Welcome to my blog
Acupuncture for fertility and miscarriage
My Guest blog articles and Reviews
Guest blog articles
Reviews and articles
Maggie Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
Maggie Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
Maggie Ju (2020) The Potentiality of COVID-19 Treatment with Chinese Herbal Medicine in the UK
The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Saturday, 28 April 2018
A healthy tendon is up to twice as strong as the muscle, making the body of the tendon unlikely to tear before the muscle unless the tendon has already been weakened by degenerative changes. The effects of ageing, wear and tear, genetic pre-disposition and inflammation are known factors contributing to tendon injuries. Tendons consist of collagens, proteoglycans, glycoproteins, water and cells. In case of injury, repair will take place only through scar tissue. This leads to decreased functional properties of these injured regions and to a greater risk of recurrent injury. Injured tendon can cause pain, loss of limb function and prevent exercise and activities of daily living.
There are ∼2 million Achilles tendon sports-related injuries each year worldwide. Of these, over 250 000 require surgical intervention and prolonged rehabilitation. However, patients with these injuries seldom regain full pre-injury function. These ailments are difficult to manage, frequently resulting in long-term pain and discomfort. The poor repair of tendons is a direct consequence of their limited vascularity and relatively acellular nature. Most frequently injured are the rotator cuff, the patellar and the Achilles tendons, with pathology ranging from tendinopathy and calcific tendinopathy, to partial tears, to complete ruptures. The poor tendon self-repair makes recovery difficult.
Calcification is the accumulation of calcium salt in the tissue. Bone is the common place to occur, but calcification can happen in the soft tissue, such as fascia and tendon causing hardening of the tissue. Soft tissue calcifications happens anytime and any location of the body. The most common place is in the damaged tissue, such as injured tendon causing calcific tendinitis. Calcium phosphate is accumulated in the tendon causing pain and inflammation. Chronic pain is the most common symptom of tendon calcification. Other symptoms include stiffness, snapping, catching or weakness on related tendon and joints. It is involved in abnormal repairment of damaged tissue. Acupuncture can help to reduce the pain, improve stiffness and improve circulation to help reabsorbing the calcium.
Pain and burning in the affected area, decreased strength and flexibility, and pain caused by everyday activities are very common. This is often caused by tendinopathy-tendon injury.
The healing time for injured tendon varies depending on whether treatment starts with early presentation or chronic presentation. Healing time for acute injury can be a few days to 6 weeks. Treatment at an early stage can be as brief as 6–10 weeks. Once it becomes chronic the treatment can take 3–6 months. The effective treatment might take up to 9 months to 36 months when it is chronic. Knowing these timelines is part of creating an effective treatment plan.
Acupuncture helps with tendon injury
Acupuncture is used to treat tendon injury and it improves pain and functional activity in patients with tendinopathy. This is suggested that acupuncture can modulate both anti-inflammatory and mechanotransduction molecular pathways which can increase type I collagen synthesis. Collagen synthesis is the main factor that influences tendon biomechanical properties. Therefore one reason of acupuncture for tendon healing is that acupuncture increases synthesis and subsequent reorganisation of type I collagen during tendon healing process.
MacPherson H et al (2016) Pain Oct 17 Epub ahead of print
Wednesday, 25 April 2018
Recent research has shown that acupuncture can help with sinusitis. A study with 24 participants has shown that acupuncture reduced nasal congestion caused by sinusitis. A survey from 321 practioners has shown that they use acupuncture in the treatment of patients with chronic sinus and nasal symptoms and obtain good results.
Sertel S et al Am J Rhinol Allergy 2009 Nov-Dec;23(6):e23-8. doi: 10.2500/ajra.2009.23.3380. Epub 2009 Sep 18.
Pletcher SD Am J Rhnol, (2006) Mar-Apr;20(2):235-7.
Monday, 23 April 2018
The hip bone is formed by three parts: illium, ischium and pubis.
The ilium is the highest and largest part of the hipbone consists of the body and wing.
The ischium is the lowest part of the hip bone and made up of three parts–the body, the superior ramus and the inferior ramus.
The pubis is at the anterior of the hip bone. It is divided into the body, superior ramus and inferior ramus.
