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Auricular Acupuncture for Dental Anxiety: A Randomized Controlled Trial
Abstract
Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.
... In clinical setting, AS appeared to be safe [9,13] and superior to a variety of control conditions, as well as equally effective to benzodiazepines in reducing of anxiety scores in surgical patients [9,[13][14][15][16][17][18][19]. However, these clinical investigations demonstrated a heterogeneity in regard to surgical procedures, control conditions and effect size, thus making it difficult to draw any definitive recommendations for clinical practice. ...
... Out of 12,863 screened publications, 91 were selected and studied in full-text; 76 were excluded due to the reasons, listed at Fig. 1. Fifteen trials with 1630 patients were included in systematic review (Table 1), where 4 trials enrolled patients scheduled to dental treatment [16,19,26,27], one of them examining children [26], 2 trials reported on patients scheduled to otorhinolaryngology surgery [28,29], 2 trials included patients prior to lithotripsy [28,29], 3 trials on patients undergoing various ambulatory surgeries [15,19,32], 1 trial on patients prior to in-vitro fertilization [14], and another 3 trials on patients prior to gynecological [17], abdominal surgery [33] and cardiac catherization [34]. Among 1630 patients 67% were females. ...
... Out of 12,863 screened publications, 91 were selected and studied in full-text; 76 were excluded due to the reasons, listed at Fig. 1. Fifteen trials with 1630 patients were included in systematic review (Table 1), where 4 trials enrolled patients scheduled to dental treatment [16,19,26,27], one of them examining children [26], 2 trials reported on patients scheduled to otorhinolaryngology surgery [28,29], 2 trials included patients prior to lithotripsy [28,29], 3 trials on patients undergoing various ambulatory surgeries [15,19,32], 1 trial on patients prior to in-vitro fertilization [14], and another 3 trials on patients prior to gynecological [17], abdominal surgery [33] and cardiac catherization [34]. Among 1630 patients 67% were females. ...
Study objective
Previous randomized controlled trials (RCTs) suggest that auricular stimulation (AS) is safe and effective in treatment of preoperative anxiety; however, a systematic evaluation is lacking. The aim was to summarize the evidence on efficacy and safety of AS for preoperative anxiety, as well as for other outcomes.
Design
We conducted a systematic review of RCTs including patients from all available populations. The search was done through MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and Scopus Database from inception to June 2020. Study selection and data extraction were performed in by 2 independent reviewers with ability to resolve disagreements by a third author. Meta-analyses as well as the risk of bias and evidence quality assessments were performed according to the Cochrane 6.2, 2021 handbook recommendations.
Interventions
We compared AS with pharmacological and non-pharmacological interventions for different outcomes.
Measurements
We assessed the repercussion of the evaluated interventions over anxiety scores and their safety, physiological parameters, perioperative medications requirement and intensity of postoperative pain.
Main results
We have included 15 studies with 1603 patients. AS has presented reduced anxiety scores as compared to the sham control (Standardized Mean Difference (SMD) -0.72, 95% confidence interval (CI) -1.09 to −0.36, p < 0.0001; 8 trials; 701 patients; heterogeneity: I² 80%; GRADE: moderate certainty) and to no intervention (SMD -1.01, 95% CI -1.58 to −0.45, p = 0.0004; 4 trials; 420 patients; heterogeneity: I² 84%; GRADE: very low certainty). There was no difference between AS and benzodiazepines (SMD -0.03; 95% CI: −0.34 to 0.28; p = 0.84; 3 trials; 158 patients; heterogeneity: I² 0%; GRADE: very low certainty). No trials reported serious adverse effects of AS.
Conclusions
AS may be useful in treatment of preoperative anxiety. Due to heterogenous certainty in effect estimates, further research is needed to clarify the actual efficacy of AS for preoperative anxiety.
... It has already been used to treat situational anxiety in experimental and clinical conditions [12]. In several randomised controlled trials (RCTs) evaluating a treatment of preoperative anxiety, auricular stimulation was superior to an array of control procedures, including placebo and sham interventions, and equally effective like premedication with benzodiazepines in patients scheduled for surgery under general anesthesia [13][14][15][16][17]. Moreover, this method was associated with fewer side effects compared with benzodiazepines, as well as a diminished physical stress reaction such as a reduced response of the autonomic nervous system [12,16,17]. ...
... In several randomised controlled trials (RCTs) evaluating a treatment of preoperative anxiety, auricular stimulation was superior to an array of control procedures, including placebo and sham interventions, and equally effective like premedication with benzodiazepines in patients scheduled for surgery under general anesthesia [13][14][15][16][17]. Moreover, this method was associated with fewer side effects compared with benzodiazepines, as well as a diminished physical stress reaction such as a reduced response of the autonomic nervous system [12,16,17]. ...
... An array of data suggest that auricular stimulation might become such an effective, safe and easy-to-perform treatment for preoperative anxiety in adults scheduled for elective surgery and painful procedures with sedation [12][13][14][15][16][17]. Despite these promising results from clinical trials on the treatment of preoperative anxiety using auricular stimulation supported by neurophysiological explanation of its potential mechanisms [25], the systematic evaluation of the evidence for the treatment of anxiety using auricular acupuncture is not available. ...
Background: Preoperative anxiety causes profound psychological and physiological reactions that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in the treatment of preoperative anxiety; however there is a lack of systematic evidence on this topic. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction in anxiety in patients in a preoperative setting, compared to other forms of acupuncture, pharmacological, or no control interventions and measured with questionnaires regarding anxiety and fear. Methods: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by two reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3. Conclusions: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences. Registration number: PROSPERO ID CRD42020.
... Auricular acupuncture is a complementary medicine technique, which is physiologically based on the mechanical stimulation of auricular branch of vagal nerve, auriculotemporal nerve (from trigeminal nerve and great auricular nerve from the cervical plexus [8]. Auricular acupuncture was shown to reduce situational anxiety in various clinical situations, such as dental treatment and surgery [9,10]. In a recent randomized crossover trial, both acupuncturelike auricular stimulation (AS) and placebo intervention reduced pre-exam anxiety and duration of sleep in medical students, where AS was superior to placebo procedure in treatment of anxiety [11]. ...
... observed in the present study is comparable with that from our previous investigations [11,15] and several other studies on the effects of AS on situational anxiety where the state anxiety decreased by about 15-20% from baseline after AS in patients scheduled for various medical procedures with high level of situational anxiety [9,10,19]. ...
... relaxation techniques and biofeedback [5,27,28]. Moreover, after appropriate investigations, AS using present methodology might be used to treat pre-operative anxiety in surgical patients [9,10,19,29]. ...
Objective
Auricular stimulation (AS) is a promising method in the treatment of situational anxiety. Expressive writing (EW) is an established psychological method, which reduces test anxiety and improves exam results. The aim of this crossover trial was to compare AS with EW, and with the no intervention (NI) condition, for treatment of exam anxiety.
Methods
Healthy medical students underwent 3 comparable anatomy exams with an interval of one month, either performing EW, receiving AS or NI prior to the exam; the order of interventions was randomized. AS was applied using indwelling fixed needles bilaterally at the areas innervated mostly by the auricular branch of the vagal nerve on the day before the exam. Anxiety level, measured using State-Trait-Anxiety Inventory (STAI) before and after the interventions and immediately before exam, was the primary outcome. Quality of night sleep, blood pressure, heart rate and activity of salivary alpha-amylase (sAA) were analyzed across 3 conditions.
Results
All 37 included participants completed the study. Anxiety level (STAI) decreased immediately after AS in comparison with baseline (P = 0.02) and remained lower in comparison with that after EW and NI (P<0.01) on the day of exam. After EW and NI anxiety increased on the day of exam in comparison with baseline (P<0.01). Quality of sleep improved after AS in comparison with both control conditions (P<0.01). The activity of sAA decreased after EW and after AS (P<0.05) but not after NI condition.
Conclusion
Auricular stimulation, but not expressive writing, reduced exam anxiety and improved quality of sleep in medical students. These changes might be due to reduced activity of the sympathetic nervous system.
... In randomised controlled trials (RCTs) for the treatment of preoperative anxiety, auricular stimulation was superior to an array of control procedures, including placebo and sham interventions, and was similar in effect to premedication with benzodiazepines in patients scheduled for surgery under general anesthesia. (13)(14)(15)(16)(17). Moreover, this method was associated with fewer side effects compared with benzodiazepines, as well as with a diminished stress reaction, measured as a reduced response of the autonomic nervous system (12,16,17). ...
... (13)(14)(15)(16)(17). Moreover, this method was associated with fewer side effects compared with benzodiazepines, as well as with a diminished stress reaction, measured as a reduced response of the autonomic nervous system (12,16,17). ...
... An array of data suggest that auricular stimulation might become such an effective, safe and easy-toperform treatment for preoperative anxiety in adults, scheduled for elective surgery and painful procedures with sedation (12)(13)(14)(15)(16)(17). Despite these promising results from clinical trials on treatment of preoperative anxiety using auricular stimulation, supported by neurophysiological explanation of its potential mechanisms (25), the systematic evaluation of evidence for treatment of anxiety using auricular acupuncture is not available. ...
Background: Preoperative anxiety causes a profound psychological and physiological reactions, that may lead to a worse postoperative recovery, higher intensity of acute and persistent postsurgical pain and impaired quality of life in the postoperative period. Previous randomized controlled trials (RCTs) suggest that auricular acupuncture (AA) is safe and effective in treatment of preoperative anxiety; a systematic evidence on this topic is missing. Therefore, this protocol was developed following the PRISMA guidelines to adequately evaluate the existing literature regarding the value of AA for the reduction of anxiety in patients in a preoperative setting, compared to other forms of acupuncture or pharmacological or no control interventions and measured with questionnaires regarding anxiety and fear.
Methods and analysis: The following databases will be searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, Scopus Database and Google search. RCTs will be included if an abstract is available in English. Data collection and analysis will be conducted by 2 reviewers independently. Quality and risk assessment of included studies will be done using the Cochrane 5.1.0 handbook criteria and meta-analysis of effectiveness and symptom scores will be conducted using the statistical software RevMan V.5.3.
Ethics and dissemination: This systematic review will evaluate the efficacy and safety of AA for preoperative anxiety. Since all data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. The results may be published in a peer-reviewed journal or be presented in relevant conferences.
Registration number: PROSPERO ID CRD42020184795
... Auricular acupuncture (AA), a combination of modern and traditional techniques, has been proved to be effective in reducing situational anxiety, such as dental anxiety and preoperative anxiety [7][8][9]. For exam anxiety, data on the effect of AA are limited. ...
... In this study, acupoints located on both ears were used [6]. Researches on AA for other situational anxiety types have indicated that anxiety level could be reduced by using acupoints on the nondominant side [7][8][9]. Therefore, this study aims to determine whether AA points on the non-dominant side can reduce exam anxiety in medical students. ...
... This is in agreement with previous findings. Karst et al., using the same acupoints to treat dental anxiety, reported that state anxiety scores reduced by about 18% from baseline after AA in 19 patients [7]. Similarly, Michalek-Sauberer et al. demonstrated a decrease by about 18% from baseline in state anxiety scores after AA in 61 patients for dental procedures [8]. ...
Background and Objectives: Exam anxiety is a commonly seen problem among medical students. Auricular acupuncture has been shown to have an anxiety-reducing effect, however, data on exam anxiety is limited. Research in dental and preoperative anxiety has indicated that anxiety level could be reduced by using ear acupoints on the non-dominant side. Therefore, this study aims to determine whether needling at acupoints on the non-dominant side can reduce exam anxiety in medical students. Method: This is a prospective observational study on 32 students at The Faculty of Traditional Medicine, Ho Chi Minh City University of Medicine and Pharmacy. Eligible students received auricular acupuncture on the non-dominant side at the Master cerebral, Tranquilizer and Relaxation points. Levels of anxiety were measured using a visual analogue scale before and after the intervention as well as before the exam. The State-Trait Anxiety Inventory, heart rate, exam performance and adverse events occurring during the study were also collected. Results: Exam anxiety level and heart rate decreased 30 minutes after auricular acupuncture (p<0.05). Before the exam, exam anxiety level and heart rate increased significantly compared to after the intervention but still lower than baseline (p<0.05). The exam anxiety level with heart rate at each time point did not differ significantly in gender and trait anxiety levels (p>0.05). No adverse events from auricular acupuncture were observed. Conclusion: Auricular acupuncture at the Master cerebral, Tranquillizer and Relaxation points on the non-dominant side is effective in reducing exam anxiety in medical students.
