tag:theconversation.com,2011:/ca/topics/acupuncture-2222/articles
Acupuncture – The Conversation
2023-09-06T12:27:15Z
tag:theconversation.com,2011:article/212502
2023-09-06T12:27:15Z
2023-09-06T12:27:15Z
Traditional medicine provides health care to many around the globe – the WHO is trying to make it safer and more standardized
<figure><img src="https://images.theconversation.com/files/546464/original/file-20230905-503-nlkg3v.jpg?ixlib=rb-1.1.0&rect=3%2C9%2C2114%2C1400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ayurveda is one form of traditional medicine that can integrate aromatherapy. It's popular in South Asia. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ayurveda-aromatherapy-with-essential-oil-diffuser-royalty-free-image/1333713382?phrase=ayurveda&adppopup=true">Microgen Images/Science Photo Library</a></span></figcaption></figure><p>For approximately <a href="https://www.who.int/news/item/25-03-2022-who-establishes-the-global-centre-for-traditional-medicine-in-india">80% of the world’s population</a>, the first stop after catching a cold or breaking a bone isn’t the hospital — maybe because there isn’t one nearby, or they can’t afford it. Instead, the first step is consulting traditional medicine, which cultures around the world have been using for thousands of years.</p>
<p><a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">Traditional medicine</a> encompasses the healing knowledge, skills and practices used by a variety of cultures and groups. </p>
<p>Examples of traditional medicine include <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/herbal-medicine">herbal medicine</a>; <a href="https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763">acupuncture</a>; <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/tui-na">Tui Na</a> – which is a type of massage originating in China; <a href="https://www.nccih.nih.gov/health/ayurvedic-medicine-in-depth">Ayurveda</a> – which is an ancient system of promoting health through diet, exercise and lifestyle from India; <a href="https://www.britannica.com/science/Unani-medicine">and Unani</a> – which is another ancient system of health from South Asia, balancing key aspects of the mind, body and spirit. </p>
<p>In recognizing that traditional medicine and other alternative forms of healing are critical sources of health care for many people worldwide, the World Health Organization and the government of India co-hosted their first-ever <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Traditional Medicine Summit</a>. The summit took place in August 2023 in Gandhinagar, Gujarat, India. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/jW-B8BpLQJE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">August 2023 marked the WHO’s first global summit on traditional medicine.</span></figcaption>
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<p>The summit brought together health care policymakers, traditional medicine workers and users, international organizations, academics and private sector stakeholders from 88 <a href="https://www.who.int/countries">WHO member states</a>. Leaders at the summit aimed to share best practices and scientific evidence and data around traditional medicine. </p>
<p>As researchers interested in how to provide patients both in the U.S. and around the globe with the best <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">possible medical care</a>, <a href="https://scholar.google.com/citations?user=Wng1Wh0AAAAJ&hl=en">we were interested</a> in the summit’s findings. Understanding traditional medicine can help health care professionals create sustainable, personalized and culturally respectful practices.</p>
<h2>Critical health care for many</h2>
<p>In many countries, traditional medicine costs less and is <a href="https://doi.org/10.1093%2Fheapol%2Fczw022">more accessible</a> than conventional health care. And many conventional medicines come from the same source as compounds used in traditional medicine – <a href="https://doi.org/10.1021/acs.jnatprod.9b01285">up to 50% of drugs</a> have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">natural product root</a>, <a href="https://doi.org/10.1016/j.vph.2018.10.008">like aspirin</a>. </p>
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<a href="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man wearing a gray button-down shirt sorts bundles of dried herbs into eight piles, behind him is a wall of wooden drawers." src="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An herbalist sorts herbs at the Great China Herb Company in Chinatown in San Francisco. Herbal medicine is one form of traditional medicine.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TravelTripSanFranciscoChinatown/c09c3fae7725457ca4e548ceda2a2f34/photo?Query=traditional%20medicine&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=377&currentItemNo=1&vs=true">AP Photo/Eric Risberg</a></span>
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<p><a href="https://doi.org/10.2147/PPA.S398644">Many factors</a> may influence whether someone chooses traditional medicine, such as age and gender, religion, education and income level, and <a href="https://doi.org/10.1155/2021/9962892">distance to travel for treatment</a>. Cultural factors may also influence people’s use of traditional medicine. </p>
<p>In China, for example, as more people have embraced Western culture, fewer have <a href="https://doi.org/10.2105/AJPH.93.7.1082">chosen traditional medicine</a>. In contrast, many African migrants to Australia continue to use traditional medicine to express their cultural identity and maintain <a href="https://doi.org/10.1186/s12906-021-03424-w">a cohesive ethnic community</a>. A patient’s preference for traditional medicine often has significant personal, environmental and cultural relevance.</p>
<h2>A framework for traditional medicine</h2>
<p>Countries have been pushing the WHO to study and track data on traditional medicine for years. In the past, WHO has developed a “<a href="https://www.who.int/publications/i/item/9789241506096">traditional medicine strategy</a>” to help member states research, integrate and regulate traditional medicine in their national health systems. </p>
<p>The WHO also <a href="https://www.who.int/teams/integrated-health-services/traditional-complementary-and-integrative-medicine">created international terminology standards</a> for practicing various forms of traditional medicine.</p>
<p>The practice of traditional medicine varies greatly between countries, depending on how accessible it is and <a href="https://www.who.int/publications/i/item/978924151536">how culturally important it is</a> in each country. To make traditional medicine safer and more accessible on a broader scale, it’s important for policymakers and public health experts to develop standards and share best practices. The WHO summit was one step toward that goal.</p>
<p>The WHO also aims to collect data that could inform these standards and best practices. It is conducting the <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Global Survey on Traditional Medicine</a> in 2023. As of August, approximately 55 member states out of the total 194 have completed and submitted their data.</p>
<h2>Acupuncture – a case study in safety and efficacy</h2>
<p>Some traditional medicine practices <a href="https://doi.org/10.7453/gahmj.2014.042">such as acupuncture</a> have shown consistent and credible benefits, and have even started to make it <a href="https://time.com/6171247/acupuncture-health-benefits-research/">into mainstream medicine</a> in the U.S. But leaders at the summit emphasized a need for more research on the efficacy and safety of traditional medicine. </p>
<p>Although traditional medicine can <a href="https://www.who.int/news-room/feature-stories/detail/traditional-medicine-has-a-long-history-of-contributing-to-conventional-medicine-and-continues-to-hold-promise">have a range of benefits</a>, some treatments come with health risks. </p>
<p>For example, acupuncture is <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#">a traditional healing practice</a> that entails inserting needles at specific points on the body to relieve pain. But acupuncture can <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know">cause infections and injuries</a> if the practitioner doesn’t use sterile needles or if needles are inserted incorrectly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two hands insert a needle into a patient's back, which is partially covered with a towel and which already has seven needles stuck in two lines." src="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Acupuncture is an example of a form of traditional healing that’s been implemented on a wide scale in the U.S. It has a variety of benefits, including no risk of addiction.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AcupuncturePainRelief/0b79ca38552c4b86a845bf4645755106/photo?Query=acupuncture&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=246&currentItemNo=1&vs=true">AP Photo/M. Spencer Green</a></span>
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<p>Still, acupuncture is the most commonly used traditional medicine practice across countries, with <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">113 WHO member states</a> acknowledging their citizens practiced acupuncture in 2019.</p>
<p>Interestingly, <a href="https://news.va.gov/94087/battlefield-acupuncture-an-emerging-and-promising-alternative-to-risky-pain-medications/">battlefield acupuncture</a> has successfully treated many U.S. military members, for example, for pain reduction. It is simple to use, transportable and has no risk of addiction.</p>
<p>There’s also some evidence supporting the use of traditional medicine, including <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp">acupuncture</a>, <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Meditation.asp">meditation</a> and <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Yoga.asp">yoga</a> to treat post-traumatic stress disorder. </p>
<p>However, acupuncture practitioners aren’t trained in a uniform way across countries. To provide guidelines for best practice, the WHO developed standardized <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">benchmarks for practicing acupuncture</a> in 2021. The WHO aims to develop similar standards for other forms of traditional medicine as well. </p>
<p>Interest in traditional medicine is growing among those who have mainly used conventional medicine in the past. More research and collaborative efforts to develop safety standards can make traditional medicine accessible to all who seek it.</p><img src="https://counter.theconversation.com/content/212502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Ling Zhao received her medical training in China and PhD in the US. Her research focuses on novel interventions for chronic diseases. She has received research funding from NIH, including NCCIH. </span></em></p><p class="fine-print"><em><span>Paul D. Terry does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
More people are seeking out traditional forms of medicine, from acupuncture to herbal medicines. The WHO is working to develop standards to make these healing practices implementable on a wide scale.
Ling Zhao, Professor of Nutrition, University of Tennessee
Paul D. Terry, Professor of Epidemiology, University of Tennessee
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/181348
2022-07-11T12:29:10Z
2022-07-11T12:29:10Z
Migraine sufferers have treatment choices – a neurologist explains options beyond just pain medication
<figure><img src="https://images.theconversation.com/files/472113/original/file-20220701-26-9o11ui.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5084%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some, too much medication might make migraine worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/headache-conceptual-artwork-3d-illustration-royalty-free-image/1156927795?adppopup=true">peterschreiber.media/iStock via Getty Images Plus</a></span></figcaption></figure><p>Migraine headaches currently affect more than one billion people across the globe and are the <a href="https://doi.org/10.1186/s10194-020-01208-0">second-leading cause</a> of disability worldwide. Nearly one-quarter of U.S. households have at least <a href="https://doi.org/10.1046/j.1526-4610.2001.041007646.x">one member who suffers from migraines</a>. An estimated <a href="https://doi.org/10.1177/0333102410363766">85.6 million workdays</a> are lost as a result of migraine headaches each year. </p>
<p>Yet many who suffer with migraine dismiss their pain as simply a bad headache. Rather than seeking medical care, the condition often <a href="https://pubmed.ncbi.nlm.nih.gov/25588281/">goes undiagnosed</a>, even when other incapacitating symptoms occur alongside the pain, including light and sound sensitivity, nausea, vomiting and dizziness.</p>
<p>Researchers have discovered that genetics and environmental factors play a role in the condition of migraine. They happen when changes in your brainstem activate <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve">the trigeminal nerve</a>, which is a major nerve in the pain pathway. This cues your body to release inflammatory substances such as <a href="https://www.scienceofmigraine.com/pathophysiology/cgrp">CGRP</a>, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.</p>
<h2>For some, medication has its limits</h2>
<p>A migraine can be debilitating. Those who are experiencing one are often curled up in a dark room accompanied by only their pain. Attacks can last for days; life is put on hold. The sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to forego work, school, social gatherings and time with family.</p>
<p>Numerous prescription medications are available for both the prevention and treatment of migraine. But for many people, conventional treatment has its limitations. Some people with migraine have a poor tolerance for certain medications. Many can’t afford the high cost of the medicines or endure the side effects. Others are pregnant or breastfeeding and can’t take the medications.</p>
<p>However, as a <a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/29586">board-certified neurologist</a> who specializes in headache medicine, I’m always amazed at how open-minded and enthusiastic patients become when I discuss alternative options. </p>
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<figcaption><span class="caption">Your brain sends you warning signals, such as fatigue and mood changes, to let you know a migraine may be on the way.</span></figcaption>
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<p>These approaches, collectively, are called <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine">complementary and alternative medicine</a>. It might be surprising that a traditionally trained Western doctor like me would recommend things like yoga, acupuncture or meditation for people with migraine. Yet in my practice, I value these <a href="https://doi.org/10.7326/0003-4819-135-5-200109040-00011">nontraditional treatments</a>. </p>
<p>Research shows that alternative therapies are associated with <a href="https://doi.org/10.1016/j.ctcp.2017.12.003">improved sleep, feeling better emotionally and an enhanced sense of control</a>. Some patients can avoid prescription medications altogether with one or more complementary treatments. For others, the nontraditional treatments can be used along with prescription medication. </p>
<p>These options can be used one at a time or in combination, depending on how severe the headache and the cause behind it. If neck tension is a contributor to the pain, then physical therapy or massage may be most beneficial. If stress is a trigger, perhaps meditation would be an appropriate place to start. It is worth talking to your provider to explore which options may work best for you. </p>
<h2>Mindfulness, meditation and more</h2>
<p>Because stress is a <a href="https://www.healthline.com/health/migraine-from-stress#bottom-line">major trigger for migraines</a>, one of the most effective alternative therapies is <a href="https://americanmigrainefoundation.org/resource-library/understanding-migraine-cattreatmentmindfulness-meditation-migraine/">mindfulness meditation</a>, which is the act of focusing your attention on the present moment in a nonjudgmental mindset. Studies show that mindfulness meditation can reduce <a href="https://medcentral.net/doi/full/10.4103/0366-6999.228242">headache frequency and pain severity</a>. </p>
<p>Another useful tool is <a href="https://americanmigrainefoundation.org/resource-library/biofeedback-and-relaxation-training/">biofeedback</a>, which enables a person to see their vital signs in real time and then learn how to stabilize them. </p>