The hip bone has a few groups of muscles attached as follows
The abdominal muscles include the abdominal external oblique muscle (attaches to the iliac crest) , the abdominal internal oblique muscle (ataches to the pectin pubis) and the transverses abdominis muscle (ataches to the pubic crest and the pectin pubis),
The back muscles include the multifidus muscle (attaches to the medial surface of the posterior superior iliac spine, the posterior sacroiliac ligaments and part of the sacrum)
The gluteal muscles include three gluteal muscles: gluteal maxmus muscle, gluteal medium muscle and gluteal mininus muscle. They all arise from the outer surface of the hip bone and
The lateral rotator group of muscles include piriformis muscle, superior gemellos muscle, obturator internus muscle , inferior gemellos muscle and obturator externus muscle.
Adductor group of muscles include adductor brevis, adductor longus, adductor magnus, adductor minimus, pectineus, gracilis and obturator externus.
Hamstrings include long head biceps femoris, semitendinous and semimembranosus
Two muscles at the anterior of the thigh rectus femoris muscle and sarturius muscle
One shoulder muscle--- the latissimus dorsi muscle (attaches to the iliac crest ).
Chronic pain and tenderness around the pelvic bone very common. Acupuncture can help release the pain.
Thursday, 19 April 2018
Acupuncture is effective to treat hay fever. There is a paper just published titled Impact of acupuncture on antihistamine use in patients suffering seasonal allergic rhinitis: secondary analysis of results from a randomised controlled trial. In this research patients were allocated into three study groups: acupuncture plus medication, sham acupuncture plus medication, and medication alone. The data from 414 patients were analysed. The acupuncture group used antihistamines significantly less often compared with the other groups. The pre-post comparison suggested that the acupuncture patients did not need to increase the days of antihistamine use to alleviate their symptoms. Acupuncture appeared to significantly reduce the number of days of antihistamine use for the patients with hay fever.
Adam D et al Acupunct med 2018 Feb 10. pii: acupmed-2017-011382. doi: 10.1136/acupmed-2017-011382. [Epub ahead of print]
Friday, 13 April 2018
Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder condition. It is a feeling of pain and pressure in the bladder area and the symptoms have lasted for more than 6 weeks, without having an infection or other clear causes. Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don't go away. The pain may be worse when the bladder is full and may be temporarily relieved after urination. The pain could be worse during periods or after having certain foods or drinks. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex. This condition is poorly understood. Apart from the pain, it is also accompanied with problems of urination, such as sudden, strong urges to urinate, more frequent urination than normal, pain when passing water, waking up quite a few times during the night to urinate. The exact cause of interstitial cystitis isn't clear. Unlike other types of cystitis, there's no obvious infection in the bladder and antibiotics don't help.
I help people with interstitial cystitis with acupuncture. A patient told me that it is a nice feeling of standing on the beach without having to go to toilet.
Thursday, 12 April 2018
Frozen shoulder is a painful condition in the shoulder. The medical term for frozen shoulder is adhesive capsulitis. It presents a painful persistent stiffness of the shoulder joint that it is difficult to carry out everyday tasks such as dressing, driving and sleeping comfortably. Some people are unable to move their shoulder at all. This is caused when the capsule surrounds the shoulder joint becomes inflamed. The capsule that surrounds your shoulder joint becomes swollen, thickened and tightened This leaves less space for your upper arm bone in the shoulder joint, and makes the movement stiff and painful. The symptoms of frozen shoulder can vary greatly, but tend to get worse slowly over the time. They are usually felt in three stages spread over a number of months or years. This is a common condition affecting about 2% of adults.
The most common symptoms are pain and stiffness in the shoulder. Also the amount of movement in affected shoulder joint is reduced. In severe cases, the shoulder may not be moved at all. Though it is a common condition, the treatment remains challenging. Jain and Sharma from University of Kansas Medical Center USA reviewed current best evidence for the use of physical therapy intervention for frozen shoulder. Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion and function in patients with stage 2 and 3 of frozen shoulder. Low level laser therapy is strongly suggested for pain relief and moderately suggested for improving function but not recommended for improving range of motion. Corticosteroid injections can be used for stage 1 frozen shoulder. Acupuncture is an option of treatment. Acupuncture with therapeutic exercises is moderately recommended for pain relief, improving range of motion and function.