... [17][18][19][20][21][22] In the dental field, a study on adult populations reported reduction in anxiety after acupuncture; another study proved this procedure to be as effective as intranasal midazolam in reducing dental anxiety. 23,24 However, a major complication with this technique is bacterial infections caused by reusable needles, according to a systematic review. 25 The painful nature of the procedure and the reported complications might be projected as reasons for the inability of researchers to assess the efficacy of this technique to reduce dental anxiety in children. ...
... One of the anxiolytic acupoints selected in the present study was the extra one acupoint or the Yin Tang point, located midway between the medial ends of the two eyebrows, documented to induce sedation and change sympatoparasympathetic nerve balance. 28,30,31,44 Another anxiolytic point selected was the Shen Men, located on the ear situated at the apex of the triangular fossa, which was documented to induce relaxation 20,23,32,39,41,43 (Figures 1 and 2). ...
... 28 Two anxiolytic points were selected in the present study, extra one point (the Ying Tang) and auricular point (Shen Men); the extra one point was selected, due to its reported ability to reduce anxiety. 2,10,16,22,23 An auricular point (Shen Men) was also selected, due to a proven fact that auriculotherapy works on the principle of reflexology; the somatotopic map pattern of external ear matching the image of an inverted fetus in the womb. 27 According to Nogier's theory, auriculotherapy works on a microsystem basis, with the ear serving as a self-contained microsystem that can affect corresponding areas of the whole body. ...
PURPOSE: Acupressure is a non-invasive variant of acupuncture and is known to reduce general anxiety. The purpose of this study was to test acupressure's effect on children's dental anxiety.
METHODS: Eight- to 12-year-old children undergoing scaling and/or restorative procedures were randomly assigned to one of the following groups: acupressure (Group 1); sham (Group 2); or control (Group 3). Anxiety was recorded for all the children using the Modified Child Dental Anxiety scale (MCDAS). Acupressure beads with a piece of adhesive strip were employed over the selected acupoints for groups one and two. Anxiety was further recorded for all the children prior to and after completion of the treatment using MCDAS. The Frankl scale was used as the objective measure to assess the behavior of all the children. A physiologic parameter (pulse rate) was also recorded. The scores obtained from all the three groups were tabulated, compared, and analyzed statistically.
RESULTS: A significant difference was found in MCDAS, pulse rate, and the Frankl behavior ratings among the three groups of children, with acupressure group displaying a lower level of anxiety.
CONCLUSION: Acupressure can be a viable alternative to reduce dental anxiety in children undergoing scaling and restorative procedures.
... For the Chinese language databases, a separate flow diagram shows how 68 potential studies were identified, see Appendix C. After removal of duplicates and application of inclusion criteria, 13 full-text publications were assessed as potentially eligible: seven English language [9][10][11][12][13][14][15], four Chinese language [16][17][18][19], one German language [20], and one Portuguese language [21]. A final decision on inclusion/exclusion was agreed upon by two reviewers, resulting in six studies included in this review: Elbay et al. [9], Karst et al. [10], Michalek-Sauberer et al. [11], Lu et al. [12], Liang [19], and Bremenkamp et al. [20]. ...
... After removal of duplicates and application of inclusion criteria, 13 full-text publications were assessed as potentially eligible: seven English language [9][10][11][12][13][14][15], four Chinese language [16][17][18][19], one German language [20], and one Portuguese language [21]. A final decision on inclusion/exclusion was agreed upon by two reviewers, resulting in six studies included in this review: Elbay et al. [9], Karst et al. [10], Michalek-Sauberer et al. [11], Lu et al. [12], Liang [19], and Bremenkamp et al. [20]. Appendix D provides an explanation of why a number of English and Portuguese language studies were excluded from this review at the final full-text article screening stage. ...
... The studies of Karst et al. [10] and Michalek-Sauberer et al. [11] were associated with moderate-to-high and high methodological quality, respectively. Comments on details of risks of bias in all studies included in this review can be found in Appendix E. ...
Introduction: Dental anxiety affects an estimated 4% to 30% of the adult population in countries world-wide. The objective of this study was to conduct the first systematic review and meta-analysis of randomised controlled trials of acupuncture to reduce anxiety in dental patients. Methods: Online databases (OVID/AMED, Cochrane Library, CINAHL, OVID/Medline, EMBASE, PROSPERO, PsycINFO, PubMED, as well as databases in Chinese, Portuguese, Spanish and German) were searched up to July 2017 for eligible trials involving dental patients receiving an acupuncture intervention with measured anxiety scores. Comparators were placebo, usual care, or another dental anxiety intervention. Included studies were assessed using the Cochrane Risk of Bias Tool. Results: From 129 trials identified as potentially eligible, six trials with 800 patients were included in this review. Two trials (combined n = 249) were rated as moderate-to-high or high quality, both used auricular acupuncture, and were the only two trials to report continuous post-intervention anxiety scores, both using the (80-point) State-Trait Anxiety Inventory (STAI). A meta-analysis comparing acupuncture with no-intervention controls found a statistically significant and clinically relevant reduction in anxiety of −8.43, 95% CI (−11.90, −5.00). A meta-analysis comparing acupuncture to placebo/sham acupuncture found a clinically irrelevant and non-significant reduction of −1.54, 95% CI (−4.73, 1.64), a contrast that might be explained by context effects. Conclusions: There is limited evidence from two good quality trials that auricular acupuncture can achieve a significant and clinically meaningful reduction of anxiety in dental patients. There is no conclusive effect of acupuncture when compared with a sham/placebo control.
... Eight trials concerned body acupuncture [9,18e24], four trials, auricular acupuncture [25e28] and one electroacupuncture [16]. Regarding auricular acupuncture, Karst [25] and Michalek-Sauberer [27], used the same 3 acupoints (relaxation, tranquilizer and master cerebral), Shayestehfar [28] used 2 acupoints (relaxation and shenmen) but Klausenitz [26] used more points, namely, lung, shenmen, kidney, subcortex and adrenal gland. In all cases, auricular acupuncture was effective in reducing anxiety. ...
... Of the 13 papers, two [9,27] used no intervention at all on the control group, three submitted their control group to pharmacological treatment [16,19,24], two used Sham acupuncture [18,22], two used a waiting list control group [21,28] and three [20,23,26] submitted their control groups to the same situational environment, with Bussell [20] being quite thorough having control patients' acupoints swabbed with alcohol and ensuring the same level of physical and verbal contact. One study used two control groups: a no intervention control group, and a placebo group [25]. A sum of different control groups or waiting list control group may be the most ethical and adequate option, as well as having different control groups if this option is available for the research team. ...
... It would be interesting to expand the study to a larger group of patients and most importantly, to use the same acupuncture points for all patients to validate these results. Three other studies [18,25,28] complemented their results with the measurement of physiological parameters. Karst et al. [25] used heart rate and oxygen saturation measurements, Acar et al. [18] used a bispectral index electrode and Shayestehfar et al. [28] heart rate and skin conductance. ...
Anxiety disorders are one of the most common mental health concerns with a major contribution to the global burden of disease. When not treated, anxiety can be aggravated to more serious and complicated health problems. Pharmacology and psychotherapy stand for the conventional treatment for anxiety disorders but these present limited efficacy, especially in the case of chronic anxiety, with high relapse rates and often causing adverse side effects. Clinical research studies render acupuncture as a valid treatment therapy for anxiety disorders without significant adverse effects.
The objective of this paper is to review the literature on the effectiveness of acupuncture and electroacupuncture for the treatment of patients with anxiety disorders in order to find strong scientific evidence for its regular practice in Western culture.
The systematic review of the clinical research was focused on published clinical trials (controlled, randomized and non-randomized) regarding the treatment of anxiety with acupuncture. Only clinical trials where anxiety was treated as the therapeutic target, and not as a secondary measurement or being associated with other health condition or disease, were considered. Two authors extracted the data independently and exclusion and inclusion criteria were set. The search rendered 1135 papers addressing anxiety as a primary therapeutic target. After review, 13 papers were identified to match exclusion and inclusion criteria and were selected for this analysis. Methodology, design, and quality of the research were highly variable and are discussed and compared.
Overall, there is good scientific evidence encouraging acupuncture therapy to treat anxiety disorders as it yields effective outcomes, with fewer side effects than conventional treatment. More research in this area is however needed.
... (2)(3)(4)(5) Although interscalene block is the gold standard for postoperative pain management following shoulder surgery, the duration of the block only covers the initial rehabilitation period, and in most cases, patients require the use of opioids. (6) Auriculotherapy is a non-invasive, complementary technique that has been studied in several surgical models, including tooth extraction, (7,8) hip arthroplasty, (9) gynecologic procedures, (10,11) and depression. (7,12) All recent reviews have concluded that additional evidence is required to determine the role that such a technique may play in perioperative pain management because there is still a limited number of randomized, placebo-controlled studies (13)(14)(15)(16) on its use. ...
... (6) Auriculotherapy is a non-invasive, complementary technique that has been studied in several surgical models, including tooth extraction, (7,8) hip arthroplasty, (9) gynecologic procedures, (10,11) and depression. (7,12) All recent reviews have concluded that additional evidence is required to determine the role that such a technique may play in perioperative pain management because there is still a limited number of randomized, placebo-controlled studies (13)(14)(15)(16) on its use. Furthermore, several techniques are reported to interact with the ear points included in the proposed treatment, including needles (17) , , lasers (18) , magnetic sticking (10) , and electrostimulation (19) . ...
Background
In the context of the current opioid crisis, there is a growing interest in evaluating non-pharmacological solutions to manage post-operative pain. Evidence supports the concept that auriculotherapy may provide significant analgesia
Objective
Investigating the efficacy of cryo-auriculotherapy to reduce postoperative opioid consumption following a rotator cuff surgery.
Settings
Academic medical center, USA
Methods
This trial was registered to Clinicaltrials.gov ( NCT03860259 ). A total of 39 subjects undergoing rotator cuff surgery and randomized to receive either an active cryo-auriculotherapy treatment (Auriculotherapy; n=20) or a placebo treatment (placebo; n=19) were included in the analysis. For each cryo-auriculotherapy subject, the treatment was performed in the recovery room. The primary endpoint was overall opioid consumption (oral morphine equivalent = OME). Secondary endpoints included pain and overall non-narcotic analgesic consumption on postoperative day 5, patient satisfaction and function recovery using the 12-Item Short Form Health Survey (SF-12), time to discharge from the recovery room and the hospital and patient satisfaction, as well as the number of subjects from each group readmitted because of pain-related issues.
Results
The use of cryo-auriculotherapy was associated with a 35% decrease in total opioid requirement over the first five-day recovery period and a 15% decrease in pain with movement. Pain with movement in the auriculotherapy group remained lower compared to the placebo group for at least 14 days (4.47 ± 2.12 vs 5.84 ± 2.39, respectively; p=0.0394).
Conclusions
Our data suggests that cryo-auriculotherapy represents an alternative to opioids in patients undergoing rotator-cuff surgery.
... A number of studies have shown that acupuncture has a positive effect on situational anxiety related to operations, dental treatment, and examinations [9][10][11][12]. There are also several reviews and meta-analyses that have shown that acupuncture has positive effects on state anxiety [13,14]. ...
... Anxiety is a core manifestation of anxiety disorder, which is characterized by persistent fear and despair, and is accompanied by the development of physical symptoms such as tachycardia, tension, pain, and inability to relax. Several reviews and meta-analyses have proven the positive effect of acupuncture on reducing state anxiety [8][9][10][11]. To our knowledge, there have been no other meta-analyses of RCTs conducted concerning the effectiveness of acupuncture on anxiety disorder. Our metaanalysis of 20 RCTs showed the effects of acupuncture on reducing anxious symptoms in patients with anxiety disorder. ...
Background
A number of studies have shown the positive effects of acupuncture on state anxiety. However, the efficacy of acupuncture in treating anxiety disorder remains unclear. This review and meta-analysis aimed to explore whether acupuncture has a positive effect on anxiety disorder.
Methods
Randomised controlled trials (RCTs) published in English and Chinese were found through various electronic databases, including PubMed, Scopus, the Cochrane Central Register of Controlled Trials, Embase, and the Chinese databases WanFang data, VIP Chinese Sci tech periodical database, and China National Knowledge Infrastructure. The primary outcome variable was extent of anxiety symptoms. The secondary outcomes included side effects and dropout rate. Effect sizes were pooled by random-effects modelling using Rev Man 5.3.
Results
Twenty RCTs were included in this systematic review and meta-analysis. All included studies were designed for patients with generalised anxiety disorder (GAD), and 18 studies were published in Chinese. Egger’s test showed that the asymmetry of the funnel plot in all studies was not significant ( t = − 0.34, p = 0.74). The meta-analysis of anxiety symptoms showed that acupuncture was more effective than the control condition, with a standard mean effect size of − 0.41 (95% CI − 0.50 to − 0.31; p < 0.001), and that acupuncture intervention showed good tolerance and safety in the treatment of anxiety disorder.