<p>For example, if you are stressed, you may notice muscle tightness, perspiration and a fast heart rate. With biofeedback, these changes appear on a monitor, and a therapist teaches you exercises to help manage them. <a href="https://doi.org/10.1016/j.pain.2006.09.007">There is strong evidence</a> that biofeedback can lessen the frequency and severity of migraine headaches and reduce headache-related disability.</p>
<p><a href="https://www.medicalnewstoday.com/articles/yoga-for-migraine#can-it-help">Yoga</a> derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with a goal of uniting the mind, body and spirit. Practicing yoga consistently <a href="https://americanmigrainefoundation.org/resource-library/yoga-and-migraine/">can be helpful</a> in reducing stress and treating migraine.</p>
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<figcaption><span class="caption">Meditation is an alternative therapy that could help with your migraine.</span></figcaption>
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<h2>Manipulation-based therapy</h2>
<p><a href="https://www.webmd.com/migraines-headaches/physical-therapy-for-migraine">Physical therapy</a> uses manual techniques such as <a href="https://www.myofascialtherapy.org/myofascial-therapy">myofascial and trigger-point release</a>, <a href="https://www.healthline.com/health/exercise-fitness/passive-stretching">passive stretching</a> and <a href="https://www.verywellhealth.com/manual-cervical-traction-2696409">cervical traction</a>, which is a light pulling on the head by a skilled hand or with a medical device. Studies show that <a href="https://doi.org/10.1016/j.apmr.2015.12.006">physical therapy with medication was superior</a> in reducing migraine frequency, pain intensity and pain perception over medications alone. </p>
<p>By lowering stress levels and promoting relaxation, massage can <a href="https://www.webmd.com/migraines-headaches/migraine-massage-therapy">decrease migraine frequency</a> and <a href="https://doi.org/10.1207/s15324796abm3201_6">improve sleep</a>. It may also reduce stress in the days following the massage, which adds further protection from migraine attacks. </p>
<p>Some patients are helped by <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture">acupuncture</a>, a form of traditional Chinese medicine. In this practice, fine needles are placed in specific locations on the skin to promote healing. A large 2016 meta-analysis paper found <a href="https://doi.org/10.1111/head.12857">acupuncture reduced the duration and frequency of migraines</a> regardless of how often they occur. Acupuncture benefits <a href="https://doi.org/10.1001/jamainternmed.2016.9378">are sustained after 20 weeks of treatment</a>.</p>
<p>What’s also fascinating is that acupuncture <a href="https://doi.org/10.2147/JPR.S162696">can change the metabolic activity</a> in the thalamus, the region of the brain critical to pain perception. This change correlated with a decrease in the headache intensity score following acupuncture treatment.</p>
<h2>Vitamins, supplements and nutraceuticals</h2>
<p><a href="https://my.clevelandclinic.org/health/drugs/15829-herbal-supplements">Herbal supplements</a> and <a href="https://americanmigrainefoundation.org/resource-library/nutraceuticals-for-migraine/">nutraceuticals</a>, which are food-derived products that may have therapeutic benefit, can also be used to prevent migraine. And there is evidence to suggest vitamins work reasonably well compared to traditional prescription medication. They also have fewer side effects. Here are some examples:</p>
<ul>
<li><p>Magnesium is believed to help regulate the <a href="https://doi.org/10.1111/j.1526-4610.2011.01847.x">blood vessels and electrical activity in the brain</a>. A study found that patients given 600 milligrams of magnesium citrate daily for 12 weeks had a 40% <a href="https://doi.org/10.1046/j.1468-2982.1996.1604257.x">decrease in migraine</a>. Side effects included diarrhea in nearly 20% of patients. </p></li>
<li><p>Vitamin B2, or riboflavin, <a href="https://doi.org/10.1111/head.12789">is also considered useful in migraine</a> prevention. When dosed at 400 milligrams daily for 12 weeks, researchers found it <a href="https://doi.org/10.1111/head.12789">reduced migraine frequency by half</a> in more than half of participants. </p></li>
<li><p>Another beneficial supplement is Coenzyme Q10, which is involved in <a href="https://doi.org/10.1073/pnas.95.15.8892">cellular energy production</a>. After three months, about half of those taking 100 milligrams of Coenzyme Q10 three times a day <a href="https://pubmed.ncbi.nlm.nih.gov/15728298/">had half the number of migraine attacks</a>. </p></li>
<li><p>A potential natural solution is <a href="https://headaches.org/feverfew-tanacetum-parthenium/">feverfew</a> or <em>Tanacetum parthenium</em>, a daisylike perennial plant known to have <a href="https://doi.org/10.4103/0973-7847.79105">anti-migraine properties</a>. Taken three times daily, feverfew <a href="https://doi.org/10.1111/j.1468-2982.2005.00950.x">reduced migraine frequency by 40%</a>. </p></li>
</ul>
<h2>Devices can be beneficial</h2>
<p>The Food and Drug Administration has approved several <a href="https://www.everydayhealth.com/migraine/guide/treatment/nerve-stimulation-devices/">neurostimulation devices</a> for migraine treatment. These devices work by neutralizing the pain signals sent from the brain.</p>
<p>One is the <a href="https://doi.org/10.3389/fpain.2021.753736">Nerivio device</a>, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare. </p>
<p>Another device that shows promise is the <a href="https://americanmigrainefoundation.org/resource-library/understanding-migrainecefaly-for-migraine-prevention/">Cefaly</a>. It delivers a mild electrical current to the <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve#">trigeminal nerve</a> on the forehead, which can lessen the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, and the relief lasted up to 24 hours. Side effects are uncommon and include sleepiness or skin irritation. </p>
<p>These alternative therapies help treat the person as a whole. In just my practice, many success stories come to mind: the college student who once had <a href="https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/">chronic migraine</a> but now has rare occurrences after a regimen of vitamins; the pregnant woman who avoided medication through acupuncture and physical therapy; or the patient, already on numerous prescription medications, who uses a neurostimulation device for migraine instead of adding another prescription. </p>
<p>Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.</p><img src="https://counter.theconversation.com/content/181348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wilhour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Research suggests that alternative treatments for migraine, including physical therapy, massage and vitamin supplements, can make a difference.
Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Anschutz Medical Campus
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/181939
2022-06-27T03:47:10Z
2022-06-27T03:47:10Z
Physio ‘dry needling’ and acupuncture – what’s the difference and what does the evidence say?
<figure><img src="https://images.theconversation.com/files/468636/original/file-20220614-22-2dsj01.jpg?ixlib=rb-1.1.0&rect=17%2C250%2C5725%2C3569&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/woman-relaxes-acupuncture-procedure-acupuncturist-600w-1635120196.jpg">Shutterstock</a></span></figcaption></figure><p>Physiotherapists are increasingly offering needling therapies in addition to their standard care. Many Australian <a href="https://australian.physio/research/prf/translation/five-facts-about-acupuncture-and-dry-needling-musculoskeletal-pain">physiotherapists</a> in private practice now offer dry needling or Western medical acupuncture as part of a treatment approach.</p>
<p>Is it just a fad or does science support it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-my-muscles-ache-the-day-after-exercise-41820">Health Check: why do my muscles ache the day after exercise?</a>
</strong>
</em>
</p>
<hr>
<h2>Needling, three ways</h2>
<p>Physiotherapists can be trained to use dry needling, Western acupuncture and/or traditional acupuncture. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/23801002/">Dry needling</a> involves penetrating the skin with needles to altered or dysfunctional tissue in order to improve or restore function. This often involves needling muscle trigger points to activate a reflexive relaxation of the muscle. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28739020/">Western acupuncture</a> uses traditional needling <a href="https://www.sciencedirect.com/science/article/pii/S2005290110600143">meridians</a> (the ancient idea of energy channels through the body) and trigger points. But these ideas are applied to Western understandings of anatomy. In Western acupuncture, points are stimulated to create local tissue changes, as well as spinal and brain effects. The goals is to trigger pain-relieving chemicals, muscle activation or relaxation.</p>
<p>Even though traditional acupuncture points are used with this style of needling, Western acupuncture is not viewed as traditional Chinese medicine. </p>
<p><a href="https://healthtimes.com.au/hub/pain-management/44/research/kk1/acupuncture-for-pain-management/1581/">Traditional acupuncture</a> uses meridian lines or other points based on traditional Chinese medicine assessment methods and approaches. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chinese medicine chart with lines through body" src="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465898/original/file-20220530-26-1cisb.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A traditional Chinese medicine acupuncture chart from the 1800s.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/xk6jb43t">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>All physiotherapists trained in either acupuncture or dry needling meet safety standards which are viewed as within scope by the <a href="https://www.ahpra.gov.au/">Australian Health Practitioners Regulatory Agency</a> and the <a href="https://www.physiotherapyboard.gov.au/">Physiotherapy Registration Board</a>. These standards cover the level of training required, registration to practice and safety standards that include needle safety and hygiene to protect the public. </p>
<p>Minor reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015026/#:%7E:text=Examples%20of%20minor%20adverse%20reactions,pain%20during%20or%20after%20treatment.">side effects</a> related to acupuncture including pain and bleeding or bruising from needle insertion are fairly common. But major adverse events – pneumothorax (collapsed lung), excessive bleeding, prolonged aggravation – are rare. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/this-ancient-chinese-anatomical-atlas-changes-what-we-know-about-acupuncture-and-medical-history-140506">This ancient Chinese anatomical atlas changes what we know about acupuncture and medical history</a>
</strong>
</em>
</p>
<hr>
<h2>What’s needling good for?</h2>
<p>Research into the effectiveness of acupuncture and dry needling is variable. Some studies show comparable results between dry needling and acupuncture, while others show more favourable results for one or the other depending on the condition being treated. </p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedling">review</a> that assessed the effects of acupuncture and dry needling for the treatment of low-back pain found they may be useful add-on therapies but could not make firm conclusions due to a lack of quality trials. </p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600071/#CIT0034">review</a> reported the growing popularity of dry needling world wide and across disciplines and points out that many questions still remain regarding the use of needling. </p>
<p>For <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001218.pub3/full?highlightAbstract=acupuncture%7Cmigraine%7Cmigrain%7Cacupunctur">migraine</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007587.pub2/full?highlightAbstract=acupuncture%7Cheadach%7Ctension%7Cacupunctur%7Cheadache%7Ctype">tension</a> headaches, experts say acupuncture seems to reduce the frequency and intensity of attacks – though more research is needed to compare it to other treatments.</p>
<p>Acupuncture and dry needling may reduce pain and improve function for people with <a href="https://pubmed.ncbi.nlm.nih.gov/17224820/">neck pain</a>. A systematic review found significant differences between acupuncture and “sham acupuncture” (which is performed away from acupuncture points) when used to treat <a href="https://pubmed.ncbi.nlm.nih.gov/22965186/">certain types of chronic pain</a>. However, some research only shows <a href="https://pubmed.ncbi.nlm.nih.gov/33066556/">small and temporary</a> relief for neck pain with dry needling.</p>
<p>Results from randomised control trials support the use of needling for <a href="https://pubmed.ncbi.nlm.nih.gov/27062955">shoulder pain</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32301166/">tennis elbow</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/32186030/">osteo arthritic knee pain</a>. But a recent systemic review of research reported only weak evidence to support needling to treat <a href="https://pubmed.ncbi.nlm.nih.gov/33760098/">plantarfasciitis and chronic ankle instability</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man lies on treatment bed while physio inserts needles into his back" src="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465896/original/file-20220530-18-ws2b72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An increasing number of physiotherapists offer dry needling or acupuncture treatment.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Not just for sporting injuries</h2>
<p>Similarly, small randomised control trials have shown acupuncture and dry needling might reduce <a href="https://pubmed.ncbi.nlm.nih.gov/17095133/">problematic jaw pain</a> (<a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd#:%7E:text=Temporomandibular%20disorders%20(TMD)%20are%20disorders,may%20result%20in%20temporomandibular%20disorder.">temporo mandibular disorder</a>) and improve mouth opening.</p>
<p>Systematic reviews have reported needling and acupuncture were safe and effective recommendations for the treatment of broad conditions of <a href="https://www.healthline.com/health/tendinopathy">tendinopathy</a> (the breakdown of collagen in tendons) and <a href="https://pubmed.ncbi.nlm.nih.gov/30787631/#:%7E:text=At%20follow%2Dup%20in%20the,for%20the%20management%20of%20FM.">fibromyalgia</a> (chronic pain in the muscles and bones).</p>
<p>For women’s health, acupuncture has been shown to be effective for reducing pain with <a href="https://pubmed.ncbi.nlm.nih.gov/29879061/">periods</a>, compared to no treatment or non-steroidal pain relief medications – but the research had design limitations.</p>
<p>Though <a href="https://www.cochrane.org/CD002962/PREG_acupuncture-or-acupressure-induction-labour#:%7E:text=Acupuncture%20involves%20the%20insertion%20of,with%20onset%20of%20labour%20contractions.">widely used</a> in pregnancy, research into the use of acupuncture to <a href="https://pubmed.ncbi.nlm.nih.gov/32032444/">induce labour</a> reports it may increase satisfaction with pain management and reduce pain intensity. But it may have little to no effect on the rates of caesarean or assisted vaginal birth.</p>
<p>In summary, it appears needling techniques – whether dry needling or acupuncture – generally show positive effects over no treatment or “sham” treatments, but more research and high quality trials are needed. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1435103532856889344"}"></div></p>
<h2>Just one part of a treatment program</h2>
<p>Needling <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001351.pub2/full?highlightAbstract=dry%7Cdri%7Cneedl%7Cneedlin">may be useful</a> as part of multimodal care – that is, when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780149/">more than one treatment</a> is used in conjunction to treat a problem. </p>
<p>Physiotherapists may combine needling therapies with exercise prescription, hands-on care including massage, mobilisations and manipulations, and taping techniques. They may also employ therapies that apply external energy such as ultrasound, laser, transcutaneous (under the skin) electrical nerve stimulation and biofeedback.</p>
<p>Finally, while the various needling techniques all use a filiform needle (with a solid filament as opposed to a hollow bore needle), the styles with each can be quite different. Ask what style of needling is being employed to treat you, and if you have a history of finding one style works better for you, discuss this with your practitioner.</p><img src="https://counter.theconversation.com/content/181939/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Dry needling and Western acupuncture don’t incorporate traditional chinese medicine philosophies – but may be helpful for pain and releasing muscle tension.
