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Acupuncture Use in the United States: Findings from the National Health Interview Survey

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Abstract

Acupuncture has become an important provider-based complementary and alternative medicine (CAM) treatment. To improve understanding of its role in personal health care, an analysis of national data was conducted to examine user sociodemographics, conditions treated, and the relationship of use with conventional Western medical care. A nationally representative cross-sectional survey. The 2002 National Health Interview Survey (NHIS), conducted in all 50 states and the District of Columbia. Thirty-one-thousand and forty-four (31,044) adults who completed the NHIS Sample Adult Core. The primary outcome measure was recent use of acupuncture, defined as use within the previous 12 months. In the 2002 NHIS sample, 4.1% of the respondents reported lifetime use, and 1.1% (representing 2.13 million Americans) reported recent use of acupuncture. Recent use (n = 327) was positively associated with being an Asian female, living in the West or Northeast, having poorer self-reported health status, a higher level of education, and being an ex-smoker. Among recent users, the most typical treatment regimen was two to four treatments (34.5%), with musculoskeletal complaints being the most frequently reported conditions, led by back pain (34.0%). Reports of perceived benefit were generally high. Respondents indicated that acupuncture was used both as an alternative and as a complementary therapy. A reasonable number also reported being referred to acupuncture by a conventional medical professional (25.3%). The cross-sectional nature of the data precluded analysis of transitions in health care use (between conventional and CAM treatments) over time. Utilization of acupuncture was somewhat lower than expected given its significant national and international recognition and its visibility in the media. This may in part be a function of provider availability and cultural factors.

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... Acupuncture, which is an important component of traditional Chinese medicine (TCM), has been used to treat headaches in East Asian countries for thousands of years. At present, it is also used for migraine treatment across many other regions worldwide, owing to its significant efficacy, few side effects, and cost-effectiveness (5)(6)(7). Results from numerous clinical trials have confirmed the immediate and long-term effects of acupuncture on migraine headaches and their corresponding symptoms, such as number of migraine days, headache frequency, and headache intensity (8)(9)(10)(11)(12). Although acupuncture is an effective and safe therapy for treatment of migraine, a recent report from Cochrane Database of Systematic Reviews revealed that non-specific effects play an important role in its efficacy (13). ...
... (4) To prevent the risk bias on the results, data collectors, outcome assessors, and data analysts will be blinded to the allocation. (5) In order to ensure compliance by all researchers, group meetings will be held every week for communication and study, and solutions will be put forward in time if difficulties or problems are encountered in the trial. ...
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Introduction Acupuncture is an efficacious and safe treatment choice for migraine prevention. Results from clinical trials have shown that non-specific effects play an important role in acupuncture's efficacy. To date, however, there is no evidence available quantitatively evaluating the effect of non-specific effects, such as patients' expectations and beliefs for acupuncturists, on acupuncture efficacy, necessitating further exploration. Methods A total of 156 patients with migraine without aura (MwoA) will be randomized to either junior or senior acupuncturist group, at a ratio of 1:1. The study will last 24 weeks, for each patient, comprising baseline, treatment, and follow-up phases lasting 4, 8, and 12 weeks, respectively. All patients will undergo 12 sections of acupuncture treatment delivered by either a junior or senior acupuncturist following the same acupuncture prescription and manipulation. The primary outcomes will be changes in the number of migraine days and frequency of attacks per 4 weeks cycle, relative to the baseline. Secondary outcomes will include severity of headache pain, quality of life, anxiety/depression levels, and use of non-steroidal anti-inflammatory drugs (NSAIDs) per 4 weeks cycle, compared to the baseline, as well as adverse events and rate of positive response to treatment. Prior to randomization of patients into junior or senior acupuncturist groups, the Acupuncture Expectations Evaluation Scale (AES) will be used to evaluate their expectations and belief with regards to acupuncture efficacy delivered by senior or junior acupuncturists. Discussion Results from this clinical randomized controlled trial will help to quantitatively evaluate the extent of the effect of acupuncture treatment delivered by a senior or junior acupuncturist (high relative to low expectations) in migraine patients. Ethics and Dissemination This trial has been approved by the Institutional Review Boards and Ethics Committees of Hospital of Chengdu University of Traditional Chinese Medicine (Approval No. 2020KL-058).
