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Auricular Acupuncture in the Treatment of Postoperative Pain

Keywords:
PAIN, POSTOPERATIVE PAIN, POSTSURGICAL PAIN - Acupuncture, Auricular Acupuncture, Chinese Medicine, Traditional East Asian Medicine

Summary:
In a review of the evidence related to the efficacy of auricular acupuncture for postoperative pain control, the authors conclude, based on the results of 9 studies (of 23 identified) that fulfilled the inclusion criteria, that "The evidence that auricular acupuncture reduces postoperative pain is promising but not compelling." In 8 of the trials, auricular acupuncture was superior to control conditions, and 7 of the randomized clinical trails scored 3 or more points on the Jadad scale, though none reached the 5 point maximum. These results suggest that auricular acupuncture shows potential as an effective therapy in the treatment of postoperative pain. Additional research is warranted.

"Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials," Usichenko TI, Lehmann Ch, Ernst E, Anaesthesia, 2008; 63(12): 1343-8. (Address: Department of Anaesthesiology and Intensive Care Medicine, University of Greifswald, Germany).

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Acupressure Device Effectively Reduces Insomnia

Keywords:
INSOMNIA, SLEEP DISORDER, ANXIETY - Acupressure, Acupuncture, HT-7, Shen Men

Summary:
In a double-blind study involving 40 patients with insomnia, treatment with a device which applies pressure to an acupuncture point on the wrist, known to help reduce anxiety and alleviate insomnia, HT-7 (Shen Men), was found to improve quality of sleep and reduce anxiety. Subjects wore the device to sleep for 20 nights (or a placebo). In addition to improvement in symptoms, a higher percentage of subjects who wore the device were found to have normal 24 hours urinary melatonin metabolite rhythm, as compared to those who wore a placebo device. Considering the prevalence of insomnia, and its significant impact on decreasing quality of life, these results are promising, suggesting that wearing this acupressure device may be a safe and effective method for improving quality of sleep in persons with insomnia.

"Efficacy of wrists overnight compression (HT 7 point) on insomniacs: possible role of melatonin?" Nordio M, Romanelli F, et al, Minerva Med, 2008; 99(6): 539-47. (Address: Department of Medical Physiopathology University of Rome ''Sapienza'', Rome, Italy. E-mail: maurizionordio1@gmail.com ).

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Acupuncture in the Treatment of Patients with Cardiac Arrhythmias

Keywords:
CARDIAC ARRHYTHMIAS, ARRYTHMIA, HEART

Summary:
In a review of 8 studies examining the effects of acupuncture in patients with cardiac arrhythmias, 87-100% of subjects involved in the studies were found to convert to normal sinus rhythm after acupuncture. However, the authors point out that the methodological quality of the studies was not optimal, pointing to the need for better designed and controlled clinical trials. The authors conclude, "…More rigorous studies are needed with standardized treatment protocols, diverse patient populations, and long-term follow-up."

"The effects of acupuncture on cardiac arrhythmias: a literature review," VanWormer AM, Lindquist R, Sendelbach SE, Heart Lung, 2008; 37(6): 425-31. (Address: Arin M. VanWormer, MS, University of Minnesota School of Nursing, 4-136 WDH, 308 Harvard St SE, Minneapolis, MN 55455, USA).

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Acupuncture Benefits Persons with Rheumatoid Arthritis Topic: Acupuncture and Autogenic Training Benefit Persons with Rheumatoid Arthritis

Topic: Acupuncture and Autogenic Training Benefit Persons with Rheumatoid Arthritis

Keywords: RHEUMATOID ARTHRITIS - Acupuncture, Electroacupuncture, Auricular Acupuncture, Ear Acupuncture, Chinese Medicine, Autogenic Training, Relaxation Technique, Sympathetic, Parasympathetic, Yoga, Meditation, Visualizations, Stress

Reference: "Adjuvant auricular electroacupuncture and autogenic training in rheumatoid arthritis: a randomized controlled trial. Auricular acupuncture and autogenic training in rheumatoid arthritis," Bernateck M, Becker M, et al, Forsch Komplementmed, 2008; 15(4): 187-93. (Address: Department of Anesthesiology, Pain Clinic, Hannover, Germany. E-mail: bernateck.michael@mh-hannover.de ).

