acupuncture, Uncategorized

Acupuncture does have a place in Evidence Based Medicine

acupuncture needleLast time I was at Western Sydney University (WSU) I was staying on campus and shared a unit with a medical doctor who was working at the local hospital. On finding out I was an acupuncturist she said, “so, is acupuncture evidence based? Our medicine is evidence based.”

I took a deep breath and summed up all of the tact I could muster and calmly replied “well, some of it is, and some of it isn’t, just like you guys.”

I’m not here to create an ‘us and them’ situation. I have great respect for a lot that western medicine has to offer. I regularly refer to GPs as I should. We do different jobs and a GP can do a lot that I can’t as an acupuncturist – I am aware of where my scope of practice ends. I consider myself to be an integrative practitioner making sure that my patients have access to all of the health practitioners who will ultimately see them reach the best outcome possible. Working as a team is good for patients.

Strap yourselves in. This is a going to be a long post. But I sincerely hope you read through to the end. 

Please read this post with the intention in which it was written: to take an Evidence Based Medicine approach to all medicines and therapies regardless of the school they belong to. Patient outcomes are what matter in the end, there is no room for ego or turf wars. And working together we achieve more.

What is Evidence Based Medicine?

You could be forgiven for thinking that Evidence Based Medicine (EBM) is solely based on using only medicines/therapies that have gold standard randomised controlled trials (RCTs) to prove that they work, or at least that’s what we’re lead to believe through the media.

Well it isn’t just that. This is only part of it. There is a lot more to it.

David Sackett is considered to be the father of EBM. He sadly passed away this year but made great contributions to the fields of epidemiology and best clinical practice.

Sackett considered that EBM had three fundamental components (and you may have seen these linked together in this Venn diagram):

  • Best external evidence (eg. systematic reviews, randomised controlled trials but also research that measures qualitative patient outcomes)
  • Individual clinical expertise (eg. the individual experience and training of the practitioner)
  • Patient values and expectations (eg. what the patient will and won’t do, or can and can’t do)

Like the diagram implies, none of these parts always hold more weight than the others for every clinical patient situation.

Anyone who has ever managed a patient with several chronic or unusual illnesses knows that relying only on the best quality external evidence might not give you many treatment options for your patients.

Bias is alive and well

Have you ever asked your doctor or specialist, “so, is pharmaceutical medication or surgery evidence based?” No, probably not. Because it is actually a stupid question. When inquiring about evidence we want to know if there is evidence for a therapy giving a clinically significant outcome on a particular health condition or symptom. Asking if pharmaceutical medication or surgery is evidence based as a general question is not likely to give you a useful answer, just as it doesn’t if you were to ask that of physiotherapy, chiropractic, osteopathy, acupuncture, Chinese medicine, massage, herbal medicine, naturopathy or nutrition. And no modality of medicine should be ruled out on such a general question. I think there is bias in anyone who thinks that you can. Bias is the opposite of what scientific research is all about.

What we’re interested in is blow by blow, which therapies are best for which condition. Where we have the best external evidence we can use it. Sometimes we can’t or it doesn’t suit the patient’s needs. And we all know that certain practitioners are sought after because they are known to have excellent clinical experience, judgement and patient care, even though they all have access to the same external evidence.

If you’re still not sure that western medicine isn’t completely based on the best external evidence then you should view ABC TV’s 4 Corners: Wasted, ABC TV’s Catalyst’s: Too Much Medicine and then have a listen to ABC RN’s Background Briefing: Cold Comfort: Is the fertility industry misleading women?

Arthroscopy for osteoathritis of the knee anyone? How about a scan for that uncomplicated back pain? Do we have the clinical trials to show if that long list of medications that you’re on work well together and are all still benefiting you now? Or what about freezing 10 eggs, or was it 15, to maybe fertilise some years later and possibly get a positive pregnancy test but probably not a live birth?