Many case reports were published showing effectiveness of acupuncture in reducing pain on frozen shoulder. For example, Wang XH et al observed 60 cases with frozen shoulder. These patients were divided into two groups for acupuncture or acupuncture plus moxibustion treatments. The acupuncture points selected were Jianyu (LI15), Jianliao (TE14) and Jianzhen (SI9). Tender points were also selected in acupuncture-moxibustion group. They found that acupuncture alone or acupuncture plus moxibustion were effective for frozen shoulder. Acupuncture combined with moxibustion may have better cured rate, but the effective rate has no significant difference. Some clinical trials suggest that acupuncture may improve recovery in patients with a frozen shoulder, either when used alone or in combination with physiotherapy. Acupuncture has effect of frozen shoulder in reducing pain, inflammation muscle and joint stiffness. This is because acupuncture stimulates nerve ends releasing analgesic substances such as endorphins; it reduces inflammation and improves local blood flow. The meridians involved in treating frozen shoulders are muscle meridian of Hand-Yangming, Hand-Shaoyang, Hand-Taiyang, and three yin meridians of hand appeared at proximal points of shoulder joint.
Rotator cuff disorders
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm to the shoulder blade. The rotator cuff tendons provide stability to the shoulder; the muscles allow the shoulder to rotate. The rotator cuff keeps the joint in the correct position, allowing it to move in a controlled way. It keeps the upper arm bone in the shoulder socket and it raises and twists the arm. If it is irritated or damaged, rotator cuff disorders occur. Rotator cuff disorders include inflammation of the tendons or a bursa; impingement in which a tendone is squeezed and rubs against bone, calcium buildingup in the tendons, tears of the tendons. Rotator cuff disorders are common cause of shoulder pain. Most rotator cuff disorders are caused by a combination of normal wear and tear and overuse. Using the shoulder for many years slowly damages the rotator cuff. As ageing, everyday activities can lead to changes in the rotator cuff, such as thinning and fraying of the tendons and reduced blood supply. Activities in which you use your arms above your head a lot-such as tennis, swimming, or house painting-can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff. A simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged. Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb hair, tuck in shirt, or reach for something. You may have pain during the night and trouble sleep. It is important to treat a rotator cuff problem. Without treatment, it may get weaker and lifting up your arm could be a problem. Acupuncture is very effective to treat rotator cuff disorder and helps reducing the inflammation and pain, relaxing rotator cuff muscles and improving blood supply.
New research shows that acupuncture is effective for shoulder pain
Shoulder impingement syndrome which is the common cause of shoulder pain presents pain and weakness in the shoulder especially when you raise your arm. This will limit the movement of the shoulder making daily life difficult. This syndrome involves the rotator cuff tendon which connects the muscles in the shoulder to the top of the arm. You may experience a constant aching in the shoulder and pain at night. It can start suddenly after an injury or it can come on gradually without any obvious causes. The pain tends to be worse when you raise your arm over the head.
Recently a report has shown the effectiveness of acupuncture for shoulder impingement syndrome. In this report the effect of acupuncture in decreasing the intensity of short- and mid-term pain in the injured shoulder was studied. 68 participants with a mean age of 33.4 years were divided into two groups: one group received true acupuncture and the other received acupuncture at sham points. The treatment was carried out over 4 weeks, with the participants receiving a session every week. The result has shown significant difference in pain reduction between two groups both after treatment and 3 months after treatments. No side effects were reported.
Acupuncture is effective for shoulder pain. Shoulder pain is a common reason for patients to visit an acupuncturist. If you have had acupuncture for this, do you know the effect of acupuncture for shoulder pain is closely related to the acupuncture points chosen? Wang et al has analysed some clinical trial to study the acupuncture points for shoulder pain and they assessed the effectiveness of Ashi points stimulation on response rate compared with conventional acupuncture. They have found that there was a significantly greater recovery rate in group of Ashi points stimulation. The conclusion was Ashi points stimulation might be superior to conventional acupuncture, drug therapy and no treatment forshoulder pain. Another study compared the effect of trigger point acupuncture (TrP), with that of sham (SH)acupuncture treatments, on pain and shoulder function in patients with chronic shoulder pain. After treatment, pain intensity between pretreatment and 5 weeks after TrP decreased significantly. Shoulder function also increased significantly between pretreatment and 5 weeks after TrP. Compared with SH acupuncture therapy, TrP therapy appears more effective for chronic shoulder pain.
Muscles related to shoulder pain
There are many muscles that surrounded shoulder for shoulder movement.