Summary: In a study involving 44 patients with rheumatoid arthritis, treatment with acupuncture (auricular electroacupuncture), once a week for a period of 6 weeks, was found to be more effective than autogenic training (relaxation technique involving visualizations) in reducing pain and reducing erythrocyte sedimentation rate. Patients received either auricular electroacupuncture or autogenic training once a week for six weeks. Statistically significant and clinically meaningful improvements were found among subjects in both groups, both immediately following the 6 week treatment period and at 3 months follow-up. The beneficial effects appeared earlier among patients receiving acupuncture (after the 2nd treatment), and were in general more pronounced. By the 4th treatment, patients receiving acupuncture reported significantly less pain than those undergoing autogenic training. Furthermore, erythrocyte sedimentation rate (ESR) was significantly less and serum tumor necrosis factor-alpha was significantly increased among patients receiving acupuncture, as compared to autogenic training. At the end of the treatment period, patients who received acupuncture assessed their outcome as significantly more improved than those who received autogenic training. Given the safety of such treatments, the results of this study suggest that acupuncture, as well as autogenic training, may be effective in reducing pain and inflammation in patients with rheumatoid arthritis.

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Japanese-style Acupuncture Reduces Pelvic Pain in Adolescents with Endometriosis

Topic: Japanese-style Acupuncture Reduces Pelvic Pain in Adolescents with Endometriosis

Keywords: ENDOMETRIOSIS, CHRONIC PELVIC PAIN - Acupuncture, Japanese, Japanese-style Acupuncture

Reference: "Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial," Wayne PM, Kerr CE, et al, J Pediatr Adolesc Gynecol, 2008; 21(5): 247-57. (Address: Harvard Medical School, Osher Research Center, Boston, Massachusetts 02215, USA. E-mail: peter_wayne@hms.harvard.edu ).

Summary: In a study involving 14 young women between the ages of 13 and 22 years with endometriosis-related chronic pelvic pain, treatment with a Japanese style of acupuncture was found to significantly reduce pain. Patients received 16 treatments over a period of 8 weeks - 9 patients received actual acupuncture and 5 patients received a sham treatment. Results found that after 4 weeks of treatment, subjects in the acupuncture group experienced a 62% reduction (4.8 point reduction) in pain (on an 11 point scale), compared to a mere 1.4 point reduction among subjects in the sham treatment group. A six-month post-treatment assessment found that reductions in pain persisted among patients who had received acupuncture. Furthermore, all health-related quality of life measures found greater improvements among patients who received acupuncture, although many of these improvements were not statistically significant. The results of this study suggest that Japanese-style acupuncture may be a safe and effective treatment for adolescent girls with endometriosis-related pelvic pain.

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Acupuncture Stimulates Saliva Production in Patients with Radiation-Induced Dry Mouth

Topic: Acupuncture Stimulates Saliva Production in Patients with Radiation-Induced Dry Mouth

Keywords: DRY MOUTH, XEROSTOMIA, RADIATION, CANCER, SALIVA - Acupuncture, Chinese Medicine, Traditional East Asian Medicine

Reference: "The effect of acupuncture on salivary flow rates in patients with radiation-induced xerostomia," Braga FP, Sugaya NN, et al, Minerva Stomatol, 2008; 57(7-8): 343-8. (Address: Department of Oral Diagnosis, School of Dentistry, University of São Paulo, São Paulo, Brazil. E-mail: fbraga@usp.br ).

Summary: In a study involving 12 patients with severe radiation-induced xerostomia (dry mouth), treatment with acupuncture (twice a week for 6 weeks) was found to significantly increase saliva production. Results showed a 142% increase in resting salivary flow, and a 73.5% increase in stimulated salivary flow. Patients reported improvement as well, with an average 36 point increase in visual analogue scale score for 'sensation of more saliva production.' The results of this small study suggest that acupuncture may be a safe and effective treatment for patients with radiation-induced xerostomia. Additional research is warranted.