Wayne Hing, Professor, Physiotherapy, Bond University
Leigh McCutcheon, Lecturer, Bond University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/140506
2020-09-02T12:53:47Z
2020-09-02T12:53:47Z
This ancient Chinese anatomical atlas changes what we know about acupuncture and medical history
<figure><img src="https://images.theconversation.com/files/355813/original/file-20200901-16-1qexa6v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/acupuncture-needles-ancient-medicine-illustration-showing-635954000">Pixeljoy/Shutterstock.com</a></span></figcaption></figure><p>The accepted history of anatomy says that it was the ancient Greeks who mapped the human body for the first time. <a href="http://www.bbc.co.uk/history/historic_figures/galen.shtml">Galen</a>, the “Father of Anatomy”, worked on animals, and wrote anatomy textbooks that lasted for the next 1,500 years. Modern anatomy started in the Renaissance with Andreas Vesalius, who challenged what had been handed down from Galen. He worked from human beings, and wrote the seminal “<a href="https://www.bl.uk/collection-items/vesalius-anatomy">On the Fabric of the Human Body</a>”.</p>
<p>Scientists from ancient China are never mentioned in this history of anatomy. But <a href="https://doi.org/10.1002/ar.24503">our new paper</a> shows that the oldest surviving anatomical atlas actually comes from Han Dynasty China, and was written over 2,000 years ago. Our discovery changes both the history of medicine and our understanding of the basis for acupuncture – a key branch of Chinese medicine.</p>
<p>There is an ever increasing body of <a href="https://www.nccih.nih.gov/health/acupuncture-in-depth">evidence-based research</a> that supports the efficacy of acupuncture for conditions as varied as migraine to osteoarthritis of the knee. The most recent <a href="https://www.nice.org.uk/guidance/gid-ng10069/documents/draft-guideline">draft NICE guidelines</a>, published in August 2020, recommend the use of acupuncture as a first line treatment for chronic pain.</p>
<p>During an acupuncture treatment session, fine needles are inserted into the body at specific points (acupoints) in order to promote self healing. This happens because the needles (somehow) create balance in the life force or “<em>Qi</em>” of the person. How this happens is the subject of much research. The underlying assumption is that acupoints have some as yet undiscovered physiological property that is probably neurologically based.</p>
<h2>Ancient Chinese texts</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chinese characters on a brown manuscript." src="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1325&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1325&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1325&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1664&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1664&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354392/original/file-20200824-24-1qgz9vq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1664&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mawangdui Manuscript, ink on silk, 2nd century BCE.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Mawangdui_LaoTsu_Ms2.JPG">© Hunan Province Museum</a></span>
</figcaption>
</figure>
<p>The texts we worked on are the <a href="http://www.hnmuseum.com/en/content/changsha-mawangdui-han-dynasty-tombs-exhibition">Mawangdui medical manuscripts</a>, which were lost to us for two millenia. They were written during the Han dynasty and were so valued that a copy was buried with the body of Lady Dai, a Han dynasty aristocrat in 168 BCE. The tombs of Lady Dai and her family were opened in 1973, and the Mawangdui manuscripts were discovered. </p>
<p>They are clearly precursors to the famous acupuncture texts of the Yellow Emperor’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287209/">Canon of Internal Medicine</a> (<em>Huangdi Neijing</em>), which was copied and recopied through history, and is revered in China as the source of acupuncture theory and practice. The descriptions of meridians and points found in it are still the basis of traditional Chinese medicine today.</p>
<p>The earlier Mawangdui texts don’t actually mention acupuncture points, and the descriptions they give of meridians are simpler and less complete. But some passages from them have clearly been directly copied into the Yellow Emperor’s Canon, all of which shows that these texts were written first. </p>
<figure class="align-left ">
<img alt="Man with meridians drawn on" src="https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=891&fit=crop&dpr=1 600w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=891&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=891&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/354394/original/file-20200824-18-14jlaeq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Illustration of traditional Chinese medicine.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:ChineseMedecine.JPG">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Meridian pathways have always been interpreted as being based on esoteric ideas about the flow of vital energy “<em>Qi</em>” rather than as empirical descriptions of the body. But what the Mawangdui text describes is a set of meridians – pathways through the body. In later texts, these are usually illustrated pictorially as lines on the skin.</p>
<p>A meridian is described in terms of how it progresses through the body. The arm <em>tai yin</em> meridian, for instance, is described as starting in the centre of the palm, running along the forearm between the two bones, and so on. We wondered: what if these descriptions are not of an esoteric energy pathway, but of physical anatomical structures?</p>
<h2>Dissecting history</h2>
<p>To find out, we did detailed dissections of the human body, looking for pathways which ran through it along the routes described in the Mawangdui.</p>
<p>This is a very different view of the body than that of the Western scientist. In modern western medicine, the body is divided into systems that each have their own distinct function: like the nervous system or cardiovascular system.</p>
<p>That clearly wasn’t what the writers of the Mawangdui were doing. Their descriptions are more focused on how different structures interlink to create a flow through the body. They pay no attention to the specific function of the structures. We think this is because these scientists were making their observations of the human body for the first time, and purely described what they saw.</p>
<p>For our research, the anatomical substance of the work had to be unearthed by carefully replicating the authors’ scientific dissections. This was problematic. They had left us no pictures of what they were describing, so we had to reconstruct from their texts. Later Chinese anatomists, from the <a href="http://en.tcm-china.org/art/2012/12/18/art_3282_69184.html">Song dynasty</a>, did make pictures. These works were based on the recorded dissections of a criminal gang for whom dissection was a part of their punishment.</p>
<figure class="align-center ">
<img alt="White statue of a man with Chinese characters drawn on." src="https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=822&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=822&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=822&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1034&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1034&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355815/original/file-20200901-16-1blkkva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1034&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An ancient acupuncture statue.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/29792566@N08/5494900763/">Traditional and Modern Medicine/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Then there was the issue of translation: so much can get lost when we translate texts, especially ancient ones, and one of us (Vivien) spent huge amounts of time cross-checking and confirming translations of the meridian descriptions. Finally, we had to look at Han-era society and show that anatomical examination would fit in their cultural context.</p>
<p>What we found was very exciting. Each of the Mawangdui meridians mapped onto major structures of the human body. Some of these structures are visible only to anatomists through dissection, and cannot be seen in the living person. To return to arm <em>tai yin</em>, for instance, the pathway is described at the elbow as going “below the sinew to the bicep”. When we look at the dissected human elbow, there is a flat band of tissue called the bicipital aponeurosis, and the arteries and nerves of the arm pass underneath it. </p>
<p>We think this is what the ancient Chinese anatomists were describing. There is no way to know about these structures except by doing anatomy, or reading the work of someone who has.</p>
<h2>The implications</h2>
<p>We therefore believe that the Mawangdui manuscripts are the world’s oldest surviving anatomical atlas based on direct observation of the human body. The authors’ purpose presumably was to record the human body in detail. Anatomical examination of this kind would have been a rare privilege, available only to a select group of scientists favoured by the Emperor. It is likely that the purpose of the texts was expressly to pass this knowledge on to others. Physicians and students of medicine could use the texts to learn about anatomy, and engage in medical debate based on a sound knowledge of the human body.</p>
<p>This gives us new insights into the scientific prowess of Han dynasty China, which is famous for its <a href="https://www.history.com/news/han-dynasty-inventions">wealth of discoveries</a>. That Han scientists also did anatomy would make perfect sense, and adds richness to our understanding of their science. </p>
<p>Our work also has fundamental implications for acupuncture theory and so for modern research. The Yellow Emperor’s Canon quite clearly draws on and develops the content of the Mawangdui. If the Mawangdui is an anatomical atlas, it is highly likely that the <a href="https://pubmed.ncbi.nlm.nih.gov/26861920/?from_term=vivien+shaw&from_pos=1">succeeding texts</a> are grounded in anatomy too. </p>
<p>The research shines a light on the hitherto unrecognised contributions of Chinese anatomists, and repositions them at the centre of the field. This new information challenges the perceived esoteric nature of acupuncture, and roots it instead in anatomical science.</p><img src="https://counter.theconversation.com/content/140506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
New research shows that the oldest surviving anatomical atlas comes from Han Dynasty China, and was written over 2,000 years ago.
Vivien Shaw, Lecturer in Anatomy, Bangor University
Isabelle Catherine Winder, Lecturer in Zoology, Bangor University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/122931
2019-10-07T19:16:58Z
2019-10-07T19:16:58Z
Only 2 in 3 physios provide ‘recommended care’, but that’s still higher than medicine
<figure><img src="https://images.theconversation.com/files/295331/original/file-20191003-49361-1yplypv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physiotherapists sometimes use acupuncture to treat knee osteoarthritis and low back pain, but it's not recommended.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/690310138?src=2Z9DIu7FjvgK_D62StOvkA-1-17&size=huge_jpg">NiP Studio/Shutterstock</a></span></figcaption></figure><p>When people visit a GP clinic or hospital in <a href="https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia">Australia</a> or the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12826639">United States</a>, they receive the recommended care around 55-57% of the time. </p>
<p>Recommended care means they get the tests or treatments that evidence-based guidelines say a patient should receive for their condition. This is usually because they’re the most effective or cost-effective option. The <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommended care for people with knee osteoarthritis</a>, for example, is exercise and weight loss. </p>
<p>Clinicians may not provide recommended care for several reasons. These include wishes of the patient, lack of trust in the evidence or guidelines, or experience providing certain types of care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/man-v-mountain-how-to-overcome-the-evidence-overload-7041">Man v mountain: how to overcome the evidence overload</a>
</strong>
</em>
</p>
<hr>
<p>Doctors often refer patients with musculoskeletal problems such as back pain and osteoarthritis for physical therapy. But until now, it has been unclear how often physiotherapists provide the recommended care for these patients. </p>
<p>Our review of the international evidence, published today in <a href="https://bmjopen.bmj.com/content/9/10/e032329">BMJ Open</a>, found 63% of physiotherapists provided recommended treatments. But 27% provided treatments that weren’t based on evidence and which the guidelines recommended against. </p>
<p>Fortunately, failing to provide recommended care is unlikely to harm patients. Nevertheless, ditching non-recommended treatments could result in more efficient care and fewer resources being wasted. </p>
<h2>Our study</h2>
<p>We reviewed 94 studies from 19 countries, including Australia, to investigate the treatments physiotherapists provided for a range of musculoskeletal conditions. These included back pain, knee osteoarhtirits, neck pain, whiplash, foot or ankle pain and shoulder pain. </p>
<p>We used physiotherapists’ clinical notes to determine which treatments they provided. We then compared their treatment choices with recommendations from evidence-based guidelines, or guidelines that were considered most credible for each condition.</p>
<p>Overall, we found 63% of physiotherapists provided recommended treatments, which appears higher than in hospitals and GP clinics overall. A 2012 Australian audit, for example, found <a href="https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia">57% of patients surveyed</a> received recommended care.</p>
<p>But in our study, almost half of physiotherapists (45%) provided treatments that guidelines didn’t mention because there wasn’t enough evidence to say if they worked or not.</p>
<p>And one in four (27%) provided treatments the guidelines recommend against. This was usually because the evidence showed they’re ineffective. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295338/original/file-20191003-49350-cxpuat.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Often, the recommended treatment for pain conditions is to advise patients to stay active.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/301939577?src=P5Rjt83FjOGeVo3hWDiDSA-1-3&size=huge_jpg">Aleksandra Suzi/Shutterstock</a></span>
</figcaption>
</figure>
<p>Physiotherapists can provide a range of treatments, some recommended and others not, so these percentages don’t add up to 100. Of the 63% who provide recommended care, for instance, some might also be providing treatments that are not recommended or that are not mentioned in guidelines.</p>
<h2>Why does it matter?</h2>
<p>Back pain, neck pain, osteoarthritis and other musculoskeletal conditions can have a substantial impact on people’s lives, and often cause <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32154-2/fulltext">disability</a>.</p>
<p>Traditionally, these conditions were <a href="https://www.cdc.gov/drugoverdose/prescribing/guideline.html">managed with medication</a> and surgery. However, medications such as opioids cause harm and there is growing evidence some common surgical procedures are ineffective. This has <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">prompted a shift</a> in what is recommended for musculoskeletal conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-guidelines-on-low-back-pain-are-clear-drugs-and-surgery-should-be-the-last-resort-94746">The guidelines on low back pain are clear: drugs and surgery should be the last resort</a>
</strong>
</em>
</p>
<hr>
<p>Today, clinical practice guidelines <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">recommend treatments provided by physiotherapists</a> over <a href="https://www.cdc.gov/drugoverdose/prescribing/guideline.html">medication</a> and surgery. </p>
<p>There is, however, a range of treatments physiotherapists can provide.