Now, we wouldn’t write off western medicine over these findings, but what we do know is we need to find therapies that might work for these patients instead. We’ll also still happily use western medicine for the treatments that do show good evidence for positive patient outcomes, and there are plenty of those. It would be a shame to lose the baby with the bathwater. Let’s apply the same rule to acupuncture and other integrative medicines.

I also need to point out that the gold standard of research, the double blind RCT, is best suited to therapies that involve taking a pill. Giving a ‘pretend medicine’ (sham) to the control group is much easier when you can give a sugar pill which looks the same as the medication. Giving ‘pretend acupuncture’ is a whole lot harder. Surgeons, physiotherapists and massage therapists all face this problem when designing randomised controlled trials. Acupuncture research will always lag in methodological quality if double blind RCTs remain the primary measurement tool of clinical effectiveness.

Which conditions does the best external evidence support acupuncture for?

If you’re reading this Australian Federal Health Minister, Sussan Ley, some of these should be on the table for consideration if we are actually serious about providing the best of EBM to patients. (Because we are taking a scientific approach and aren’t biased about these things are we?)

Let’s not muck about and head straight to the the gold standard of medical evidence, The Cochrane Review. (Some of the authors conclusions below rightly mention the problem with acupuncture trial methodology as discussed above).

Here are some of the author conclusions from the results of a search of acupuncture Cochrane Reviews:

  • Tension-type headache“In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.”
  • Migraine prophylaxis“Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.”
  • Neck disorders“There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.”
  • Chronic low back pain“For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain.”
  • Dysmenorrhoea (period pain)“Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials.”
  • Low back pain and pelvic pain in pregnancy“Evidence from single studies suggests that acupuncture or craniosacral therapy improves pregnancy-related pelvic pain, and osteomanipulative therapy or a multi-modal intervention (manual therapy, exercise and education) may also be of benefit.”
  • Pain management in labour“Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.”
  • Cephalic version (breech presentation) “There is some evidence to suggest that the use of moxibustion may reduce the need for oxytocin. When combined with acupuncture, moxibustion may result in fewer births by caesarean section; and when combined with postural management techniques may reduce the number of non-cephalic presentations at birth, however, there is a need for well-designed randomised controlled trials to evaluate moxibustion for breech presentation which report on clinically relevant outcomes as well as the safety of the intervention.”
  • Irritable Bowel Syndrome (IBS) – “In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from two antispasmodic drugs (pinaverium bromide and trimebutine maleate), both of which have been shown to provide a modest benefit for IBS.”
  • Schizophrenia“Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects.”

But like Sackett taught, research trials are not the whole picture, sometimes we need to provide patients with treatment that may offer some benefit, with low risk of serious adverse events, because we simply have nothing with better evidence left to try. Acupuncture often fits into this picture when practiced by a Chinese Medicine Board of Australia registered acupuncturist (AHPRA).

How does the story end?

And if you are wondering about the doctor at the beginning of the blog, well in the end she asked where she could see a Chinese Medicine practitioner to help with her low immune system because nothing else she had tried from ‘her medicine’ had worked. Good luck to her, I’m glad we were able to have that open minded conversation over the breakfast bench that day at WSU.

To book an appointment at the clinic or further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health.

acupuncture

Acupuncture and stroke rehabilitation

Bronze man webLast month I was asked to present a series of educational sessions to the medical team at the Princess Alexandra Hospital’s Brain Injury Rehabilitation Unit (BIRU).

I was really impressed with BIRU. The doctors, nurses and allied health practitioners have created an incredible program and facility to support the progress of their patients.

My presentation focused on acupuncture and its role in stroke rehabilitation.

I’ve long been interested in this area of Chinese medicine. While I was completing my internship in China I observed Chinese doctors treating acute stroke patients with both western and Chinese medicine side-by-side in hospitals. In Australia, while I was training at college we were trained to give acupuncture to patients at varying stages post-stroke. Some of the results were quite remarkable and it was observed with our small group of stroke patients that the sooner acupuncture was commenced post-stroke, the better the results were for rehabilitation.