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Acupuncture Benefits Patients with Tension Neck Syndrome

Topic: Acupuncture Benefits Patients with Tension Neck Syndrome

Keywords: NECK PAIN, CHRONIC PAIN, TENSION NECK SYNDROME - Acupuncture, Physiotherapy, Physical Therapy, Chinese Medicine

Reference: "Tension neck syndrome treated by acupuncture combined with physiotherapy: A comparative clinical trial (pilot study)," Franca DL, Senna-Fernandes V, et al, Complement Ther Med, 2008; 16(5): 268-77. (Address: Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, Brazil; Academia Brasileira de Arte e Ciência Oriental/Colégio Brasileiro de Acupuntura, ABACO/CBA, Brazil. E-mail: Daisy L.M. Franca, dfranca.8@oi.om.br ).

Summary: In a prospective, comparative clinical trial involving 46 patients with tension neck syndrome (TNS), treatment with acupuncture plus physiotherapy was found to be more effective than physiotherapy alone in reducing pain and functional disability, and treatment with acupuncture plus physiotherapy was found to be more effective than acupuncture alone in improving isometric neck muscle strengthening. After a period of 10 weeks during which subjects received 1-2 treatments/sessions per week, improvements in pain intensity, muscle tension, functional disability, and muscle strength were found among subjects in all 3 groups - 1) acupuncture plus physiotherapy; 2) physiotherapy alone; 3) acupuncture alone. More significant improvements in pain and functional disability were found with acupuncture plus physiotherapy, as compared to physiotherapy alone, and more significant improvements in muscle strength were found with acupuncture plus physiotherapy, as compared to acupuncture alone. These results suggest that acupuncture combined with physiotherapy may be a more beneficial treatment for patients with neck tension syndrome, rather than either treatment alone.

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Acupuncture Benefits Patients with Fibromyalgia

Topic: Acupuncture Benefits Patients with Fibromyalgia

Keywords: FIBROMYALGIA, CHRONIC PAIN, FATIGUE - Acupuncture, Chinese Medicine, Exercise, Tricyclic Anti-Depressants

Reference: "A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia," Targino RA, Imamura M, et al, J Rehabil Med, 2008; 40(7): 582-8. (Address: Departamento de Patologia, Avenida Doutor Arnaldo 455, Sao Paulo, Brazil. E-mail: targino@usp.br ).

Summary: In a randomized study involving 58 women with fibromyalgia, treatment with acupuncture (20 sessions), added to exercise and tricyclic antidepressant drug therapy, was found to significantly reduce pain (assessed via a visual analogue scale) and improve quality of life in 5 of the SF-36 subscales more effectively than treatment with exercise and antidepressant drug therapy alone. After 6 months, subjects who received acupuncture continued to have significantly less tender points, significantly better pressure pain threshold at the 18 tender points, and better scores on 3 subscales of the SF-36. After 1 year, subjects in the acupuncture group still showed improved in 1 subscale of the SF-36, and at 2 years, no differences between the 2 groups were noted. The authors conclude, "Addition of acupuncture to usual treatments for fibromyalgia may be beneficial for pain and quality of life for 3 months after the end of treatment."

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Acupuncture and Strength Training Reduce Muscle Spasticity and Improve Motor Function in Chronic Stroke Survivors

Topic: Acupuncture and Strength Training Reduce Muscle Spasticity and Improve Motor Function in Chronic Stroke Survivors

Keywords: STROKE, MUSCLE SPASTICITY - Acupuncture, Chinese Medicine, Strength Training, Physical Therapy

Reference: "Electroacupuncture may help motor recovery in chronic stroke survivors: A pilot study," Liu W, Mukherjee M, et al, J Rehabil Res Dev, 2008; 45(4): 587-9. (Address: Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. E-mail: wliu@kumc.edu ).

