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The Contribution of Acupuncture and Moxibustion to Healthcare: an Evidence-based Approach

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Patients deserve the “best of both worlds” when it comes to their healthcare. Ideally healthcare blends the best of both worlds by combining healthcare options from the perspective of both Western and complementary medicine. The synergy between modern medicine and complementary health care, and the value of blending these disciplines, has been the focus of this thesis. The aim was to identify the strengths and limitations of acupuncture and moxibustion, as described in Traditional Chinese Medicine, and evaluate how these therapies can be implemented in modern medicine, taking the perspective of patients, physicians, complementary therapists, health insurers, and healthcare policymakers. The thesis consists of three parts. Part one, the general approach, introduces the use of acupuncture in a general practice. The observational study presents the health-related quality of life in patients with musculoskeletal complaints in a general acupuncture practice. The aim of this pragmatic study was to gain insight into whether the HRQoL of patients undergoing routine acupuncture treatment for musculoskeletal complaints differs with that in a Dutch population sample; and to investigate changes in HRQoL during the course of acupuncture treatment. In the second part we discuss also using TCM in the diagnosing of patients with complex regional pain syndrome type 1. The pilot study reports a different TCM-approach to diagnose the patient with CRPS1, by questioning the menstrual cycle conform TCM, which might eventually lead to a new treatment approach. The topic of the third part of the thesis is breech presentation. Described is the development and tracking of nonvertex position (mainly breech position) throughout pregnancy and the prognostic value of ultrasound in predicting nonvertex presentation at delivery in the Generation R study. The aim was to get better information about the natural history of the position of the fetus that leads to breech at delivery. In addition, systematic review and meta-analysis of the existing literature about (randomized) controlled trials on the acupuncture-type interventions on Zhiyin (BL 67) was performed, to elicit a version of a fetus in breech position, including a letter about the same topic. Finally, the results of the modeling approach of a decision analysis and cost analysis of breech version by acumoxa offered to women with a breech fetus at 33 weeks of gestation are reported. In this modeling approach, with sensitivity analysis, also the selective use of a) Moxa, b) the manipulation using external cephalic version, and c) home-births was considered.
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... Hopton and McPherson [7] conclude on the basis of a systematic review of pooled data from meta-analyses that acupuncture is more than a placebo for commonly occurring chronic pain conditions. In addition, in her thesis, van den Berg [8] recently demonstrated positive effects of acupuncture on obstetric health problems (breech presentation). Also, Servan-Schreiber [9] presents a series of recent examples of the transition from CAM to conventional medicine in depression treatment. ...
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Background: Low back pain limits activity and is the second most frequent reason for physicians visits. Previous research shows widespread use of acupuncture for low back pain. Purpose: To assess acupuncture's effectiveness for treating low back pain. Data Sources: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues. Study Selection: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain. Data Extraction: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed. Data Synthesis: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. Limitations: The quantity and quality of the included trials varied. Conclusions: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.