Conclusion
Our findings suggest that acupuncture therapy aimed at reducing anxiety in patients with GAD has certain beneficial effects compared to controls. More RCTs with high quality should be conducted to fully understand the role of acupuncture in the treatment of various types of anxiety disorder. The protocol of this review was registered at the Prospero International Prospective Register of Systematic Reviews (Registration ID: PROSPERO 2020CRD42020148536).
... Acupuncture is felt to be safe and cost effective in many disease states [9,10]. Auricular acupuncture has been studied in cocaine dependence [11], smoking cessation [12], dental anxiety [13], and PTSD [14]. It is the activity of auricular acupuncture against post-traumatic stress disorder that first prompted our interest in exploring it as a potential therapy for PNES. ...
... In addition to benefiting from a standardized treatment protocol, our study also looked to NADA specifically because anti-trauma and anxiolytic properties were reported following application during the tragedies of 9/11 in New York City and Hurricane Katrina in New Orleans [21]. As previously noted, the strong association of abuse and trauma with PNES made the exploration of auricular acupuncture's benefits in anxiety [13], trauma [14], and conversion disorders [15,16] particularly enticing. ...
Objective
The aim of this pilot study was to examine the safety and tolerability of an eight-week treatment of twice weekly auricular acupuncture as a therapeutic intervention for the treatment of psychogenic nonepileptic seizures (PNES). The secondary aim was to determine if auricular acupuncture was effective at reducing PNES event frequency. Psychogenic nonepileptic seizures are as common as multiple sclerosis and are highly resistant to intervention. Unfortunately, there is no standard of care therapy, although mental health treatment referrals are commonly made. Acupuncture is felt to be a safe and cost-effective treatment for many diseases and symptoms including mental health disorders such as posttraumatic stress disorder (PTSD), anxiety, and conversion disorders. We propose to examine auricular acupuncture as a treatment for PNES.
Methods
A single-center, 16-week trial of auricular acupuncture was designed: a four-week baseline period, followed by an eight-week active treatment period during which subjects received twice weekly auricular acupuncture, then followed by a four-week washout period. Tolerability was defined as completion of 12 of 16 treatments. Successful compliance with seizure diary was defined as > 80%, or 100 of 120 days completed. Safety profile was established and seizure count per week was also calculated.
Results
A total of 29 subjects enrolled from a consecutive sample of 73 PNES diagnoses discharging from our epilepsy unit. Twenty-two subjects entered the study with 91% completing more than 12 of 16 treatments, 91% meeting the endpoint of completing > 80% of diary entries. Adverse events were mild, and only two subjects were withdrawn due to increased PNES frequency. Although short-term in design, using one-way repeated measures analysis of variance (ANOVA), we observed a statistically significant reduction in seizure count from baseline at treatment month one, treatment month two, and at the washout period (p = 0.0083). Eleven of 12 subjects (52.3%) who received at least one treatment recorded a 50% frequency reduction. Three of 21 subjects (14%) were PNES-free at the end of the study.
Significance
Auricular acupuncture is well-tolerated in a population with PNES and exhibits similar event frequency reductions as cognitive behavioral therapy (CBT). We believe that this is the first literature report examining auricular acupuncture for the treatment of PNES.
... Two studies comparing auriculotherapy with midazolam have been performed previously 22 . However, they used needles in the auriculotherapy procedure, while we used a less invasive and probably more acceptable approach. ...
... The present study also used a sham auriculotherapy, which was not possible in the other designs. Furthermore, auriculotherapy using needles could influence the anxiety 7,21,22 . ...
Anxiety is common and still represents a barrier to appropriate professional care for patients requiring dental treatment. The aim of this study was to compare the effects of auriculotherapy and midazolam for the control of anxiety in patients submitted to third molar extractions. This was a randomized, double-blind, controlled, crossover clinical trial. Thirty healthy volunteers requiring bilateral third molar extraction received midazolam 15 mg (oral) and sham auriculotherapy during one session, and a placebo tablet (oral) and auriculotherapy during the other; the sessions were randomized. The level of anxiety was assessed through questionnaires and physical parameters (blood pressure, heart rate, and oxygen saturation (SpO2)) at three time points: baseline, on the day of surgery, and at follow-up. No significant differences between the protocols were observed for blood pressure and SpO2. Auriculotherapy induced a lower heart rate than midazolam during some periods. Auriculotherapy induced more events remembered after surgery than midazolam (P < 0.0001). More undesirable effects were observed with midazolam (P < 0.0001). However, patient preference for auriculotherapy (53.3%) was not higher than preference for midazolam (46.7%). Auriculotherapy showed an anxiolytic effect equivalent to the midazolam effect, without the undesirable effects usually attributed to the benzodiazepine. © 2018 International Association of Oral and Maxillofacial Surgeons
... 9 Auricular acupuncture (AA) is a complementary medicine technique, which has already been used to treat situational anxiety in clinical settings. [10][11][12][13] In 1987, Lewis and Litt found auricular acupressure and relaxation methods to be as effective as diazepam for premedication in 90 patients scheduled for surgery under general anaesthesia; those alternative treatments were associated with a reduced autonomous stress reaction as well as fewer side effects compared with diazepam treatment. 10 Karst et al 11 confirmed these results using the same model of situational anxiety in 67 patients scheduled for dental extraction. ...
... 19 The choice of acupuncture points was based on the methodology of our randomised controlled study of the treatment of situational (exam) anxiety in medical students, 20 21 as well as the AA patterns from previous investigations. [10][11][12][13] Before needle insertion, the skin was disinfected with alcohol swabs. Patients were instructed by the acupuncturist to stimulate the auricular needles for 3-5 min if they felt anxious. ...
Objective
Auricular acupuncture (AA) is a promising alternative treatment for situational anxiety. The aim of this pilot investigation was to test the acceptability and feasibility of AA as a treatment for preoperative anxiety (PA) in preparation for a subsequent randomised controlled trial.
Methods
AA was offered for treatment of PA to female patients who were scheduled for ambulatory gynaecological surgery. In patients who agreed, indwelling fixed needles were applied bilaterally at the points MA-IC1, MA-TF1, MA-SC, MA-AH7 and MA-T the day before surgery. Patients who declined AA but agreed to be examined constituted the control group (no intervention). State anxiety (primary outcome) was measured using the State-Trait-Anxiety Inventory (STAI) before AA (time I), the evening before surgery (time II) and immediately before surgery (time III). Anxiety was measured with a 100 mm visual analogue scale (VAS-100); heart rate, blood pressure and serum cortisol were also quantified.
Results
Data from 62 patients (32 with AA and 30 with no intervention) were analysed. Whereas preoperative anxiety was reduced after AA the evening before surgery (P<0.01), anxiety levels in the control group increased from the first to the last measurement (P<0.001). Secondary outcomes were comparable between the patients from both groups.
Conclusions
AAwas acceptable and feasible as a treatment for preoperative anxiety. The results were used for the sample size calculation of a subsequent randomised controlled clinical trial.
Trial registraion number
NCT02656966; Results.
... Segundo Karst et al. (2007), quanto à auriculoterapia, esta prática vem se mostrando bastante apropriada para o tratamento de diferentes doenças pois mostrou-se similar em eficácia, quando comparada ao efeito de Midazolam para ansiedade, antes de extração dentária em estudo randomizado com 67 pacientes. Também se mostrou positiva para ansiedade e estresse em estudantes universitários (NAKAI, 2008) e em profissionais da Enfermagem na Unidade de Terapia Intensiva de um hospital (GIAPONESI; LEÃO, 2009). ...
No decorrer da história, o advento da modernidade, associado ao aumento progressivo do estresse ocupacional, que pode ser definido como um estado emocional desagradável, pela tensão, frustração, ansiedade, exaustão emocional em função de aspectos do trabalho definidos pelos indivíduos como ameaçadores, culminou na exigência de constante adaptação do trabalhador para administração do estresse e sendo este inevitável na configuração atual, à utilização de mecanismos de enfrentamento ou alívio do mesmo, entre as quais se encontram as técnicas de relaxamento podem ser utilizadas. Este trabalho buscou conhecer as medidas de alívio e enfrentamento utilizadas para reduzir o estresse laboral e a eficácia destas técnicas. Trata-se de uma revisão integrativa da literatura, este tipo de pesquisa possibilita que os resultados apontados na revisão integrativa constituam evidências cientificas, dando suporte para tomada de decisão na prática clínica. Foram incluídos 10 artigos em português, publicados entre 1994 e 2014. Os métodos identificados foram: Atividades em Grupos, Terapia Cognitivo-Comportamental (COPING), Reki e Auriculoterapia. O método de maior prevalência foi o coping, apresentando-se em 60 % da amostra. Os métodos de Atividades em grupo, Reiki e Auriculoterapia apresentaram eficácia comprovada. Com relação à terapia Cognitivo-Comportamental a eficácia da técnica não foi mencionada em duas pesquisas, visto que as estratégias são muito subjetivas e dependem de cada indivíduo que adota, contudo nos outros trabalhos, relacionados a essa técnica, percebeu-se que a medida em si é considerada um método eficaz no alívio e enfrentamento do estresse desde que se utilizem as estratégias adequadas para cada caso. Concluiu-se dessa forma que todos os métodos se mostraram eficazes no manejo do estresse laboral e que há necessidade da realização de mais pesquisas no âmbito da saúde ocupacional e uso de medidas de alívio e enfrentamento do estresse para corroborar os achados até o momento.
... The anxiolytic effects promoted by auriculotherapy are widely known in the health area, generating little or no adverse effects [9,10]. In our study, mustard seeds were used because, in addition to being non-invasive, they are more accepted than needles for anxious patients [18]. ...
Anxiety is a psychiatric disorder that can be disabling, causing suffering. As it has a high prevalence among Brazilians, intensified by COVID-19 pandemic, safe management of its signs and symptoms should be explored, such as integrative practices. The aim of this study was to evaluate the effectiveness of a single session of auriculotherapy in the management of anxiety in young people and adults with levels of anxiety classified as moderate to high. The volunteers were randomized into 2 groups: in the Real Auriculotherapy Group, an auriculotherapy session was performed using points to control anxiety, and the Placebo Auriculotherapy Group, which received points without therapeutic values for anxiety (lumbar spine line). Anxiety levels were classified using the Visual Analogue Scale (VAS) and State-Trait Anxiety Inventory (STAI), which were collected at the initial (before the session) and late (after 4 days) moments of the study. The volunteers also had their energy measured by the Ryodoraku method at the beginning, final (after the session) and late of the study. Both real and placebo therapy were able to reduce VAS and STAI anxiety scores comparing early and late times. All volunteers started the study with an average of general energy in deficiency, which still had a reduction in the final and late moments. The Ryodoraku measures showed a regulation of energy especially in the meridians related to the therapy chosen for each group, and in the Real Group the meridian in question was the Small Intestine, and in the Placebo was the Bladder meridian (related to the points on the lumbar line). The present study demonstrated that a single session of auriculotherapy was able to reduce anxiety in young and adult volunteers in both groups, and there was a change in the energy profile in the real and placebo groups.
... In the dental field, a study on adult populations reported a reduction in anxiety after acupuncture; another study proved this procedure to be as in effect as intranasal midazolam in decreasing anxiety in dental patients. 2,3 The constant need to incorporate alternative techniques into clinical dental practice led to the introduction of acupuncture, which is apart of ancient Chinese medicine. The technique is created upon the conception of Qi (whose pronunciation is "chee" meaning "life force, energy flow"), which states that most of the physical and emotional issues begin at a level of functions that is subtler than the chemistry of the brain and organ function. ...
... Fear and anxiety in Dental Practice: A ReviewSMA Sadat et al.Auricular acupuncture for treating chronic and acute anxiety has shown promising results.47,48 A randomized controlled trial which compared auricular acupuncture with intranasal midazolam for managing dental anxiety found that both treatment methods showed similar results.49 ...