Summary: In a randomized, crossover study involving 10 chronic stroke survivors with moderate or severe muscle spasticity, acupuncture, added to strength training, was found to reduce muscle spasticity more effectively than strength training alone. For 6 weeks, subjects received strength training alone, or strength training plus acupuncture (electroacupuncture), twice a week. After the first 6 weeks, the groups were crossed over for another 6 weeks. After the combined treatment, improvements were found in quantitative measurements of wrist spasticity, active wrist extension range of motion (mean increase: 16.3), and clinical evaluation with Fugl-Meyer upper-limb motor scores (mean increase: 4.9 points), while no such improvements were found with strength training alone. These results suggest that acupuncture plus strength training may reduce muscle spasticity in chronic stroke survivors.

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Acupuncture Found to Be Effective in the Treatment of Diabetic Gastroparesis

Topic: Acupuncture Found to Be Effective in the Treatment of Diabetic Gastroparesis

Keywords: DIABETES MELLITUS, GASTROPARESIS, DIABETIC GASTROPARESIS, GASTRIC EMPTYING TIME, STOMACH, GASTROINTESTINAL - Acupuncture, Electroacupuncture, Chinese Medicine, Vagus Nerve

Reference: "A Single-Blinded, Randomized Pilot Study Evaluating Effects of Electroacupuncture in Diabetic Patients with Symptoms Suggestive of Gastroparesis," Wang CP, Kao CH, et al, J Altern Complement Med, 2008 August 23; [Epub ahead of print]. (Address: Ching-Liang Hsieh, MD, Department of Chinese Medicine, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung City, 404, Taiwan, R.O.C. E-mail: clhsieh@mail.cmuh.org.tw ).

Summary: In a randomized, single-blinded, pilot study involving 19 diabetic patients (type 2) with symptoms of gastroparesis (a disorder in which the stomach takes too long to empty its contents) for more than 3 months, treatment with acupuncture (electroacupuncture at ST-36/Zusanli and LI-4/Hegu), twice a week for 2 weeks, was found to significantly reduce gastric half-emptying time (143.8 minutes versus 98.8 minutes), as compared to treatment with sham acupuncture, which did not reduce gastric half-emptying time. Furthermore, among patients treated with real acupuncture, symptom severity (assessed using the Gastroparesis Cardinal Symptom Index) improved significantly immediately following the 2 weeks of treatment (2.38 versus 1.48), and continued to show improved status 2 weeks after the end of the trial (2.38 versus 1.65). No such benefits were found with the sham acupuncture. The results of this study suggest that acupuncture may be a safe and effective treatment for patients with diabetic gastroparesis. The authors conclude, "…A larger trial is required to draw definitive conclusions."

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Acupuncture Reduces Pain, Improves Mood, and Reduces Medical Expenses in Persons with Low Back Pain

Topic: Acupuncture Reduces Pain, Improves Mood, and Reduces Medical Expenses in Persons with Low Back Pain

Keywords: LOW BACK PAIN, CHRONIC PAIN, MOOD - Acupuncture, Chinese Medicine

Reference: "Acupuncture can reduce perceived pain, mood disturbances and medical expenses related to low back pain among factory employees," Sawazaki K, Mukaino Y, et al, Ind Health, 2008; 46(4): 336-40. (Address: Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan).

Summary: In a study involving 72 employees of a steel company (70 male, 2 females, mean age: 53 years) experiencing low back pain, treatment with acupuncture, once/week for a period of 8 weeks, was found to reduce pain, reduce mood disturbances, reduce visits to conventional hospitals (12.1 vs. 0.8 per month), and reduce standardized medical expenses for low back pain, as compared to the levels recorded prior to treatment. Workers at a neighboring branch factory who served as controls and did not receive any acupuncture treatments did not experience such improvements. The authors conclude, "It is suggested that acupuncture can reduce medical expenses for LBP through improvement in mood and pain."

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Specific Acupuncture Points Influence Cortical Auditory Evoked Potentials

Topic: Specific Acupuncture Points Influence Cortical Auditory Evoked Potentials

Keywords: HEARING, AUDITORY FUNCTION - HEARING, CORTICAL AUDITORY EVOKED POTENTIALS

Reference: "Acupuncture of specific points influences cortical auditory evoked potentials--a volunteer crossover study," Lietz P, Schmidt R, et al, Acupunct Electrother Res, 2008; 33(1-2): 1-8. (Address: Department of Surgery, Military Hospital of Berlin, Germany).