... The efficacy of acupuncture for migraine has been confirmed by several clinical trials and a series of systematic reviews, including a Cochrane Review (15,16). Consequently, acupuncture is becoming a more accepted form of integrative medicine in the Western countries for the prevention and treatment of migraine (17) and is administered for migraine prophylaxis and chronic pain treatment all over the world (15,18): migraine and other headaches were the primary indications for acupuncture treatment in 9.9% of US patients (17). ...
... The efficacy of acupuncture for migraine has been confirmed by several clinical trials and a series of systematic reviews, including a Cochrane Review (15,16). Consequently, acupuncture is becoming a more accepted form of integrative medicine in the Western countries for the prevention and treatment of migraine (17) and is administered for migraine prophylaxis and chronic pain treatment all over the world (15,18): migraine and other headaches were the primary indications for acupuncture treatment in 9.9% of US patients (17). ...
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Introduction: Migraine is a chronic paroxymal neurological disorder characterized by attacks of moderate to severe headache and reversible neurological and systemic symptoms. Treatment of migraine includes acute therapies, that aim to reduce the intensity of pain of each attack, and preventive therapies that should decrease the frequency of headache recurrence. The objective of this systematic review was to assess the efficacy and safety of acupuncture for the prophylaxis of episodic or chronic migraine in adult patients compared to pharmacological treatment. Methods: We included randomized-controlled trials published in western languages that compared any treatment involving needle insertion (with or without manual or electrical stimulation) at acupuncture points, pain points or trigger points, with any pharmacological prophylaxis in adult (≥18 years) with chronic or episodic migraine with or without aura according to the criteria of the International Headache Society. Results: Nine randomized trials were included encompassing 1,484 patients. At the end of intervention we found a small reduction in favor of acupuncture for the number of days with migraine per month: (SMD: −0.37; 95% CI −1.64 to −0.11), and for response rate (RR: 1.46; 95% CI 1.16–1.84). We found a moderate effect in the reduction of pain intensity in favor of acupuncture (SMD: −0.36; 95% CI −0.60 to −0.13), and a large reduction in favor of acupuncture in both the dropout rate due to any reason (RR 0.39; 95% CI 0.18 to 0.84) and the dropout rate due to adverse event (RR 0.26; 95% CI 0.09 to 0.74). Quality of evidence was moderate for all these primary outcomes. Results at longest follow-up confirmed these effects. Conclusions: Based on moderate certainty of evidence, we conclude that acupuncture is mildly more effective and much safer than medication for the prophylaxis of migraine.
... Since acupuncture is a typical modality of CAM that is widely used in Asia, Europe and the United States, research into the characteristics of acupuncture users has been actively conducted [3,4]. In addition, the relationship between the use of acupuncture and subjective health status has been investigated mainly in the United States, and it has been reported that acupuncture users were two to four times as likely to report poor self-rated health than non-users [5,6]. However, these reports compared subjective health status between acupuncture users and non-users, and the relationship between frequency of use and subjective health status has not been examined. ...