Fear is expressed as an unpleasant emotion caused by threat of danger, pain and harm. Anxiety is an emotional state of a person such as doubt, mental-conflict, and disappointment. Phobia is persistent, unrealistic and intense fear of a specific stimulus, leading to absolute avoidance of the perceived danger. Corah’s Dental Anxiety Scale (CDAS), Modified Dental Anxiety Scale (MDAS), and Dental Fear Survey (DFS) are the tools to assess fear and anxiety. Dental fear and anxiety can be managed by change in dental set up and office environment, improving communication skill of practitioner and trust building among patients. Other approaches like behaviour-management techniques e.g., technique of relaxation, attention distraction, hypnotherapy, positive reinforcement, systematic desensitization and pharmacological management e.g., general anaesthesia and conscious sedation are also used to prevent and treat dental fear and anxiety in dental practice. J Bangladesh Coll Phys Surg 2022; 40: 292-298
... Auricular acupuncture has also been suggested for treating severe gag reflex. It can be postulated that stimulation of the auricular acupuncture point may inhibit the muscular activity, thus reducing the gag reflex [29] . ...
Acupuncture is a traditional Chinese method (TCM), in which disease is treated by inserting needles at various points on the body referred to as the 'acupuncture points'. The most common use of acupuncture is in pain management, for which a number of studies have shown effective results, particularly in the treatment of musculoskeletal pain. It is intended that acupuncture may play a promising role in certain dental conditions like temporomandibular joint disorder, decreasing the level of anxiety, facial pain and reducing gag reflex. Studies have shown the use of laser therapy at points of acupuncture as an alternative to metal needles. Laser acupuncture is now by far the third most popular method for treating pain in the world. The current manuscript reviews the existing literature regarding the effects of laser acupuncture in dentistry, seeking treatment modalities in which this technique is used and which are able to generate positive clinical results. It is concluded that laser acupuncture could supplement conventional treatment modalities in the future.
... Therefore, we reran the primary outcome in this meta-analysis using the Inverse Variance Heterogeneity model with WMD (8), and also re-evaluated the results and conclusions according to the MCID in a clinical context. Finally, a clinically significant difference was detected in the reanalysis outcomes according to the pooled analysis of 9 included studies (4,6,(13)(14)(15)(16)(17)(18)(19)) (see Figure 1B). All included studies reported preoperative anxiety scores by STAI (total N = 711; AS group: n = 378; control group: n = 333). ...
... A utilização das PICS foi essencial em todo processo, sendo utilizada, dentre as práticas ampliadas e autorizadas pelo SUS, a musicoterapia, a meditação, o reiki e auriculoterapia, sendo esta última prática integrante da medicina tradicional chinesa.11,[18][19][20] Alguns estudos apontam para a efetividade na utilização das PICS em situações diversas ligadas ao tratamento odontológico, incluindo redução da ansiedade, estresse, analgesia e redução da pressão arterial; tendo inclusive resultados equiparados ao uso do midazolam intranasal na redução da ansiedade.[21][22][23] No entanto, a adoção das PICS como mecanismo auxiliar nos processos de cuidado ainda enfrenta obstáculos significativos, não somente em relação às questões ideológicas, mas envolvendo questões científicas e técnicas. ...
A percepção do cirurgião-dentista na Atenção Primária à Saúde acerca do cuidado integral do usuário perpassa pela compreensão da importância da atuação em equipe junto ao conceito da clínica ampliada e compartilhada. Dentre as possibilidades de atuação na perspectiva da interconsulta, as Práticas Integrativas e Complementares em Saúde compõem a diversidade de nuances do cuidar ofertadas pelo Sistema Único de Saúde. O objetivo deste trabalho é relatar a experiência exitosa da utilização dessas práticas durante o atendimento odontológico realizado de forma multiprofissional e interdisciplinar em uma Unidade de Saúde da Família – USF de Camaçari/Bahia. Esse relato foi construído a partir do processo de reflexão diante da vivência de condução multiprofissional de atendimento e procedimento odontológico utilizando-se de musicoterapia, reiki, auriculoterapia e meditação em interconsulta, que favoreceu a mudança comportamental da usuária, reduzindo seus níveis de medo e angústia ao ambiente do consultório, além de proporcionar um procedimento rápido e tranquilo. A aplicação dessas práticas durante os atendimentos odontológicos ainda é pouco difundida. Torna-se fundamental a ampliação do campo científico acerca do tema, incluindo o relato de profissionais quanto aos resultados obtidos em sua aplicação, possibilitando a construção de novos conceitos e técnicas, melhorando o cuidado e a assistência ao usuário.
... There were 54 trials (total of 5,160 patients) having more than three arms. In 18 of those [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69], one or more additional arms were disregarded (a total of 796 patients) in order to calculate the PCE for groups that had comparable interventions. In the remaining 36 trials with more than three arms, all arms were relevant and therefore included which left a total number of 16,655 patients for the meta-analysis. ...
Background
Contextual effects (i.e., placebo response ) refer to all health changes resulting from administering an apparently inactive treatment. In a randomized clinical trial (RCT), the overall treatment effect (i.e., the post-treatment effect in the intervention group) can be regarded as the true effect of the intervention plus the impact of contextual effects. This meta-research was conducted to examine the average proportion of the overall treatment effect attributable to contextual effects in RCTs across clinical conditions and treatments and explore whether it varies with trial contextual factors.
Methods
Data was extracted from trials included in the main meta-analysis from the latest update of the Cochrane review on “ Placebo interventions for all clinical conditions” (searched from 1966 to March 2008). Only RCTs reported in English having an experimental intervention group, a placebo comparator group, and a no-treatment control group were eligible.
Results
In total, 186 trials (16,655 patients) were included. On average, 54% (0.54, 95%CI 0.46 to 0.64) of the overall treatment effect was attributable to contextual effects. The contextual effects were higher for trials with blinded outcome assessor and concealed allocation. The contextual effects appeared to increase proportional to the placebo effect, lower mean age, and proportion of females.
Conclusion
Approximately half of the overall treatment effect in RCTs seems attributable to contextual effects rather than to the specific effect of treatments. As the study did not include all important contextual factors (e.g., patient-provider interaction), the true proportion of contextual effects could differ from the study’s results. However, contextual effects should be considered when assessing treatment effects in clinical practice.
Trial registration
PROSPERO CRD42019130257 . Registered on April 19, 2019.
... Acupuncture treats various conditions or disorders by stimulating specific points on the body including points on the ear [20]. AA has proven to be a convenient method of treatment that is particularly effective for pain and anxiety [21][22][23]. ...
Objective: The aim of this study was to pilot test an integrated treatment approach, including mindful yoga and auricular acupuncture, for Veterans with overlapping mental health disorders and persistent pain. Design: A single-arm, quasi-experimental study with a 12-week intervention period. Methods: Veterans were referred to the program through their established mental health provider, which was marketed as a trauma sensitive mindful yoga program with optional auricular acupuncture for Veterans currently undergoing mental health treatment. The program consisted of 12 weekly 90-minute group yoga sessions that included mindful breathing, mindful movement, and guided relaxation. Auricular acupuncture was also offered but not required prior to each yoga session, where five acupuncture points were targeted for relaxation and stress relief. Stress, pain, and anxiety were assessed pre and post intervention using the Perceived Stress Scale, the PEG scale, and the Generalized Anxiety Disorder-7 Scale. Results: Out of fifty-five Veterans entering the program with a mental health diagnosis, twenty-seven Veterans completed the 12-week Mindful Yoga program. For those that completed the program, the average attendance was 9.5 out of 12 sessions. Means scores show improvement in perceived stress, pain, and anxiety compared with baseline scores. Statistically significant improvements were noted in both perceived stress (P = 0.0007) and anxiety (P = 0.0093). Conclusions: This study suggests that combining mindful yoga with auricular acupuncture can reduce symptoms of stress, pain, and anxiety in Veterans that commit to the program. Although this was a small sample, mean scores showed statistically significant improvements in perceived stress and anxiety and modest improvements in pain, warranting further study.
... It is widely used in insomnia, obesity, acute and chronic pain, and other diseases. [11][12][13][14][15] Previous studies have shown that EAP is also effective and safe for AR. [16] But there is not enough evidence to prove this. ...
Background:
Allergic rhinitis is a global problem. About 10% to 40% of the global population is affected by allergic rhinitis and is on the rise, which has a significant health and economic impact on society. Ear acupuncture is a non-invasive acupuncture therapy, which has been used in the treatment of allergic rhinitis, and some positive results have been reported, but there is not enough evidence to prove its efficacy and safety.
Methods:
This is a single-center, randomized, single-blind, sham-controlled trial. With the approval of the ethics committee of our hospital, participants with allergic rhinitis will be randomly assigned to receive either real or sham ear acupuncture once a week for 8 weeks, followed by 12 weeks of follow-up. Evaluate the patient's nasal symptom score and Standardised Rhinoconjunctivitis Quality of Life Questionnaire score, and monitor adverse events. Finally, the data are analyzed by SPSS 22.0 software.
Discussion:
The results of this study will determine the efficacy and safety of ear acupuncture in the treatment of allergic rhinitis and provide a basis for promoting the application of ear acupuncture in the treatment of allergic rhinitis.
Trial registration:
OSF Registration number: DOI 10.17605/OSF.IO/MVEF7.
... In the dental field, a study on adult populations reported a reduction in anxiety after acupuncture; another study proved this procedure to be as in effect as intranasal midazolam in decreasing anxiety in dental patients. 2,3 The constant need to incorporate alternative techniques into clinical dental practice led to the introduction of acupuncture, which is apart of ancient Chinese medicine. The technique is created upon the conception of Qi (whose pronunciation is "chee" meaning "life force, energy flow"), which states that most of the physical and emotional issues begin at a level of function that is subtler than the chemistry of the brain and organ function. ...
... Also, in the TAS group, the mean of state anxiety after intervention decreased significantly when compared to the score before the study, while in the control group state anxiety increased when compared to the values before study; this difference was not significant, which could be due to an increase in the anxiety immediately before the invasive procedure. As shown in the study by Karst et al., after acupuncture of the ear about 30 minutes before dental surgery, in the control group anxiety was evident from 53.03 to 56.5 immediately Groups Groups before surgery (35). Also, in Hashemi's study, before cardiac catheterization, 66% of patients in the control group had severe anxiety, whose anxiety levels reached 84% one hour after the intervention and immediately before the procedure (36). ...
Women experience a high level of anxiety and negative emotional responses during colposcopy, which results in women's' unwillingness to return for follow-up. Transcutaneous auricular stimulation may be useful in reducing anxiety. Therefore, the aim of this study was to determine the effect of transcutaneous auricular stimulation on anxiety before colposcopy. This randomized controlled clinical trial study was performed on 65 female candidates for colposcopy who were referred to Ghaem Hospital, Mashhad, Iran, in 2017. Women were randomized into one of the two groups. In the intervention group, a pointer Excel device was used for forty minutes before colposcopy; electrical stimulation at 4 points (Shenmen, relaxation, tranquillizer and endocrine) was performed on ears, with the frequency of 2 Hz for 30 seconds at each point. Women received routine care in the control group. The anxiety level was assessed by Spielberger Questionnaire before intervention and also 40 minutes after intervention. Data analysis was performed using the t-test, paired t-test, and MannWhitney test in SPSS software, version16. P value less than 0.05 was considered significant. After intervention, the state anxiety score was 43.9 ± 9.19 in the control group and 54.3 ± 9.07 in the intervention group, and the difference between the two groups was statistically significant (P = 0.00), while there was no significant difference in the level of trait anxiety in the two groups (P = 0.21). Regarding the reduction of state anxiety level after intervention, transcutaneous auricular stimulation is recommended as a suitable method to reduce anxiety of patients who are candidates for colposcopy.
... That the side-effects seen in the pharmacological treatment group were not seen in the ACU group was emphasised as a positive aspect. The effects of ACU on anxiety were investigated by observing changes in the parameters of oxygen saturation and heart rate by Karst et al. (26) and in heart rate and skin conductivity by Shayestehfar et al. (27) . As ACU reduced heart rate in both groups, it was concluded to be effective on anxiety. ...
Objective:
To investigate the effect of acupuncture on reducing pain and anxiety related to hysterosalpingography (HSG).
Materials and methods:
A total of 107 patients planned to undergo HSG were randomly separated into 3 groups; the acupuncture group (n=36), intramuscular diclofenac sodium group (n=35), and control group (n=37). In the acupuncture group, electro-acupuncture was applied to specified points for 20 mins before the procedure. In the intramuscular diclofenac sodium group, an intramuscular injection of 75 mg diclofenac sodium was applied 30 mins before the procedure. No analgesics were administered to the patients in the control group before intervention. Pain was evaluated with a Visual Analog scale (VAS) and anxiety with the State-trait Anxiety inventory -state (STAI-S), preoperatively and at specified times postoperatively.
