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Monday, 15 April 2013
Acupuncture is one of the most popular treatments in the UK
How many people visited complementary and alternative medicine practitioners?
Do you ever think about visiting complementary and alternative medicine (CAM) practitioners, if you have some conditions that affect your quality of life and there are limited medication which could help? Do you know that how many people who visited the CAM practitioners? There was a report by Cooper KL from Sheffield UK that reviewed a 12 months prevalence of visits to five types of CAM practitioners. The data was from countries 12 countries include Europe, North America, Australia, East Asia, Saudi Arabia and Israel and data was included 41 surveys to 2011. The CAM include five therapies acupuncture, homeopathy, osteopathy, chiropractic ad medical herbalism. The prevalence of visits by adults were: acupuncturists 1.4%, homeopaths 1.5%, osteopaths 1.9%, chiropractors 7.5% and medical herbalists 0.9%.
Acupuncture is a form of CAM. In European countries, acupuncture and homeopathic treatments are most used. Doctors have been changing their views towards using acupuncture. There is a survey studying if doctors are intended to use acupuncture for their own diseases in Norway. There was over 10,000 physicians participated. There was 18% physicians used acupuncture for their own diseases in 2004 which is doubled compared to those in 1994 (only 8%). Half of the physicians intended to use acupuncture for their own diseases.
There was a new research across surrey in the UK which studied current situation of acupuncture in health care. The data was collected using questionnaire responded by 330 acupuncture practitioners with professional background including 29% doctors, 29% physiotherapists, 15% nurses and 27% independent acupuncturists. 68% of the practitioners are in independent practice. Patient’s ages are from 9 to 94 year old. The most common visits are for pain conditions including low back, neck, shoulder and knee pain, as well as headaches and migraine. Anxiety, stress and depression were the three most common psychological complaints. Treatment for infertility by independent acupuncturists increased fivefold in 10 years. There are many visits for other conditions including obstetric, gynaecological conditions and digestive, respiratory circulatory and skin complaints etc. In the UK, about 4 million sessions of acupuncture were provided each year, two thirds of which were from independent practice. The style of acupuncture is that 67% is western medical acupuncture and 41% is traditional Chinese medicine. About 90% physiotherapists, nurses and doctors use Western medical acupuncture; while 90% acupuncturists use traditional Chinese medicine.
NHS acupuncture outcome
Most patients pay for private acupuncture treatment, because use of acupuncture in NHS is limited. There is a survey by Robinson TW from Barton House, Beaminster UK published in J Altern Complement Med (2012). This study was to investigate the response to Western acupuncture performed in a National Health Service (NHS) general practice. This is a good survey which included 3 year patient feedback. The outcomes, patient experience, impact on conventional therapies, and appropriateness of acupuncture in general practice were assessed. The patients received acupuncture treatments from all age groups and female to male ratio is 64%:36%. Following the course of acupuncture,
75% of patients noted an improvement in their presenting condition;
26% of patinets were reported complete improvement and 38% major improvement. 24% noted no change.
72% of patients thought that their quality of life was improved.
69% of patients had a reduction or cessation of painkillers and/or anti-inflammatory drugs.
57% of patients thought that referral to hospital specialist or physiotherapist was avoided due to the acupuncture treatment.
23% of patients found acupuncture to be painful; of those 60% said the pain was only mild.
72% of patients were treated within 1 week of being seen by the general practitioner (GP).
81% of patients had one to three treatments.
The patients’ response scores from an anonymised questionnaire showed beneficial outcomes from acupuncture.
Acupuncture is the most available CAM therapy in the EU
Complementary and alternative medicine (CAM) plays an important role in health care field. Von Ammon K et al conducted a study to investigate the current status of CAM practitioners in European Union (EU). They found that about 305,000 registered CAM providers can be identified in the EU (160,000 non medical and 145,000 medical practitioners). Acupuncture (n=96,380) is the most available therapeutic method for both medical (80,000) and non medical (16,380) practitioners. Homeopathy is the second with 45,000 medical and 5,800 non medical practitioners. Herbal medicine (29,000 practitioners) and reflexology (24,600 practitioners) are mainly provided by non medical practitioners. Naturopathy (22,300) is dominated by 15,000 (mostly German) doctors. Anthroposophic medicine (4,500) and neural therapy (1,500) are practised by doctors only.
Complementary and alternative medicine (CAM) offered by hospital in Switzerland
Complementary and alternative medicine (CAM) is offered almost by half of the hospital of the French-speaking part of Switzerland. This report was from a survey from medical directors in the hospitals between June 2011 and March 2012. There were 37 medical responded. 19 medical directors indicated that their hospital offered at least on CAM and 18 reported that they did not. Acupuncture was the most frequently available CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology and obstetrics, palliative care, psychiatry, and anaesthetics. The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have increased since 2004.