Some treatments <a href="https://www.nice.org.uk/guidance/cg177">are effective</a>, such as exercise for knee osteoarthritis. Other treatments are not, such as <a href="https://www.nice.org.uk/guidance/ng59">acupuncture for low back pain</a>. </p>
<p>To ensure patients receive the right care, physiotherapists are expected to follow recommendations from clinical practice guidelines. These guidelines are <a href="http://www.acsep.org.au/content/Document/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">often multidisciplinary</a> and intended to be used by GPs, physiotherapists, and surgeons. </p>
<h2>Physios manage some pain better than other pain</h2>
<p>When it comes to following clinical guidelines, we found physiotherapists manage some conditions better than others. </p>
<p>For shoulder pain, up to 76% of physiotherapists provided recommended treatments (such as strengthening exercises and massage). Only 8% provided treatments that were not recommended (such as magnetic field therapy, which uses an electrical current to alleviate pain). </p>
<p>There is room for physiotherapists to improve their use of recommended treatments for knee osteoarthritis and low back pain. </p>
<p>For knee osteoarthritis, 65% of physiotherapists provided recommended treatments (to advise patients to stay active, undertake aerobic and strength exercises and lose weight). One in five (21%) provided treatments that were not recommended (such as acupuncture and advice to reduce activity levels).</p>
<p>For low back pain, half provided recommended treatments (advice to stay active and reassure patients that most people recover from back pain without formal treatment); while 18% provided treatments that were not recommended (acupuncture, lumbar braces, or advice to rest in bed until the pain goes).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pain-drain-the-economic-and-social-costs-of-chronic-pain-49666">Pain drain: the economic and social costs of chronic pain</a>
</strong>
</em>
</p>
<hr>
<p>Physiotherapists have a lot to offer patients with musculoskeletal conditions. But it’s important they don’t dilute appropriate care with inappropriate care. </p>
<p>Better adhering to clinical practice guidelines could increase the efficiency of physiotherapy services and ensure patients only receive care that is truly necessary.</p><img src="https://counter.theconversation.com/content/122931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joshua Zadro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
New international research shows one in four physiotherapists provide treatments that aren’t based on evidence. These treatments aren’t likely to cause harm, but they might waste patients’ time.
Joshua Zadro, Postdoctoral Research Fellow, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/94746
2018-05-16T01:40:09Z
2018-05-16T01:40:09Z
The guidelines on low back pain are clear: drugs and surgery should be the last resort
<figure><img src="https://images.theconversation.com/files/216438/original/file-20180426-175038-1fq8089.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most people with low back pain aren't getting the most effective treatment.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Low back pain is the <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30488-4.pdf?code=lancet-site">leading cause of disability</a> worldwide and is becoming more common as our population ages. Most people who have an episode of low back pain <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">recover within six weeks</a>, but two-thirds still have pain after three months. By 12 months, pain may linger but is usually less intense. </p>
<p>Still, <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">recurrence is common</a> and in a small number of people it may become persistent and disabling. Chronic back pain affects well-being, daily functioning and social life. </p>
<p>A series on low back pain by the global medical journal <a href="https://www.thelancet.com/series/low-back-pain?code=lancet-site">The Lancet</a> outlined that most sufferers aren’t getting the most effective treatment. The articles state that recommended first-line treatments – such as advice to stay active and to exercise – are <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf?code=lancet-site">often overlooked</a>. Instead, many health professionals seem to favour less effective treatments such as rest, opioids, spinal injections and surgery.</p>
<p>So, here’s what evidence shows you need to do to improve your low back pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needless-treatments-spinal-fusion-surgery-for-lower-back-pain-is-costly-and-theres-little-evidence-itll-work-91829">Needless treatments: spinal fusion surgery for lower back pain is costly and there's little evidence it'll work</a>
</strong>
</em>
</p>
<hr>
<h2>Risk factors for low back pain</h2>
<p>The cause of most people’s low back pain remains unknown. But we do know of a number of <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf">risk factors</a> that could increase the chance of developing low back pain. These include a physically demanding job that involves lifting, bending and being in awkward postures. Lifestyle factors such as smoking, obesity and low levels of physical activity are also associated with developing low back pain. </p>
<p>People with low back pain should see a health professional to rule out the more serious causes of pain such as fracture, malignancy (cancer) or infection.</p>
<p>Once patients are cleared of these, the <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf?code=lancet-site">current guidelines</a> from Denmark, the UK and the US advise self-management and psychological therapies as the initial response for persistent low back pain. These include staying active, doing appropriate exercises and undertaking a psychological program to help manage the pain.</p>
<p>Exercises such as Tai Chi, yoga, motor control (to restore strength, co-ordination and control of the deep core stabilising muscles supporting the spine) and aerobic exercises (such as walking, swimming, cycling and general muscle reconditioning exercises) are recommended.</p>
<p>If any of these therapies fail or stop working, the guidelines point to manual and physical therapies such as spinal manipulation (Denmark, UK, US), massage (UK and US) and yoga and acupuncture (US) – particularly for low back pain lasting more than 12 weeks. </p>
<iframe src="https://datawrapper.dwcdn.net/v2KH1/2/" scrolling="no" frameborder="0" allowtransparency="true" width="100%" height="323"></iframe>
<h2>Exercise and psychological therapy</h2>
<p>The guidelines are based on many studies that have shown the benefits of exercise and psychological therapies. For instance, a 2006 study compared pain levels across two groups of <a href="https://www.researchgate.net/publication/36215732_Evaluation_of_a_targeted_exercise_rehabilitation_approach_and_its_effectiveness_in_the_treatment_of_pain_functional_disability_and_muscle_function_in_a_population_with_longstanding_unresolved_low_back">physically active people</a> with chronic low back pain. </p>
<p>Participants who followed a four-week program using Pilates exercise equipment reported a more significant reduction in pain and disability than those in a control group who received usual care (consultations with a health care professional as needed). The benefit for the exercise group was maintained over a 12-month period.</p>
<p>Another, 2011 trial explored the benefits of Tai Chi for those with <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/acr.20594">persistent low back pain</a>. Participants who completed a ten-week course of Tai Chi sessions had less bothersome back symptoms, pain intensity and self‐reported disability, compared with a control group who continued with their normal medical care, fitness or health regimen.</p>
<p>Chronic pain is linked with chemical and structural changes at all levels of the nervous system. These include the level of neurotransmitter changes that alter pain modulation, and sensitisation of the nerves involved in transmitting pain signals. Incoming pain signals can be modified by our response to persistent pain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-pain-and-what-is-happening-when-we-feel-it-49040">Explainer: what is pain and what is happening when we feel it?</a>
</strong>
</em>
</p>
<hr>
<p>Psychological treatments – such as mindfulness-based stress reduction – focus on increasing awareness and acceptance of physical discomfort, as well as challenging emotions often associated with chronic pain. </p>
<p>In a trial including 342 participants, around 45% of those who had completed eight sessions of cognitive behaviour therapy or mindfulness-based stress reduction had clinically <a href="https://jamanetwork.com/journals/jama/fullarticle/2504811">meaningful improvements</a> in bothersome pain at 26 weeks of follow-up. This was compared to only 26.6% of people who had received usual care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216592/original/file-20180427-175050-ruegyy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercises such as swimming can help strengthen the core.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Manual therapy</h2>
<p>In Australia, physiotherapists, chiropractors and osteopaths use manual and physical therapy to treat lower back pain. The treatments often include some form of spinal manipulation and massage, as well as advice to stay active and do exercises. This is consistent with The Lancet’s recommendations, also based on evidence from studies. </p>
<p>A 2013 trial of <a href="https://www.ncbi.nlm.nih.gov/pubmed/23026869">people with acute low back pain</a> compared the effects of spinal manipulation with those of the non-steroidal anti-inflammatory drug diclofenac (Voltaren) and placebo on their pain. Spinal manipulation was found to be significantly better than diclofenac and clinically superior to placebo in reducing disability, pain and the need for rescue medication. It was also found to improve quality of life.</p>
<p>Similar results came from <a href="https://www.ncbi.nlm.nih.gov/pubmed/15319761">another study</a> of 192 people with low back pain that lasted around two to six weeks. Participants were randomly allocated to one of three groups: chiropractic manipulation with a placebo medication; muscle relaxants with sham manipulation; or placebo medicine with sham manipulation. All subjects improved over time, but the chiropractic group responded significantly better, with a bigger decrease in pain scores, than the control group.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ouch-the-drugs-dont-work-for-back-pain-but-heres-what-does-72283">Ouch! The drugs don't work for back pain, but here's what does</a>
</strong>
</em>
</p>
<hr>
<p>Physiotherapists, chiropractors and osteopaths are required by law to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) to practise in Australia. To be registered, a person must complete a minimum of four years’ study at a university in a degree that includes a focus on non-pharmacological (drug-based), non-surgical management of musculoskeletal conditions, including low back pain. </p>
<p>Under the government’s <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdisease-pdf-infosheet">Chronic Disease Management Plan</a> patients with persistent low back pain may be referred to physiotherapists, chiropractors or osteopaths for evidence-based therapies such as spinal manipulation and massage. If patients are unfamiliar with these therapies, they can discuss referral with their GP.</p>
<p>Physiotherapists, chiropractors and osteopaths can also be consulted without referral. Their services are usually covered by private health insurance. The AHPRA website lists <a href="https://www.ahpra.gov.au/">registered practitioners</a> in your area. </p>
<p>One thing to look out for when you see a practitioner is the number of treatments they recommend. Patients usually start with a short course of two to six treatments to see if the treatment helps. It shouldn’t take many treatments for a change in symptom pattern to become obvious.</p>
<p>The message to the public and to health professionals is clear. People with non-specific low back pain need to learn how to independently manage their pain while remaining active, staying at work and maintaining their social life as far as possible.</p><img src="https://counter.theconversation.com/content/94746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sandra Grace is an academic member of Chiropractic & Osteopathic College of Australia Research Ltd and a member of Osteopathy Australia.</span></em></p><p class="fine-print"><em><span>Roger Mark Engel is an academic in the Department of Chiropractic, Faculty of Science Engineering at Macquarie University and an academic member of the Chiropractors Association of Australia, the Chiropractic and Osteopathic College of Australasia, Chiropractic Australia and Osteopathy Australia. </span></em></p><p class="fine-print"><em><span>Subramanyam R Vemulpad is an academic in the Department of Chiropractic, Faculty of Science Engineering at Macquarie University. </span></em></p>
A recent series on low back pain by the global medical journal The Lancet shows doctors often overlook recommended treatments, such as advice to stay active and to exercise.