Trapezius muscle is a broad triangular muscle at neck and upper back, one of the largest superficial muscles at the back. It attaches to the base of the skull and extends down to the neck, the upper back until mid back; laterally it inserts to the shoulder blades. There are three functional regions to the muscle: the Upper, middle, and lower trapezius, and each region has its own function: upper region moves the shoulder blades and support the arms; the middle region retracts the shoulder blades and the lower region rotates and depresses the shoulder blades.
Pain caused from this muscle may be on the top of the shoulder, neck, mid back and/or upper shoulder pain; pain at the back of the shoulder blade which could go down the inside of the arm to the ring and little fingers.
Latissimus dorsi is the largest flat muscle at the back. This muscle is involved in adducting the arms, extending the shoulders and rotating shoulder joints medially. It also plays a role in extension and lateral flexion of the lumbar spine. The latissimus dorsi originated from the lumbodorsal fascia of the lower back, arising from the inferior thoracic and lumbar vertebrae, sacrum, iliac crest, and the four most inferior ribs, it runs laterally up through the back, inferior part of shoulder blades and insert on the humerus at the upper front of the upper arm. Tight latissimus dorsi and the trigger points on the muscles could be one of the causes of chronic mid back pain, shoulder pain, forearm pain, pain between shoulder blades, shoulder blades and pain in front of shoulder. The characteristic of pain is at lower shoulder blade and mid back and also the pain can go down the backside of the arm or the inner side of the arm and reach the hand and 4th and 5th fingers. Pain can be present at the front of the shoulder and to the side of the body just above the hip.
Rotator cuff comprises four muscles which are supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They all originate from the scapula and insert into humerus. They connect scapula to the head to humerus , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder.
Rotator cuff disorder is one of the problems that cause shoulder pain. The main symptoms are pain around the shoulder and reduced shoulder joint movement. Acupuncture can help reduce the pain.
Teres major muscle
Teres major muscle is the muscle that connects shoulder blades to the upper arms. It starts from lower angle of the shoulder blade and ends at the upper arm in the front of the shoulder. The teres major muscle adducts the arm, extends the shoulder and rotates it inwardly. It also helps stabilize the humeral head. The pain caused in the teres major trigger is the back of your shoulder and also this pain can radiate to the front and side of the shoulder and down the backside of the arm. The trigger points for this muscle can be found at the lower angle of shoulder blades. Acupuncture can help release the pain.
How many muscles connect the humerus (upper arm) to the scapula (shoulder blade)?
There are muscles that connect the upper arm to the shoulder blades and help the movement of the shoulder. Do you know how many of them? There are seven muscles that connect the upper arm to the shoulder blades. They are coracobrachialis muscle, four rotator cuff muscles including infraspinatus, subscapularis, supraspinatus and teres minor muscles, teres major muscle and deltoid muscle. Overuse or injury to these muscles can cause shoulder and arm pain. Acupuncture can help release the pain.
The deltoid muscle is the big muscle on the shoulder which forms the rounded contour of the shoulder. It has three parts; the front or anterior, middle and back or posterior. The anterior fibers are involved in flexing the shoulder and internally rotating the arm. The posterior fibers are involved in extending the shoulder and externally rotating the arm. The lateral fibers are involved in shoulder abduction. Deltoid muscle strain is less common than rotator cuff muscles strain.
Pectoralis major and minor muscles and shoulder pain
The perctoralis major muscle is a muscle located at the chest. Underneath the pectoralis major is the pectoralis minor muscle- a small triangular muscle.
The pectoralis muscle originated from inner half of the clavicular bone, sternum as well as the cartilage of the sixth or seventh rib and the aponeurosis of the abdominal muscle. The muscle run laterally and insert into the upper humerus. It adducts the arm and rotates the shoulder inwardly, pull down the shoulder joint and elevated the arm to the front. The muscle trigger points contribute to the shoulder pain and upper and inner side of the forearm.
Pectoralis minor originates from the third, fourth and fifth ribs and it runs upward and laterally and inserts to the surface of the coracoids process of the scapula. It pulls the shoulder blade downward, forward and inward towards the ribs, stabilizes the shoulder, prevents the shoulder blade from being pushed backwards. The trigger point of themuscle contributes to the pain in front of the shoulder, that could radiate to the chest and all the way down the inner arm.