Acupuncture is still the most popular CAM treatment option in the UK
In many countries, complementary and alternative medicine (CAM) usage during the last decade is increasing. Perry R et al from University of Exerter, Devon, UK conducted a survey to study the current situation of usage in CAM. They posted a questionnaire to GPs to ask them if they treat, refer, endose or discuss eight common CAM therapies including acupuncture. They also asked about their views on NHS funding, effectiveness, CAM training needs and theoretical validity of each therapy. They compared the results with those from the similar survey collected in 1999. They found that the response rate from GPs was low (30%) compared with that in 1999 (52%). The result showed that the most popular therapies were still acupuncture, hypnotherapy and chiropractic and the least popular therapies were aromatherapy, reflexology and medical herbalism. They suggested that GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy ad become less supportive. In my opinion agreed with GPs, acupuncture indeed does amazing job to many people, as I can see many patients have been benefited from acupuncture treatments.
What do GPs think about acupuncture?
More people recognised that acupuncture can help them to get better and use acupuncture for various reasons. What is the opinion of GPs? There was a survey studied the opinions of GP on acupuncture in Italy. Among the responders of GPs, 95% are in favor ofacupuncture, 84.2% believe that it is scientifically based, 6% practice acupuncture, 25.2% use it on themselves, and 66.2% have sent at least one patient to an acupuncturist in the last year. 82% of responders are in favour of adding acupuncturetraining to their own professional practice, and 71.9% believe it would be useful to include acupuncture in specific training for general practice. 64% believe that acupuncture should be included into the benefits offered by the NHS. Data show that interest for acupuncture is higher than that observed in previous international studies carried out on the same topics in the last 20 years. From this study, we can see an increase in confidence and trust in acupuncture.
What is health professional’s opinion about acupuncture in the UK?
British Medical Acupuncture Society is a registered charity and an association of medical practitioners interested in acupuncture. It was established in 1980. There are over 2700 members who use acupuncture in primary or secondary care. They promote the use and scientific understanding of acupuncture as part of the practice of medicine for the public benefit. It also provides education and training of qualified practitioners. What do these health professionals think what sorts of conditions respond to acupuncture treatment? In their opinion there are many conditions responding to acupuncture treatments. For example, Acupuncture is effective in a broad range of painful conditions such as back, shoulder, neck and leg pain; headaches, migraines, trapped nerves, chronic muscle strains and rheumatic and arthritic pain. Some other conditions include functional bowel or bladder problems such as IBS and urinary incontinence; allergies; sinus problems and chronic catarrh; stopping smoking; weight loss and women’s problems etc. This is not complete list and there are many more conditions that can be treated by acupuncture.
Acupuncture use is increasing in the US
A National Health Interview Survey (NHIS) in the United State was conducted by Upchurch DM & Rainisch BW, UCLA School of Public Health, Los Angeles, CA to study the usage of acupuncture in the US. 22512 adults aged 18 and over were involved in this survey. They showed that from data in 2007 6.8% of adults used acupuncture in their lifetime and 1.5% used in the past 12 months. This showed significantly increased usage of acupuncture compared with previous NHIS survey in 2002 with 4.1% of reported lifetime use of acupuncture and 1.1% use in the past 12 months. Musculoskeletal conditions and pain were the top health conditions treated and integrated conventional and acupuncture were applied to some extent. Negative attitude or scepticism about acupuncture were not common reasons for nonuse among prior and never users. This survey showed a promising result about acupuncture use and recognition in health care in the US population. Indeed acupuncture does have amazing effects on many chronic conditions and does not have severe side effects like many medicines do. Acupuncture could play an important role in health care system.
Acupuncture is most often referred by clinicians in the US
Integrative medicine is a relatively new field which combines conventional medicine and complementary and alternative medicine (CAM) such as herb medicine, acupuncture and meditation. In US many academic health centers have established integrative medicine clinics for patient care. Ehrlich from University of Washington conducted a nationwide survey of clinicians who work at academically affiliated integrative health centers to assess who these clinicians are and to characterize the integrative medicine that they practice. Participants included clinicians who practice at 30 different integrative medicine clinics that are affiliated with academic health centers. They found that clinicians most often reported providing themselves were breathing exercises (66%), herbal medicine prescribing (61%), meditation (44%), and functional medicine (34%). The integrative therapies that clinicians most often referred their patients for were acupuncture (96%), massage (92%), yoga (85%), and meditation (79%). 54% clinicians reported having been involved in research related to integrative medicine in the past year. 20% of their time was spend on teaching.
How much training is required for CAM practitioners in Canada?
There is increased interest in complementary and alternative medicine (CAM) which includes naturopathic, chiropractic, massage therapy and acupuncture etc. There is a tendency towards increased usage of these therapies. When you visit these practitioners, do you know how much training they received? There was a survey from Canada about training of CAM practitioners. Overall training length is ranged from 1930 to 5000 hours. Naturopathic and chiropractic schools offer the most training hours (mean 4600 hours) and massage therapy is 2270 hours and acupuncture is 2167 hours. Research methods and evidence-based health care training, and opportunities for collaboration with biomedical peers and continuing education were also offered to a certain extent.
Who is likely to see acupuncture practitioners?