Sandra Grace, Associate Professor in Osteopathy, Southern Cross University
Roger Mark Engel, Senior Lecturer, Department of Chiropractic, Macquarie University
Subramanyam R Vemulpad, Associate Professor, Macquarie University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/96459
2018-05-15T20:20:01Z
2018-05-15T20:20:01Z
Acupuncture during IVF doesn’t increase chances of having a baby
<figure><img src="https://images.theconversation.com/files/218722/original/file-20180514-178757-x4ridg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Acupuncture might alleviate stress for women undertaking IVF. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Acupuncture has become a <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-828X.2007.00702.x">frequently used</a> treatment prior to and during in-vitro fertilisation (IVF). Women hope it will increase their chances of having a baby, but also provide support with reducing stress, and feeling relaxed and well while undergoing treatment. </p>
<p>Several small clinical trials
<a href="https://www.ncbi.nlm.nih.gov/pubmed/11937123">have</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16616748">previously suggested</a> acupuncture improved outcomes of stressful and unpredictable fertility treatments. But our <a href="https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.5336">new study</a> has found this is not the case. </p>
<p>The study of more than 800 Australian and New Zealand women undergoing acupuncture treatment during their IVF cycles has failed to confirm significant difference in live birth rates. </p>
<p>The findings published today in the Journal of the American Medical Association (<a href="https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.5336">JAMA</a>) support recent guidelines from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28366416">American Society for Reproductive Medicine</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23814102">two</a> high-quality <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006920.pub3/abstract;jsessionid=3F6D129E2C3EE0F3DBF183828B1A1293.f03t02">meta-analyses</a> (which combine data from multiple studies to identify a common effect).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">Modern acupuncture: panacea or placebo?</a>
</strong>
</em>
</p>
<hr>
<h2>What the study found</h2>
<p>We examined the effects of a short course of acupuncture administered during an IVF cycle. We were not able to show that acupuncture increased live births, clinical pregnancy or having fewer miscarriages.</p>
<p>Undertaken across 16 IVF centres in Australia and New Zealand, the randomised controlled clinical trial (that compares the effects of an experimental treatment on one group with those of a placebo or alternative treatment in another group) aimed to increase live births and pregnancies among 848 women aged 18 to 42, undergoing an IVF cycle using fresh embryos, over a four year period.</p>
<p>The first acupuncture treatment was given at the start of the IVF process when medication is given to stimulate the ovary to produce follicles. </p>
<p>Following successful fertilisation, acupuncture to recognised acupuncture points was performed prior to, and immediately following, the transfer of the embryo to the woman’s womb. </p>
<p>The control group in this study was sham acupuncture. This looks like real acupuncture but does not involve insertion of the needle through the skin. For both groups the needle is held in place by a plastic tube, but as the practitioner places the needle on the skin, for the control group the shaft of the needle disappears into the handle, while in the treatment group the needle pierces the skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-traps-to-be-aware-of-when-reading-success-rates-on-ivf-clinic-websites-68806">Five traps to be aware of when reading success rates on IVF clinic websites</a>
</strong>
</em>
</p>
<hr>
<p>The results showed a clinical pregnancy was achieved in 25.7% of women who received acupuncture and 21.7% of women in the sham control, and that a live birth was achieved for 18.3% of women who received acupuncture compared to 17.8% who received the control.</p>
<p>While a 4% increase might sound hopeful, given the low percentage of successful IVF births to begin with, this is not a big enough increase for scientists to conclude there is a difference. This means the study does not support that acupuncture can improve pregnancy or live birth rates for women undergoing IVF.</p>
<p>However, in clinical practice, acupuncture may include more sessions prior to an IVF cycle starting. Whether this would make a difference hasn’t been tested.</p>
<h2>Why is this important?</h2>
<p>Despite recent technological improvements to IVF, the success rate is still low. Consequently, new drugs, laboratory techniques and other treatments need to be developed and rigorously tested to explore their effects on producing healthy babies for women undergoing IVF. </p>
<p>Acupuncture has long been used for gynaecological and obstetric problems. In 2002, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/11937123">first randomised controlled trial</a> of acupuncture administered a specific form of IVF acupuncture at the time of embryo transfer. The results indicated the chance of achieving a pregnancy from acupuncture was twice that of women undergoing IVF treatment alone. </p>
<p><a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD006920.pub3/abstract;jsessionid=3F6D129E2C3EE0F3DBF183828B1A1293.f03t02">Further clinical trials were conducted</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/23814102">to examine</a> if these results could be replicated. Some trials found acupuncture had some effect and others found it had none.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218725/original/file-20180514-178734-1wp73w4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">IVF is an emotionally tumultuous time.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gFlxfX545BY">k b unsplash</a></span>
</figcaption>
</figure>
<h2>Where did the acupuncture belief come from?</h2>
<p>An adequate blood flow to develop immature eggs, and the endometrium (the lining of the uterus), is important to female fertility and pregnancy. Studies on a stronger form of acupuncture, electro-acupuncture, found it may influence central sympathetic nerve activity, <a href="https://www.ncbi.nlm.nih.gov/pubmed/8671446">and may</a>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/16514000">increase blood flow</a> in parts of the body, including improved blood flow and oxygenation to ovarian and uterine tissue. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-questions-answered-on-donor-conception-and-ivf-45715">Your questions answered on donor conception and IVF</a>
</strong>
</em>
</p>
<hr>
<p>Stress is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22698634">thought to play a role</a> in infertility. Among women undertaking IVF treatment, <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0063743">previous research has found</a> an association between lower levels of stress and anxiety and increased pregnancy. </p>
<p><a href="https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-9-50">In our</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/16600225">earlier research</a>, acupuncture was shown to reduce the emotional stress and burden experienced by women during IVF treatment.</p>
<p>We hope the new findings will enable women and practitioners to make evidence-formed decisions about the use of acupuncture to achieve a pregnancy and live birth. </p>
<p>But unpublished findings from our trial highlight a supportive role from acupuncture with reducing stress, increased relaxation and improving how women feel about themselves while undergoing the demands of IVF treatments. These findings suggest while it probably won’t improve a woman’s chance of having a baby, acupuncture could help women deal with the emotional turmoil of IVF.</p><img src="https://counter.theconversation.com/content/96459/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Smith received funding for this study from the National Health and Medical Research Council (NHMRC) Grant/Award number APP1003661; and needles were supplied from Helio Supply Co.
Caroline Smith declares as a medical research institute, NICM Health Research Institute receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. </span></em></p><p class="fine-print"><em><span>Robert Norman is a shareholder with FertilitySA.</span></em></p>
A new study has countered old reports acupuncture can improve your chances of having a baby when going through IVF.
Caroline Smith, Professor Clinical Research, Western Sydney University
Robert Norman, Professor of Reproductive and Periconceptual Medicine, The Robinson Institute, University of Adelaide
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/79430
2017-06-19T01:04:46Z
2017-06-19T01:04:46Z
Emergency doctors are using acupuncture to treat pain, now here’s the evidence
<figure><img src="https://images.theconversation.com/files/174109/original/file-20170616-519-1v70ply.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Doctors with special training in acupuncture and practitioners of traditional Chinese medicine worked together in emergency departments.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/467699921?src=UHqdQ2DUj9poIUxTG_8Haw-1-36&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Emergency medicine is not all about life and death situations and high-tech solutions. Our study, the largest of its kind in the world, shows using acupuncture in the emergency department can relieve acute pain.</p>
<p>The study, published today in the <a href="https://www.mja.com.au/journal/2017/206/11/acupuncture-analgesia-emergency-department-multicentre-randomised-equivalence">Medical Journal of Australia</a>, finds acupuncture is as effective as medication in treating pain for lower back pain and ankle sprain. But it took more than an hour for either to provide adequate pain relief.</p>
<p>Our study builds on previous research to show the effectiveness of acupuncture to treat <a href="http://www.bmj.com/content/338/bmj.a3115">chronic</a> (long-term) <a href="https://www.ncbi.nlm.nih.gov/pubmed/20070551">pain</a>.</p>
<p>Yet, there are several barriers to using acupuncture routinely in emergency departments.</p>
<h2>What is acupuncture and who practices it?</h2>
<p>Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.</p>
<p>For generations <a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102?sa=google&sq=acupuncture&sr=1">various cultures</a> around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the <a href="http://www9.health.gov.au/mbs/search.cfm?q=173-195&sopt=I">Medicare Benefits Schedule</a> when administered by a medical doctor.</p>
<hr>
<p><em>Further reading: <a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102?sa=google&sq=acupuncture&sr=1">Modern acupuncture: panacea or placebo?</a></em></p>
<hr>
<p>Acupuncture is one of the <a href="http://online.liebertpub.com/doi/abs/10.1089/acm.2005.11.995">most accepted</a> forms of complementary medicine among Australian general practitioners. It also appears in treatment guidelines for doctors in <a href="https://tgldcdp.tg.org.au/guideLine?guidelinePage=Analgesic&frompage=etgcomplete">how to manage</a> pain. </p>
<h2>Why we ran the study and what we did</h2>
<p>Anecdotally, we were aware that several emergency department doctors, in both public and private hospitals in Australia, were treating patients’ pain with acupuncture. But until this large federally-funded study, no-one had set up a trial like it to show how effective it was.</p>
<p>Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than <a href="https://theconversation.com/explainer-what-is-the-placebo-effect-and-are-doctors-allowed-to-prescribe-them-55219?sa=google&sq=placebo&sr=1">placebo</a>. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.</p>
<p>So, we randomly assigned more than 500 patients to receive standard painkillers, standard painkillers plus acupuncture, or acupuncture alone when they presented with back pain, migraine or ankle sprain at four Melbourne hospitals (some private, some public). While the patients knew which treatment they had, the researchers involved in assessing their pain didn’t (known as a single-blind study).</p>
<p>The type of acupuncture we used included applying needles at specific points on the body for each condition, as well as along points chosen by the treating acupuncturist. This was to reflect what would happen during regular clinical practice.</p>
<p>Doctors who were also qualified medical acupuncturists and practitioners of traditional Chinese medicine (registered in Victoria with the <a href="http://www.chinesemedicineboard.gov.au/">Chinese Medicine Registration Board of Australia</a>) performed the acupuncture.</p>
<p>After treatment, we assessed patients’ pain after an hour, and every hour until discharge. We also rang them for an update 24-48 hours after being discharged.</p>
<h2>What we found</h2>
<p>We found acupuncture, either alone or with painkillers, was equivalent to drugs-alone in providing pain relief for lower back pain, ankle sprain, but not for migraine.</p>
<p>When patients looked back on their treatment, the vast majority (around 80%) were satisfied with their treatment regardless of which treatment they had.</p>
<p>However, no treatment provided good pain relief until after the first hour.</p>
<h2>What are the implications?</h2>
<p>Our findings suggest acupuncture may be a viable option for patients who come to the emergency department for pain relief. This is especially important for those who cannot or choose not to have analgesic drugs. </p>
<p>This is also an important finding in light of the potential for side effects and abuse with opioid analgesics, which might otherwise be used to relieve pain in the emergency department.</p>
<p><a href="http://www.iama.edu/OtherArticles/acupuncture_WHO_full_report.pdf">Previous research</a> shows using acupuncture to treat chronic pain is comparable to morphine, is safer and doesn’t lead to dependence. Our findings suggest acupuncture also has a role in treating acute pain.</p>
<p>However, our research raises several issues, not only about conducting such research but also in implementing our findings in practice.</p>
<p>We had to overcome many ethical, policy and regulatory issues before we started. These included issues around the qualifications of medical and non-medical acupuncturists and employing traditional Chinese medicine practitioners to deliver acupuncture in a western medical hospital.</p>
<p>And to more widely implement our findings, we need to discuss the type of practitioners best placed to deliver acupuncture in hospital, what type of training they need to work in the emergency department and what type of conditions they should treat.</p>
<p>Hopefully, our study will spark further research to address these issues and lead to the development of safe and effective protocols for acute pain relief that may involve combining both modern and ancient forms of medicine to achieve rapid and effective analgesia for all emergency department patients.</p><img src="https://counter.theconversation.com/content/79430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen received funding from the NHMRC. </span></em></p>
Some emergency doctors are already using acupuncture to relieve patients’ pain. Now a new study shows when it works, when it doesn’t and how emergency departments of the future might use it.