Biceps and the shoulder, arm and elbow pain
In the upper arm, there is a muscle called biceps brachii or biceps. This muscle is two headed lies on the upper arm between the shoulder and the elbow. The two heads start from the scapular of the shoulder and join together to one muscle on the upper arm (humarus) and attach to the bones radius and ulnar in the front of the elbow. The biceps turn the arm outward, turn the palm upward, flex the elbow and flex the shoulder (bring the shoulder forward and upwards). The biceps can contribute to the pain on the front of the arm, the elbow and the shoulder. Also it contributes to the medial rotation of the shoulder.
The triceps brachii muscle or three headed muscle of the arm is the large muscle on the back of the upper limb. The three heads include long head, medial head and lateral head. The long head originates from the top of the scapula (the infraglenoid tubercle of the scapula). The medial head originates from the upper part of the limb (the groove of the radial nerve, the dorsal surface of the humerus, the medial intermuscular septum and the lateral intermuscular septum). The lateral head originates from the back of the upper limb (the dorsal surface of the humerus, lateral and proximal to the groove of the radial nerve, the greater tubercle down to the region of the lateral intermuscular septum. The three heads join together, form a tendon and attach to the elbow (the olecranon process of the ulna). The triceps extend the elbow and shoulder joint to straighten the elbow and move the arm backwards and also pull the arm towards the body. If the triceps contain trigger points, you can experience pain on the shoulder, arm, elbow or the pain can radiate to the forearm.
Wang XH Zhongguo Zhen Jiu (2010) 30:364-6
Jain TK and Sharma NK J Back Musculoskelet Rehabil (2013) Nov 27
You Z et al Zhongguo Zhen Jiu (2014) 34:565-8
Wang et al Chin Integr Med (2015) Jun 30
Itoh K et l J Acupunct Meridian Stud (2014) 7:59-64
Rueda Garrido JC et al Complement Ther Med (2016) 25:92-7
Tuesday, 10 April 2018
The common causes of pelvic pain are appendicitis, bladder disorders, sexually transmitted diseases, kidney infection, kidney stones, intestinal disorders, nerve condition, hernia, pelvic inflammatory diseases, IBS, (ovulation, periods pain, endometriosis, ovary cysts in women), (prostatitis in men) and many more. Diagnosis is needed by doctors.
Chronic pelvic pain which is continuous or episodic pain in the lower abdomen or pelvis lasting at least six months is one of the most common pain conditions experienced by women. It has great negative impact on women’s quality of life including constant physical and psychological aspects. It depends on what causes the pain and various treatments are available including surgical and non surgical approaches such as hormonal therapy. Improving day-to-day pain management, functioning, and quality of life through multidisciplinary and holistic approaches are also recommended care to women with chronic pelvic pain. The use of complementary health approaches is common for pain conditions. An estimated 35-52% of patients with chronic pain use therapies such as vitamins and mineral supplements, massage therapy or acupuncture for their symptoms. This is applied to chronic pelvic pain. A survey showed that 60% of perimenopausal women with self-reported pelvic pain, and 84% of women with interstitial cystitis used some form of complementary medicine. Recently a study from the US has shown that most women who used acupuncture (91%) had at least some improvement in symptoms based on self-report.
Recent review has shown that acupuncture can reduces chronic prostatitis/chronic pelvic pain syndrome for men. In this review, (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure Acupuncture likely results in little to no difference in adverse events. It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants
Chao et al Pain Med (2015) 16:328-40
Franco JV et al Cochrane Database Syst Rev (2018) Jan 26
Saturday, 7 April 2018
The early sign of dehydration is thirst. If you are thirsty, you are in dehydration. The other common signs of dehydration include: dark yellow coloured urine and not passing much urine when you go to the toilet, headaches, tiredness and feeling lightheaded. How much water do we need a day? We need 1.5 to 3 litres to make up to the water that we loss every day in moderate condition. This is about 8 medium glasses of water. We may need more water during hot weather or physical activity. You can tell if you drink enough of water by the colour of your urine. If the urine is pale straw colour, you have enough water intakes.
There are three layers of the skin. The outer layer contains skin cells, pigment, and proteins. It is the outlook of the skin. It provides a waterproof barrier and creates the skin tone. In this layer there are no blood vessels and the skin cells are nourished by the blood supply of deeper layers.
The skin contains 64% water. Water makes the skin pliable and smooth. Dehydration causes skin wrinkles and is also related to dry, scaly skin and irritant dermatitis. Drink plenty of water to prevent the skin from dehydration. Exposure to cold, wind, sun and low humidity makes the skin dry; this is due to water loss and poor circulation from the skin.