Results:
The VAS scores at 1 and 5 minutes after HSG were similar in acupuncture group and intramuscular diclofenac sodium group, and significantly lower than in the control group. At 30 mins postoperatively, there was no significant difference between the 3 groups in respect of the VAS scores. The STAI-S scores at 1 hour preoperatively were similar in all the groups (p=0.563). In the comparisons of the STAI-S values at preoperative 5 mins, following acupuncture in acupuncture group and the diclofenac injection in intramuscular diclofenac sodium group, and at postoperative 30 mins, the acupuncture group values were determined to be statistically significantly lower than those of the other groups (p<0.001, p<0.001).
Conclusion:
Acupuncture has similar effects on the reduction of pain as other analgesics and reduces anxiety. It can therefore be used in HSG in suitable clinics.
... Controlled trials have shown that ear acupuncture is as effective as intranasal midazolam in reducing dental anxiety [14] and that acupuncture is more effective than placebo in the prevention of postoperative dental pain [15] and in reducing the gagging reflex. [2] The ear sites have the advantage that they lie out of the area of work, and are unaffected by local anesthesia used for treatment. ...
... While the use of some CAM in dentistry is supported by clinical evidence in safety and/or efficacy, [13][14][15][16] research is lacking for most, as there are limited randomised controlled trials. 10 Adverse effects, such as potential drug interactions and overdose, are possible for many CAM interventions. ...
Objectives
While Complementary and alternative medicines (CAM) are used by more than half of Australians, their role in dentistry is rarely covered in the curricula of Australian dental schools. This study aimed to investigate dental students’ knowledge of and attitudes towards CAM therapies.
Design
Australian dental students in the final two years of their study were invited to undertake a survey. These questions consisted of five clinically relevant case vignettes, for which there was only one correct answer amongst four possible options and seven self-reported perspective-based questions. Results were analysed using descriptive statistics.
Results
Of the 185 students that participated, the mean correct response rate for the five clinical scenarios was 3.46 ± 0.95 (range: 0–5 out of 5). Of 185 students, 157 (85 %) answered more than half of the questions correctly. All five questions were answered correctly by 19 (10 %) students. Most (74 %) students self-reported to have little to no knowledge. More than two-thirds of dental students reported an interest in and belief in the effectiveness of CAM. A similar proportion expressed a desire for the integration of CAM content into their undergraduate curriculum.
Conclusions
Despite approximately three out of four of dental students in this study having little to no knowledge on CAM, attitudes towards CAM therapies, and the need to integrate them into the dental curriculum, were generally positive. Future research into identifying specific knowledge gaps could help to redesign improved dental curricula.
... A randomized controlled trial has shown that auricular acupuncture was no different than intranasal midazolam and was superior to no intervention for reducing dental anxiety. 5 BFA has also been shown to reduce sore-throat pain for 24 hours and decrease the use of pain medication for up to 48 hours in a randomized controlled trial. 6 CONCLUSIONS BFA is a safe and effective treatment option for rapid pain reduction. ...
Background:Botulinum toxin type A injection is a common and safe procedure used for the treatment of overactive muscles through local injection. This toxin inhibits the release of acetylcholine in the neuromuscular junction. The benefits usually last only 3-6 months; thus, repeated injections are often required. The procedure, however, can be difficult if a patient's spasticity and pain prevents access to the muscles for injection or if a patient is anxious. Battlefield Acupuncture (BFA), a technique developed by Richard C. Niemtzow, MD, PhD, MPH, in 2001, is a form of auricular acupuncture using a very specific sequence of gold Aiguille semipermanente needles inserted into the ear. BFA can be very effective for reducing pain quickly, with few potential side-effects. Cases: BFA was performed prior to Botulinum toxin A injections on 2 patients who had either pain limitations or anxiety limitations during prior Botulinum toxin A injections. Case 1 was a 70-year-old male veteran with painful, right upper-extremity spasticity with hand contractures. Case 2 was a 69-year-old male veteran with spasticity who had anxiety related to his fear of needles. Results: Application of BFA prior to Botulinum toxin A injections enabled the 2 patients who either had pain limitations or anxiety limitations to tolerate the toxin injections much better. Conclusions: BFA is a safe and effective treatment option for rapid pain reduction, enabling Botulinum toxin A to be administered more easily to patients who have had pain or anxiety during prior injections.
... However, the tip of the needle was bent so as to cause a pricking sensation mimicking real acupuncture without actually puncturing the skin. 22 All IA and sham IA treatments were performed by doctors of Korean medicine who have been certified by the Korean Ministry of Health and Welfare, had at least 3 years of clinical experience, and had received more than 6 years of college education in Korean medicine. ...
Purpose:
Ninety percent of patients with advanced cancer have moderate to severe pain, and up to 70% of patients with cancer pain do not receive adequate pain relief. This randomized controlled clinical trial was designed to determine the feasibility and evaluate the effects and safety of intradermal acupuncture (IA) in patients who were being administered analgesics for cancer pain.
Methods:
Advanced cancer patients experiencing pain were randomly assigned to IA or sham IA treatment for 3 weeks (15 patients for each group), wherein the CV12, bilateral ST25, LI4, LR3, PC06, and Ashi points were selected and stimulated. Follow-up evaluations were conducted 3 weeks after the end of treatments. The grade and dosage of analgesics for cancer pain, pain intensity, quality of life, and safety were assessed.
Results:
Twenty-seven patients (90%) completed 6-week trial, and no serious adverse events were associated with either IA or sham IA procedures except the transient side effect such as fatigue. Nine patients in the IA group (64.3%) and 5 in the sham IA group (38.5%) responded to the 3-week intervention. These patients were mostly in the nonopioid and the weak opioid levels of the World Health Organization analgesic ladder. Self-reported pain declined by -1.54 ± 1.45 and -1.15 ± 1.57 in the IA and sham IA groups, respectively, with improved quality of life reported.
Conclusions:
IA treatment appears feasible and safe for advanced cancer patients. It might reduce analgesic usage in the early World Health Organization analgesic ladder stage cancer patient, though it could not show significant outcome differences due to design limitation of sham IA.
... State Anxiety Inventory (SAI) merupakan kuesioner dengan metode evaluasi diri (self reporting instrument) yang dikemukakan oleh Spielberger dkk yang telah banyak dipergunakan dalam kasus terkait ansietas pada beberapa penelitian di dunia (Karst, 2007). Kuesioner SAI ini terdiri dari 20 pertanyaan yang berkenaan dengan kondisi atau perasaan pasien terhadap reaksi stres akut yang dialami pasien saat menghadapi suatu stressor tertentu (Spielberger, 1970). ...
Background: Students final assignment is a scientific work requires precision, time consuming, energy as well as concentrations. Students may experience stress within the process of completing the final assignment, which can lead to variety of disorder; physical, emotional, intellectual and interpersonal. Purpose: The aim of this study was to determine the state anxiety inventory scores among final students with scientific project. Those score were then being used as preliminary data to decide the next step of the study which are giving acupuncture therapies to those students with high score of anxiety. Methods: This was a descriptive study with one shot/cross sectional study, using questionnaires distributed to respondents for data completion. Respondents were 100 students from Faculty of Vocational Education Universitas Airlangga who were taking the final assignment subject. Results: The results of State Anxiety Inventory Score were obtained as average score of 53.03 with standard deviation of 10.4. Conclusion: The mean values showed a reasonably anxious outcome.
... The acupuncture point PC6 Neiguan, located on the palmer side of the forearm -two inches above the transverse crease of the wrist, belongs to the pericardium meridian, which has the effect of "calming the heart which houses the spirit". It was proposed that acupuncture may trigger an increase in circulating β-Endorphine, which binds to the opioid receptor, creating an anti-emetic effect [33]. More studies to verify the effectiveness of acupuncture in controlling gag reflex should be carried out. ...
Acupuncture is a technique which has originated in China, in which different
health issues are treated by inserting specially designed needles at various
points on the body - acupuncture points. Acupuncture stimulates the nervous
system and alters the perception and processing of pain signals and also
releases natural painkillers. These painkillers (endorphins and serotonin) are
present in the nervous system. These points serve as a tunnel to deeper
circulating channels and stimulation of these points activates the body’s
natural healing ability. The most common use of acupuncture is in the
management of pain, for which a number of studies have shown it to be
effective, particularly in the treatment of temporomandibular pain. It is
intended that acupuncture may play a promising role in certain dental
conditions like temporomandibular joint (TMJ) dysfunction, facial pain,
decreasing the level of anxiety and reducing gag reflex. Aim of this article was
to review acupuncture techniques and related articles in the literature that
have focused on its applications in preventing gag reflex and TMJ pain
... But not all of the often recommended CAM remedies are evidencebased. While some naturopathic remedies and ear acupuncture are supported by scientific evidence, [59][60][61][62] there are no studies for osteopathic medicine with a medium or high degree of evidence in dentistry. ...
Objectives
The aims of this study were to analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM.
Design
A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n = 250, 55% male, 45% female; mean age 49.1 ± 11.4 years).
Results
Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), but also relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher (p < 0.0001) by CAM proponents than opponents. However also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove. For ear acupuncture these scores did not significantly differ between both groups. With respect to the characteristic of the proponents, the majority of CAM endorsing dentists were women. The mean age (50.4 ± 0.9 vs 47.0 ± 0.9 years) and number of years of professional experience (24.2 ± 1.0 vs 20.0 ± 1.0 years) were significantly higher for CAM proponents than the means for opponents (p < 0.0001 respectively). CAM proponents worked significantly less (p < 0.0001) and their perceived workload was significantly lower (p = 0.008). Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher (p ≤ 0.01 and p < 0.0001) compared to dentists who abandoned these treatment options. The logistic regression model showed (exploratively) an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women.
Conclusion
Various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.
Background
The number of randomized controlled trials using auricular stimulation (AS) such as transauricular vagus nerve stimulation, or other auricular electrostimulation or auricular acupuncture or acupressure, in experimental and clinical settings, has increased markedly over the last three decades. This systematic review focusses on cardiovascular effects of auricular stimulation.
Methods and analysis
The following databases were searched: MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science, and Scopus Database. RCTs were reviewed that had been published in English and European languages. Data collection and analysis was conducted by two reviewers independently. Quality and risk assessment of included studies was performed and the meta-analysis of the effect of the most frequently assessed biomarkers.
Results
Altogether, 78 trials were included. 38 studies assessed heart rate (HR), 19 studies analyzed heart rate variability (HRV), 31 studies analyzed blood pressure (BP) and 7 studies were identified that measured oxygen saturation (O2), 2 studies on baroreflex sensitivity and 2 studies on skin conductance were evaluated in this review. 26 studies contained continuous data and were eligible for meta-analysis, 50 trials reported non continuous data and were evaluated descriptively. The overall quality of the studies was moderate to low. AS leads to a significant reduction of HR, the changes though were not considered an adverse reaction. Furthermore, when looking at HRV, AS was able to reduce the LF/HF ratio significantly compared to control procedures. No other cardiovascular parameters (blood pressure, oxygen saturation, baroreflex sensitivity) were changed significantly. AS produced only minor side effects in all trials.
Conclusion
AS can lead to clinically safe reduction of HR and changes in the LF/HF ratio of the HRV, which is presumably via an increase in vagal activity. More research is needed to clarify whether AS can be used to modulate tachycardia or indications with autonomic imbalance.
Systematic review registration
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231885 PROSPERO, ID CRD42021231885.
Root canal treatment (RCT) employed for painful endodontic conditions like apical periodontitis and irreversible pulpitis is associated with a high incidence of postoperative pain. Pharmacological management for this purpose is effective, but not entirely free from side effects and in some cases may fail to provide adequate relief. Furthermore, concerns have been raised regarding the transmission of coronavirus disease-2019 (COVID-19) as a result of the aerosols generated and prolonged chair side time required for RCT. Acupuncture is a traditional Chinese therapy commonly employed as an alternative for the treatment of pain. And what's more, the use of acupuncture has been recently reported as treatment for the management of endodontic pain as well as on the anesthetic success in patients with irreversible pulpitis. This review aims to evaluate the current evidence for acupuncture in endodontics and its potential role in emergency pain relief and management for patients. To combat this, a thorough search for literature within the field was performed in five electronic databases. Retrieved studies were screened according to the pre-defined eligibility criteria. After both an electronic and manual search, five studies were selected for review. These studies reported the beneficial effects of acupuncture in reducing the failure of nerve block in patients with irreversible pulpitis and in controlling both intraoperative and postoperative pain following RCT. In addition, it was also reported to reduce anxiety surrounding the dental procedure and minimized the intake of analgesics after the endodontic procedure, which can result in some unwanted side effects. However, more in depth clinical research is required before any recommendation regarding the application of acupuncture in endodontic patients can be made.
