Using Guasha to treat musculoskeletal pain: A systematic review of controlled clinical trials.

March 9, 2010

Using Guasha to treat musculoskeletal pain: A systematic review of controlled clinical trials.

Chin Med. 2010;5:5

Authors: Lee MS, Choi TY, Kim JI, Choi SM

ABSTRACT: BACKGROUND: Guasha is a therapeutic method for pain management using tools to scrape or rub the surface of the body to relieve blood stagnation. This study aims to systematically review the controlled clinical trials on the effectiveness of using Guasha to treat musculoskeletal pain. METHODS: We searched 11 databases (without language restrictions): MEDLINE, Allied and Complementary Medicine (AMED), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Korean Studies Information (KSI), DBPIA, Korea Institute of Science and Technology Information (KISTI), KoreaMed, Research Information Service System (RISS), China National Knowledge Infrastructure (CNKI) and the Cochrane Library. The search strategy was Guasha (OR scraping) AND pain. Risk of bias was assessed with the Cochrane criteria (i.e. sequence generation, blinding, incomplete outcome measures and allocation concealment). RESULTS: Five randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) were included in the present study. Two RCTs compared Guasha with acupuncture in terms of effectiveness, while the other trials compared Guasha with no treatment (1 trial), acupuncture (4 trials), herbal injection (1 trial) and massage or electric current therapy (1 trial). While two RCTs suggested favorable effects of Guasha on pain reduction and response rate, the quality of these RCTs was poor. One CCT reported beneficial effects of Guasha on musculoskeletal pain but had low methodological quality. CONCLUSION: Current evidence is insufficient to show that Guasha is effective in pain management. Further RCTs are warranted and methodological quality should be improved.

PMID: 20205902 [PubMed - in process]

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Acupuncture in Primary Care.

March 3, 2010

Related Articles

Acupuncture in Primary Care.

Prim Care. 2010 Mar;37(1):105-117

Authors: Mao JJ, Kapur R

Acupuncture, an ancient traditional Chinese medical therapy, is used widely around the world. When practiced by a certified provider, it is safe and patients often find it calming and relaxing. Animal and human studies have found a physiologic basis for acupuncture needling in that it affects the complex central and peripheral neurohormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically relevant short- and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain, and headache. The integration of acupuncture into a primary care setting also appears to be cost-effective. The practice of acupuncture in primary care requires rigorous training, financial discipline, and good communication skills. When done correctly, acupuncture is beneficial for both patients and providers.

PMID: 20189001 [PubMed - as supplied by publisher]

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Acupuncturists’ perspectives on outcome measures to evaluate acupuncture care for chronic low back pain.

February 25, 2010

Acupuncturists’ perspectives on outcome measures to evaluate acupuncture care for chronic low back pain.

Complement Ther Med. 2010 Feb;18(1):28-41

Authors: Stomski NJ, Mackintosh S, Stanley M

OBJECTIVES: To examine Australian acupuncturists’ perspectives of: chronic low back pain outcome domains; their use of outcome measures to assess chronic low back pain; and their attitudes and perceptions of barriers to using the existing measures to evaluate acupuncture care for chronic low back pain. DESIGN: A postal questionnaire was used in a cross-sectional survey. PARTICIPANTS: 359 randomly selected Australian acupuncturists. RESULTS: 139 questionnaires were returned (response rate: 38.7%). The respondents’ demographic characteristics were similar to Australian Bureau of Statistics acupuncturist demographic data. Overall, acupuncturists endorsed a broad approach to assessing acupuncture care for chronic low back pain. However, they had typically used pain severity measures but generally did not use other types of measures. Acupuncturists tended to hold positive attitudes towards using outcome measures. The principal barriers acupuncturists perceived to using outcome measures concerned doubts about whether the concepts which underpin acupuncture practice had been explicitly articulated and whether the available measures capture the specific context and particular outcomes of acupuncture care for chronic low back pain. IMPLICATIONS: The findings of this study suggest that a broad range of outcome measures are required to adequately assess chronic low back pain acupuncture care outcomes. While numerous outcome measures have been developed that are relevant to chronic low back pain care, whether these measures are appropriate for use by acupuncturists is unclear. Further studies are warranted to explore if established outcome measures are useful to evaluate chronic low back acupuncture care.

PMID: 20178876 [PubMed - as supplied by publisher]

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Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey.

