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, Diet, fertility, food, martial arts, nature, pregnancy, Traditional Chinese Medicine

10 things you should know about Chinese Medicine

I’ve spoken at a few Endeavour College of Natural Health open days now. Prior to presenting to the prospective students I always get to thinking about all of the things I love about acupuncture and Chinese medicine. This medicine really has been a great lifetime passion of mine. (“Really?” You say.)

So here are the top 10 reasons why I love acupuncture and Chinese medicine:

  1. Diagnosis and treatment are completely individualised. It doesn’t matter if you have osteoarthritis, endometriosis or Chronic Fatigue Syndrome (CFS), in Chinese medicine we are interested in your unique signs and symptoms and we may give you a Chinese medicine diagnosis which is completely different from that of another person with the same disease name but a slightly different presentation. Your treatment will be individualised just for you.
  2. Yin yang cupcake iced solo webThere are no super foods. Or good foods. Or bad foods. Or fad diets. I know that goji berries and shiitake mushrooms are seen as foods of the gods, and soy has a reputation as the fruit of the devil for every single person on the planet (according to nutrition in the media) but in Chinese medicine we just don’t see it that way. All foods have different energetic properties (eg. cooling, heating, move upwards or downwards, drain damp, nourish blood or open the pores) and so they are used to bring your body back into balance when it isn’t already. For example, if it’s hot it needs cooling and if you are carrying excess fluid you need to drain damp. Of course your body’s needs change as you age, with the season and with illness or regaining health. As this happens your diet also needs to change. It’s not black and white. Which is exactly what the taiji (yin yang) symbol represents: there is always some black in the white and vice versa. Be sensible with your eating, strive for balance and pay attention to how foods make you feel.
  3. 5 elementsThere is a strong connection to nature within the medicine. Five element theory is a way of applying the principles of nature to our bodies. It’s based on thousands of years of observation. We can describe and diagnose people’s temperaments and body conditions according to Earth, Metal, Water, Wood and Fire. Each element relies upon and is interrelated to the others to keep delicate balance. Just like nature is. For example too much Earth can make us heavy, too much water can create fluid retention and too much fire can make us overheated. It’s a more complex system them this but those are just some simple examples.
  4. It can be an outright treatment, an alternative or a complementary medicine. So we all know that acupuncture alone is sometimes great for sorting out that sore shoulder or helping you sleep better. Other times acupuncture can work very well alongside other western medicine treatment. Some conditions that spring to mind are when we use acupuncture with IVF treatment or alongside chemotherapy which may reduce some of the side effects like nausea. As acupuncture does not involve ingestion of herbs or medicines it is rarely contraindicated with other therapies.
  5. Most people feel relaxed and emotionally ‘like a weight has lifted’ immediately following an acupuncture treatment. Patients often comment that they can fall asleep during an acupuncture treatment when they can’t take afternoon naps at home. It is a relaxing treatment and believe it or not – no the needles don’t really hurt most of the time. In fact relaxation has been described as a side effect of acupuncture in this study.
  6. ear acupuncture modelHaving a knowledge of acupuncture and acupressure is like having a first aid kit with you wherever you go. Symptoms like nausea and headaches can often be relieved if you know the right spots to push. I often take some ‘ear seeds’ with me when I go camping or hiking to manage musculoskeletal pains (these little seeds apply pressure to parts of the ear that correspond to other parts of your body – like acupressure. Anyone who has used a Sea-Band on their wrist for seasickness is doing acupressure – you place the hard bit of the band onto an acupuncture point! Of course, it can’t do everything and it’s always handy to have a regular first aid kit too.
  7. Energy flow is fundamental to Chinese medicine and acupuncture. Learning good posture and effective breathing is essential not only to good health but also being a good practitioner. Think of tai chi, Qi gong, yoga and martial arts. We apply these same postural and breathing techniques when inserting needles. But really, you can apply good posture and effective breathing to everything that you do.
  8. The history of Chinese Medicine is decorated with beautiful stories, poetry and artworks to document and share the medicine. An appreciation of the arts is also considered a part of holistic healthcare. I often describe to my fertility or pregnancy patients that one of the acupuncture points is called ‘zigong’ or ‘the palace of the child’. How gorgeous is that? We can incorporate these beautiful descriptions into meditations or visualisations during treatment.
  9. The future of Chinese medicine is bright as we are now seeing higher quality clinical trials to highlight traditional and new uses for our medicines. For example the research using fMRI to understand the effect of acupuncture needling on the brain is fascinating. Check out this BBC documentary for a look at this research. (It’s an hour long but it’s well worth it.)
  10. In Australia we are now a registered profession (just like physiotherapists and dentists). This means that acupuncturists, Chinese herbalists and Chinese medicine practitioners now have to comply with AHPRA regulations under the Chinese Medicine Board of Australia (CMBA) including a minimum level of education (bachelor degree) and other professional and ethical standards. So in the interests of public safety and getting the most effective treatment for your condition always seek treatment from a CMBA registered practitioner. (For the record, dry needling is not registered in this way.)