Acupuncture can help increase water and oil content for facial skin. This is proved by a research paper. In this research, two women received five consecutive acupuncture sessions once a week for a month. Water content and oil content of the facial skin were measured and compared before and after the first acupuncture session and before and after the five consecutive acupuncture sessions. The result suggested that cosmetic acupuncture increased the water and oil content of facial skin in a female participant whose water content and oil content were lower before receiving acupuncture (which mean the skin was dry before acupuncture treatment).
N. Donoyama, A. Kojima, S. Suoh, and N. Ohkoshi, “Cosmetic acupuncture to enhance facial skin appearance: a preliminary study,” Acupuncture in Medicine, vol. 30, no. 2, pp. 152–153, 2012.
Thursday, 5 April 2018
95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.
In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.
Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?
There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.
With 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.
Low back pain with acupuncture treatment
Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.
NHS recommended acupuncture combined with self-care for persistent low back pain.
Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.
Mechanisms of acupuncture for low back pain
Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment
Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937
Hogeboom CJ et al (2001) Complement Ther Med 9:154-66
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Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Plantar fasciitis can be painful. The pain of plantar fasciitis has unique characteristics -- pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas. It is associated with long standing. The main symptom is sharp heel pain which is worsen by bearing weight on the heel after long periods of rest for example after getting out of bed or after prolonged periods of sitting. After continuing walk, the pain symptoms is improved. There may be other symptoms accompanied the pain such as numbnesss, tingling, swelling or radiating pain.
Acupuncture can be used to treat heel pain effectively. Some high quality studies report significant benefits of acupuncture. Acupuncture was associated with significant improvement in pain and function.
A study investigated effectiveness of acupuncture for patients with chronic plantar fasciitis. Acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone (13%). The effects lasted for at least six weeks follow-up.
There are some other clinical evidences by recent research on this aspect. There is a study which investigated the efficacy of electro-acupuncture coupled with conventional treatments and compared it with the efficacy of conventional treatments alone in patients with chronic plantar fasciitis. Subjects in the control group received five weeks of conventional treatments, including stretching exercise, shoe modification and rescue analgesics. Subjects in the acupuncture group received the same treatments plus ten sessions of electro-acupuncture twice weekly. At the end of treatment, pain score decreased significantly in the acupuncture group compared with and control group. At the sixth week follow-up, subjects in the acupuncture group showed a better foot function index and success rate for pain during the day than those in the control group. Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone. The effects lasted for at least six weeks. Another study also compared the effect of acupuncture with that of conventional treatment including treatment with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. They also found acupuncture had better effects than those conventional treatment and they suggested that acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.There was a study compared effect of miniscalpel-needle (MSN) ( a special type of acupuncture) with steroid injection for the treatment for plantar fasciitis. Their results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Their data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection.
Clark & Tighe Acupunct Med (2012) 30:298-306
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Kemnerddee W and Pattapong N Am J Chin Med (2012) 40:1167-76
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Acupuncture is an appropriate option for tennis elbow treatment. Previous research showed acupuncture had short term benefit (three days to two months) in pain reduction. The longer term effect still needs to be studied. More recently a study published in a Chinese acupuncture journal. 34 patients with tennis elbow were in two groups for acupuncture treatment in different acupuncture points. Group A was used anti-Ashi-points (points of pain relief or disappearance after local press) and group B was used Ashi-points (pain spots) and surrounded points. Acupuncture was performed once in every two days; 2 courses treatment was given with 10 treatments for 1 course. The effect was assessed at the end of the treatment day, the 7th day, the 30th day, the 6th months and one year after treatment. They found that short term effect was better for group A than group B, but the long term effect (6 months and one year) were similar between the two groups.
Another study analysed the effectiveness of acupuncture on lateral elbow pain (LEP). By comparison of acupuncture and sham acupuncture treatment, patients with LEP received acupuncture treatment had significantly more reduction in pain and greater improvement in elbow mobility, more strength in the arm. There was immediate effect after acupuncture treatment and the effect last for 2 weeks followup period.
By comparison of acupuncture and conventional treatment, it was found from those studies that the acupuncture group had a significantly higher cured rate than conventional therapy, including prednisolone injection, triamcinolone acetonide, lidocaine injection. At 6 month followup, Acupuncture group had significant reduction in VAS pain score when compared with the group that received pulsated ultrasound and massage. Study has shown there was no significant difference between moxibustion and conventional treatment.