Summary: In a study involving 10 healthy volunteers, acupuncture at specific acupuncture points (TH-3 and GB-43) related to the auditory system according to traditional Chinese medicine was found to influence Cortical Auditory Evoked Potentials (CAEP), while acupuncture at points not specifically linked to the auditory system in Chinese medicine (HT-7 and ST-44), did not have the same influence on the auditory system. Subjects received 4 sessions of acupuncture at points specifically related to the auditory system (TH-3 and GB-43) and at points non-specific for the auditory system (HT-7 and ST-44), with a one week interval between each session. Before and after each acupuncture treatment, the latencies and amplitudes of CAEP were registered. After stimulation of TH-3, the mean peak latencies of P2 component decreased by 11 ms while components of N2 increased by 9 ms. After stimulation of GB-43, the mean peak latencies of P2 component decreased by 14 ms, while N2 component increased by 4 ms. On the other hand, stimulation of HT-7 and ST-44 did not lead to such changes. The authors conclude, "These findings confirm the specificity of acupuncture points TH3 and GB43 in relation to auditory system."

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Acupuncture Activates Brain Regions Associated with Alzheimer's Disease

Topic: Acupuncture Activates Brain Regions Associated with Alzheimer's Disease

Keywords: ALZHEIMER'S DISEASE, DEMENTIA, COGNITIVE DECLINE - Acupuncture, Chinese Medicine

Reference: "Effect of acupuncture given at the HT 7, ST 36, ST 40 and KI 3 acupoints on various parts of the brains of Alzheimer' s disease patients," Zhou Y, Jin J, et al, Acupunct Electrother Res, 2008; 33(1-2): 9-17. (Address: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China).

Summary: In a study involving 26 patients with clinically-diagnosed Alzheimer's Disease (AD), acupuncture treatment was found to stimulate areas of the brain associated with cognitive function which are known to be impaired in patients with AD. Subjects received acupuncture treatment at four acupuncture points: HT-7 (Shen Men), ST-36 (Zu San Li), ST-40 (Feng Long), and KI-3 (Tai Xi). During treatment, patients underwent functional magnetic resonance imagine (fMRI). Results of fMRI showed right main hemisphere activations at the temporal lobe, including hippocampal gyrus, insula, and some areas of the parietal lobe, and left hemisphere activations at the temporal lobe, parietal lobule, and some regions of the cerebellus. Several of the areas activated are areas associated with cognitive function such as memory, language, and reasoning. These results suggest that acupuncture treatment in patients with AD may stimulate various affected regions of the brain. Additional research is needed to assess the clinical effects of acupuncture in patients with AD.

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Acupuncture Relieves Insomnia: Results of a Randomized Clinical Trial

Topic: Acupuncture Relieves Insomnia: Results of a Randomized Clinical Trial

Keywords: INSOMNIA, SLEEP DISORDERS - Acupuncture, Abdominal Acupuncture, Chinese Medicine

Reference: "Abdominal acupuncture for insomnia in women: a randomized controlled clinical trial," Wang XY, Yuan SH, et al, Acupunct Electrother Res, 2008; 33(1-2): 33-41. (Address: Department of Gynecology, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, PR China. E-mail: zp@gdivdc.com ).

Summary: In a randomized, single-blind study involving 44 women (between the ages of 22 and 56 years) experiencing insomnia, daily treatment with acupuncture for 3 days followed by treatment every three day for the next 11 days was found to significantly relieve insomnia (lowering the score on the Leeds Sleep Evaluation Questionnaire by 26 points). Subjects were randomly assigned to receive either acupuncture or medication (estazolam) plus sham acupuncture. Acupuncture treatment consisted of needling the following abdominal acupuncture points: CV-17, CV-10, CV-4, CV-6, KI-17, ST-24, Xiafengshidian, and Qipang. Even after controlling for potentially confounding factors, the effects of acupuncture continued to be statistically significant. The authors conclude, "Results indicate that short-term abdominal acupuncture is more effective than pharmacological treatment for relieving insomnia in adult women and has few adverse effects."

