To evaluate the efficacy of acupuncture, and sweeping of the fetal membranes, as methods for induction of labor.
Four hundred and seven pregnant women with normal singleton pregnancies and cephalic presentations were randomized at three delivery wards in Denmark at day 290 of gestation into groups of acupuncture, sweeping, acupuncture and sweeping and controls. The primary objective was to compare the proportion of women going into labor before induction of labor at 294 days in the four groups. The secondary objective was to compare the combined groups: with and without acupuncture, and with and without sweeping of the fetal membranes. The midwives, completing the forms for the trial at labor or induction, were blinded to group assessments.
Four hundred and seventeen women were randomized. Ten were excluded after randomization. One hundred and four women were randomized to acupuncture, 103 to sweeping of the membranes, 100 to both acupuncture and sweeping, and 100 were randomized to the control group. Comparison of the four groups demonstrated no significant difference in the number of women achieving spontaneous labor before planned induction. No difference was demonstrated by comparing the combined groups treated with acupuncture with the groups not treated with acupuncture (P=0.76). However, significantly more women went into labor before planned induction (P=0.02) in the combined groups receiving sweeping, compared with the groups not treated with sweeping.
Acupuncture at 41+ weeks of gestation did not reduce the need for induction. The study was of a sufficient size to demonstrate, in parallel, that sweeping of the fetal membranes significantly reduced the need of induction, sparing about 15% for formal induction of labor.
Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture.
Perinatal Center, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, East Hospital, Göteborg, Sweden. helen.elden@vgregion.se
OBJECTIVE: To investigate whether acupuncture has a greater treatment effect than non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. DESIGN: Randomised double-blinded controlled trial. SETTING: East Hospital, Gothenburg, and 25 antenatal primary care units in the region of Västra Götaland, Sweden. POPULATION: A total of 115 pregnant women with a clinical diagnosis of PGP who scored > or =50 on a 100-mm visual analogue scale (VAS). METHOD: Women were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for 8 weeks. MAIN OUTCOME MEASURES: Main outcome measure was pain. Secondary outcomes were frequency of sick leave, functional status, discomfort of PGP, health-related quality of life and recovery of severity of PGP as assessed by the independent examiner. RESULTS: After treatment, median pain decreased from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group (P = 0.493) as assessed on a VAS. Women in the acupuncture group were in regular work to a higher extent than women in the sham group (n = 28/57 versus 16/57, P = 0.041). The acupuncture group had superior ability to perform daily activities measured with the disability rating index (DRI) (44 versus 55, P = 0.001). There were no significant differences in quality of life, discomfort of PGP and recovery from severity of PGP between the groups. CONCLUSIONS: Acupuncture had no significant effect on pain or on the degree of sick leave compared with non-penetrating sham acupuncture. There was some improvement in performing daily activities according to DRI. The data imply that needle penetration contributes to a limited extent to the previously reported beneficial effects of acupuncture.
BACKGROUND: Seizures are poorly controlled in many people with epilepsy despite adequate current antiepileptic treatments. There is increasing interest in alternative therapies such as acupuncture; however, it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture. This is an update of a Cochrane review first published in 2006. OBJECTIVES: To determine the effectiveness and safety of acupuncture in people with epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's Specialized Register (March 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2008), MEDLINE, EMBASE, and other databases from inception to March 2008. Reference lists from relevant trials were reviewed. No language restrictions were imposed. SELECTION CRITERIA: Randomised controlled trials comparing acupuncture with placebo or sham treatment, antiepileptic drugs or no treatment; or comparing acupuncture plus other treatments with the same other treatments. involving people of any age with any type of epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted trial data and assessed trial quality. MAIN RESULTS: Eleven small trials with 914 participants, of generally poor methodological quality and with short follow up met the inclusion criteria. Ten trials were carried out in China and one in Norway.Two trials found that more children treated with needle acupuncture plus Chinese herbs achieved 75% or greater reduction in seizure frequency (RR 1.52, 95% CI 1.12 to 2.05) and 50% or greater reduction in seizure duration (pooled RR 1.29, 95% CI 1.03 to 1.62) compared with Chinese herbs alone. However, after combining the results of four trials that compared the treatment group with a control group that could yield the net effect of needle acupuncture, we found that there was no significant difference between the treatment and the control groups in any reduction of seizure frequency (pooled RR 1.05, 95% CI 0.97 to 1.17). Compared to phenytoin, the pooled results from two trials showed that patients who received needle acupuncture appeared more likely to achieve 75% or greater reduction in seizure frequency (pooled RR 2.14, 95% CI 1.47 to 3.1). Compared to valproate, the pooled results from three trials showed catgut implantation at acupoints appeared more likely to result in 75% or greater reduction in seizure frequency (pooled RR 2.33, 95% CI 1.01 to 5.36). AUTHORS' CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy.