When I put the education sessions together for the BIRU medical team, I was really keen to read the latest research on acupuncture and stroke rehabilitation. Here is a little snapshot of some of the research I found:

  • The Cochrane Review of acupuncture and acute stroke found that ›acupuncture when compared with sham acupuncture or control had a borderline significant trend towards fewer patients being dead or dependent, and significantly fewer being dead in the acupuncture group after 3 months or more. There was a significant difference favouring acupuncture in the mean change of global neurological deficit score and severe adverse events were rare.
  • Another Cochrane Review examining the evidence supporting acupuncture for stroke rehabilitation found ›“the overall estimate from four trials suggested the odds of improvement in global neurological deficit was higher in the acupuncture group compared with the control group.”
  • A meta-analysis of scalp acupuncture (where needles are threaded along the scalp – which is not as painful as it sounds) in acute stroke patients found that acupuncture had fewer serious adverse reactions than many accepted medical interventions when practiced by well trained practitioners. The researchers also concluded that the studies considered indicate that acupuncture improved the neurological deficit score.
  • A systematic review found that acupuncture was an effective treatment for shoulder pain following stroke, particularly when combined with exercise.
  • A small study found that when patients with stroke in the left hemisphere of the brain were given acupuncture on their right arms (the affected side), interestingly, it was the right side of the brain that responded to the acupuncture. This was thought to be enhancing the compensatory process.

It should be noted that the researchers stated that larger, high-quality trials are needed to conclusively support the role of acupuncture in stroke rehabilitation. However, the research that we do have is promising and acupuncture has been shown to have a low risk of adverse reactions.

For further information on stroke rehabilitation with acupuncture contact Sarah George.  Sarah is a practitioner of acupuncture (CMRB registered), massage therapy and natural medicine at Acupuncture & Natural Therapies Centre and lectures at the Endeavour College of Natural Health in Chinese Medicine.

 

massage, Traditional Chinese Medicine

What is TCM remedial massage and who can it help?

Massage pushing web2Traditional Chinese Medicine (TCM) remedial massage, otherwise known as tui na, is a therapy that dates back two thousand years ago to ancient China. The words ‘tui na’ translate to ‘push grasp’ which describes this style of massage with its assorted techniques including kneading, tapping, rubbing and pressing. The pressure used is suited to the individual patient and can be light on the skin or firm for deep tissue techniques. Pressure is applied to acupuncture points to stimulate them for specific conditions.

This form of massage is part of the greater system of TCM, a diverse system of medicine that covers all major systems within the body; which means it can be used for a wide range of acute and chronic ailments. TCM is focused on treating the underlying cause of disease as well as the presenting symptoms. This involves a holistic approach linking the body, mind and emotions in both the cause of disease and its treatment. TCM remedial massage may also be used to optimise overall wellness.

How does TCM remedial massage work?

By using a range of massage techniques your massage therapist will aim at best treating the particular condition you wish to have treated – whether that’s pain relief, reducing tension, healing injury or just making you feel better.

Peer-reviewed medical research has shown that massage techniques may provide:

  • Pain relief – For musculoskeletal injuries, tension headaches and back pain.
  • Mental alertness – After massage, EEG patterns indicate enhanced performance and alertness on mathematical computations.
  • Reduced anxiety and depression – Massage nay reduce subclinical depression.
  • Detoxification – Massage may stimulate the immune system by increasing blood flow and lymph drainage.
  • Muscle recovery – Massage may help to clear muscles of lactic and uric acid that build up during exercise.
  • Muscle tone – Improving muscle tone and delaying muscle atrophy resulting from inactivity.
  • Prevent injury – Deep massage may separate fascial fibres, prevent adhesions and reduce inflammation and oedema.
  • Relaxation – The release of endorphins and serotonin inducing a relaxed, ‘feel good’ state may improve sleep, reduce blood pressure and heart rate.
  • Healing – Massage may increase circulation and therefore improves the delivery of oxygen and nutrients to the cells.

