been properly needled.
The patients underwent the needling process for 30 minutes two to three times a week for the five-week course of radiotherapy.
The number of days on which patients had nausea did not differ statistically between the groups. Those getting acupuncture had 19 days of nausea during the treatment; those getting the sham treatment had 17 days of nausea.
Similarly, about 28% of the acupuncture patients experienced vomiting during the study period compared with 24% of those getting the sham treatment -- again, a non-significant difference, Enblom reported.
When patients were asked about the treatment:
93% of the actual acupuncture patients reported that they believed the procedure had "moderate" to "much" effectiveness for them.
96% of the sham acupuncture patients reported they believed the procedure had "moderate" to "much" effectiveness for them.
89% of both groups expressed "moderate" to "much" interest in using acupuncture again.

Alexander Eggermont, M.D., Ph.D., Erasmus University Medical School, Rotterdam
"There have been people -- especially in the alternative and complementary medicine field -- who have said these types of well-designed studies can't be done for treatments such as acupuncture," said Alexander Edgemont, M.D., of Erasmus University in Rotterdam, the Netherlands, who acted as moderator at the session. The Swedish study showed that such studies can be accomplished, he said.
While the study clearly shows that acupuncture is no more successful than non-acupuncture in controlling nausea, he noted that the big difference between Enblom's patients and those who have undergone radiation treatment without acupuncture indicates the potent "placebo" effect that can occur in clinical trials.
"I think this study underscores why it is necessary in clinical trials that we have control groups," he said.
"Our study may indicate that attitudes and expectations play a major role in the experience of the effect of the treatment," Enblom said.
A similar study comparing acupuncture, a sham procedure, and conventional treatment for low-back pain was reported in the Sept. 24 issue of Archives of Internal Medicine. That study, too, found sham acupuncture worked just as well as the real thing. (See: Acupuncture Tops Conventional Therapy for Low-Back Pain) Primary source: European Journal of Cancer SupplementsSource reference: S. Borjeson et al, "Invasive acupuncture for radiotherapy-induced nausea and vomiting is not more effective than placebo acupuncture, Abstract P#1103", European Journal of Cancer Supplements, Vol 5 No 4, Page 142

Acupuncture Tops Conventional Therapy for Low-Back Pain

BOCHUM, Germany, Sept. 24 -- Acupuncture offers an effective alternative to conventional therapy for low-back pain, investigators here reported.
Almost twice as many patients responded to acupuncture versus conventional therapy, Heinz G. Endres, M.D., of Ruhr-University Bochum, and colleagues reported in the Sept. 24 issue of Archives of Internal Medicine.
However, sham acupuncture worked just as well as verum, or true, acupuncture, they reported.
"Acupuncture constitutes a strong alternative to multimodal conventional therapy," the authors concluded. "Acupuncture gives physicians a promising and effective treatment option for chronic low-back pain, with few adverse effects or contraindications."
As for the equally good results with fake or real acupuncture, the authors said, "The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals, or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy."
Used to treat many medical conditions, acupuncture has a controversial role in the management of low-back pain, although a recent Cochrane review concluded that it might be useful as an adjunct to other therapies (Cochrane Database Syst Rev 2005;(1):CD001351).
Dr. Endres and colleagues reported findings from what they believe to be the first randomized, controlled trial of verum versus sham acupuncture for treatment of low-back pain. The German Acupuncture Trials involved clinicians in 340 outpatient practices and included 1,162 patients who had a history of low-back pain lasting an average of eight years.
The patients were treated with either verum or sham acupuncture or conventional therapy, which consisted of a combination of drugs, physical therapy, and exercise. Verum acupuncture consisted of 10 30-minute sessions of treatment according to principles of traditional Chinese medicine. Patients assigned to sham acupuncture received superficial needling at non-acupuncture points.
The primary outcome was six-month response rate, with response defined as at least 33% improvement on three pain-related items on the Von Korff Chronic Pain Grade Scale or 12% improvement on the back-specific Hanover Functional Ability Questionnaire.
At the end of the study, 47.6% of patients in the verum acupuncture group had responded, as had 44.2% in the sham acupuncture group, and 27.4% in the group that received conventional therapy. Both acupuncture groups had significantly higher response rates compared with conventional therapy (P<0.001).
The inferiority of conventional therapy to both acupuncture groups "raises questions about qualitative and quantitative aspects of conventional therapy," the authors stated. Even so, results with conventional therapy exceeded those observed in a previous German-based study of routine care for low-back pain.
They also pointed out that "the effectiveness of sham acupuncture and the principle of nihil nocere suggest that a discussion is called for about the necessary depth of insertion of acupuncture needles."
The finding that both sham and true acupuncture relieved back pain is puzzling, commented Rex Marco, M.D., an orthopedic surgeon at the University of Texas Health Science Center in Houston. He speculated that the sham needling could have triggered endorphin release or other potentially therapeutic effects. The sham procedures also could have had an unexpectedly large placebo effect.
Alternatively, he said, the pain-relieving benefits of sham acupuncture might have been emotional or psychological in nature.
"It's possible that the physical contact during the sham procedures had a relaxing or soothing effect that helped relieve the pain," said Dr. Marco. "Maybe the contact and interaction with the acupuncturist was beneficial. It's really impossible to know why the sham procedures had a therapeutic effect. For that matter, it's entirely possible that the sham and true procedures worked through similar or the same underlying mechanisms."
The findings are at odds with previous studies that have shown a difference between true and sham acupuncture, said Eric Manheimer, a clinical research associate at the University of Maryland in Baltimore. More than one study has shown at least a trend in favor of true acupuncture.
The authors reported no financial conflicts of interest. The study was supported by German public health insurance companies. Primary source: Archives of Internal MedicineSource reference: Haake M et al. "German Acupuncture Trials (GERAC) for chronic low back plain. Randomized, multicenter, blinded, parallel-group trial with 3 groups." Arch Intern Med 2007;167:1892-1898.