Marc Cohen, Professor of Health Sciences, RMIT University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/46742
2016-02-10T19:09:20Z
2016-02-10T19:09:20Z
A shift in social attitudes can make menopause a positive experience
<figure><img src="https://images.theconversation.com/files/110247/original/image-20160204-5826-t1q1as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studies show Chinese women view advanced age as a positive time of wisdom and maturity.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series examining women’s hidden health conditions. You can read about bacterial vaginosis, pelvic inflammatory disease and other pieces in the series <a href="https://theconversation.com/au/topics/womens-health-series">here</a>.</em></p>
<hr>
<p>It’s a sensation familiar to <a href="http://www.ncbi.nlm.nih.gov/pubmed/16037762">three out of every four women</a> going through menopause. First, there’s a sudden and intense feeling of heat, accompanied by extreme sweating and redness in the face and chest. This is followed by chills. Then, it’s repeated several times an hour around the clock. </p>
<p>An estimated <a href="http://womenworkandthemenopause.com/menopause-and-the-workplace/">one million Australian women</a> suffer hot flushes, and suffer they do. They don’t just leave women feeling hot and bothered, but also have considerable impact on quality of life. </p>
<p>Hot flush episodes go on <a href="http://www.maturitas.org/article/S0378-5122(08)00041-8/abstract">for an average of three to four minutes</a> at a time. For some women, they can last up to an hour. </p>
<p>Flushes aren’t usually a transient experience either. They persist for an average of five to seven years. About <a href="http://www.ncbi.nlm.nih.gov/pubmed/25706184">40% of women will still experience them</a> into their early 60s.</p>
<p>Despite this <a href="http://www.bjog.org/details/news/1375983/Older_women_still_suffer_from_hot_flushes_and_night_sweats_years_after_the_menop.html">high prevalence</a>, women usually suffer alone, breaking their silence only with close girlfriends or partners. </p>
<p>Social attitudes around menopause need to shift toward valuing the experience and maturity that comes with ageing. This will inevitably reduce the menopausal distress women experience.</p>
<h2>Avoiding social interactions</h2>
<p>Patients have told me they avoided social interactions because they’ve been embarrassed about their hot flushes, which over time led to depression. Some said they avoided shopping because they feared being mistaken for a shoplifter – as the sweating and red face made them appear nervous and guilty. </p>
<p>Women have told me their symptoms were ruining their lives and they were at the absolute end of their tether. Studies have backed this anecdotal evidence, showing hot flushes left many women feeling <a href="http://www.ncbi.nlm.nih.gov/pubmed/20955869">embarrassed, physically unattractive and stupid</a>.</p>
<p>Women across the world experience menopausal symptoms differently. In China, for instance, the <a href="http://www.tandfonline.com/doi/abs/10.1080/13697130601181486?journalCode=icmt20#.VpblG4R5hUU">prevalence of hot flushes</a> is relatively low, at around 20% to 30%. </p>
<p>While biological differences may certainly play a role, there are suggestions cultural differences shape these experiences. One study showed Chinese women <a href="http://journals.lww.com/menopausejournal/Abstract/1998/05010/Chinese_Midlife_Women_s_Perceptions_and_Attitudes.6.aspx">viewed ageing positively</a>; some felt it signalled a time of wisdom and maturity. </p>
<p>By contrast, in the West, menopause conjures up themes around loss of femininity, beauty and sexuality. Such negative cultural attitudes <a href="http://www.tandfonline.com/doi/abs/10.1080/13697130601181486?journalCode=icmt20#.Vgnb7bTZk2s">could contribute to the severity</a> of hot flushes experienced by Western women. </p>
<h2>Menopause in the workforce</h2>
<p>Hot flushes and other menopausal symptoms, including sleep disturbance and memory loss, can have a considerable impact on women at work. This is highly relevant as <a href="http://www.dca.org.au/dca-research/older-women-matter.html">women of menopausal age comprise 17% of the Australian workforce</a>. </p>
<p>A large Australian <a href="http://womenworkandthemenopause.com/menopause-and-the-workplace/">study on menopausal women in the workplace</a> found many felt stressed and anxious at work, which led to poor self-esteem and loss of confidence. Some said their symptoms made them lose concentration and focus.</p>
<p>Unfortunately, it also showed managers and human resources staff weren’t skilled at effectively managing menopausal staff. Women reported “gendered ageism”, such as feeling “invisible” once they reached menopausal age. Some felt they had been overlooked for promotions and other opportunities because they were viewed as no longer intellectually desirable.</p>
<p>A <a href="https://www.tuc.org.uk/sites/default/files/TUC_menopause_0.pdf">study from the United Kingdom</a> reported criticism and even harassment directed at women taking menopause-related sick leave. </p>
<p>Positively though, the study outlined strategies women found helpful at their place of work. These included having control over ambient temperature, access to cold water and toilets, and understanding from managers about menopause-related sick leave and flexibility of working hours. </p>
<h2>Treatment options</h2>
<p>Hormone replacement therapy (HRT) is effective for relieving menopausal symptoms, with studies showing <a href="http://www.ncbi.nlm.nih.gov/pubmed/15495039">up to a 75% reduction in frequency</a> compared to placebo. </p>
<p>But new research suggests that despite its effectiveness and although it’s <a href="http://www.menopause.org/docs/default-document-library/psht12.pdf?sfvrsn=2">safe for many women</a>, particularly those under 60, HRT is <a href="http://www.ncbi.nlm.nih.gov/pubmed/26240945">significantly underused</a>. This means the majority of women suffering from severe hot flushes remain untreated. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=609&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=609&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=609&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=765&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=765&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110262/original/image-20160204-3020-ukndhg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=765&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Access to cold water can be helpful.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Some women find <a href="https://www.menopause.org.au/for-women/information-sheets/734-complementary-and-herbal-therapies-for-hot-flushes">complementary therapies</a>, such as acupuncture, help relieve symptoms. But trials testing the effectiveness of these therapies have been conflicting. <a href="http://annals.org/mobile/article.aspx?articleid=2481811">Our recent study</a>, for instance, showed acupuncture was as effective as sham acupuncture for relieving hot flushes.</p>
<p>Strategies other women find helpful are: layering of clothing, such as removing a cardigan when a flush happens; avoiding triggers such as hot drinks, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/20955869">psychological techniques</a> such as communicating with openness and humour. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031101/">Mind-body interventions</a> such as meditation may help, and there is growing interest among researchers and clinicians in the role of <a href="http://www.medscape.com/viewarticle/805079">cognitive behavioural therapy</a>. </p>
<p>The increasing evidence for the effectiveness of psychological techniques strengthens the idea that social attitudes and perceptions of the condition can impact its severity.</p>
<h2>A positive experience</h2>
<p>Actress Angelina Jolie’s decision to remove both her ovaries and therefore enter menopause was <a href="http://www.smh.com.au/comment/angelina-jolie-poster-girl-for-menopause-20150324-1m6zlc.html">heralded as a milestone</a>. It was a time when Hollywood, and indeed society, was finally forced to have <a href="http://qz.com/368804/angelina-jolies-surgery-means-hollywood-will-finally-have-to-talk-about-menopause/">a conversation about menopause</a>. </p>
<p>It takes a beautiful young celebrity facing the risk of breast cancer for society to finally bring up this last taboo. </p>
<p>There are positives of going through menopause. Women speak of a new independence from menstruation and worrying about birth control. It can be an empowering life stage if a cultural shift leads to awareness, support, and open and honest communication.</p>
<p>Organisations should recognise menopause as an occupational issue and build capacity to support women through this difficult transition. Menopause <a href="https://www.psychologytoday.com/blog/face-it/201210/the-2nd-talk-women-arent-having">must become normalised as a natural</a> and commonly occurring event. </p>
<hr>
<p><em>Carolyn will be on hand for an Author Q&A between 12 and 12:30pm AEDT on Friday, 12 February, 2016. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/46742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Ee receives funding from the National Health and Medical Research Council (Postgraduate Scholarship). </span></em></p>
Three out of four women going through menopause suffer hot flushes, and suffer they do. But research shows the way society views ageing and menopause can reduce the severity of symptoms.
Carolyn Ee, PhD Candidate and researcher at the Department of General Practice; GP and Acupuncturist, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/41177
2015-05-05T04:50:10Z
2015-05-05T04:50:10Z
‘Holistic’ dentistry: more poppycock than panacea?
<figure><img src="https://images.theconversation.com/files/80254/original/image-20150504-2070-1nt4ws1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">All dentists should be practising evidence-based dentistry for the sake of their patients.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/gobikey/4568757099">John Dill/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Many Australian dentists’ websites proudly advertise that they practise holistic dentistry, a philosophy that promotes health and wellness rather than simply treating disease, and considers the whole body and mind, not just teeth. </p>
<p>It sounds exciting. The implication is that this practice is very different – and superior – to the type of dentistry being practised by mainstream dental professionals. But different doesn’t actually mean superior.</p>
<p>Most holistic dental surgeries embrace and encourage alternative therapies. A quick internet search finds Australian dentists practising or endorsing <a href="http://www.lotusdental.com.au/homeopathy-dentistry/">homeopathy</a>, <a href="http://www.thepaddingtondentalsurgery.com.au/about/naturopath-sydney-nsw/">naturopathy</a>, <a href="http://www.davidhoward.com.au/services/wd_homeopathic.html">Bach flower essences</a>, <a href="http://www.myhillsdentist.com/service/acupuncture/">acupuncture</a>, <a href="http://www.naturaltherapypages.com.au/connect/liminac/service/37299">traditional Chinese medicine</a>, <a href="http://www.dentalpartners.com.au/practice-locations/new-south-wales/windsor-chiropractic-dentistry/">chiropractic</a>, <a href="http://www.shdc.com.au/tag/ayurvedic/">ayurvedic medicine</a>, <a href="http://www.brunswickdental.com">osteopathy</a>, <a href="http://www.oakdale.net.au">kinesiology</a>, <a href="http://www.brunswickdental.net/dentistry.php">crystals, aromatherapy, reiki</a>, <a href="http://www.veranese.com/#!dr-jon-dental/c2414">vibrational healing</a>, <a href="http://www.holisticdentist.com.au/vital-breathing-method.html">Buteyko</a> and <a href="http://www.evolvedental.com.au/about">esoteric chakra-puncture</a>.</p>
<p>Since all dentists are registered by the <a href="http://www.ahpra.gov.au/Notifications/Hearing-Decisions/Before-the-national-scheme/Dental.aspx">Australian Health Practitioner Regulation Agency</a>, the public tends to assume they must be reputable and their treatments, even if out of the ordinary, must be effective. And, surely, we have to respect the centuries of ancient wisdom from whence many of these therapies came, right? Well, yes and no.</p>
<h2>Not quite right</h2>
<p>Many ancient remedies have given us modern medical treatments. Hippocrates recognised that <a href="http://en.wikipedia.org/wiki/Willow#Medicine">powdered willow bark</a> (containing aspirin) alleviated headaches. South Americans used <a href="http://en.wikipedia.org/wiki/Jesuit%27s_bark#Medicinal_uses">cinchona bark</a> (containing quinine) to treat malaria. Traditional Chinese medicine gave us <a href="http://en.wikipedia.org/wiki/Ephedrine#Agricultural_sources">ephedrine</a>, a commonly used stimulant and decongestant, and the anti-malarial drug <a href="http://en.wikipedia.org/wiki/Artemisinin">artemisinin</a>. Both are now effective pharmaceuticals.</p>
<p>But doing something for centuries doesn’t automatically make it right. From the time of the ancient Greeks and Mesopotamians up to the late 19th century, <a href="http://www.history.com/news/a-brief-history-of-bloodletting">misguided medicos bled patients</a>, sometimes to death, in vain attempts to treat a multitude of ills. Bloodletting is still <a href="http://www.ibtimes.co.uk/bloodletting-razor-blade-india-leech-therapy-488462">a core belief</a> in some traditional health systems. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=659&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=659&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=659&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=829&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=829&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80255/original/image-20150504-2070-1wcv0q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=829&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doing something for centuries doesn’t automatically make it right.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/marceldouwedekker/7206160814">Marcel Douwe Dekker/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>And traditional Chinese medicine also uses rhino horns, tiger penises, shark fins and bear bile. Even ignoring the appallingly cruel way these “medicines” are obtained, none has any proven health benefits. Rhino horns are <a href="http://www.businessinsider.com.au/rhinos-horns-worth-more-than-gold-2012-5">more expensive by weight than gold</a>. As they consist largely of the protein keratin, purchasers could have saved a fortune by chewing their toenails.</p>
<p>Former Victorian dentist and self-styled “professor” Noel Campbell was practising (very) alternative dentistry in the late 1990s when charged with <a href="http://www.news.com.au/ozone-gas-healer-preyed-on-the-dying/story-fna7dq6e-1111117329113">administering ozone to a patient’s rectum to relieve her facial pain</a>. Not surprisingly, it didn’t work. </p>
<p>Campbell avoided disciplinary action by allowing his dental registration to lapse but continues to provide unproven alternative therapies to patients with cancer and other conditions through his website. And he’s not alone.</p>
<p>The recent cases of Wellness Warrior <a href="http://www.news.com.au/lifestyle/real-life/wellness-warrior-jess-ainscough-dies-from-cancer/story-fnq2o7dd-1227242521955">Jessica Ainscough</a> and The Whole Pantry’s <a href="http://www.mamamia.com.au/news/belle-gibson-cancer-claims/">Belle Gibson</a> show the importance of safe and effective health-care recommendations being based on more than a pretty smile and social media presence. </p>
<h2>Importance of evidence</h2>
<p>But aren’t some alternative therapies safe and effective? And how can we tell the difference? Thankfully, we have very good ways of determining if health treatments are effective. </p>
<p>The concept of <a href="http://www.community.cochrane.org/about-us/evidence-based-health-care">evidence-based health care</a> has arisen over the past few decades and is now almost universally accepted as the required standard for professional health practice. </p>
<p>Evidence-based dentistry accepts patients’ needs and preferences, while insisting treatments be based on the highest-quality scientific evidence and regular systematic reviews of published research.</p>
<p>Currently, most alternative therapies have a very limited <a href="http://www.ama.com.au/position-statement/complementary-medicine-2012">evidence base</a> to support their practice, and research methodologies are often poor. If a beneficial effect is shown, it’s often no greater than that <a href="http://www.nhs.uk/Livewell/complementary-alternative-medicine/Pages/placebo-effect.aspx">achieved by placebo treatment</a>, and <a href="http://www.quackwatch.com/01QuackeryRelatedTopics/altwary.html">less than that achieved by mainstream health care</a>.</p>
<p>Most “natural” medications have never been placed on the <a href="http://www.tga.gov.au/australian-register-therapeutic-goods">Australian Register of Therapeutic Goods</a> simply because they’ve never shown effectiveness. And alternative therapies found to be safe and effective become part of the mainstream health-care arsenal.</p>
<p>Does that really matter though, as long as patients receive the treatment they want and feel better as a result? Yes, it does matter. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80256/original/image-20150504-2052-shjzjm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A patient-dentist relationship must be based on trust and professionalism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/trypode/6347677054">The Guy With The Yellow Bike/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Most holistic dental practices will provide a wonderfully caring and nurturing environment for patients, but a patient-dentist relationship must also be based on trust and professionalism. A dentist who provides or endorses treatment options based on centuries of “eye of newt and toe of frog” without finding out if any beneficial effect is real or merely a placebo is not acting in the patient’s best interests, even if their belief is genuine. </p>
<p>Not only is any placebo effect unlikely to be maintained in the long term, patients may have wasted considerable amounts of money and been deprived of legitimate treatments that could have provided much greater benefits.</p>
<h2>Still the same</h2>
<p>More than 2,000 years ago, Hippocrates wrote:</p>
<blockquote>
<p>There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance. </p>
</blockquote>
<p>The public expects all health professionals to practise competently, ethically and professionally. Would you prefer a dentist who provides treatment and advice based on evidence from the most recent and highest-quality research studies, or based on clouds of dubious and scientifically unsupported mysticism?</p>
<p>In 1948, the <a href="http://www.who.int/about/definition/en/print.html">preamble to the constitution of the World Health Organisation</a> defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. This description still holds up today, and sits very well with the concept of holistic dentistry. So holistic dentistry is really nothing new. </p>
<p>All dentists should be practising holistic dentistry. And they should all be practising evidence-based dentistry, too.</p><img src="https://counter.theconversation.com/content/41177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Foley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Holistic dentistry claims to promote overall wellness rather than simply treating disease. But the lack of evidence for the alternative therapies underpinning it are cause for concern.