Traditionally, acupressure is explained by influencing the flow of Qi (energy or life force) within the body. For example, someone with throbbing headaches has too much Qi moving upwards, or someone with pain that is worse for rest has Qi that is ‘stuck’ or not circulating well. Researchers have identified that stimulating an acupuncture point (with a needle or acupressure) can create measurable changes in the body. Acupuncture points have an influence over the area that surrounds them. An acupuncture point can also have an influence over areas far removed from the actual point being needled.

Who can benefit?

TCM remedial massage is ideal for most musculoskeletal pain. It can also be beneficial for other health conditions, particularly when combined with acupuncture and/or other techniques such as cupping or herbal medicine.

People who can benefit from TCM remedial massage include those with specific pains such as stiff neck, tight shoulders or lower back pain; as well as anyone who suffers from chronic stress or general muscle tension.

I have many clients who choose to book regular monthly massages to promote wellness, reduce stress and prevent injury.

For further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health at her Broadbeach clinic and is the Chinese Medicine Senior Lecturer at the Endeavour College of Natural Health Gold Coast campus.

acupuncture

Acupuncture point injection therapy: can it relieve your muscle pain?

Sarah George APIT webI was lucky enough to be one of the first practitioners to have completed Australian training in Acupuncture Point Injection Therapy (APIT) a few years ago. This therapy originated in China and is very useful for relieving stubborn muscle and tendon pain.

APIT operates on the same acupoint system as traditional acupuncture. The difference being that instead of leaving the regular acupuncture needles in place for the treatment time, small amounts of saline solution BP are injected via very fine needles (much finer and less painful than a regular injection) into each selected acupoint.

Injecting saline solution is simply a different way of stimulating acupoints and offers:

  • Treatments that can be much faster for those with limited time.
  • Strong point stimulation.
  • The bolus of saline solution can stimulate the acupoint after the needle has been withdrawn.
  • Saline solution can have a local healing effect on the surrounding tissue. Saline has the same balance of salts as our cells, blood and interstitial fluid. Injecting saline solution into damaged muscle tissue may help to improve nutrient and waste transfer to aid healing.

Muscular pains (even stubborn ones) often respond well to APIT. The following are examples of conditions which may benefit from APIT:

  • bursitis
  • tendinopathy
  • ITB irritation syndrome
  • carpal tunnel syndrome
  • sprain

Acupuncture Point Injection Therapy is just one of the treatments that I provide at my clinic.

To book an appointment at the clinic or further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health.

acupuncture, fertility, pregnancy

Pelvic pain in pregnancy: the latest Cochrane Review findings

acu statue backOne of the things I love most about my job is working with women who are undergoing preconception care, fertility treatment and pregnancy support. So I was absolutely delighted to see this Cochrane Review come out recently in support of acupuncture for pelvic and lower back pain (LBP) in pregnancy. The authors concluded:

“Moderate-quality evidence suggested that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic pain or lumbo-pelvic pain more than usual care alone, acupuncture was significantly more effective than exercise for reducing evening pelvic pain.”

In my experience, pelvic and lower back pain associated with pregnancy is one of those conditions that frequently responds very well and extremely quickly to acupuncture treatment. However, everyone is unique and depending on the cause of the pain the prognosis may differ from this.

A well-trained acupuncturist with experience in pregnancy acupuncture will select acupuncture points in the local area, and on the legs, maybe the arms or even ears to reduce pains. The points used will be selected to be effective for the individual presentation of pain and low-risk based on the gestational age. The treatment is not only pain-relieving but also very relaxing – something every pregnant lady needs!

And if you want to see a a video of how amazing the whole sperm-meets-egg-pregnancy-baby process is then check this out.

For further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health at her Broadbeach clinic and is the Chinese Medicine Senior Lecturer at the Endeavour College of Natural Health Gold Coast campus.

acupuncture, health, herbal medicine

Get your free Herbs, Health & Acupressure ebook

ebook cover HHAThe fabulous naturopath Kathleen Murphy and I co-authored a little gem of an e-book a short while ago. It followed on from a presentation that we gave at the packed Blue Lotus tent at the Woodford Folk Festival.