Adding Acupuncture to Advice, Exercise Does Not Benefit Knee Osteoarthritis

August 20, 2007 — The addition of acupuncture to a course of advice and exercise delivered by physiotherapists provides no additional improvement in pain scores in patients with osteoarthritis of the knee, according to the results of a prospective, randomized, controlled trial published in the August 15 Online First issue of BMJ.
"Systematic reviews conclude that acupuncture is more effective than placebo for osteoarthritis of the knee," write Nadine E. Foster, from Keele University in Stafford, United Kingdom, and colleagues. "However, questions about the benefit of adding acupuncture to mainstream, recommended treatments for this population remain unanswered. We have shown that exercise based physiotherapy is more effective than usual primary care for older adults with knee pain, but no high quality trial has investigated the additional benefit of integrating acupuncture with a recommended treatment such as exercise based physiotherapy for this population."
At 37 physiotherapy centers accepting primary care patients referred from general practitioners in the Midlands, United Kingdom, 352 adults aged 50 years or older with a clinical diagnosis of knee osteoarthritis were randomized to receive advice and exercise (n = 116), advice and exercise plus true acupuncture (n = 117), and advice and exercise plus nonpenetrating acupuncture (n = 119). Acupuncture was administered by experienced physiotherapists.
The main endpoint was change at 6 months in osteoarthritis index pain subscale scores on the Western Ontario and McMaster Universities scales, and secondary endpoints included 2-week, 6-week, 6-month, and 12-month ratings for function, pain intensity, and unpleasantness of pain.
Mean baseline pain score was 9.2 ± 3.8. At 6 months, follow-up rate was 94%. Mean decreases in pain score were 2.28 ± 3.8 for advice and exercise, 2.32 ± 3.6 for advice and exercise plus true acupuncture, and 2.53 ± 4.2 for advice and exercise plus nonpenetrating acupuncture.
Mean differences in change scores between advice and exercise alone and each acupuncture group were 0.08 (95% confidence interval [CI], -1.0 to 0.9) for advice and exercise plus true acupuncture and 0.25 (95% CI, -0.8 to 1.3) for advice and exercise plus nonpenetrating acupuncture. At subsequent follow-up points, similar nonsignificant differences were observed.
For true acupuncture vs advice and exercise alone, there were small, statistically significant improvements in pain intensity and unpleasantness at 2 and 6 weeks. Similar improvements in pain intensity and unpleasantness were seen for nonpenetrating acupuncture at all follow-up points.
"The addition of acupuncture to a course of advice and exercise for osteoarthritis of the knee delivered by physiotherapists provided no additional improvement in pain scores," the authors write. "Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects."
Study limitations include use of fewer treatment sessions than in previous studies of acupuncture practice.
"True acupuncture did not show any greater therapeutic benefit than a credible control procedure in patients with a clinical diagnosis of knee osteoarthritis," the authors conclude. "Further research is needed to investigate the possible mechanisms of acupuncture, particularly the role of expectancy effects."
The Arthritis Research Campaign, United Kingdom, and the North Staffordshire Primary Care Research Consortium for the National Health Service supported this study. The authors have disclosed no relevant financial relationships.
BMJ. Published online August 15, 2007.