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Objective There are few studies on the relationship between the frequency of acupuncture use and subjective health status. Therefore, we investigated this relationship using data of a previously performed cross-sectional survey of patients visiting Japanese acupuncture clinics. Methods This study used data from a cross-sectional survey conducted in 2011 on patients visiting 180 acupuncture clinics nationwide that were run by members of the alumni association of Meiji University of Integrative Medicine Faculty of Acupuncture and Moxibustion, and did not provide treatment other than acupuncture. We calculated the frequency of visits to acupuncture clinics (< 24 times, 24–47 times, 48–95 times, or ≥ 96 times per year) and the Short Form-36 (SF-36) summary scores (physical, mental, role/social) based on the response of the questionnaire conducted at the time of the survey. Multiple linear regression analysis with multiple imputation was performed with three SF-36 summary scores as the dependent variables, and the frequency of visits to acupuncture clinics as the independent variable. Results The questionnaire was distributed to 2,379 outpatients of acupuncture clinics, 1,409 of whom met the criteria and were included in the analysis. More frequent visits to acupuncture clinics were associated with lower scores on all three SF-36 summary scores. Compared to those who visited < 24 times a year, those who visited ≥ 96 times a year had unstandardized regression coefficients (95% confidence interval) of -5.6 (-7.8 to -3.3) for the physical, -2.0 (-3.9 to -0.1) for the mental, and -2.9 (-5.4 to -0.4) for the role/social SF-36. Conclusions Frequent visits to acupuncture clinics were associated with poor subjective health status, especially physical health.
... Meantime, as a complementary and alternative therapy, acupuncture has gained popularity in Western communities and the world at large. Te 2007 National Health Interview Survey demonstrated that over 14 million Americans have used acupuncture as part of their health care, which was an increase from 8 million in 2002 [16]. Te rise indicates that more individuals are accepting acupuncture treatment as part of their current health-care regimen. ...
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Background: Oral ulcer (OU) is a common oral mucosal disease manifested with obvious pain. In some studies, the efficacy of acupuncture in OU has been confirmed, but systematic reviews and meta-analyses for them are lacking. Our aim is to evaluate the efficacy of acupuncture in the treatment of OU. Methods: We searched the literature from eight databases from their inception to December 2021. We included randomized controlled trials of acupuncture for the treatment of oral ulcer. The meta-analysis was carried out using Review Manager 5.3 and Stata 16.0. The main outcomes were the effective rate and the recurrence rate, the secondary outcomes were the visual analogue score (VAS) and the ulcer healing time. Results: Totally, 18 studies were finally included in the meta-analysis, including 1,422 patients. In meta-analyses, we found that in comparison with Western medicine, acupuncture can improve effective rate (OR = 5.40, 95% CI: 3.40 to 8.58), reduce the ulcer recurrence rate (OR = 0.21, 95% CI: 0.13 to 0.33), and relieve the ulcer pain (MD = -2.26, 95% CI: -4.27to-0.24). In addition, compared with Western medicine, acupuncture plus Western medicine also can improve effective rate (OR = 2.95, 95% CI: 1.48 to 5.85). Compared with the Chinese medicine, the acupuncture plus Chinese medicine can improve the effective rate (OR = 8.26, 95% CI: 3.61 to 18.88) and relieve the ulcer pain (MD = -1.85, 95% CI: -2.51 to -1.19). Conclusion: Acupuncture may be more effective than Western medicine in terms of efficacy rate, and acupuncture combined with Western or Chinese medicine may have the potential to reduce the recurrence of ulcer and relieve the ulcer pain. However, due to limited evidence, higher quality and more rigorously designed clinical trials with larger sample sizes will be needed to further confirm our findings.
... Approximately one million patients with pain syndrome receive Acupuncture annually in the United States. 19 Studies have shown that patients with migraine have a reduction in pain severity with acupuncture treatment. 20 Wang et al. applied real and sham Acupuncture to 150 patients during migraine attacks, and pain severity was evaluated with VAS scores. ...