BACKGROUND: Seizures are poorly controlled in many people with epilepsy despite adequate current antiepileptic treatments. There is increasing interest in alternative therapies such as acupuncture; however, it remains unclear whether the existing evidence is rigorous enough to support the use of acupuncture. OBJECTIVES: To determine the effectiveness and safety of acupuncture in people with epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's Specialized Register (June 2005) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005). We also searched MEDLINE, EMBASE, CINAHL, AMED, TCMLARS, China Biological Medicine Database, Chinese Acupuncture Trials Register, National Center for Complementary and Alternative Medicine, and National Institute of Health Clinical Trials Database from inception to June 2005. Reference lists from relevant trials were reviewed. No language restrictions were imposed. SELECTION CRITERIA: Randomised controlled trials evaluating any form of acupuncture involving people of any age with any type of epilepsy were included. Trials included were those comparing acupuncture with placebo, sham or no treatment; or comparing acupuncture plus other treatments with the same other treatments. Trials that only compared different acupuncture methods or compared acupuncture alone with other treatments were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted trial data and assessed trial quality using the Jadad score. Relative risk (RR) was used for binary data and weighted mean difference for continuous data, and 95% confidence intervals are given. Where possible, analyses were by intention to treat. MAIN RESULTS: Three small trials of varying methodological quality and with short follow up met the inclusion criteria. Two studied children in China and one studied adults in Norway. The two Chinese studies compared acupuncture plus Chinese herbs with Chinese herbs alone while the Norwegian study compared acupuncture with sham acupuncture. The two Chinese studies found that more children treated with acupuncture achieved 75% or greater reduction in seizure frequency (RR 1.52, 95% CI 1.12 to 2.05) and seizure duration (RR 2.38, 95% CI 1.13 to 5) with a significant 50% or greater reduction in seizure duration (RR 1.36, 95% CI 1.07 to 1.73). However, the two trials were of low quality without adequate description of randomisation method, concealment of randomisation or blinding. On the other hand, the higher quality Norwegian trial found that acupuncture did not improve the mean seizure frequency, seizure-free weeks, or quality of life in adults. AUTHORS' CONCLUSIONS: The current evidence does not support acupuncture as a treatment for epilepsy. Much larger high quality clinical trials employing appropriate controls are needed.
The objective of this study was to assess the effect on health-related quality of life of acupuncture and sham acupuncture as adjunctive treatment in intractable epilepsy. We performed a randomized controlled trail with two parallel treatment arms at The National Center for Epilepsy in Norway, a comprehensive epilepsy center. Thirty-four patients with long-standing drug resistant epilepsy completed the study. The intervention consisted of 20 acupuncture treatments (bilateral needling of three acupoints plus one or two individually chosen points) or sham acupuncture (bilateral needling with smaller needles of three points outside the traditional meridians) over 8 weeks. The main outcome measures were changes in mean health-related quality of life scores for the two groups after 8 weeks, using the 89-item Quality of Life in Epilepsy (QOLIE-89) questionnaire. We found no difference between the acupuncture and sham acupuncture groups in score changes in any dimension of the QOLIE-89 questionnaire, despite testing a large number of dimensions. We also found no change in QOLIE-89 scores between baseline and 8 weeks in either groups. In conclusion, we could not demonstrate a significant effect of traditional acupuncture or sham acupuncture on the health-related quality of life of patients with intractable epilepsy.
To investigate whether acupuncture reduces the duration and intensity of crying in infants with colic. Patients and methods 90 otherwise healthy infants, 2-8 weeks old, with infantile colic were randomised in this controlled blind study. 81 completed a structured programme consisting of six visits during 3 weeks to an acupuncture clinic in Sweden. Parents blinded to the allocation of their children met a blinded nurse. The infant was subsequently given to another nurse in a separate room, who handled all infants similarly except that infants allocated to receive acupuncture were given minimal, standardised acupuncture for 2 s in LI4.