Blood Pressure Changes With Acupuncture Comparable to Those With ACE Inhibitor Monotherapy

June 15, 2007 — A study billed as the first rigorous, randomized trial in the West to test acupuncture against a sham needle technique to treat hypertension suggests that, performed properly, acupuncture may produce blood pressure changes on par with monotherapy in mild-to-moderate hypertension.
"It's certainly not like a wonder-drug; it's not a massive effect, but it's a clear effect," lead investigator Dr Frank A Flachskampf (Universitätsklinikum Erlangen, Germany) told heartwire.
Smaller randomized trials have been performed in China, with mixed results, while one randomized study in the West found no difference in blood pressure lowering between traditional Chinese acupuncture, standardized acupuncture, and a sham procedure, the authors note. This earlier study did not use ambulatory blood pressure measurements, believed to be superior to office-based measurements.
Results of their study appear in Circulation online, June 4, 2007.
Needlework
For the study, 160 outpatients with uncomplicated, mild-to-moderate hypertension were randomized to 6 weeks of acupuncture performed by Chinese medicine practitioners, trained in China, or to a sham procedure. In both arms, patients underwent 22 sessions, each 30 minutes in length. By the end of the six weeks, 24-hour ambulatory systolic and diastolic blood pressures were significantly reduced from baseline in the acupuncture-treated patients (5.4 mm Hg and 3.0 mm Hg, respectively) and this change was also significantly different from values in the sham-treated patients in whom no meaningful changes were seen.
After three and six months, however, the blood pressure reductions disappeared, leading investigators to conclude that ongoing acupuncture treatments would be required to maintain the blood pressure reductions.
"The main finding is that for the first time in a reasonably sized, but still relatively small randomized study, this establishes beyond a reasonable doubt that acupuncture lowers blood pressure," Flachskampf commented. "It's a modest but undeniable effect on both systolic and diastolic blood pressure."
The extent of the blood pressure reductions are comparable to those seen with angiotensin-converting enzyme (ACE) inhibitor monotherapy, or aggressive lifestyle changes, including radical salt restrictions, he added.
A "Demanding" Alternative to Drugs
Flachskampf had some caveats, acknowledging that the regular acupuncture sessions used in the study represent a significant time investment: each acupuncture session lasted 30 minutes — not including transportation and administrative time — and took place several times a week. The study subjects were also reasonably healthy, with no other major risk factors and with only mild-to-moderate hypertension.
"This is clearly something that would probably not work as well with very sick people or people with blood pressure at dangerous levels," he said. "We cannot easily extrapolate to people, for example, with complicated hypertension who have had a myocardial infarction."
Flachskampf believes, however, that acupuncture likely represents an attractive option in specific patients, particularly those averse to taking medical therapy who are open to so-called 'alternative' medicine.
"This is probably only for people who somehow relate to this spiritually, who say I am profoundly against taking drugs and I'm very fond of oriental wisdom or things like that," Flachskampf told heartwire. "I don't want to make a joke about this, but this certainly needs more compliance than taking two or three pills a day. It's much more demanding."
Unlike drugs, acupuncture appeared to have little or no side-effects, although 2 people complained that the needles were painful. "Clearly many millions of Chinese get acupuncture without any major problems so I think this is really a minor point," Flachskampf observed.
Circulation. Published online June 4, 2007.