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INTRODUCTION: This study investigated the effect of acupuncture treatment on attack frequency, pain intensity, and disability in patients with migraine without aura that receives prophylaxis treatment. METHODS: Eighty-four patients with migraine without aura were randomized to the intervention group (IG; n=42) and control group (CG; n=42). IG received 12 sessions of Acupuncture in addition to prophylaxis treatment. CG received only prophylaxis treatment. The primary outcome measures were monthly attack frequency, duration of attacks and pain severity during attacks. The secondary outcome measure included a change of Migraine Disability Assessment (MIDAS) scores from baseline to endpoints. All participants were followed up for three months. RESULTS: A total of 80 participants completed the study. There were no statistically significant differences between the IG and CG for either socio-demographic features or the outcome measures at baseline. VAS score decreased from 8.8+-0.9 to 3.9+-1.5 in IG, while it decreased from 8.7+-0.8 to 4.4+-2.4 in CG (p=0.001). After three months mean monthly attack frequency decreased from 7.2+-3.0 to 3.3+-2.3 in IG, while it decreased from 6.3+-3.3 to 4.4+-2.4 in CG (p=0.040). The mean duration of attacks was 12.1+- 2.6 hours before intervention; it decreased to 3.1+-1.7 hours in IG (p=0.002). There was a significantly higher proportion of participants in IG who had MIDAS Grade 2 compared to those with CG (42.50% versus 2.50%) at the end of the study (p=0.001). DISCUSSION AND CONCLUSION: Acupuncture may be suggested as a complementary treatment option to optimize the clinical management of patients with migraine without aura via decreasing attack frequency and pain severity, also improving disability.
... This growth came consequently to the National Institute of Health (NIH) consensus statement published in 1997 in support of the efficacy of AC in managing cases of pain and nausea [9]. In 2002, the National Health Interview Survey (NHIS) reported that around 2.13 million Americans had used AC, with musculoskeletal complaints being the most frequently reported conditions [10]. ...
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Introduction Acupuncture (AC) is among the complementary treatment modalities to manage chronic myofascial pain. The aim of this investigation was to assess the additive effect of AC in reducing the intensity of primary chronic myalgia/myofascial head and neck pain in patients using oral orthotic appliances (OA). Methods A retrospective chart review was conducted for 103 patients diagnosed with primary chronic myalgia/myofascial pain and received OA with/without AC at Tufts University School of Dental Medicine (TUSDM). Subjective reporting of face/TMJ/neck pain was recorded at the initial visit and at short-term and long-term follow-ups using patient-reported pain/discomfort numeric rating scale (NRS). Results Most subjects were females (77.7%) with the mean age of the entire study population being 53 years old. In patients with refractory response to OA, combining AC with OA showed significant improvement in NRS score compared to baseline, in TMJ pain (P=0.023), neck pain (P= 0.055), facial pain (P=0.006). The addition of AC to OA has also brought refractory pain to low levels, comparable to what OA-only respondents reported [TMJ pain (P= 0.395), neck pain (P=0.694), face pain (P=0.553)]. Conclusion AC may provide a complementary therapeutic modality to manage refractory cases of primary chronic myofascial pain.
... In 2002, a National Health Interview Survey (NHIS) surveyed 31,044 adults in the United States inquiring about recent use (within the last 12 months) and lifetime use of acupuncture. Results indicated that 1.1% of adults, which represented an estimated 2.13 million American adults, had used acupuncture in the last 12 months with 4.1% reporting lifetime use (23). A 2018 survey indicated that the total number of licensed acupuncturists in the United States increased 257% in the 20-year period from 1998 to 2018, reflecting the large-scale growth and demand of acupuncture in the United States (24). ...
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Acupuncture has been a staple of Eastern medicine for thousands of years. Recent evidence has shown that benefits for spinal stenosis are strong. In this comprehensive review, we overview the history and available literature. We discuss how the techniques have evolved and the clinical utility. The process and progression of spinal stenosis is addressed. We discuss mechanism of action for acupuncture as well as relevant treatment implications. This is important in alleviating pain and providing strong quality of life. We highlight both the findings in the pre-operative, peri-operative, and post-operative periods. Finally, the pre-clinical data provides compelling evidence in terms of novel pathways being targeted. This resource will serve as a user-friendly guide for the clinician and scientist regarding this important topic. It will be the catalyst of ongoing investigation from both the clinical and pre-clinical side.