There was a difference (p=0.034) favouring the acupuncture group in the time which passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing was lower in the acupuncture group the first (74 vs 129 min; p=0.029) and second week (71 vs 102 min; p=0.047) as well as the duration of colicky crying in the second intervention week (9 vs 13 min; p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (193 vs 225 min; p=0.025) and the second intervention week (164 vs 188 min; p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (22 vs 6 min; p=0.028), for colicky crying in the second week (92 vs 73 min; p=0.041) and for TC in the second week (44 vs 29 min; p=0.024), demonstrating favour towards the acupuncture group.
Minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. Further research using different acupuncture points, needle techniques and intervals between treatments is required.
BACKGROUND: The study was designed to evaluate the analgesic effect and possible adverse effects of acupuncture for pelvic and low-back pain during the last trimester of pregnancy. METHODS: Following individual informed consent, 72 pregnant women reporting pelvic or low-back pain were randomized during pregnancy weeks 24-37 to an acupuncture group (n = 37) or to a control group (n = 35) at three maternity wards in southern Sweden. Traditional acupuncture points and local tender points (TP) were chosen according to individual pain patterns and stimulated once or twice a week until delivery or complete recovery in acupuncture patients. Control patients were given no sham stimulation. Throughout the study period each patient made weekly visual analog scale (VAS) evaluations of maximal and minimal pain intensity as well as three-point assessments of pain intensity during various activities. RESULTS: During the study period, VAS scorings of pain intensity decreased over time in 60% of patients in the acupuncture group and in 14% of those in the control group (p
The acupuncture treatment for postmenopausal hot flushes (Acuflash) study: traditional Chinese medicine diagnoses and acupuncture points used, and their relation to the treatment response.
the multicentre, pragmatic, randomised controlled Acuflash study evaluated the effect of traditional Chinese medicine (TCM) acupuncture on postmenopausal vasomotor symptoms and health-related quality of life. It concluded that use of acupuncture in addition to self-care can contribute to a clinically relevant reduction of hot flushes and increased health-related quality of life. This article reports on the TCM syndrome diagnoses and acupuncture points used and their relation to the treatment response, and on treatment reactions and adverse events.
the acupuncture group (n = 134) received 10 acupuncture treatment sessions and advice on self-care; the control group (n = 133) received advice on self-care only. The study acupuncturists met the current membership criteria of the Norwegian Acupuncture Society, and had at least 3 years' experience of practising TCM acupuncture. They were free to diagnose and select acupuncture points for each participant, after initial discussion.
fifty per cent of the participants in the acupuncture group were diagnosed with Kidney Yin Xu as their primary TCM syndrome diagnosis. No statistically significant differences were demonstrated between the syndrome groups regarding the distribution of responders and non-responders, nor regarding the change in health-related quality of life scores. A core of common acupuncture points (SP6, HT6, KI7, KI6, CV4, LU7, LI4, and LR3) were used in all the syndromes, and in addition multiple idiosyncratic points. Core point selection and frequency of use did not differ between responders and non-responders. No serious adverse events were reported.
factors other than the TCM syndrome diagnoses and the point selection may be of importance regarding the outcome of the treatment.
Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Ulriksdal 8C, N-5009 Bergen, Norway. terje.alrek@isf.uib.no
Polycystic ovary syndrome (PCOS) affects 5-10 percent of all fertile women and is associated with anovulation/oligoovulation, hyperandrogenism, and polycystic ovaries. Pharmacological treatment is often effective but associated with unwanted side effects. Acupuncture treatments have been shown to improve menstrual bleeding patterns and ovulation as well as hyperandrogenism, without side effects. The purpose of the present study was to describe the experience of acupuncture for women diagnosed with PCOS.
Eight women with PCOS living in western Sweden, were interviewed following repeated acupuncture treatments. Data was analyzed using systematic text condensation as described by Malterud.
The experience of acupuncture for women diagnosed with PCOS can be described in five categories; the experience of hope, getting results, feelings of responsibility, skepticism and proof of effect, and feeling normal.
Since acupuncture is a promising treatment for the symptoms of the common syndrome PCOS, the present study adds to the knowledge base by providing the important experiences of patients receiving the treatment. Acupuncture provides a possibility for patients to gain hope as the treatment shows results. The results show that acupuncture empowers the patients to take responsibility for their future well-being, although they may have been initially skeptical to the treatment. Because the syndrome had affected them for some time, even small changes offered a chance for them to feel that their bodies were capable of normal function.