Just a word of warning: nowhere here have I said Chinese medicine is a cure all. I just wanted to highlight the things that Chinese medicine does really well. For information about your own health please speak with a registered Chinese medicine practitioner.

What is it that you love about acupuncture and Chinese medicine? Tell me in the comments. I’d love to know.

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, pregnancy

Hip (h)op, sore necks and pelvic pain in pregnancy: what do they have in common?

Survived my first (and hopefully only) operation.
Daggy selfy alert! I survived my first (and hopefully only) operation.

The answer is: they sum up where my time went last month.

Yes, I’ve been quiet the last four weeks. And for good reason. But the great news is I’m back on deck and The Wellness Ninja is once again karate chopping out the good news for your health and happiness.

So here’s a recap:

  • Hip (h)op: Well this time last month I was having a hip arthroscopy. With a nicely cleaned-up hip joint, I should be back into the karate, hiking, cycling and diving that I love in around two months. I’m doing very well in my recovery (I was back at work a week later) and will put out a blog on the combination of complementary therapies I’ve engaged to support me in tolerating the most medications I’ve ever taken in my life, healing connective tissue, relieving pain and rehabilitating my dodgy ‘hoppy’ hip.
  • Sore necks: We’re half way through the UWS Traditional Chinese Medicine Masters course semester and so I’ve been beavering away on my assessment pieces. First up, I immersed myself in all of the available research we have on neck pain and acupuncture. My findings? Well, actually no therapies have high-quality research to support their use in neck pain. (And that includes surgery, NSAIDs, chiropractic, massage, yoga and acupuncture.) That’s not much help for people with neck pain. But The Cochrane Review on this topic reports that there is moderate-quality evidence to support the use of acupuncture for chronic mechanical neck pain or neck pain with radicular symptoms. And the chance of serious adverse reactions is low. In my experience neck pain is often treated well with acupuncture, it may be well worth a try for a pain in the neck.
  • Low back and pelvic pain in pregnancy: This was assignment number two’s topic. I’ve written before on the good effect acupuncture has in this area. Last week I read everything that there was to read in English on the treatment of low back and pelvic pain in pregnancy with acupuncture. Safety, for both mother and baby, was carefully assessed in these trials which found that acupuncture does not have a higher rate of serious adverse reactions for the mother or the baby than was experienced in the control groups. A Cochrane Review reports that there is moderate-quality evidence for pain relief and improved functionality with acupuncture treatment for these conditions. But I loved this quote from an editorial in the British Medical Journal:

“Those caring for women with pregnancy related pelvic pain now need to press for increased availability of acupuncture.”

So that’s my month (well not completely – I also devoured series one and two of the TV series ‘Rake‘). I have so many good blog topics in a back log ready to come your way. Stay tuned for some tasty new recipes, some acupuncture stroke rehabilitation research I recently presented at a major hospital, information on an acclaimed new book on motherhood and the scent on some new medicinal aromatherapy oils.

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.