Les applications de l’auriculothérapie dans le domaine de la dentisterie font l’objet de ce travail. Cette pratique est peu connue des chirurgiens-dentistes mais représente un outil d’aide intéressant dans la prise en charge des patients. Ce travail décrit d’abord l’historique de l’auriculothérapie, ainsi que ses principales indications et contre-indications. Après quelques rappels anatomiques, les bases neurophysiologiques sur lesquelles reposent cette discipline et les cartographies du pavillon de l’oreille sont abordées. La pratique concrète de l’auriculothérapie est ensuite décrite, notamment le déroulement d’une séance ainsi que les outils diagnostiques et thérapeutiques utilisés. La partie suivante étudie les différentes applications de l’auriculothérapie dans le domaine de l’odontologie : prise en charge de la douleur, de l’anxiété, de la xérostomie et de l’hyposialie, du réflexe nauséeux, du bruxisme, du trismus, des troubles de l’articulation temporo-mandibulaire et de l’addiction au tabac. Pour finir, ce travail mentionne la législation de l’auriculothérapie en France ainsi que les formations existantes.
Background:
Control interventions in randomised trials provide a frame of reference for the experimental interventions and enable estimations of causality. In the case of randomised trials assessing patients with mental health disorders, many different control interventions are used, and the choice of control intervention may have considerable impact on the estimated effects of the treatments being evaluated.
Objectives:
To assess the benefits and harms of typical control interventions in randomised trials with patients with mental health disorders. The difference in effects between control interventions translates directly to the impact a control group has on the estimated effect of an experimental intervention. We aimed primarily to assess the difference in effects between (i) wait-list versus no-treatment, (ii) usual care versus wait-list or no-treatment, and (iii) placebo interventions (all placebo interventions combined or psychological, pharmacological, and physical placebos individually) versus wait-list or no-treatment. Wait-list patients are offered the experimental intervention by the researchers after the trial has been finalised if it offers more benefits than harms, while no-treatment participants are not offered the experimental intervention by the researchers.
Search methods:
In March 2018, we searched MEDLINE, PsycInfo, Embase, CENTRAL, and seven other databases and six trials registers.
Selection criteria:
We included randomised trials assessing patients with a mental health disorder that compared wait-list, usual care, or placebo interventions with wait-list or no-treatment .
Data collection and analysis:
Titles, abstracts, and full texts were reviewed for eligibility. Review authors independently extracted data and assessed risk of bias using Cochrane's risk of bias tool. GRADE was used to assess the quality of the evidence. We contacted researchers working in the field to ask for data from additional published and unpublished trials. A pre-planned decision hierarchy was used to select one benefit and one harm outcome from each trial. For the assessment of benefits, we summarised continuous data as standardised mean differences (SMDs) and dichotomous data as risk ratios (RRs). We used risk differences (RDs) for the assessment of adverse events. We used random-effects models for all statistical analyses. We used subgroup analysis to explore potential causes for heterogeneity (e.g. type of placebo) and sensitivity analyses to explore the robustness of the primary analyses (e.g. fixed-effect model).
Main results:
We included 96 randomised trials (4200 participants), ranging from 8 to 393 participants in each trial. 83 trials (3614 participants) provided usable data. The trials included 15 different mental health disorders, the most common being anxiety (25 trials), depression (16 trials), and sleep-wake disorders (11 trials). All 96 trials were assessed as high risk of bias partly because of the inability to blind participants and personnel in trials with two control interventions. The quality of evidence was rated low to very low, mostly due to risk of bias, imprecision in estimates, and heterogeneity. Only one trial compared wait-list versus no-treatment directly but the authors were not able to provide us with any usable data on the comparison. Five trials compared usual care versus wait-list or no-treatment and found a SMD -0.33 (95% CI -0.83 to 0.16, I² = 86%, 523 participants) on benefits. The difference between all placebo interventions combined versus wait-list or no-treatment was SMD -0.37 (95% CI -0.49 to -0.25, I² = 41%, 65 trials, 2446 participants) on benefits. There was evidence of some asymmetry in the funnel plot (Egger's test P value of 0.087). Almost all the trials were small. Subgroup analysis found a moderate effect in favour of psychological placebos SMD -0.49 (95% CI -0.64 to -0.30; I² = 53%, 39 trials, 1656 participants). The effect of pharmacological placebos versus wait-list or no-treatment on benefits was SMD -0.14 (95% CI -0.39 to 0.11, 9 trials, 279 participants) and the effect of physical placebos was SMD -0.21 (95% CI -0.35 to -0.08, I² = 0%, 17 trials, 896 participants). We found large variations in effect sizes in the psychological and pharmacological placebo comparisons. For specific mental health disorders, we found significant differences in favour of all placebos for sleep-wake disorders, major depressive disorder, and anxiety disorders, but the analyses were imprecise due to sparse data. We found no significant differences in harms for any of the comparisons but the analyses suffered from sparse data. When using a fixed-effect model in a sensitivity analysis on the comparison for usual care versus wait-list and no-treatment, the results were significant with an SMD of -0.46 (95 % CI -0.64 to -0.28). We reported an alternative risk of bias model where we excluded the blinding domains seeing how issues with blinding may be seen as part of the review investigation itself. However, this did not markedly change the overall risk of bias profile as most of the trials still included one or more unclear bias domains.
Authors' conclusions:
We found marked variations in effects between placebo versus no-treatment and wait-list and between subtypes of placebo with the same comparisons. Almost all the trials were small with considerable methodological and clinical variability in factors such as mental health population, contents of the included control interventions, and outcome domains. All trials were assessed as high risk of bias and the evidence quality was low to very low. When researchers decide to use placebos or usual care control interventions in trials with people with mental health disorders it will often lead to lower estimated effects of the experimental intervention than when using wait-list or no-treatment controls. The choice of a control intervention therefore has considerable impact on how effective a mental health treatment appears to be. Methodological guideline development is needed to reach a consensus on future standards for the design and reporting of control interventions in mental health intervention research.
Die Ohrakupunktur wird häufig bei der Behandlung vegetativer und psychischer Gesundheitsstörungen eingesetzt. Auch wenn die tradierten Grundlagen vor dem Hintergrund aktueller anatomischer und neurophysiologischer Erkenntnisse in Summe nicht haltbar sind, zeigt die vorliegenden Studienlage doch deutliche Hinweise auf eine Wirksamkeit bei Angst und depressiven Störungen. In diesem Artikel werden die relevanten wissenschaftlichen Grundlagen der Ohrakupunktur rekapituliert und insbesondere ein pragmatisches Therapiekonzept zur Behandlung situativer Angst vorgestellt.
Akupunktur wird in zunehmendem Umfang an deutschen psychiatrischen Kliniken angeboten. Die Evidenz in der publizierten Literatur hat über die letzten Jahre deutlich zugenommen. Die Qualität der Studien muss sich allerdings weiterhin verbessern, um zu klaren Ergebnissen und Empfehlungen in Metaanalysen zu kommen. Insbesondere bei depressiven Erkrankungen und Traumafolgestörungen könnte Akupunktur durch seine Nebenwirkungsarmut in Zukunft einen größeren Stellenwert gewinnen. Akupunktur lässt sich in unterschiedliche Behandlungsstrategien relativ einfach integrieren. Eine große Hürde stellt allerdings die geringe Verbreitung einer ausreichenden Ausbildung bei Behandlern in psychiatrischen und psychosomatischen Kliniken dar.
Nonpharmacological complementary and integrative medical therapies comprise those acceptable healthcare approaches outside of our conventional medicine. According to the National Center for Complementary and Integrative Health at National Institute of Health, more than 30% of adults and 12% of children use nonconventional medical therapies. Many complementary and integrative medical therapies can be used in pediatric sedation which include guided imagery, acupuncture-related techniques, music therapy, hypnotherapy, and sucrose sucking in infants. These remedies are generally underutilized and can be successfully integrated in conjunction with available conventional medical treatments for pediatric sedation.
Objective: The purpose of this study was to evaluatephotobiomodulation applied at auriculotherapy points forsleep disorder (SD) and anxiety related to temporomandibulardysfunction (TMD).
Methods: The study consisted of two groups of 20 participants: Auriculotherapy group (A) and Control Group(C). The participants responded to the RDC/TMD, Fletcher & Luckett questionnaires, and the Beck Anxiety Inventory to analyze TMD, SD, and anxiety before and after the treatment.
Results: The participants presented scores corresponding to mild to moderateanxiety (MDN = 17; CI = [13.16;22.31]) and after treatment, normalor non-existent anxiety (MDN = 9; CI = [8.76; 17.12]) (p = 0.005). There was no significant difference (p > 0.05) between the controland 20 auriculotherapy groups for TMD and SD.
Discussion: The results suggest that auriculotherapy was effective in the treatment of anxiety. However, it did not prove effective with the results of the SD and symptoms of TMD.
Pain is a complex feeling with emotional driving and vegetative nerve reactions, and is one of the most common symptoms in the clinic. Pain has dual meanings to the human body. On the one hand, pain serves as a warning sign of injury, disease, and abnormality. A person with a loss of congenital pain cannot quickly respond to internal and external insults that often cause trauma, scald, or other injury. Those that have no pain or are insensitive to pain cannot respond to visceral disorders in time, which delays or misleads the diagnosis and treatment. On the other hand, persistent or severe pain brings suffering to the patient, and needs to be treated. However, many issues remain unsolved in term of pain management, e.g., analgesics-induced drug addiction. An abundance of research has shown that acupuncture or electroacupuncture can induce a good analgesic effect with little side effects. This chapter will summarize clinical and laboratory research on this topic and update recent progress.
Purpose
To evaluate the methodological quality and summarize evidence of important outcomes of systematic reviews (SRs)/Meta analyses (MAs) of acupuncture for anxiety.
Methods
We conducted a comprehensive literature search for SRs/MAs in PubMed, EMBASE, Cochrane library, Chinese Biomedical Databases (CBM), Wanfang database and China National Knowledge Infrastructure (CNKI) until November 30, 2018. Three reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence. In the pre-experiment, we used the intra-class correlation coefficient (ICC) to assess reviewer agreement, the ICC value for overall score was 0.978.
Results
Ten reviews were included. The assessment results of AMSTAR-2 showed that the methodological quality of all included studies was critically low. The lowest score were item “provide a list of excluded studies and justify the exclusions” and item “report sources of funding for the included studies”, none of studies provided information about the above two items, followed by the “providing a priori design” item with only two (20%) studies conforming to this item. For GRADE, of the 7 outcomes, high quality evidence was provided in only 1 (14.3%), moderate in 2 (28.6.7%), and low in 4 (57.1%).
Conclusion
Although most of the included reviews indicated that acupuncture group was more effective than control group in the treatment of anxiety, more importantly, the methodological quality of the included reviews and the quality of evidence were low. More high-quality evidence is needed to determine whether acupuncture is more effective than other treatments.
Dental anxiety is an acute anxiety reaction that often occurs in several individuals. Severe cases of dental anxiety may negatively affect oral health because of the avoidance of and delays in dental treatments. Medical therapy has been the first-line therapy in managing dental anxiety. However, it can cause respiratory depression and prolonged sedation. The present study aimed to identify the effects of auricular laser puncture at the depressing, tranquilizer, and master cerebral points on anxiety levels using the Spielberger State-Trait Anxiety Inventory Moreover, the effects were compared between the treatment (sham auricular laser puncture) and control groups. In the treatment group, the same procedure was performed, except for the laser pen that was turned off. Results showed that the mean score of the treatment group (15.56 ± 7.188) was higher than that of the control group (5.39 ± 3.867). Auricular laser puncture is more effective than sham laser puncture in decreasing the anxiety levels in patients with dental anxiety.
Importance
Hypnosis is now widespread in medical practice and is emerging as an alternative technique for pain management and anxiety. However, its effects on postoperative outcomes remain unclear.
Objective
To evaluate the efficacy of a preoperative hypnosis session for reducing postoperative breast pain in patients who underwent minor breast cancer surgery.
Design, Setting, and Participants
The HYPNOSEIN prospective randomized clinical trial was conducted from October 7, 2014, to April 5, 2016. In this multicenter study in France, 150 women scheduled for minor breast cancer surgery were randomized between control and hypnosis arms, and 148 (71 control and 77 hypnosis) were included in the intent-to-treat analysis.
Intervention
On the day of surgery, eligible patients were randomly assigned (1:1) to the control arm or the hypnosis arm. Patients (but not the care teams) were blinded to the arm to which they were assigned. A 15-minute hypnosis session before general anesthesia in the operating room was performed in the hypnosis arm.
Main Outcomes and Measures
The primary end point was breast pain reduction (by 2 on a visual analog scale), assessed immediately before discharge from the postanesthesia care unit (PACU). Secondary end points were nausea/vomiting, fatigue, comfort/well-being, anxiety, and PACU length of stay, assessed at different times until postoperative day 30.