February 14, 2010

Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey.

BMC Musculoskelet Disord. 2010 Feb 11;11(1):32

Authors: Fleckenstein J, Zaps D, Ruger LJ, Lehmeyer L, Freiberg F, Lang PM, Irnich D

ABSTRACT: BACKGROUND: Myofascial pain is a common dysfunction with a lifetime prevalence affecting up to 85% of the general population. Current guidelines for the management of myofascial pain are not available. In this study we investigated how physicians on the basis of prescription behaviour evaluate the effectiveness of treatment options in their management of myofascial pain. METHODS: We conducted a cross-sectional, nationwide survey with a standardized questionnaire among 332 physicians (79.8% male, 25.6% female, 47.5 +/- 9.6 years) experienced in treating patients with myofascial pain. Recruitment of physicians took place at three German meetings of pain therapists, rheumatologists and orthopaedists, respectively. Physicians estimated the prevalence of myofascial pain amongst patients in their practices, stated what treatments they used routinely and then rated the perceived treatment effectiveness on a six-point scale (with 1 being excellent). Data are expressed as mean +/- standard deviation. RESULTS: The estimated overall prevalence of active myofascial trigger points is 46.1 +/- 27.4%. Frequently prescribed treatments are analgesics, mainly metamizol/paracetamol (91.6%), non-steroidal anti-inflammatory drugs/coxibs (87.0%) or weak opioids (81.8%), and physical therapies, mainly manual therapy (81.1%), TENS (72.9%) or acupuncture (60.2%). Overall effectiveness ratings for analgesics (2.9 +/- 0.7) and physical therapies were moderate (2.5 +/- 0.8). Effectiveness ratings of the various treatment options between specialities were widely variant. 54.3% of all physicians characterized the available treatment options as insufficient. CONCLUSIONS: Myofascial pain was estimated a prevalent condition. Despite a variety of commonly prescribed treatments, the moderate effectiveness ratings and the frequent characterizations of the available treatments as insufficient suggest an urgent need for clinical research to establish evidence-based guidelines for the treatment of myofascial pain syndrome.

PMID: 20149248 [PubMed - as supplied by publisher]

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Acupuncture needling sensation: the neural correlates of deqi using fMRI.

December 23, 2009

Acupuncture needling sensation: the neural correlates of deqi using fMRI.

Brain Res. 2009 Dec 15;

Authors: Asghar AU, Green G, Lythgoe MF, Lewith G, Macpherson H

The needling sensation of deqi is considered by most acupuncturists to be an important component of acupuncture, yet neuroimaging research that investigates this needle sensation has been limited. In this study we have investigated the effect of deqi and acute pain needling sensations upon brain fMRI blood oxygen level-dependent (BOLD) signals. Seventeen right-handed participants who received acupuncture at the right LI-4 (Hegu) acupoint were imaged in a 3T MRI scanner. fMRI datasets were classified, on the basis of psychophysical participants’ reports of needling scores, into those that were associated with predominantly deqi sensations versus those with predominantly acute pain sensations. Brain areas showing changes in BOLD signal increases (activations) and decreases (deactivations) were identified. Differences were demonstrated in the pattern of activations and deactivations between groupings of scans associated with deqi versus pain sensations. For the deqi grouping, significant deactivations occurred, whereas significant activations did not. In contrast, the predominantly acute pain grouping was associated with a mixture of activations and deactivations. For the comparison between the predominately deqi sensation grouping and the acute pain sensation grouping (deqi > pain contrast), only negative Z value voxels resulted (mainly from deactivations in the deqi grouping and activations in the pain grouping) in the limbic/sub-cortical structures and the cerebellum regions of interest. Our results show the importance of collecting and accounting for needle sensation data in neuroimaging studies of acupuncture.

PMID: 20025853 [PubMed - as supplied by publisher]

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Adverse event reporting in acupuncture clinical trials focusing on pain.

December 23, 2009

Adverse event reporting in acupuncture clinical trials focusing on pain.