... While about 70% of women will seek symptom relief, some women will experience very mild symptoms and may not see the need to seek symptom relief from a health care provider (9). Vasomotor manifestations are exceptionally common crosswise over menopausal stages in many social orders (10). ...
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Objective: Acupuncture is frequently utilized to manage climacteric symptoms and other gynecological conditions. Laser acupuncture has the advantages of being noninvasive, reproducible, and convenient. This study sought to explore the effectiveness of laser acupoint stimulation in relieving symptoms associated with menopause. Methods: A randomized, double-blind, controlled study was conducted on 120 women diagnosed as menopausal patients (>1 year past last menstruation), aged 40 - 60 years with a Kupperman Menopause Index (KMI) equal or more than 15. women were randomized into Group A: Laser acupuncture (n=30), Group B: (HRT); Tibolone 2,5 mg/day (n=30) orally, Group C: Laser acupuncture and Tibolone 2,5 mg/day orally (n=30), Group D: Non interventional (self-care group) (n=30). Each patient was given a standard daily log and was required to record the frequency and severity of hot flashes and side effects of the treatment felt daily. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment. Results: 120 women with postmenopausal symptoms were divided randomly into four equal groups; After the treatment and the follow-up, in (Group A) there was no significant difference regarding FSH, LH and E2 level before treatment and after treatment with LASER acupuncture, as regard (Group B); there was statistically significant difference before and after treatment concerning hot flashes of KMI and he levels of FSH, LH decreased significantly and the level of E2 increased significantly. Combined treatment using hormonal replacement therapy with Laser Acupoints (Group C) showed dramatic improvement in study subjects and the improvement was more than that in group B. There were no significant differences were found regarding self-care group on either frequency of hot flashes, FSH, LH and E2 level. Conclusions: Laser acupoints are effective and can be used as an alternative treatment to decrease the frequency and severity of postmenopausal hot flashes and postmenopausal symptoms especially if combined with Tibolone.
... Acupuncture therapy has been used in China for more than 2000 years [44] and has been generally practiced in Western countries in recent years. [45] Recently, despite some evidence of acupuncture for aMCI emerging, methodological quality is generally not high enough to produce convincing and suggestive results. ...
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Patients with amnesic mild cognitive impairment (aMCI) are more likely to develop Alzheimer disease than corresponding age normal population. Because Alzheimer disease is irreversible, early intervention for aMCI patients seems important and urgent. We have designed a pilot multicenter, randomized, parallel controlled trial to assess the efficacy and safety of acupuncture on aMCI, explore the feasibility of acupuncture in the treatment of aMCI, so as to provide a reference for large-sample clinical trials in the next stage. We designed a pilot multicenter, randomized, parallel controlled trial. This trial aims to test the feasibility of carrying out a large-sample clinical trial. In this trial, 50 eligible patients with aMCI will be included and allocated to acupuncture group (n = 25) or sham acupuncture group (n = 25) at random. Subjects will accept treatment 2 times a week for 12 weeks continuously, with a total of 24 treatment sessions. We will select 6 acupoints (GV20, GV14, bilateral BL18, bilateral BL23). For the clinical outcomes, the primary outcome is Montreal cognitive assessment, which will be assessed from baseline to the end of this trial. And the secondary outcomes are Mini-mental State Examination, Delayed Story Recall, Clinical Dementia Rating scale, Global Deterioration Scale, Activity of Daily Life, Alzheimer Disease Assessment Scale-Cognitive Section, brain magnetic resonance imaging, brain functional magnetic resonance imaging, and event-related potential P300, which will be assessed before and after treatment. In addition, we will assess the safety outcomes from baseline to the end of this trial and feasibility outcome after treatment. We will evaluate neuropsychological assessment scale (Montreal cognitive assessment, Mini-mental State Examination, Alzheimer Disease Assessment Scale-Cognitive Section) at 3 months and 6 months after treatment. This pilot trial aims to explore the feasibility of the trial, verify essential information of its efficacy and safety. This pilot study will provide a preliminary basis for carrying out a larger clinical trial of acupuncture on aMCI in near future.