Michael Foley, Senior Lecturer, Public health dentistry, The University of Queensland
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/10273
2012-10-30T19:04:50Z
2012-10-30T19:04:50Z
Acupuncture research – the path least scientific?
<figure><img src="https://images.theconversation.com/files/16831/original/xwct3vnm-1351033631.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The idea of Chi (life force) flowing through meridians has an allegorical quality and the appeal of an ancient provenance.</span> <span class="attribution"><span class="source">jacqueline/Flickr</span></span></figcaption></figure><p>A recent, rather flattering, <a href="https://theconversation.com/modern-acupuncture-panacea-or-placebo-8102">article on acupuncture</a> on this website holds a mirror to a broader problem in the world of acupuncture research. A problem that goes to the heart of the most fundamental scientific principles.</p>
<p>There’s no doubt that acupuncture is gaining traction on the grounds that it holds up under scientific interrogation. But does it really? </p>
<p>Let’s go back to basics. The scientific method involves proposing a theory based on plausible principles, and then trying to disprove it. Let’s say the theory proposes that a particular treatment is effective for a certain condition. </p>
<p>First, we ask whether it’s based on plausible principles. And, if so, we design studies to rule out every possible explanation for the observed effect except the explanation captured in the theory. If the effect remains after all reasonable controls have failed to remove it, we conclude that, on balance, it’s probably real.</p>
<h2>Shaky foundations</h2>
<p>Acupuncture is based on implausible principles. The concepts of Chi – an invisible, unmeasurable life force, flowing through meridians (unobservable pathways with no known anatomical correlation) - have both an allegorical quality and the appeal of an ancient provenance. But these aren’t held up by anything the scientific method has revealed. </p>
<p>Perhaps despite its implausible principles, acupuncture point combinations are based on centuries of practice and consistent observations of this effect. Very unlikely – we have previously <a href="http://bodyinmind.org/acupuncture-for-pain-placebo-review-paper/">reflected on this</a>. Even limiting the number of needles that are inserted to four (in order to develop crude evidence that specific points are effective for specific ailments) requires an astronomical number of tests. </p>
<p>Let’s presume, for instance, that in China at the time when the first acupuncture tomes were generated with their 400 or so acupuncture points, the average lifespan was 50 years. In order to get all the needle combinations tested, every member of the Chinese population would have had to suffer from the same condition throughout their lifespan, and then receive eight separate treatments a year for every year of their life. </p>
<p>For a number of reasons, this estimate should be <a href="http://bodyinmind.org/acupuncture-for-pain-placebo-review-paper/">considered wildly conservative</a> – and this is for just one condition. Acupuncture is recommended for an astounding range of afflictions.</p>
<h2>Research evidence</h2>
<p>Ensuring robust double-blinding studies of acupuncture is a tricky business. Nonetheless, good quality trials across a range of <a href="http://www.ncbi.nlm.nih.gov/pubmed/16956145">clinical conditions and outcomes,</a> overwhelmingly show that acupuncture fails to outperform sham. </p>
<p>What’s more, when the studies are good, it appears that it <a href="http://www.ncbi.nlm.nih.gov/pubmed/18538996">doesn’t matter where </a> one inserts the needles, how <a href="http://www.ncbi.nlm.nih.gov/pubmed/19174438">deeply they are inserted</a>, whether or not they are manipulated once in situ, and, crucially, whether they are inserted at all. </p>
<p>So, according to scientific method, the theory has been disproved. In more classical scientific parlance, the key hypotheses that arise from the founding principles of acupuncture have been refuted.</p>
<p>Intriguingly, despite this the studies keep coming. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/22965186">recent meta-analysis</a> of individual patient data received a great deal of media attention as it was suggested to provide compelling evidence that acupuncture works. It found that while acupuncture was better than no treatment controls, there was a small, clinically trivial but statistically significant benefit of acupuncture over sham. </p>
<p>It took the power of a large sample to demonstrate that effect, and the authors conclude that it represents the active ingredient of real acupuncture. But as we have already seen, in imperfectly blinded trials, one would expect to see some small difference simply from the resulting bias. </p>
<p>So which interpretation is more plausible? Have the authors really fulfilled their obligation to falsify more plausible alternative explanations?</p>
<h2>Fundamental problems</h2>
<p>There’s a great deal of energy being devoted to unpicking the potential mechanisms of acupuncture. We’re told that acupuncture causes local tissue changes or activation differences in certain areas of the brain. We suggest that it’s hardly surprising that inserting needles into the skin causes a reaction in the tissues or a change in the brain. Indeed to not find such changes would be considered genuinely revolutionary. </p>
<p>These findings neither validate acupuncture nor provide a cogent mechanism for its therapeutic action. Indeed, we think this approach reflects some fundamental problems with much acupuncture research. The retrofitting of physiological mechanisms to explain a non-existent effect is scientifically upside down. Designing experiments to demonstrate that something works or hunting down an elusive mechanism for a cherished idea is not scientific. </p>
<p>We would suggest that if experiments that control for all possible explanations except acupuncture clearly show no benefit, but experiments that don’t control for other possible explanations clearly do show a benefit, then we should be investigating those other possible explanations rather than acupuncture.</p>
<p>There’s a thriving industry of acupuncture research that will no doubt continue to optimistically mine pockets of subtle or manufactured uncertainty. This is understandably human - what else would one do if one absolutely knew something was true but could not prove it? </p>
<p>But from a scientific viewpoint, acupuncture shouldn’t work, and comfortingly, when tested properly, it doesn’t. </p>
<p>The sharpest experimental probes have dismantled the principles on which acupuncture is based but have failed to puncture the balloon of naïve acceptance that floats aloft in the popular media, the public consciousness and in the acupuncture research community. A re-acquaintance with the most basic scientific principles may just be the sharp prick required.</p><img src="https://counter.theconversation.com/content/10273/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neil O'Connell does not receive funding or sponsorship from any organisation that might benefit from the content of this article.</span></em></p><p class="fine-print"><em><span>Lorimer Moseley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
A recent, rather flattering, article on acupuncture on this website holds a mirror to a broader problem in the world of acupuncture research. A problem that goes to the heart of the most fundamental scientific…
Neil O'Connell, Lecturer in Physiotherapy, Brunel University London
Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, University of South Australia
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/8102
2012-10-10T03:38:07Z
2012-10-10T03:38:07Z
Modern acupuncture: panacea or placebo?
<figure><img src="https://images.theconversation.com/files/16362/original/7w4b8dcs-1349829839.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modern research techniques are looking for evidence of efficacy for this 2,500-year-old practice.</span> <span class="attribution"><span class="source">Peter Fasano</span></span></figcaption></figure><p><em>PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines.</em></p>
<p>Acupuncture has been practiced in China for over 2,500 years. During the reign of Emperor Huang Ti, some 800 hundred years ago, the practice was formalised into a medical system as part of Traditional Chinese Medicine (TCM).</p>
<p>TCM promoted health and well-being practices using herbs, physical therapies such as massage and exercise (Tai Chi and Qigong) and acupuncture. Mind-body interactions were recognised as central to good health, and this holistic approach was also applied to patients being treated for ailments. </p>
<p>TCM spread to nearby Japan and Korea then further afield to Europe via the Old Silk Road. Today, France, Austria and Germany are among the <a href="http://www.icmart.org">many European countries</a> well known for their research into the scientific evidence for acupuncture and its clinical applications.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16334/original/8mhzckgq-1349761383.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">THe WHO has established an international nomenclature of acupoints to be used by the scientific community.</span>
<span class="attribution"><span class="source">Megan Mallen</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.who.int/en/">World Health Organization</a> (WHO) has recognised acupuncture as an effective treatment modality for over 20 years, and established an <a href="http://books.google.com.au/books/about/Who_Standard_Acupuncture_Point_Locations.html?id=_Wwys_i2Ks8C&redir_esc=y">international nomenclature of acupoints</a> to be used by the scientific community. And in the United States, the <a href="http://www.nih.gov/">National Institutes of Health</a> (NIH) has <a href="http://consensus.nih.gov/1997/1997acupuncture107program.pdf">accepted acupuncture</a> as a valid treatment strategy since 1997. More recently, the NIH has also <a href="http://nccam.nih.gov/training/centers/descriptions.htm%23neuro1">supported neuroimaging research</a> into acupuncture mechanisms.</p>
<p>Acupuncture is part of the teaching programs of several medical faculties in the United States and Canada. Integrated with standard medical care, acupuncture can be <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322129/">helpful in many clinical conditions</a> from analgesia in painful conditions to alleviating depression.</p>
<p>Most importantly, its minimal adverse effects profile is attractive to both patients and health-care providers.</p>
<h2>Current and emerging evidence</h2>
<p>In the 1980s, acupuncture was <a href="http://books.google.com.au/books?id=hsjd5nterXQC&source=gbs_citations_module_r&cad=7">recognised to work</a> via the spinal pain pathways to the brain. Manual and electro-acupuncture were investigated for their usefulness for managing pain. The <a href="http://apps.who.int/medicinedocs/en/d/Js4926e/">results were mixed</a> and many studies concluded that acupuncture was only as good as sham or placebo – but better than no intervention.</p>
<p>Two decades later, the neurophysiological evidence base for acupuncture’s effectiveness is a little clearer and it has been integrated into some disciplines of medicine. There’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/16505266">some positive evidence</a> for using <a href="http://www.ncbi.nlm.nih.gov/pubmed/15870415">acupuncture in headaches</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/15838072">lower back pain</a>. Acupuncture has also been shown to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/16818924">useful in arthritis</a> of the knee. </p>
<p>For sub-fertility, acupuncture has been helpful in increasing the “take home baby” rates, as shown by investigators in Sweden and in <a href="http://www.quanyinclinic.com/files/Acupuncture_IVF2">the United States</a>. In cancer care, acupuncture has been shown to help in <a href="http://www.ncbi.nlm.nih.gov/pubmed/22419418">minimising the adverse effects</a> of cancer treatment regimes. And on the battlefield, the <a href="http://www.dtic.mil/dtic/tr/fulltext/u2/a551935.pdf">US Defence Force uses</a> ear acupuncture to manage pain from injuries and post-traumatic stress disorder.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=511&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=511&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=511&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=642&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=642&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16358/original/nxb94qy6-1349829534.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=642&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s emerging evidence that appropriate selection of acupuncture points for a specific condition is important.</span>
<span class="attribution"><span class="source">Wonderlane/Flickr</span></span>
</figcaption>
</figure>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/16046146">Functional magnetic resonance imaging</a> (fMRI) research into acupuncture has uncovered <a href="http://www.ncbi.nlm.nih.gov/pubmed/11427311">how acupuncture works</a> on the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997288/">brain</a>. The limbic-paralimbic brain region that is modulated by acupuncture is also known as the affective or emotional cortex. The affective cortex is where placebo works but the acupuncture effect has been demonstrated to be significantly greater than placebo alone in the above fMRI studies.</p>
<p>There has been some investigation of the properties of <a href="http://www.ncbi.nlm.nih.gov/pubmed/12467083">acupoints</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/18240287">classical meridians</a>. And there’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/22809025">emerging evidence</a> that appropriate selection of acupuncture points for a specific condition is important. </p>
<p>The use of acupoints relevant in depression <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0012619">modulated mood-relevant brain regions</a> whereas acupoints not relevant to depression did not significantly activate or deactivate the brain. Also evident is the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18785846">role of acupuncture</a> in the modulation of the autonomic nervous system.</p>
<p>But overall, past clinical studies were found to be inconclusive in a <a href="http://summaries.cochrane.org/CD004046/acupuncture-for-depression">2010 Cochrane review</a> of the place of acupuncture in depression treatment. The review covered studies conducted over three decades and the variety of methodologies used in the research made the task complex.</p>
<p><a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000261">Clinical trials</a> in acupuncture have now been made uniform with the <a href="http://www.ncbi.nlm.nih.gov/pubmed/11890439">Standards for Reporting Interventions in Controlled Trials of Acupuncture</a>.</p>
<h2>Science or pseudoscience?</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=904&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=904&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=904&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16357/original/7qw7hdgy-1349828941.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The US Army uses ear acupuncture to manage pain from injuries and post-traumatic stress disorder.</span>
<span class="attribution"><span class="source">Army Medicine/Flickr</span></span>
</figcaption>
</figure>
<p>The dilemma confronting acupuncture researchers include study design, sample size and conducting studies under experimental conditions alone. There’s some recognition of the need to test acupuncture’s effect in primary care under “real conditions” – out in the community rather than in the laboratory.</p>
<p>That’s because factors such as environmental pressures, co-existing disorders and medication load are accounted for under real conditions. And this would more closely match how traditional Chinese medicine was utilised 2,500 years ago, when such factors were considered carefully before acupuncture treatment regimes were implemented.</p>
<p>These methodological conundrums are gradually being addressed. Measuring the effects of acupuncture is more complex than measuring drug or placebo effects. In the last few years, these complexities are gradually being recognised, carefully recorded and analysed.</p>