By comparison of acupuncture plus moxibustion combination and acupuncture alone, one study has suggested combination of acupuncture with moxibustion had better pain reduction and another study has shown that electro acupuncture had better pain reduction, but there was no clear conclusion because of poor methodology.
About adverse effects, there was no adverse effect reported in acupuncture treatment. One case of permanent scar from blister was reported in moxibustion treatment.
Clinically there were some cases that patients with tennis elbow were completely cured after acupuncture treatments.
Here are some success stories for elbow pain with acupuncture treatment. For example, Lisa who was 42 years of age was diagnosed with tennis elbow for 5 years. Her right elbow pain became persistent after a few years. This affected her daily life. She had terrible pain in her arms around the elbow whenever she used the arm. She tried everything she could to get rid of the pain without success. A friend told her to try acupuncture which she did. After first session of acupuncture, she felt less painful immediately. She was encouraged so much and continued to do a few sessions. She felt much better and could use the arm without feeling too much pain. She did a few more sessions again. The pain was completely gone. After a few years a follow up showed that there was no recurrence of the elbow pain.
Sarah was 50 year old. She had left elbow pain for 10 years. Initially the pain stayed at the lateral part of the elbow and the pain came and went. However the pain spread later to the medial part of the elbow, to the front and the back of the forearm and the arms as well. The pain was getting worse. She could not do anything using the left arm such as writing, combing hair or lifting arm (Because she was left-handed, this causes more problems for her). The examination showed pain at the lateral and medial part of the elbow when she was doing elbow extension and flexion, left arm lifting, left wrist extension and flexion. There were highly sensitive tender points around the elbow. This was a typical case of soft tissue injury around the left elbow or so called tennis elbow. Acupuncture was effective for this case. After a few sessions of acupuncture treatments, she could do things using her left arm without feeling too much pain. With continuing a few sessions of treatments the pain was gone completely. 1 year follow up showed there was no pain at all. She could use the left arm do anything as the right arm. Examination showed there was no pain when she was doing the left elbow extension, flexion or arm lifting. There were no tender points around the elbow.
Acupuncture help relieve symptoms of tennis elbow. It stimulates nerve ends leading to release of analgesic substances such as endorphins to relive the pain. It also reduces inflammation by improving local circulation. It also improves muscle stiffness and joint mobility by increasing local microcirculation.
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Treatments for carpal tunnel syndrome include surgical and non surgical options. The current beneficial non surgical treatments include steroid use, acupuncture and splinting. Nonsurgical treatments such as wrist splints and corticosteroid injections are recommended for mild to moderate cases of CTS. The effect of acupuncture is as effective as steroids and splinting. Acupuncture reduces pain dramatically. Acupuncture could reduce the pain completely or could reduce pain over 50% in some cases.
Research has shown that acupuncture could be an effective treatment for CTS and has greatly improved the symptoms in patients with CTS. Khosrawi S et al studied the acupuncture treatment for CTS using a randomised controlled trial. In this trial they recruited 64 patients who received 8 sessions of acupuncture treatment over 4 week period. They found that acupuncture improved the overall symptoms of CTS in these patients and nerve conduction velocity was improved as well. Another study by Kumnerddee W and Kaewtong A showed that 10 sessions of acupuncture over 5 weeks have better effect than that for night splinting in pain reduction. Yang CP observed the long term (1 year) effect of acupuncture on CTS. The patients with mild to moderate CTS received 8 sessions of acupuncture treatment over 4 week period. 1-year follow-up result showed that acupuncture treatment group had a significantly better improvement in overall symptoms, distal motor lantencies and distal sensory latencies compared to steroid group. These studies suggested that acupuncture has short term and long term effect in patients with CTS and acupuncture is a treatment option for patients with CTS.
Recently Maeda Y et al in Massachusetts General Hospital USA studied how brain contributes to the response to acupuncture in pain relief in patients with CTS. Brain response to electroacupuncture was assessed with functional MRI. The patients were allocated into three groups: local acupoints group, distal acupoint group and sham acupuncture group. In local acupoint group, two acupoints PC7 and TW5 on the affected wrist were used. In distal acupoint group, SP6 to LV4 acupoints were used. Sham acupoints were performed at nonacupoints locations on the affected wrist. They found that patients in the local and distal group reported reduced pain. Acupuncture group has greater reduction of abnormal sensation changes compared to sham group. Compared to sham group, local acupuncture produced greater activation in insula and S2 and greater deactivation in ipsilateral S1, while distal acupuncture produced greater activation in S2 and deactivation in posterior cingulated cortex. Brain activation in prefrontal cortex, SMA and S1 region was associated with analgesia.