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Acupuncture May Stimulate Saliva Production and Alleviate Dry Mouth

Topic: Acupuncture May Stimulate Saliva Production and Alleviate Dry Mouth

Keywords: DRY MOUTH, XEROSTOMIA, SALIVA - Acupuncture, Chinese Medicine

Reference:"Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study," Deng G, Hou BL, et al, BMC Complement Altern Med, 2008; 8: 37. (Address: Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021, USA. E-mail: dengg@mskcc.org ).

Summary: In a randomized, controlled, subject-blinded trial involving 20 healthy subjects, treatment with acupuncture was found to be associated with increases in saliva production. Patients were randomly assigned to receive either real acupuncture (at unilateral LI-2, a point commonly used in clinical practice to treat xerostomia) or a sham acupuncture treatment. Functional MRI was used to evaluate which cortical regions of the brain were activated or de-activated during the treatment. Results found that treatment with acupuncture was associated with bilateral activation of the insula and adjacent operculum as well as saliva production, while the sham treatment did not activate nor deactivate these regions. These results suggest that acupuncture may be a safe and effective therapy for the treatment of dry mouth (xerostomia).

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Acupuncture Benefits Patients with Osteoarthritis of the Knee

Topic: Acupuncture Benefits Patients with Osteoarthritis of the Knee

Keywords: ARTHRITIS, OSTEOARTHRITIS, KNEE PAIN, CHRONIC PAIN - Acupuncture, Electroacupuncture, Chinese Medicine

Reference: "A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee," Jubb R, Tukmachi E, et al, Acupunct Med, 2008; 26(2): 69-78. (Address: Department of Rheumatology, University Hospital Birmingham, Birmingham, UK. E-mail: Ronald.Jubb@uhb.nhs.uk ).

Summary: In a study involving 68 patients with osteoarthritis of the knee, treatment with acupuncture was found to be more effective than a 'placebo' (non-penetrating sham acupuncture) in reducing pain and stiffness and improving function. Patients were randomized to either receive actual acupuncture (manual and electroacupuncture) or a placebo treatment (non-penetrating sheathed sham acupuncture), twice weekly, for a period of 5 weeks. Acupuncture points were selected based on the theory of treating Bi syndrome, with points including: LI-4, SP-10, Xiyan, SP-9, GB-34, ST-36, LR-3, BL-40, and BL-57. Results found significantly greater improvement among patients who received acupuncture (mean difference in WOMAC score improvement: 60), as compared to the sham treatment. Subjects in the acupuncture group had a mean change in WOMAC score of 95, compared to only 35 among those who received the sham treatment. Improvements were also found in WOMAC stiffness and function. The between-group difference in improvement significantly decreased 1 month after the treatments ended, though those who received acupuncture still had less pain as compared to baseline. Levels of plasma beta-endorphin were not affected by either treatment. The authors conclude, "These results support earlier research demonstrating that acupuncture can alleviate the pain and disability of osteoarthritis of the knee."

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Acupuncture in the Rehabilitation of Women after Breast Cancer Surgery

Topic: Acupuncture in the Rehabilitation of Women after Breast Cancer Surgery

Keywords: BREAST CANCER SURGERY, LYMPHEDEMA, LYMPHOEDEMA - Acupuncture, Chinese Medicine

Reference: "Acupuncture in the rehabilitation of women after breast cancer surgery," Alem M, Gurgel M, et al, Acupunct Med, 2008; 26(2): 87-93. (Address: Department of Gynecology and Obstetrics School of Medicine, Universidade Estadual de Campinas Unicamp, Brazil. E-mail: salete@caism.unicamp.br ).

Summary: In a study involving 29 women who had undergone breast cancer surgery and were experiencing lymphedema and/or a decrease in movement amplitude of the upper limb ipsilateral to surgery, treatment with acupuncture (24 weekly treatments) was found to significantly improve range of motion of the shoulder (flexion and abduction), degree of lymphedema, and the sense of heaviness and tightness in the affected limb after 6 months of treatment. The authors conclude, "…controlled trials should be performed to ascertain whether the results were due to the natural history of the complaint or the acupuncture treatment."

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