We wanted to teach some simple self care techniques we often talk about in our clinics for these common health complaints:

  • Digestive disorders
  • Insomnia
  • Fatigue
  • Pain

Kathleen covered the easy homemade herbal remedies and I taught some simple acupressure techniques.

To thank you for following or subscribing to my blog (you can subscribe using the link on the right side of the page) I wanted to offer you a free copy of the e-book: “An introduction to health, herbs & acupressure: simple tips and home remedies for good health.”

Click here to download the ebook – herbs health acupressure 2013 for free!

To book an appointment at the clinic or further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health.

acupuncture

Acupuncture: do the needles hurt?

Sarah George fertility acupunctureAs I conduct a consultation with a first-time acupuncture patient I often notice a sense of fear masked by a shy smile. After discussing the patient’s health concerns and providing some education on how I may be able to assist them, we get to the point where it’s time for the patient to jump up onto the table for the treatment. And I often see the look in their eyes – “Will the needles hurt”? I often beat them to asking the question, explaining where I am going to place the needles and what they should expect to feel – and then follow it with “no, acupuncture isn’t painful but that doesn’t mean you won’t feel any sensation. Not all sensations are painful”.

Yes, there’s a difference between pain and sensation. Pain is a sensation, but it’s not the only type of sensation. Some sensations are in fact very pleasurable. Generally in acupuncture we try to avoid any sharp, needle-like sensation. Acupuncture is nothing like having an injection or blood test. As acupuncturists we aim to perfect our technique so the needle glides almost undetectably through the layer of the skin, although sometimes you may feel a mild prick. An acupuncturist with a good technique can use a fine or thicker gauge needle relatively painlessly. As humans, we are all different and some patients are more sensitive than others so may be more aware of needle insertions, but this is less common in my experience. Many beauty therapists will tell you that women are more sensitive to pain prior to their menstrual period and waxing is often discouraged at this time. Skin texture varies on different parts of the body so sensitivity may be more pronounced in different locations. However, acupuncture shouldn’t be characterised by strong needle ‘prick’ sensations.

In fact, most first time acupuncture patients say to me after their first needle has been inserted, “Was that it? If I’d known it was like that I would have come ages ago!”

So, the needles should glide through the skin with minimal discomfort. But after this a sensation may be felt. Acupuncturists refer to this as ‘de qi’meaning that your body has recognised that the needle has been inserted into an acupuncture point or qi/energy has come to the needle. There are many schools of thought on what and how much sensation is needed to stimulate an acupuncture point with a needle. During my observations in China I noticed that many of the patients complained if they didn’t feel enough sensation from each needle! Some research has shown that obtaining needle sensation or de qi has a different effect on the brain, than when no sensation or a sharp sensation has been felt. Classical texts report that a range of sensations may be beneficial, (note that sharp is not one of them):

  • aching
  • numbness or tingling
  • fullness, distention or pressure
  • heaviness

Once a sensation has been provoked your acupuncturist may further manipulate the needle.

Let your acupuncturist know what you are feeling during needling, especially if a needled point has a sharp, electric or burning pain.

After your acupuncturist has inserted and manipulated the needles you may still feel some sensations during your treatment but again, these should not be sharp or overly painful. And of course, movement and needles don’t mix, so keeping any body part that has been needled still during your treatment will reduce sharp sensations too!

Keeping still isn’t usually a problem. When I enter a room at the end of a patient’s acupuncture treatment most people look incredibly relaxed or have just woken up from a nap. Acupuncture is a fabulous way to enjoy some rest and relaxation during a busy day and most patients treasure their acupuncture treatment experience.

To book an appointment at the clinic or further information on Chinese Medicine contact Dr Sarah George (Acupuncture).  Sarah is a practitioner of acupuncture (AHPRA registered), massage therapy and natural health.