Clin J Pain. 2010 Jan;26(1):43-8

Authors: Capili B, Anastasi JK, Geiger JN

OBJECTIVES: To review the quality of adverse event reporting for published randomized controlled trials (RCTs) focusing on acupuncture for pain reduction. With the release of the Consolidated Standards of Reporting Trials (CONSORT) in 2001, the quality of published RCTs has improved. To improve reporting on adverse events, CONSORT expanded the section on harms (adverse events) in 2004. This paper evaluates whether the updated harms guidelines have been implemented in RCTs evaluating acupuncture for pain relief. METHODS: Systematic searches were conducted using the following databases: MEDLINE, Allied & Complementary Medicine, Cumulative Index to Nursing & Allied Health Literature, and All EBM Reviews. Each database was searched from 2005 through 2008, corresponding to the availability of the updated harms guideline. RESULTS: Ten studies met the inclusion criteria of this review. Six of the 10 studies mentioned or discussed adverse events. Four of the 6 studies did not detail how adverse events were collected. Only 2 studies discussed how adverse events were assessed. DISCUSSION: On the basis of our findings, acupuncture clinical trials for pain reduction have yet to comprehensively meet CONSORT’s guidelines for adverse event reporting. Acupuncture is commonly used by patients experiencing pain and although typically viewed as a benign and minimally invasive therapy, serious adverse events have been reported in the literature. To effectively and comprehensively document and understand these events, routine reporting according to CONSORT’s harms guidelines should become the norm. Both science and patients are served by accurately evaluating the safety of acupuncture for patient populations experiencing pain.

PMID: 20026952 [PubMed - in process]

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Acupuncture for lower back pain: a review.

December 23, 2009

Acupuncture for lower back pain: a review.

Clin J Pain. 2010 Jan;26(1):60-9

Authors: Lewis K, Abdi S

OBJECTIVE: We briefly discuss the history of acupuncture and its postulated mechanisms of action, but our primary objective is to discuss the evidence for acupuncture’s efficacy in low back pain as well as approaches of newer study protocols to define more clearly the true usefulness of this alternative modality in low back pain. METHODS: Pubmed online search of all articles and other literature in the past 50 years related to acupuncture efficacy in low back pain, including case reports, randomized controlled trials and meta-analyses. RESULTS: Lower back pain and its associated incapacitating sequelae constitute an important healthcare and socioeconomic problem. There have been multiple, generally poor quality studies on the efficacy of acupuncture for this multi-factorial pain condition. Although newer studies seem to show promise, effectiveness has not been clearly demonstrated. CONCLUSIONS: There is a paucity of high-quality research assessing efficacy of acupuncture in the management of LBP. Nonetheless, it continues to play a significant role in our clinical practice, not as a sole therapeutic modality but rather as an adjunct to a multidisciplinary integrative approach of LBP management. Most of the published articles about acupuncture in the biomedical literature consist of case reports, case series, or intervention studies with designs inadequate to assess its efficacy. Thus it is imperative that further research be performed, both preclinical to help elucidate the mechanisms underlying acupuncture, and clinical to justify its clinical application.

PMID: 20026956 [PubMed - in process]

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Acupuncture in the HNO-Area.

December 23, 2009

Acupuncture in the HNO-Area.

Laryngorhinootologie. 2009 Dec;88(12):799-813

Authors: Gleditsch J

For ENT specialists it is good to become familiar with the basics of acupuncture, as in our times this method of treatment has been spread and accepted worldwide. Modern pain research has succeeded in scientific exploring and verifying acupuncture effects. Any medical specialist having understood the facts and implications of acupuncture as laid out in this paper, may take the chance to try and put acupuncture into practice in his/her daily work. One of the challenges of doctors nowadays is the increase of functional disorders, of myofascial pain syndromes, of patients’ general ill-feeling of health. Particularly in pain management, as regards to the considerable toxic by-effects of long-term prescribed analgetics, there is a need of gentle therapies such as acupuncture, free from side-effects. It is the patients who demand alternative concepts. For ENT-doctors running a busy office, microsystem acupuncture in particular may be recommended. Inserting a couple of needles at the auricle, or injecting a few drops into the oral mucosa is a quick action which in most cases will provide beneficial results.

PMID: 20027537 [PubMed - as supplied by publisher]

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Could Acetaminophen Ease Psychological Pain?

December 23, 2009

Headaches and heartaches. Broken bones and broken spirits. Hurting bodies and hurt feelings. We often use the same words to describe physical and mental pain. Over-the-counter pain relieving drugs have long been used to alleviate physical pain, while a host of other medications have been employed in the treatment of depression and anxiety…

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