Acupuncture is believed to stimulate the nervous system releasing neurochemical molecules to reduce pain. Acupuncture stimulates limb network in the brain and alter sensory process. Acupuncture reduces inflammation which may contribute to the mechanism.
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Maeda Y et al. Evid Based Complement Alternat Med (2013) Jun 17
Acupuncture has been used in the management of neurologic conditions such as stroke, spinal cord injury, and Parkinson's disease. Acupuncture is also used in treating MS. There are also some studies on the effect of acupuncture on MS. This study is involved in a few aspects such as MS quality of life, MS fatigue, MS spasticity and MS pain.
For example, there is a case report of a sixty-five-year-old male with a twenty-year history of MS. The patient was received with Chinese scalp acupuncture once a week for ten weeks, then once a month for six more sessions. There was significant improvement in well-being, gait, balance, spasms, and incontinence. Another study has shown that after electroacupuncture of 10 weeks on nine MS patients with bladder dysfunction, mean urge frequency decreased significantly and mean number of daytime leaking episodes decreased. A study by McGuire examined the effect of acupuncture on the fatigue of a fifty-year-old female with MS who received twenty minutes of acupuncture once a week for seven weeks. There were reports of improvement on fatigue. Another study on twenty MS patients received twelve sessions of acupuncture over two months following an unsuccessful trial of the antifatigue medication Amantadine. Five of the twenty patients recorded improved scores on the FSS. Also there was a report that acupuncture improved coordination and fewer slips and trips with effects lasting for eight months in MS patient.
A study evaluated the efficacy of acupuncture in treating forty-nine MS patients with chronic pain using a case series pretest/posttest design. Patients received biweekly acupuncture treatments for six months and noticed significant improvements in the Oswestry Disability Index (ODI).
From these studies we can see acupuncture is a potential treatment option for MS patients, though much of the research needed for the efficacy of acupuncture.
There was a report by Kerr Grieve et al from Tayside MS research unit, Ninewells hospital and medical school, Dundee, Scotland. They had positive data to support that acupuncture is an effective treatment for pain and other MS symptoms. There were 20 patients with MS involved in the research. 85% were female aged 20 to 60 years. Duration of diagnosis was 1-29 years. All of the patients had been attending the clinic for between 3 and 24 months. The majority were receiving acupuncture on six weekly bases. 18 patients had some reduction in pain. 9 patients scored the level of pain relief as 8/10 or better. 18 patients had pain relief for four or more weeks. Improvement of sleep pattern, mood, energy levels and mobility was also subjectively improved, though not as much as pain relief. 9 patients had a temporary increase in pain. 55% of patientsreduced their use of pain killers and 3 stopped additional pain killers completely. The authors were confident that acupuncture could be a treatment for apin and other MS related symptoms for patients with MS.
Recently a survey conducted by Stoll SS et al from Neurology department in Drexel University College of Medicine Phyladelphia USA about using CAM treatment for patients with MS. 111 patients with MS completed the survey properly. All patients used non disease-modifying agents (non-DMA agents). 65 patients (58.6%) exercised on a weekly basis. 64 patients (57.7%) used CAM therapies such as acupuncture and massage, or osteopathic manipulative treatment and psychotherapy.
Quispe-Cabanillas JG et al investigated the effect of acupuncture in 31 patients with relapsing-remitting type of MS under treatment of immunomodulators. The patient’s quality of life was assessed to evaluate the effectiveness of acupuncture. They found that acupuncture improved various aspect of quality of life for those patients including reduction in pain and depression. Foroughipour M et al also observed the effectiveness of acupuncture in 20 patients with MS. They found that 12 sessions of acupuncture improved the fatigue symptom in patients with MS who were resistant to the medication amantadine.
A recent research found that three months of acupuncture treatment reduce MS symptoms and disability score in 3-month and 6-month follow-up were reduced as compared with those before treatment and annual recurrent rates were also reduced with acupuncture treatment.
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