... Unresolved back pain results in reduced physical function and psychological distress [8]. Hence, back pain sufferers tend to explore a wide range of health care options, including consultation with medical and allied health services [9,10]. A French study reported that 89% of the study sample of back pain suffers had visited general practitioners (GPs) 6 months before the survey, 27.3% consulted a specialist, and 55.9% had a visit from a physiotherapist [11]. ...
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Background: Back pain affects a substantial proportion of the adult population, and back pain sufferers tend to explore a wide range of health care options. This study investigates the use of medical and physiotherapy services by Australian women with back pain. Method: This is a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The study focuses on 1,851 women aged 59-64 years, who had indicated that they had previously sought help from a health care practitioner for back pain. Results: Half of the women (56.5%) with back pain had consulted a general practitioner (GP), 16.2% had consulted a medical specialist, and 37.3% had consulted a physiotherapist for their back pain. Women with regular or continuous back pain were more likely to consult a GP (OR=3.98), medical specialist (OR=5.66) and a physiotherapist (OR=1.63). Conclusion: Australian women with back pain were more likely to consult a GP, medical specialist or physiotherapist if they had more regular/continuous back pain. Future research needs to investigate further the consultation and referral patterns identified in this study.
... Acupuncture, as an essential modality of traditional Chinese medicine (TCM), has been commonly practiced in the prevention and treatment of various diseases for millennia (Ulett et al., 1998). In recent decades, it receives increased attention from both the public and health professionals worldwide, even arousing the interest of major academic medical centers, especially for chronic disorders, which are difficult to be managed with conventional therapies (NIH Consensus Conference, 1998;Burke et al., 2006;World Health Organization, 2013). There are many categories of acupuncture approaches such as manual acupuncture (MA), electroacupuncture (EA), and scalp acupuncture (SA), which have turned out to be relatively less expensive with few adverse effects (Witt et al., 2009). ...
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Background: Acupuncture may be a promising complementary therapy for vascular cognitive impairment (VCI) and has been extensively applied in China. However, its potential effects remain uncertain, and the clinical findings are inconsistent. This review aimed to systematically appraise the overall effectiveness and safety of acupuncture in treating VCI. Methods: To investigate the effects of acupuncture on VCI from inception to February 28, 2021 using randomized clinical trials (RCTs), seven electro-databases [Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang] were searched. Two independent investigators identified the eligible RCTs and extracted data into predesigned forms. The risk of bias (ROB) within each individual trial was evaluated using the Cochrane Collaboration's tool. Meta-analyses were conducted for calculating comparative effects in the RevMan software (version 5.3). The strength of attained evidence was rated using the online GRADEpro approach. Results: A total of 48 RCTs involving 3,778 patients with VCI were included. The pooled data demonstrated that acupuncture was more beneficial for a global cognitive function [mean difference (MD) 1.86, 95% CI 1.19–2.54, p < 0.01] and activities of daily living (MD −3.08, 95% CI −4.81 to −1.35, p < 0.01) compared with western medicine (WM). The favorable results were also observed when acupuncture was combined with WM (MD 2.37, 95% CI 1.6–3.14, p < 0.01) or usual care (UC, MD 4.4, 95% CI 1.61–7.19, p = 0.002) in comparison with the corresponding control conditions. Meanwhile, the subgroup analysis did not indicate a statistical effect difference between manual acupuncture (MA) and electroacupuncture (EA) (inter-group I2 < 50% and p > 0.1) when comparing acupuncture with WM. There were no significant differences in the occurrence of adverse events (AEs) between the acupuncture group and the control group (p > 0.05). Owing to the poor methodological quality and considerable heterogeneity among studies, the certainty of the evidence was low or very low. Conclusions: This review suggests that acupuncture as a monotherapy or an adjuvant therapy may play a positive role in improving the cognition and daily performance of VCI patients associated with few side effects. The difference in styles may not significantly influence its effectiveness. More rigorously designed and preregistered RCTs are highly desirable to verify the therapeutic benefits and determine an optimal acupuncture paradigm. The methodological and reporting quality of future researches should be enhanced by adhering to authoritative standardized statements. Systematic Review Registration: [PROSPERO], identifier [No. CRD42017071820].