This was a total population health survey HUNTs conducted in 2008. There were 50827 respondents provided the data. The data was analysed. They found that 5.7% for females and 2.2% for male visited acupuncture practitioners in a year. These acupuncture practitioner visitors (both males and females) were five times more likely to have had somatic complaints in the preceding year and were 2-3 times more likely to report poor global health than those non-visitors. Visitors were more likely to do hard physical activities every week and they were less likely to live alone or be daily smokers. Only female visitors were featured by having higher education and they were more likely to have a paid job than other females. It is linked to age only limited in female visitors. Acupuncture practitioner visitors were more actively to promote their health by having healthy lifestyle choices and non-smoking, meanwhile they were having worse overall health and more somatic complaints than others.
Who is using acupuncture and moxibustion in China
Acupuncture was originated from China thousands year ago. Western medicine became mainstream medicine in China as well. Is acupuncture still being used and popular in China? There was a report from the department of acupuncture and moxibustion China which studied the usage of acupuncture and moxibustion in the hospital. There were 6435 cases recorded in eight year from 01/012003 to 31/12/2010. There was a clear upward trend in the eight years. The majority are elderly patients in those cases, involving 309 different conditions. The top 10 condition treated were lumbar spondylosis (17.73%), cerebral infarction (13.77%), cervical spondylosis (13.66%), sequelae of erebral infarction (7.47%), lumba disc herniation (4.41%), osteoarthropathia (3.4%), cerebral hemorrhage (2.9%), herpes zoster (2.33%), postterpetic neuralgia (2.33%), sequelae of cerebral hemorrhage (2.32%).
Complementary and alternative medicine (CAM) in pregnancy health care
Complementary and alternative medicine (CAM) is commonly used by women than men. There are 20-60% of pregnant women who use CAM. Most popular CAM used by pregnant women includes acupuncture, acupressure, aromatherapy, chiropractic, homoeopathy, massage and yoga, for example, chiropractic care for pregnancy related back pain, acupuncture for the management of nausea and vomiting and pelvic and back pain in pregnancy. Recently a study investigated women’s use of health care during pregnancy and birthing in Australia. This survey was conducted in 2010. There were 1835 pregnant women completed the survey. 49.4% of those pregnant women consulted with a CAM practitioner for pregnancy related health conditions. Some participants consulted only with CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Some women consulted both CAM practitioners and conventional maternity health professionals including obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a GP 3-4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often. Women won had more frequent visits to a midwife were more likely to have consulted with an acupuncturist or a doula than those visiting midwives less frequently for their pregnancy care.
Is acupuncture safe?
For those people who never received acupuncture treatment before, there is always a concern about how safe acupuncture is. There was a report about safety of acupuncture from Witt CM et al Charite University Medical Center Berlin, Germany. This was an observational study including patients who received acupuncture treatment for chronic osteroarthritis pain of the knee or hip, low back pain, neck pain or headache, allergic rhinitis, asthma or dysmenorrhoea. The analysis was based on 2.2 million acupuncture sessions. 13579 physicians practising acupuncture in Germany participated the study. All physicians had least 140 h of acupuncture training and average 6.9 +/- 5.3 years of acupuncture practice. After treatment, all patients documented adverse events associated with acupuncture. A total of 229,230 patients received on average of 10 +/- 3.0 acupuncture treatments. 8.6% (19726) patients reported experiencing at least one adverse effect and 2.2% (4963) patients reported one which required treatment. The most common adverse effects were bleedings which was 58% of all adverse effects reported. 1.7% reported pain and 0.7% reported vegetative symptoms. Two patients had a pneumothorax: one needed hospital treatment and the other was observation only. The longest duration of a side effect was 180 days caused by nerve lesion of the lower limb. They concluded acupuncture provided by physicians is a relatively safe treatment.
Robinson TW J Altern Complement Med (2012) 18:555-60
Hunt et al Int J Clin Pract. (2010) 64:1496-502.
Ytrehus J Altern Complement Med. (2010) 16:449-55.
Hopton AK et al BMJ Open. (2012)11:2-9
Upchurch DM & Rainisch BW J Alterm Complement Med (2013) ahead of print
Burke A et al J Alterm Complement Med (2006) 12:639-48
Perry et al Prim Health Care Res Dev (2013) 10:1-6
Zhang Y et al Zhongguo Zhen Jiu (2011) 31:941-4
Cooper KL et al Complement Ther Clin Pract (2013)19:214-20
Lohre A Am J Chin Med (2013) 41:995-1010
von Ammon K et al Forsch Komplementmed (2012) 19 suppl 2:37-43
Carruzzo et al Swiss Med Wkly (2013) 143:w13756
BMC Pregnancy Childbirth (2012) 12:146
Toupin April K and Gabouryl BMC Complement Altern Med (2013) 13:374
Ehrlich G et al Fam Med (2013) 45:330-4
Fani M et al Ann Ig (2014) 26:213-8
Witt CM et al Forsch Komplementmed (2009) 16:91-7
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