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Cam in review may 2013 +
Health Insights Today
A SERVICE OF CLEVELAND CHIROPRACTIC COLLEGE
CAM in Review
When reading reports on new research, it is important to remember that no single study should be seen as
providing the whole truth. The following reports offer helpful clues but in most cases further research is
needed before firm conclusions can be drawn.
Multicenter Study Finds Acupuncture Effective for Chronic Low Back Pain
Cho YJ, Song YK, Cha YY, et al. Acupuncture for Chronic Low Back Pain: A Multicenter, Randomized,
Patient-Assessor Blind, Sham-Controlled Clinical Trial. Spine.
Apr 1 2013;38(7):549-557.
STUDY DESIGN: Multicenter, randomized, patient-assessor blind, sham-controlled clinical trial.
OBJECTIVE: To investigate the efficacy of acupuncture treatment with individualized setting for
reduction of bothersomeness in participants with chronic low back pain (cLBP). SUMMARY OF
BACKGROUND DATA: Low back pain is one of the main reasons of disability among adults of
working age. Acupuncture is known as an effective treatment of cLBP, but it remains unclear whether
acupuncture is superior to placebo. METHODS: One hundred thirty adults aged 18 to 65 years with
nonspecific LBP lasting for at least last 3 months prior to the trial participated in the study from 3 Korean
medical hospitals. Participants received individualized real acupuncture treatments or sham acupuncture
treatments for more than 6 weeks (twice a week) from Korean Medicine doctors. Primary outcome was
change of visual analogue scale (VAS) score for bothersomeness of cLBP. Secondary outcomes included
VAS score for pain intensity and questionnaires including Oswestry Disability Index, general health
status (Short Form-36), and Beck Depression Inventory (BDI). RESULTS: There were no baseline
differences observed between the 2 groups, except in the Oswestry Disability Index. One hundred sixteen
participants finished the treatments and 3- and 6-month follow-ups, with 14 subjects dropping out.
Significant difference in VAS score for bothersomeness and pain intensity score of cLBP has been found
between the 2 groups (P < 0.05) at the primary end point (8 wk). In addition, those 2 scores improved
continuously until 3-month follow-up (P = 0.011, P = 0.005, respectively). Oswestry Disability Index, the
Beck Depression Inventory, and Short Form-36 scores were also improved in both groups without group
difference. CONCLUSION: This randomized sham-controlled trial suggests that acupuncture treatment
shows better effect on the reduction of the bothersomeness and pain intensity than sham control in
Integrative CAM Approach More Effective Than Standard DASH Diet for Hypertension
Ziv A, Vogel O, Keret D, et al. Comprehensive Approach to Lower Blood Pressure (CALM-BP): a
randomized controlled trial of a multifactorial lifestyle intervention. J Hum Hypertens.
Apr 18 2013.
Complementary medicine advocates the use of a multifactorial approach to address the varied aspects of
hypertension. The aim of this study was to compare the blood pressure (BP) effect and medication use of
a novel Comprehensive Approach to Lowering Measured Blood Pressure (CALM-BP), based on
complementary medicine principles, with the standard recommended Dietary Approach to Stop
Hypertension (DASH). A total of 113 patients treated with antihypertensive drugs were randomly
assigned to either CALM-BP treatment (consisting of rice diet, walks, yoga, relaxation and stress
management) or to a DASH+exercise control group (consisting of DASH and walks). Ambulatory 24-h
and home BP were monitored over a 16-week programme, followed by 6 months of maintenance period.
Medications were reduced if systolic BP dropped below 110 mm Hg accompanied by symptoms. In
addition to BP reduction, medications were reduced because of symptomatic hypotension in 70.7% of the
CALM-BP group compared with 32.7% in the DASH group, P<0.0001. After 6 months, medication status
was not altered in the majority of individuals. Significant reductions in body mass index, cholesterol and
improved quality-of-life scores were observed only in the CALM-BP group. Lifestyle and diet
modifications based on complementary medicine principles are highly effective with respect to BP
control, medication use and cardiovascular risk factors. Journal of Human Hypertension
For Fibromyalgia, Integrative Medicine Including Fasting Therapy May Yield Better
Outcomes Than Conventional Rheumatology
Michalsen A, Li C, Kaiser K, et al. In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized
Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Evid
Based Complement Alternat Med.
Fibromyalgia poses a challenge for therapy. Recent guidelines suggest that fibromyalgia should be treated
within a multidisciplinary therapy approach. No data are available that evaluated multimodal treatment
strategies of Integrative Medicine (IM). We conducted a controlled, nonrandomized pilot study that
compared two inpatient treatment strategies, an IM approach that included fasting therapy and a
conventional rheumatology (CM) approach. IM used fasting cure and Mind-Body-Medicine as specific
methods. Of 48 included consecutive patients, 28 were treated with IM, 20 with CM. Primary outcome
was change in the Fibromyalgia Impact Questionnaire (FIQ) score after the 2-week hospital stay.
