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Recent Research |
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| An Overview of Two Complementary Treatments for Chronic Asthma: Acupuncture and Homeopathy | |
| Effect of Acupuncture on Pain and Subjective Peripheral Neuropathy in Persons with HIV | |
| Stimulation of P6 for Preventing Postoperative Nausea and Vomiting | |
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An Overview of Two Complementary Treatments for Chronic Asthma: Acupuncture and Homeopathy McCarney RW, et al. Department of Psychological Medicine, Imperial College, Room 4.06, Paterson Centre, 20 South Wharf Road, London W2 1PD, UK. r.mccarney@imperial.ac.ukAcupuncture and homeopathy are commonly used complementary treatments for chronic asthma. This review summarizes two recently updated Cochrane systematic reviews that assess the safety and efficacy of homeopathy or acupuncture in individuals with chronic stable asthma. Researchers only included randomized controlled trials and undertook statistical aggregation of the data where possible. Searches for both reviews were done with the assistance of the Cochrane Airways Group, and through electronic alerts. In the acupuncture review, 11 studies with 324 participants met the inclusion criteria. Trial reporting was poor and the trial quality was deemed inadequate to generalize the findings. There was variation in the type of active and sham acupunctures, the outcomes assessed, and the time points measured. The points used in the sham arm of some studies are used for the treatment of asthma according to traditional Chinese medicine. Two studies used individualized treatment strategies, and one study used a combination strategy of formula acupuncture with the addition of individualized points. No statistically significant or clinically relevant effects were found for acupuncture compared with sham acupuncture. When data from two small studies were pooled, no difference in lung function was observed (post-treatment FEV1): standardized mean difference 0.12, 95% confidence interval 0.31 to 0.55). Researchers concluded there is not enough evidence to recommend the use of acupuncture in the treatment of asthma. Further research needs to be undertaken, and this should take into account the different types of acupuncture practiced. Effect of Acupuncture on Pain and Subjective Peripheral Neuropathy in Persons with HIV Phillips KD, et al. Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.Researchers tested 21 subjects to determine the effect of 5 weeks of acupuncture treatment in a group setting on pain and symptoms of peripheral neuropathy in patients with human immunodeficiency virus (HIV). The subjects completed the Pain Rating Scale and the Subjective Peripheral Neuropathy Screen (SPNS) before and after 5 weeks of acupuncture. The acupuncture treatments occurred two evenings per week. Each of the 10 sessions consisted of participants receiving 10-15 needle insertions in acupoints that addressed the individual's changing pattern of pain, sleep problems, or other health issues. The treatment utilized only main or common points located below the elbows and knees, and on the head, neck, and ears. Only reactive points were used in the acupuncture treatments. Needles were left in situ for 30-45 minutes. A comparison of the pretreatment and post-treatment Pain Rating Scale results indicated a significant reduction in present pain (p = 0.0002), least and most pain in the last 24 hours (p < 0.0001 and p = 0.0004, respectively) and the total pain summary score (p < 0.0001). Symptoms reported in the SPNS were reduced during the 5 weeks of acupuncture. Scores for pain/aching/burning, pins and needles, and numbness in the hands and feet were reduced (all significant at less than p 0.0065), as well as the total summary score (p = 0.0001). Researchers concluded the results of this study indicate that subjective pain and symptoms of peripheral neuropathy were reduced during the period of individual acupuncture therapy delivered in a group setting. While the study design did not allow for control of nonspecific placebo factors, the data support the hypothesis that acupuncture in a group setting can reduce pain and neuropathic symptoms in HIV-infected individuals. Stimulation of P6 for Preventing Postoperative Nausea and Vomiting Lee A, Done M. et al. Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, HONG KONG.Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drug therapy to prevent PONV is only partially effective. An alternative approach is to stimulate a P6 acupoint on the wrist. Although there are many trials examining this technique, the results so far are conflicting.: To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV researchers searched CENTRAL (The Cochrane Library, Issue 1, 2003), MEDLINE (January 1966 to January 2003), EMBASE (January 1988 to January 2003) and the National Library of Medicine publication list of acupuncture studies up to and including January 2003. Reference lists of retrieved papers and reviews were consulted for additional references. They selected all randomized trials of techniques that stimulated the P6 acupoint compared with: sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, acustimulation device and acupressure. Two reviewers independently assessed methodological quality and extracted the data. Primary outcomes were incidences of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects. A random effects model was used and relative risk (RR) with associated 95% confidence intervals (95% CI) are reported. Egger's test was used to measure the asymmetry of the funnel plot. Reviewers included 26 (n = 3347), none of which reported adequate allocation concealment. There were significant reductions in the risks of nausea (RR 0.72, 95% CI 0.59 to 0.89), vomiting (RR 0.71, 95% CI 0.56 to 0.91) and the need for rescue antiemetics (RR 0.76, 95% CI 0.58 to 1.00) in the P6 acupoint stimulation group compared with the sham treatment, although many of the trials were heterogeneous. There was no evidence of difference in the risk of nausea and vomiting in the P6 acupoint stimulation group versus individual antiemetic groups. However, when different antiemetics were pooled, there was significant reduction in the risk of nausea but not vomiting in the P6 acupoint stimulation group compared with the antiemetic group (RR 0.70, 95% CI 0.50 to 0.98; RR 0.92, 95% CI 0.65 to 1.29 respectively). The side effects associated with P6 acupoint stimulation were minor. There was some evidence of asymmetry of the funnel plot. Researchers concluded this review supports the use of P6 acupoint stimulation in patients without antiemetic prophylaxis. Compared with antiemetic prophylaxis, P6 acupoint stimulation seems to reduce the risk of nausea but not vomiting. |
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