<p>In Australia, the growing scientific evidence base for acupuncture has seen its gradual integration into clinical settings from primary care to adjunct therapy in IVF, and even in emergency rooms.</p>
<p>There’s now a growing understanding of where acupuncture may be useful in improving patient health outcomes alongside standard medical care. And the incorporation of neuroimaging evidence to support clinical acupuncture studies may certainly be useful to more definitively evaluate the acupuncture effect in the future.</p>
<p><strong><em>Read the first instalment of panacea or placebo:</em></strong> </p>
<ul>
<li><a href="https://theconversation.com/myotherapy-panacea-or-placebo-9183">Myotherapy</a></li>
</ul><img src="https://counter.theconversation.com/content/8102/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Im Quah-Smith receives funding from Thyne-Reid Foundation, and BlackDog Foundation for her fMRI and clinical research into laser acupuncture in the treatment of depression at UNSW. She is Director of Medical Acupuncture Services at Balmain Hospital and trains GP acupuncturists for Monash University and the Australian Medical Acupuncture College. Im runs a wellness group focussing on preventative medicine using acupuncture, meditation and herbs.</span></em></p>
PANACEA OR PLACEBO – A weekly series assessing the evidence behind complementary and alternative medicines. Acupuncture has been practiced in China for over 2,500 years. During the reign of Emperor Huang…
Im Quah-Smith, Doctoral Candidate School of Psychiatry, UNSW Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/7995
2012-07-02T00:50:40Z
2012-07-02T00:50:40Z
Turf war over who can claim the title of acupuncturist
<figure><img src="https://images.theconversation.com/files/12462/original/6nxg6bs6-1341188658.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Acupuncture is based on the belief that a vital force (Ch’i) is transmitted along meridians.</span> <span class="attribution"><span class="source">Megan Mallen</span></span></figcaption></figure><p>Acupuncture is popular and no doubt lucrative for its practitioners. The fact that it doesn’t work seems to be of little relevance, and certainly has not curbed enthusiasm for the application of what is, in effect, a superb placebo. </p>
<p>Practitioners of traditional Chinese medicine seem culturally locked into an unshakeable belief in the pre-scientific concepts of a non-existent vital force (Ch’i) transmitted along meridians which, when blocked or imbalanced, cause disease. Trigger spots for acupuncture to correct these problems are said to lie along the meridians. </p>
<p>For anyone who believes that the appropriate standard for modern medicine should be credible scientific evidence of clinical effectiveness, it’s disturbing that so many doctors, trained to understand scientific method, are embracing the technique. It’s not a situation where doctors using acupuncture say, “Well the Chinese theories may be nonsensical but the technique actually works for unknown reasons and is effective in a large number of conditions.” </p>
<p>Acupuncture has been subjected to extensive scientific analysis, particularly in the last decade. Its ability to help with some forms of neck pain is the only benefit that has support from good science and that turns out to have nothing to do with meridian lines, mysterious forces or any of the other mystical propositions cited in support of acupuncture.</p>
<p>Last year a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21440191">review of all published studies</a> in the last ten years examining the effectiveness of acupuncture appeared in the prestigious journal, <a href="http://www.elsevier.com/wps/find/journaldescription.cws_home/506083/description#description">Pain</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=587&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=587&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12458/original/6sv29xzm-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=587&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Relieving some forms of neck pain is the only benefit of acupuncture that is supported by modern science.</span>
<span class="attribution"><span class="source">Irina Souiki/Flickr</span></span>
</figcaption>
</figure>
<p>An editorial in the same issue featured the headline “Acupuncture’s claims punctured: Not proven effective for pain, not harmless”. The journal recommended that physicians tell patients “although some patients believe that it has helped them, the evidence does not show that it (acupuncture) works any better than placebo”. </p>
<p>So it’s somewhat humorous - if it weren’t symptomatic of the broader problem of the infiltration of pseudoscience into health care in Australia – that doctors and complementary medicine practitioners (particularly traditional Chinese medicine practitioners) are at loggerheads over who can use the title acupuncturist. </p>
<p>This month will see the birth of the Chinese Medicine Board of Australia and it will require practitioners to have completed a three- to four-year accredited course in acupuncture before they can use the title. Under a proposal from the Medical Board of Australia however, doctors who can prove they’ve been performing acupuncture regularly should be able to use the title under “grandfathering” arrangements. In the future, doctors will need a ten-month course to claim the title.</p>
<p>I am one of the founding members of <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine (FSM)</a>, which was established to help minimise the amount of health-related anti-science foisted on poorly protected consumers, and to emphasise the importance of models of care that provide patients with interventions supported by scientific evidence of effectiveness.</p>
<p>Private health insurers are one of our targets because they’ve been subsidising the cost of so called “complementary and alternative medicine” (CAM) practices, including acupuncture. And by doing this, they’re giving totally undeserved credibility to many such practices. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12456/original/9h849hkq-1341186865.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncturists will have to complete a three- to four-year accreditation course under the new Chinese Medicine Board of Australia.</span>
<span class="attribution"><span class="source">Acc Bandido of Oz/Flickr</span></span>
</figcaption>
</figure>
<p>FSM was heartened when the government announced that, in the future, taxpayer dollars subsidising private health insurance would not be available for CAM activities unless the chief health officer confirmed that there was “credible scientific evidence of their clinical effectiveness”. He has been given a year to reach his conclusions. </p>
<p>But we were disheartened when it was announced that acupuncture and chiropractic would be excluded from the practices to be reviewed. They were not included because there will soon be national registration process for practitioners of traditional Chinese medicine, which would include acupuncturists, and there already is a national <a href="http://www.chiropracticboard.gov.au/">registration board</a> for chiropractors. Both are charged with upholding appropriate standards.</p>
<p>This is unsatisfactory because some of the worst offerings of pseudoscience are provided by chiropractors who believe in the “subluxation” theories of their founder (invoking yet another mystical, undefinable and undetectable force), and who are trying to become major players in the delivery of primary care, especially to children. </p>
<p>Chiropractors sympathetic to this nonsense are on the national registration board and executive of the <a href="http://chiropractors.asn.au//AM/Template.cfm?Section=Home1&WebsiteKey=d6b431a0-b077-43d6-af75-74f80487442a">Chiropractic Association of Australia</a>. Similarly, the newly-formed Chinese Medicine Board of Australia is not going to tell Australians that, while acupuncture may be worthy of continuing scientific research, at the moment there is no evidence to support its current use for a wide range of conditions.</p>
<p>FSM has written to all the private health insurers in Australia urging them to abide by the umpire’s decision. All practices that the government finds to be unworthy of taxpayer support should also be unworthy of privately provided insurance dollars. And battles about who can use what title are merely a distraction.</p><img src="https://counter.theconversation.com/content/7995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Dwyer is one of the founding members of the Friends of Science in Medicine.</span></em></p>
Acupuncture is popular and no doubt lucrative for its practitioners. The fact that it doesn’t work seems to be of little relevance, and certainly has not curbed enthusiasm for the application of what is…
John Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/5159
2012-02-03T02:54:13Z
2012-02-03T02:54:13Z
Why universities should teach alternative medicine
<figure><img src="https://images.theconversation.com/files/7368/original/qz64kg4q-1328236484.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Linking research and teaching, universities are best placed to teach evidence-based CAM.</span> <span class="attribution"><span class="source">Tulane Publications</span></span></figcaption></figure><p>Most readers would know of <a href="https://theconversation.com/alternative-medicine-can-be-scientific-say-besieged-academics-5058">the current debate</a> about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better placed to deliver evidence-based knowledge of CAM. </p>
<p>The latest controversy started when a group called Friends of Science in Medicine (FSM) wrote to vice chancellors across the country asking them to review their health science courses. FSM rightly says that rigorous academic standards and evidence for scientific conclusions and health-care practices are of the essence and should be the basis of all university teaching. </p>
<p>I’m sure that any university lecturer would agree with these principles; most would consider themselves as friends of science in medicine. But it’s a matter of concern when the debate and terminology become simplistic, generalised and uninformed. </p>
<p>CAM is a term for <a href="http://nccam.nih.gov/">many different practices and medicines</a> and there’s scientific evidence for a number of them. Some of the modalities are derived from ancient sciences, for instance, and have a very long history of successful traditional use. FSM mentions acupuncture as a therapy it considers pseudo-scientific and argues that it shouldn’t be taught at university. But this isn’t entirely true. </p>
<p>There’s clinical evidence for acupuncture as effective treatment for various conditions, including <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001218.pub2/abstract">migraines</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007587/abstract">tension-type headaches</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001351.pub2/abstract">chronic low-back pain</a>. What’s more, there’s a <a href="http://www.medicareaustralia.gov.au/public/claims/what-cover.jsp">Medicare rebate</a> available for acupuncture if it’s part of a doctor’s examination. Why <em>shouldn’t</em> medical practitioners learn about the evidence for this treatment option at universities to increase consumer choices and improve patient outcomes? </p>
<p>The National Prescribing Service’s <a href="http://www.nps.org.au/__data/assets/pdf_file/0005/69656/CMsInfoSummary.pdf">“Review of the Quality of Complementary Medicines Information Resources”</a> can be used to identify which CAM information resources are of high quality, evidence-based, unbiased and well structured. The use of such high-quality resources is available and encouraged at universities.</p>
<p>In Australia, complementary medicines are <a href="http://www.tga.gov.au/industry/cm-basics-regulation-overview.htm">regulated</a> as medicines by the Therapeutic Goods Administration (TGA). The TGA’s ambit includes homeopathic and traditional medicines, such as Traditional Chinese Medicines. According to the TGA’s <a href="http://www.tga.gov.au/pdf/cm-evidence-claims.pdf">guidelines</a> general and medium-level claims (such as the temporary relief of minor self-limiting conditions) for complementary medicine’s efficacy can be based on certain traditional use evidence. The guidelines allow the use of such medicines until high-level evidence, that would allow for high-level claims, is available.</p>
<p>A balanced view in this debate is particularly important because about <a href="http://www.ncbi.nlm.nih.gov/pubmed/20646290">70% of Australians already use CAM</a>, mostly alongside conventional medicines and treatments.</p>
<p>So the community expects health professionals to be able to provide information and guidance about the quality use of <em>all</em> medicines, which, according to <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/National+Medicines+Policy-1">Australian’s National Medicines Policy</a>, includes complementary medicines. To be able to do that, health professionals need to be knowledgeable, at least, about the principle, paradigm and available evidence for all complementary medicines, including <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Where%20Does%20Homeopathy%20Fit%20in%20Pharmacy%20Practice%3F">homeopathic </a>and traditional medicines. </p>
<p>And where else would health professionals gain this knowledge if not at university, during their degree? One of the advantages universities have is the close relationship between research and teaching – students are more engaged and inspired by research-led teaching, and research is informed by queries from students while teaching. Many universities research CAM to generate an evidence base or prove their lack of efficacy.</p>
<p>So why support research but exclude teaching of CAM from universities? Aren’t we obliged to translate our research results into practice – starting by teaching new practitioners? </p>
<p>At Griffith University, evidence-based CAM education is integrated throughout the whole pharmacy curriculum. Our teaching research has shown that pharmacy students perceive education about CAM as a core part of their professional degree. We found that CAM research and education had a moderating effect on <a href="http://www.ncbi.nlm.nih.gov/pubmed/18221569">students’ attitudes</a> towards CAM. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19002274">The training</a> also encouraged students to look at and evaluate evidence and make informed decisions in the best interests of their patients.</p>
<p>We also offer a specifically designed “<a href="http://www.integramedshortcourses.com/">Short Course in Integrative Medicine for Pharmacists</a>,” which has been accredited for continuous professional development. The course addresses the shortage of CAM knowledge among practicing Australian pharmacists as identified in a recent Pharmacy Guild-funded project, which <a href="http://www.degruyter.com/view/j/jcim.2010.7.1/jcim.2010.7.1.1411/jcim.2010.7.1.1411.xml?format=INT">surveyed Australian pharmacists nationally</a>. </p>
<p>The survey found most pharmacists supported undergraduate CAM education (76%), and the majority (85%) were interested in additional CAM education themselves. </p>
<p>Research also suggests that CAM education may also teach practitioners greater <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Hirschkorn%2C%20Sociol.%20Health%20Illn.%2C%202006">self-awareness, improved core competencies</a> (such as evidence-based practice), enhanced cultural competency and <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Gaylord%20et%20al.%2C%20Acad.%20Med.%2C%202007">patient-centred care</a>. </p>
<p>So should we turn our back on the consumer-driven trend toward holistic and integrative healthcare, or should we work together to understand, research and teach different principles, practices and evidence to improve health outcomes for customers and patients? I, for one, would prefer the latter.</p><img src="https://counter.theconversation.com/content/5159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evelin Tiralongo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Most readers would know of the current debate about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better…
Evelin Tiralongo, Senior Lecturer, Griffith University
Licensed as Creative Commons – attribution, no derivatives.