Results
The median patient age was 57 years (range, 33-79 years) in the control arm and 53 years (range, 20-84 years) in the hypnosis arm. Baseline characteristics were similar in the 2 arms. The median duration of the hypnosis session was 6 minutes (range, 2-15 minutes). The use of intraoperative opioids and hypnotics was lower in the hypnosis arm. The mean (SD) breast pain score (range, 0-10) was 1.75 (1.59) in the control arm vs 2.63 (1.62) in the hypnosis arm (P = .004). At PACU discharge and with longer follow-up, no statistically significant difference in breast pain was reported. Fatigue was significantly lower in the hypnosis arm on the evening of surgery (mean [SD] score, 3.81 [2.15] in the control arm vs 2.99 [2.56] in the hypnosis arm; P = .03). The median PACU length of stay was 60 minutes (range, 20-290 minutes) in the control arm vs 46 minutes (range, 5-100 minutes) in the hypnosis arm (P = .002). Exploratory analyses according to patient perception of whether she received hypnosis showed significantly lower fatigue scores in the perceived hypnosis subgroup on the evening of surgery (mean [SD], 4.13 [2.26] for no perceived hypnosis vs 2.97 [2.42] for perceived hypnosis; P = .01). Anxiety was also significantly lower on the evening of surgery in the perceived hypnosis subgroup (mean [SD], 0.75 [1.64] for perceived hypnosis vs 1.67 [2.29] for no perceived hypnosis; P = .03).
Conclusions and Relevance
The results of this study do not support a benefit of hypnosis on postoperative breast pain in women undergoing minor breast cancer surgery. However, other outcomes seem to be improved, which needs to be confirmed by further studies.
Trial Registration
EudraCT Identifier: 2014-A00681-46 and ClinicalTrials.gov Identifier: NCT03253159
Low-level laser therapy (LLLT), nowadays also known as photobiomodulation, consists of the therapeutic use of monochromatic coherent (laser) or noncoherent (LED) light sources.
We compared the item content of three commonly used scales of psychiatric symptoms [the broad-band Psychiatric Symptom Index (Ilfeld) and two narrow-band scales, the Center for Epidemiologic Studies-Depression Scale (Radloff) and the State-Trait Anxiety Inventory (Spielberger)], with diagnostic criteria and criterion-based symptoms for Major Depressive Episode and Generalized Anxiety Disorder as they appeared in DSM-IV. The Psychiatric Symptom Index and the Center for Epidemiologic Studies-Depression Scale each measured 7 of 9 criterion-based symptoms of Major Depressive Episode. The Psychiatric Symptom Index and State-Trait Anxiety Inventory each measured 5 of 8 domains for Generalized Anxiety Disorder. The Psychiatric Symptom Index had comparable content validity to the narrow-band measures. All met a majority of DSM-IV criteria for depression and anxiety, supporting their applicability for current research.
To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders.
Systematic literature search using PubMed, PsycLit, and the Cochrane Library.
108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.
The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.
Recent studies have suggested that maternally deprived rats exhibit anxiogenic-like behavior when exposed to stress in later life. Neuropeptide Y (NPY) is involved in the regulation of various physiological functions such as the expression of anxiety. Female Wistar rat pups were separated from their mothers for 3h daily from postnatal days 3 (P3) to 14 (P14). Acupuncture groups were treated with acupuncture at Shenmen (HT7) or Zusanli (ST36) on alternate days from P50 to P62. Their anxiety-like behavior was evaluated using an elevated plus-maze at P62, and then NPY immunohistochemistry in the basolateral amygdala (BLA) was performed. Rats exposed to maternal separation (MS) were less likely to explore the open arms of the plus-maze compared to control rats that were not exposed to MS. Among maternally separated groups, the percentage of time spent in the open arms was significantly increased in the HT7 acupuncture group, but not the ST36 acupuncture group, compared to MS group. In accordance with this behavior, the numbers of NPY-immunoreactive cells in the BLA were lower in the MS group compared to the control group. Among maternally separated groups, the numbers of NPY-immunoreactive cells in the BLA were significantly higher in the HT7 acupuncture group, but not higher in the ST36 acupuncture group, compared to MS group. These findings suggest that acupuncture treatment might reduce anxiety-like behavior in adult rats following maternal separation by modulating the NPY system in the amygdala.
The aim of the present study was to analyze the results of randomized clinical trials on the efficacy of acupuncture in the treatment of painful dysfunction of the temporomandibular joint.
A literature search of 3 electronic databases was performed, and only randomized studies comparing acupuncture-treated patients with either untreated or conservatively treated control groups were included. For this purpose, results were compared in narrative and tabular form.
To date, only 8 publications representing 6 randomized clinical trials have looked into the efficacy of acupuncture in the treatment of craniomandibular dysfunction. With the exception of one, all studies were published in Sweden, between 1985 and 1992. A more recent US study was the only one to apply sham acupuncture to test the efficacy of acupuncture. All studies share methodological shortcomings, including a lack of detailed descriptions of the randomization procedures, point selection, possible dropouts and undesirable events as well as attempts to identify a possible placebo effect of the acupuncture. Only 1 study investigated long-term results. Although based on the improvement of subjective and objective criteria, all studies consider acupuncture as an effective treatment for painful dysfunction of the temporomandibular joint, the good results achieved must be interpreted with caution because of the methodological shortcomings identified.
Acupuncture appears to be a suitable complementary treatment method in the management of craniomandibular dysfunction. However, its significance has to be further evaluated in future studies.
An introduction to the practical application of acupuncture in dentistry is presented in the light of current research. It is concluded that acupuncture could supplement conventional treatment modalities. Its value in the treatment of temporomandibular dysfunction syndrome and facial pain has been well documented and supported by randomised controlled trials. Although it may be useful in the control of post-operative pain, its use as sole analgesia for operative care is questionable. The mode of action of acupuncture can be explained with reference to modern neurophysiology. A short training course can allow the technique to be an effective tool in every dentist's hands.
Synopsis
The reliability and validity of the Visual Analogue Mood Scale (VAMS) has been demonstrated in both a military and a private psychiatric hospital, inpatient population. The repeated and concurrent administration of the VAMS and the Digit-Symbol test identifies a mood-performance correlation which distinguishes patients with affective disorders, of manic or depressed type, from other psychiatric patients.
Thirty-four alcoholics were treated with acupuncture to the ear and the body in a randomized single-blind placebo-controlled design over 14 days. Orthodox points and placebo needles to orthodox points were used daily for a total of 10 treatments starting on the first day of admission as add-on therapy to standard medication with carbamazepine. The primary outcome was the Clinical Institute Withdrawal Assessment (CIWA-Ar-scale) assessed on days 1-6, 9 and 14. No initial differences were found regarding sociodemographic data, drinking history and alcohol-related data, indicating successful randomization. Longitudinal analysis of the Clinical Institute Withdrawal Assessment (CIWA-Ar-scale) data showed that patients assigned to acupuncture had a general tendency towards better outcome results and significantly fewer withdrawal symptoms on day 14 (Wilcoxon-W=177.500, Z=-2.009, p = 0.045). No significant differences were found in the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI X1 and X2) and Eigenschaftswoerterliste (EWL S60). We conclude that acupuncture as an adjunctive treatment to carbamazepine medication shows promise for the treatment of alcohol withdrawal symptoms. Further investigation of this treatment modality appears to be warranted.
Dentists recognise various degrees of dental anxiety in their patients. There are those who are relaxed, those who are anxious and those who are dentally phobic. The question remains why should disagreeable dental experiences result in dental anxiety in one patient, have little effect upon another and cause dental phobia in a third? The aim of this paper is to propose a psychodynamic theory for dental phobia based upon the ideas of false connections and displacement.
This study includes 3000 patients undergoing MR imaging, all of them conscious, with no history of alcoholism, drug addiction, heart disease, or schizophrenia. During the course of the MR study, panic attacks occurred in 46 subjects, which prevented continuation of the examination. An IV bolus injection of diazepam was administered, which enabled completion of the examination in all 46 cases. The expected effects of a high blood level of diazepam, such as somnolence, slow reactions, overrelaxation, and inhibition of breathing, were not observed. The panic attacks disappeared rapidly after the injection. The patients agreed to a repeat MR examination under similar conditions, if necessary.
The reliability and validity of the Visual Analogue Mood Scale (VAMS) has been demonstrated in both a military and a private psychiatric hospital, inpatient population. The repeated and concurrent administration of the VAMS and the Digit Symbol test identifies a mood performance correlation which distinguishes patients with affective disorders, of manic or depressed type, from other psychiatric patients.
The aim of this study was to determine the bioavailability and absorption kinetics of midazolam given as an intranasal (i.n.)
spray. In addition, plasma concentrations of the active metabolite, 1-hydroxymidazolam, were measured to give an indication
of enteral absorption. An i.v. and i.n. midazolam dose were given in a crossover study to 14 adult surgical patients. Individual
uptake profiles of i.n. midazolam were estimated by numerical deconvolution. After an i.n. dose of 0.15 mg kg-1, maximum arterial
plasma concentrations were 192 (SD 48) micrograms litre-1 at 14 (2) min. Uptake of midazolam was rapid and bioavailability
was 83 (15)%. Formation of the 1-hydroxy metabolite after i.n. administration did not exceed that after the i.v. dose. This
demonstrates that under optimal conditions absorption of midazolam via the nasal mucosa was virtually complete. In this case
little midazolam was swallowed and subjected to first-pass metabolism in the liver and therefore pharmacologically important
amounts of active metabolite were not produced. Routinely administering i.n. midazolam under the assumption that the bioavailability
is approximately 50% (as reported previously in the literature) may lead to overdosing in some patients.
To evaluate the relationships between patient and physician pretreatment expectations of pain relief and subsequent pain relief reported by chronic pain patients immediately after treatment.
Prospective study of consecutive patients undergoing a procedure in a pain clinic for treatment of chronic pain. Patients rated their current pain level and their expectation of pain relief immediately prior to undergoing a procedure (e.g., intravenous drug infusion, nerve block) for the treatment of chronic pain. Simultaneously and independently, the treating physician completed a similar questionnaire. At completion of the procedure, patients rated their current pain level and degree of pain relief.
University of Washington Multidisciplinary Pain Center procedure suite.
Forty-six consecutive chronic pain patients.
Intravenous drug infusions and nerve blocks.
Current pain and pain relief ratings.
Patients' pain relief expectation ratings were not correlated significantly with their postprocedure pain relief ratings or pre-post procedure changes in pain ratings. However, a statistically significant correlation was found between physician expectations of pain relief and patient pain relief ratings and patient pre-post procedure changes in pain.
The results of this study suggest that physicians are better predictors than are patients of patients responses to these procedures and/or that physicians may somehow subtly communicate their expectations to patients during the procedure, and these expectations then influence patient response. Patient pretreatment expectations may not always play a significant role in nonspecific treatment effects.
Acupuncture is frequently advocated as an effective treatment of dental pain. The question whether or not it is effective for this indication remains controversial. The aim of this systematic review therefore was to assess the effectiveness of acupuncture in dental pain.
Four electronic databases were searched: Medline, Embase, CISCOM, and the Cochrane Library. Only controlled trials were included in this review.
Information was extracted from included studies and entered on standard forms independently by both authors. Methodological quality was assessed using the Jadad score.
16 such studies were located. The majority of these trials imply that acupuncture is effective in dental analgesia. However, important questions remain unanswered.
It is concluded that acupuncture can alleviate dental pain and that future investigations should define the optimal acupuncture technique and its relative efficacy compared with conventional methods of analgesia.
The author suggests that anxiety disorders are related to a deficiency in the endogenous opioid system. The author classifies deficiencies of the endogenous opioid system as congenital or acquired, and also as real or relative. Individuals with 'real deficiency' cannot function adequately in any situations, including situations which are natural for human beings. Persons with 'relative deficiency' are unable to function adequately under circumstances which are unnatural for humans: their 'adaptational reserve' is insufficient. The use of opioid substances and alcohol is a form of self-medication to reduce anxiety. Acupuncture and its variations, psychotherapy, and the administration of placebo can decrease anxiety because these therapeutic maneuvers activate the endogenous opioid system.
In order to examine the role of muscular mechanisms in chronic tension-type headache a study with needle acupuncture was performed. Needle acupuncture could be of therapeutic value because it has shown some positive effects in myofascial pain syndromes. We performed a double-blind, placebo-controlled study with 39 patients (mean age 49.0 years, SD=14.8) fulfilling the International Headache Society criteria for chronic tension-type headaches. Participants were randomly assigned to verum or placebo condition. Six weeks after end of treatment no significant differences between placebo and verum could be observed with respect to visual analogue scale and frequency of headache attacks. Nevertheless, pressure pain thresholds significantly increased for the verum group. The findings of our study support the hypothesis that peripheral mechanisms - such as increased muscle tenderness - only play a minor role in the pathogenesis of chronic tension-type headache.