Secondary outcomes included scores of pain, depression, anxiety, and well being. Assessments were
repeated after 12 weeks. At 2 weeks, there were significant improvements in the FIQ (P < 0.014) and for
most of secondary outcomes for the IM group compared to the CM group. The beneficial effects for the
IM approach were reduced after 12 weeks and no longer statistically significant with the exception of
anxiety. Findings indicate that a multimodal IM treatment with fasting therapy might be superior to CM
in the short term and not inferior in the mid term. Longer-term studies are warranted to assess the clinical
impact of integrative multimodal treatment in fibromyalgia.
Asian Exercise Therapies Appear Helpful for Fibromyalgia
Mist SD, Firestone KA, Jones KD. Complementary and alternative exercise for fibromyalgia: a meta-
analysis. Journal of pain research.
Complementary and alternative medicine includes a number of exercise modalities, such as tai chi,
qigong, yoga, and a variety of lesser-known movement therapies. A meta-analysis of the current literature
was conducted estimating the effect size of the different modalities, study quality and bias, and adverse
events. The level of research has been moderately weak to date, but most studies report a medium-to-high
effect size in pain reduction. Given the lack of adverse events, there is little risk in recommending these
modalities as a critical component in a multimodal treatment plan, which is often required for
Acupuncture Helpful for Insomnia in Postmenopausal Women
Hachul H, Garcia TK, Maciel AL, Yagihara F, Tufik S, Bittencourt L. Acupuncture improves sleep in
postmenopause in a randomized, double-blind, placebo-controlled study. Climacteric : the journal of the
International Menopause Society.
BACKGROUND: Insomnia increases in frequency as women approach and pass through menopause.
Studies have not shown acupuncture efficacy for insomnia in postmenopausal women. OBJECTIVES:
The aim of this study was to evaluate the effectiveness of acupuncture therapy on sleep parameters,
depression symptoms and quality of life in postmenopausal women with insomnia. METHODS: This
study included 18 postmenopausal women aged 50-67 years old. Participants had a body mass index </=
30 kg/m(2), presented a diagnosis of insomnia according to the DSM-IV criteria, had experienced at least
1 year of amenorrhea and had a follicle stimulating hormone level >/= 30 mIU/ml. Participants were not
using antidepressants, hypnotics or hormonal therapy. This study was randomized, double-blind and
placebo-controlled. The sample was divided into two groups: acupuncture and 'sham' acupuncture. We
performed ten sessions of acupuncture and 'sham' acupuncture during a period of 5 weeks. A
polysomnography exam (PSG) and questionnaires (WHOQOL-BREF, Beck Depression Inventory and
Pittsburgh Sleep Quality Index) were completed by all patients before and after the treatment period.
RESULTS: Anthropometric, polysomnographic, and questionnaire data were similar among the groups at
baseline. Comparison of baseline and post-treatment data of the acupuncture group showed that treatment
resulted in significantly lower scores on the Pittsburgh Questionnaire and an improvement in
psychological WHOQOL. The acupuncture group had a higher percentage of the N3 + 4 stage than the
sham group in PSG findings. CONCLUSION: Acupuncture was effective in improving reported sleep
quality and quality of life in postmenopausal women with insomnia.
Acupuncture Helpful for Inducing Ovulation in Women with Polycystic Ovary Syndrome
Johansson J, Redman L, Veldhuis PP, et al. Acupuncture for ovulation induction in polycystic ovary
syndrome: A randomized controlled trial. American journal of physiology. Endocrinology and
Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating
testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether
acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect
by analyzing luteinizing hormone (LH) and sex steroid secretion in women with PCOS. This prospective,
randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two
women with PCOS were randomized to receive either acupuncture in combination with manual and low-
frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 weeks.
Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 weeks of
treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the
secretion of sex steroids, anti-Mullerian hormone, inhibin B, and serum cortisol. Ovulation frequency
during treatment was higher in the acupuncture group compared with the control group. After 10-13
weeks of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone,
dehydroepiandrosterone-sulfate, androstenedione, testosterone, free-testosterone, dihydrotestosterone,
androsterone glucuronide, androstane-3alpha, 17beta-diol-3glucuronide, and androstane-3alpha, 17beta-
diol-17glucuronide decreased within the acupuncture group and were significantly lower than in the
control group for all of these except androstenedione. We conclude that repeated acupuncture treatments
resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective
than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no
Acupuncture Accelerates Positive Response to Depression Medication
Qu SS, Huang Y, Zhang ZJ, et al. A 6-week randomized controlled trial with 4-week follow-up of
acupuncture combined with paroxetine in patients with major depressive disorder. Journal of psychiatric
Acupuncture possesses the antidepressant potential. In this 6-week randomized controlled trial with 4-
week follow-up, 160 patients with major depressive disorder (MDD) were randomly assigned to
paroxetine (PRX) alone (n = 48) or combined with 18 sessions of manual acupuncture (MA, n = 54) or
electrical acupuncture (EA, n = 58). Treatment outcomes were measured mainly using the 17-item
Hamilton Depression Rating Scale (HAMD-17), Self-rating Depression Scale (SDS), clinical response
and remission rates. Average PRX dose taken and proportion of patients who required an increased PRX
dose due to symptom aggravation were also obtained. Both additional MA and EA produced a
significantly greater reduction from baseline in score on HAMD-17 and SDS at most measure points from
week 1 through week 6 compared to PRX alone. The clinical response was markedly greater in MA
(69.8%) and EA (69.6%) groups than the group treated with PRX alone (41.7%, P = 0.004). The
proportion of patients who required an increase dose of PRX due to symptom aggravation was
significantly lower with MA (5.7%) and EA (8.9%) than PRX alone (22.9%, P = 0.019). At 4 weeks
follow-up after completion of acupuncture treatment, patients with EA, but not MA, continued to show
significantly greater clinical improvement. Incidence of adverse events was not different in the three
groups. Our study indicates that acupuncture can accelerate the clinical response to selective serotonin
reuptake inhibitors (SSRIs) and prevent the aggravation of depression. Electrical acupuncture may have a
long-lasting enhancement of the antidepressant effects.
Pilot Study Finds Acupuncture As Effective as NSAIDs for Dysmenorrhea
Kiran G, Gumusalan Y, Ekerbicer HC, Kiran H, Coskun A, Arikan DC. A randomized pilot study of
acupuncture treatment for primary dysmenorrhea. European journal of obstetrics, gynecology, and
Mar 19 2013.
OBJECTIVE: To compare the therapeutic effect of acupuncture and non-steroidal anti-inflammatory drug
(NSAID) therapy in primary dysmenorrhea patients. STUDY DESIGN: Thirty-five young women with a
diagnosis of primary dysmenorrhea were recruited for the study. Their dysmenorrhea severity was rated
by visual analog scale (VAS) immediately prior to entry into the study. They were randomly divided into
two groups; and the following month they were given NSAID (group 1, n=24) or acupuncture treatment
(group 2, n=11). Pain was rated again using VAS during menstruation in both groups. RESULTS: After
one month's treatment, pain scores were significantly lower in both groups (p<0.05). Mean pain scores
decreased by 52.2% and 69.5% in the NSAID and acupuncture groups, respectively. CONCLUSION:
Acupuncture was as effective as NSAID therapy for patients with primary dysmenorrhea. Since this was a
pilot study with a small sample size and short follow-up period, larger studies are needed to clarify the
effect of acupuncture in the treatment of primary dysmenorrhea.
Some Patients with Lymphedema May Improve with Acupuncture
Cassileth BR, Van Zee KJ, Yeung KS, et al. Acupuncture in the treatment of upper-limb lymphedema:
Results of a pilot study. Cancer.
Apr 10 2013.
BACKGROUND: Current treatments for lymphedema after breast cancer treatment are expensive and
require ongoing intervention. Clinical experience and our preliminary published results suggest that
acupuncture is safe and potentially useful. This study evaluates the safety and potential efficacy of
acupuncture on upper-limb circumference in women with lymphedema. METHODS: Women with a
clinical diagnosis of breast cancer-related lymphedema (BCRL) for 0.5-5 years and with affected arm
circumference >/=2 cm larger than unaffected arm received acupuncture treatment twice weekly for 4
weeks. Affected and unaffected arm circumferences were measured before and after each acupuncture
treatment. Response, defined as >/=30% reduction in circumference difference between
affected/unaffected arms, was assessed. Monthly follow-up calls for 6 months thereafter were made to
document any complications and self-reported lymphedema status. RESULTS: Among 37 enrolled
patients, 33 were evaluated; 4 discontinued due to time constraints. Mean reduction in arm circumference
difference was 0.90 cm (95% CI, 0.72-1.07; P < .0005). Eleven patients (33%) exhibited a reduction of
>/=30% after acupuncture treatment. Seventy-six percent of patients received all treatments; 21% missed
1 treatment, and another patient missed 2 treatments. During the treatment period, 14 of the 33 patients
reported minor complaints, including mild local bruising or pain/tingling. There were no serious adverse
events and no infections or severe exacerbations after 255 treatment sessions and 6 months of follow-up
interviews. CONCLUSIONS: Acupuncture for BCRL appears safe and may reduce arm circumference.
Although these results await confirmation in a randomized trial, acupuncture can be considered for
women with no other options for sustained arm circumference reduction.
Abstract search by Daniel Redwood, DC
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