Acupuncture can be an effective treatment for chronic anxiety disorders. The purpose of this study was to assess the effectiveness of acupuncture in reducing anxiety in a volunteer population. If found effective, this modality could be introduced as a treatment of anxiety before surgery. Adult volunteers (n = 55), were randomized to three treatment groups: a) Shenmen group--bilateral auricular acupuncture at the "shenmen" point; b) Relaxation group-bilateral auricular acupuncture at a "relaxation" point; and c) Sham group-bilateral auricular acupuncture at a "sham" point. Press-acupuncture needles were inserted at the respective auricular areas for 48 h. State anxiety, blood pressure, heart rate, and electrodermal activity were assessed at 30 min, 24 h, and 48 h after insertion. Analyzing anxiety levels using repeated-measures analysis of variance has demonstrated a significant difference [F (2,51) =8.8, P = 0.001] between the three treatment groups. Post hoc analysis demonstrated that patients in the Relaxation group were significantly less anxious at 30 min (P = 0.007) and 24 h (P = 0.035) as compared with patients in both the Shenmen group and the Sham group, and less anxious at 48 h (P = 0.042) as compared with patients in Shenmen group. Repeated-measures analysis of variance performed for electrodermal activity, blood pressure, and heart rate demonstrated no group differences (P = ns). We conclude that auricular acupuncture at the "relaxation" point can decrease the anxiety level in a population of healthy volunteers.
Up to 37% of patients undergoing MR imaging examinations experience moderate to severe levels of anxiety that necessitate the termination of the procedure in 5-10% of patients. Although the clinical use of MR imaging has increased, effective procedures to handle claustrophobia are lacking. We evaluated the effectiveness of intranasally administered midazolam spray in preventing claustrophobic responses of patients undergoing MR imaging.
Fifty-four patients scheduled for MR imaging were included in this prospective study. Anxiety and sedation of patients were evaluated before drug administration, immediately before MR imaging, and at the end of the procedure. The Spielberger State-Trait Anxiety Inventory, the visual analogue scale of anxiety, and a five-point sedation scale were used. Half the patients received intranasal spray applications of 4 mg midazolam, whereas the other patients received a placebo, in a randomized, double-blind study design (six sprayings of 0.5% midazolam solution or NaCl 0.9%, respectively). The intensity of the sensation of burning of the nasal mucosa was rated by patients using a three-point scale (no, slight, or strong burning). The quality of scan images was evaluated by a radiologist using a five-point scale (0 = extremely poor, 5 = excellent).
No cancellations occurred with patients who received midazolam, whereas four of 27 patients receiving placebo panicked and terminated the scanning procedure. The initial anxiety and sedation scores did not differ between the groups. Patients who received midazolam spray were more sedated and less anxious immediately before entering the MR scanner and reported a more intense slight transient burning of the nasal mucosa than those in the placebo group. The quality of the MR image was higher in the midazolam group.
A sizeable reduction in MR imaging-related anxiety and improved MR image quality were seen with patients who received intranasal midazolam spray. With the exception of transient burning of the nasal mucosa, no adverse effects were reported. This simple and safe method is useful in sedating patients for MR imaging and other minor procedures.
A subanalysis of data derived from a randomized clinical trial was performed.
To evaluate the association of a patient's expectation for benefit from a specific treatment with improved functional outcome.
Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain. The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered.
In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale.
After adjustment for baseline characteristics, improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations (P = 0.01). Furthermore, patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa (P = 0.03).
The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself. In contrast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.
Implications:
Ear acupuncture can decrease preoperative anxiety in adults undergoing outpatient surgery.
Traditionally, acupuncture is embedded in naturalistic theories that are compatible with Confucianism and Taoism. Such ideas as yin-yang, qi, dampness, and wind represent East Asian conceptual frameworks that emphasize the reliability of ordinary, human sensory awareness. Many physicians who practice acupuncture reject such prescientific notions. Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the clinical efficacy of acupuncture. Evidence from these trials indicates that acupuncture is effective for emesis developing after surgery or chemotherapy in adults and for nausea associated with pregnancy. Good evidence exists that acupuncture is also effective for relieving dental pain. For such conditions as chronic pain, back pain, and headache, the data are equivocal or contradictory. Clinical research on acupuncture poses unique methodologic challenges. Properly performed acupuncture seems to be a safe procedure. Basic-science research provides evidence that begins to offer plausible mechanisms for the presumed physiologic effects of acupuncture. Multiple research approaches have shown that acupuncture activates endogenous opioid mechanisms. Recent data, obtained by using functional magnetic resonance imaging, suggest that acupuncture has regionally specific, quantifiable effects on relevant brain structures. Acupuncture may stimulate gene expression of neuropeptides. The training and provision of acupuncture care in the United States are rapidly expanding.
Little is known about the influence of acupuncture treatment on the phagocytic immune system. This trial was performed to examine whether multiple acupuncture treatment affects the respiratory burst (RB) of neutrophils, a recognised measure of their cytotoxicity.
Placebo-controlled single-blinded study.
Eleven volunteers were treated bilaterally with standard needles (real) at acupoint LI11, 11 volunteers with placebo needles (placebo) at the same point. Treatments were performed for 30 min each twice a week for 4 weeks, eight times in all. The standard needles were manipulated until needle sensation (DEQI) developed. Before the treatment course (baseline), 48 h after the fourth (follow-up 1) and 48 h after the last treatment (follow-up 2) blood samples were drawn.
RB and plasma beta-endorphin at each time point.
In the real group there was a highly significant increase in the RB at follow-ups 1 (P=0.004) and 2 (P=0.007). Beta-endorphin levels decreased, but not significantly. In the placebo group there was a significant increase in the RB at follow-up 2 (P=0.048). In addition, at follow-up 2 a significant drop in beta-endorphin levels was observed (P=0.015).
The RB of neutrophils is significantly activated by a course of several acupuncture treatments. In addition, psychological effects and a placebo that was not totally inert may contribute to the findings in the placebo group which may be mediated by the opiate endorphin system.
Auricular acupuncture at the relaxation point has been previously shown to be an effective treatment for anxiety in the preoperative setting. The purpose of this prospective, randomized, blinded study was to determine whether auricular acupressure can reduce stress and anxiety during ambulance transport.
Patients who required ambulance transport secondary to medical conditions were randomized to receive auricular acupressure at the relaxation point (n = 17) or at a sham point (n = 19). A visual analog scale was used to assess state anxiety as well as patient anticipation of hospital medical treatment (estimated waiting period for treatment, anticipated pain during treatment, attitude toward the physicians, and treatment outcomes). These variables were assessed at baseline and on arrival to the hospital.
Patients in the relaxation group reported significantly less anxiety than patients in the sham group on arrival to the hospital (visual analog scale mean +/- SD: 37.6 +/- 20.6 to 12.4 +/- 7.8 mm vs. 42.5 +/- 29.9 to 46.7 +/- 25.9 mm, respectively; P = 0.002). Similarly, patient perception of pain during treatment (mean visual analog scale +/- SD: 32.7 +/- 27.7 to 14.5 +/- 8.1 mm vs. 17.2 +/- 26.1 to 28.8 +/- 21.9 mm, respectively; P = 0.006) and treatment outcomes of their illnesses (mean visual analog scale +/- SD: 46.7 +/- 29.4 to 19.1 +/- 10.4 mm vs. 35.0 +/- 25.7 to 31.5 +/- 20.5 mm, respectively; P = 0.014) were significantly more positive in the relaxation group than in the sham group. No differences were found in the other variables assessed.
It was concluded that auricular acupressure is an effective treatment for anxiety in prehospital emergency settings.
The efficacy of acupuncture treatment for chronic low-back pain has not been reliably proven because of a lack of good quality studies, leading to the necessity of developing the German Acupuncture Trial for Chronic Low-Back Pain (GERAC-cLBP) study.
The aim is to assess the effectiveness of traditional Chinese acupuncture for chronic low-back pain compared to sham acupuncture and with a conventional standard therapy.
This trial is a nationwide, multicenter, randomized, prospective, partially blinded study. The primary endpoint is the success rate after 6 months. Success is defined as an improvement of 33% or more of three pain-related items on the Van-Korff Pain Score or an improvement of 12% or more in the disability measured by the Hanover Functional Ability Questionnaire. Assessment of the effectiveness of the blinding of patients to the form of acupuncture they received will be conducted. All clinical endpoints are assessed centrally by blinded independent observers. The sample size, with a total of 1062 patients to be enrolled, is based on power calculations. Independent central randomization, data collection, data processing, and statistical analysis are provided. Success rates will be tested for differences using two-sided Fisher exact tests. In the primary analysis, all tests will be carried out on the basis of the intention-to-treat principle. Secondary analyses will be conducted according to protocol approaches. TRIAL STATUS: The pilot phase of the trial started in February 2002, the estimated duration of the study is 2.5 years. Enrollment is anticipated to be completed in the winter of 2003.
The GERAC-cLBP study is currently the world's largest controlled trial of the effectiveness of acupuncture treatment for low-back pain. It will contribute to the evaluation of efficacy by means of evidence based medicine.
The purpose of this study was to determine whether parental auricular acupuncture reduces parental preoperative anxiety and thus allows children to benefit from parental presence during induction of anesthesia.
Mothers of children who were scheduled to undergo surgery were randomly assigned to an acupuncture intervention group (auricular press needles at relaxation, tranquilizer point, and master cerebral point) or a sham acupuncture control group (auricular press needles at the shoulder, wrist, and extraneous auricular point). The intervention was performed at least 30 min before the child's induction of anesthesia. All mothers were present during induction of anesthesia. The behavioral and physiologic anxiety of mothers and children were rated during the perioperative process.
: Multivariable analysis examining maternal anxiety as a function of group found a group-by-time interaction (F1,65 = 4.1, P = 0.04). That is, after induction, maternal anxiety in the acupuncture group was significantly lower (42.9 +/- 10 vs. 49.5 +/- 11; P = 0.014). A multivariate model (F1,65 = 4.8, P =0.031) also showed that children whose mothers received the acupuncture intervention were significantly less anxious on entrance to the operating room (34.9 +/- 20 vs. 47.4 +/- 26; P = 0.03) and during introduction of the anesthesia mask (38.6 +/- 25 vs. 55.6 +/- 31; P = 0.016). There were no significant differences in maternal blood pressure and heart rate between the two groups.
: Auricular acupuncture significantly decreased maternal anxiety during the preoperative period. Children of mothers who underwent acupuncture intervention benefitted from the reduction of maternal anxiety during the induction of anesthesia.
Both specific and non-specific factors may play a role in acupuncture therapy for pain. We explored the cerebral consequences of needling and expectation with real acupuncture, placebo acupuncture and skin-prick, using a single-blind, randomized crossover design with 14 patients suffering from painful osteoarthritis, who were scanned with positron emission tomography (PET). The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient's pain. The insula ipsilateral to the site of needling was activated to a greater extent during real acupuncture than during the placebo intervention. Real acupuncture and placebo (with the same expectation of effect as real acupuncture) caused greater activation than skin prick (no expectation of a therapeutic effect) in the right dorsolateral prefrontal cortex, anterior cingulate cortex, and midbrain. These results suggest that real acupuncture has a specific physiological effect and that patients' expectation and belief regarding a potentially beneficial treatment modulate activity in component areas of the reward system.
This article aims to review how acupuncture can provide complimentary treatments to patients through implant rehabilitation. The following topics are discussed: control of gagging reflex, control of postoperative vomiting, control of postoperative pain, enhance anesthetic effects, control of anxiety, increase saliva production, enhance immune responses, management of temporomandibular dysfunction, smoking cessation, control diabetic mellitus, stimulation of peripheral nerve regeneration, and adverse effects.
Preanesthetic sedation of preschool children using intranasal midazolam Effect of acupuncture on the neutrophil respiratory burst: a placebo-controlled singleblinded study
- Nct Wilton
- J Leigh
- Dr Rosen
- Ua Pandit
- M Karst
- D Scheinichen
- T Rueckert
Wilton NCT, Leigh J, Rosen DR, Pandit UA. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology 1988;69:972–5. 15. Karst M, Scheinichen D, Rueckert T, et al. Effect of acupuncture on the neutrophil respiratory burst: a placebo-controlled singleblinded study. Complement Ther Med 2003;11:4 –10.
- Wang