... A survey has found that 8 million locals in the United States have been treated for acupuncture, most commonly for lower back pain. [27,28] Recent studies have shown that acupuncture not only reduces pain immediately, but also promotes the recovery of systemic function. The fire needle is developed on the basis of acupuncture and moxibustion. ...
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Background: Myofascitis is a common disease in clinic. The main cause of the disease is aseptic inflammation of local muscles and connective tissues such as myofascial, which can be manifested as paralysis, distension, and other discomfort, local muscle stiffness, spasm or palpable strain-like nodules. Chinese medicine ascribes it to "bi disease" and "Arthralgia disease," while Western medicine believes that the disease is mainly due to local muscle and fascia edema and exudation caused by trauma or long-term strain, forcing nerves to jam and producing pain and other abnormal feelings. Although the disease is not life-threatening, the pain and distension caused by local inflammatory stimuli can affect the patient's daily life and sleep quality. The purpose of this systematic review is to evaluate the efficacy of fire needle vs routine acupuncture in the treatment of myofascitis. Methods: Randomized controlled trials (RCTS) of fire needle vs routine acupuncture for myofascial inflammation will be comprehensively searched from inception to September 2020 on PubMed, Embase, Cochrane Library, China Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), and Wanfang. Additionally, RCT registered sites, including http://www.ClinicalTrials.gov and http://www.chictr.org.cn, also will be the search. Visual analogue scale (VAS) was used to score the pain before and after treatment. The primary outcome will be to compare the difference in pain scores between the 2 interventions. Two independent authors filtered the literature in the above database, extracted the data, and cross-checked it. Results: This study will offer a reasonable comprehensive evidence for the treatment of myofascitis with fire needle. Conclusion: The conclusion of this study will provide evidence to judge the effectiveness of fire needle on myofascitis. Registration number: INPLASY202080034.
... [19,20] So, more and more doctors and patients are looking for a safer and more effective therapy. [17,21] As one of therapeutic methods of Traditional Chinese Medicine, acupuncture is well accepted by world people [10,[21][22][23] and widely used in various diseases. [17,18] A number of randomized controlled trials and meta-analysis have shown acupuncture can improve peoples sleep quality in perimenopause. ...
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Background: As a common symptom of perimenopausal period, perimenopausal insomnia brings great pain to many women and families. Acupuncture has been accepted by people as the incidence rate of this disease increases. The purpose of this study is to systematically compare the safety and efficacy of various acupuncture treatments for perimenopausal insomnia through network meta-analysis. Methods: We will search Web of Science, PubMed, The Cochrane Library, Embase, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Date, VIP database, conference papers and grey literature. All relevant Randomized controlled trial (RCT) using acupuncture for perimenopausal insomnia will be included. Two reviewers will independently search and screen date. Network meta-analysis will be completed by Stata and WinBUGS software. Results: This study will compare the efficacy and safety of different acupuncture treatments for perimenopausal insomnia. Conclusion: The result of this study will provide reliable evidence for evaluating the efficacy and safety of acupuncture in the treatment of perimenpausal insomnia. Inplasy registration number: INPLASY2020110047.
... Previous research in the US has found CM users also have a higher incidence of consuming alcohol daily but not meeting the classification of heavy drinking [34]. Other research elsewhere also found alcohol consumption was not a significant predictor of CM use [35,36]. The health impacts of alcohol consumption have received increased interest among public health researchers in recent years in light of conflicting findings regarding the potential risk and benefits associated with 'moderate' compared with 'heavy' alcohol use or abstinence [37]. ...
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Background Australians report consulting with a naturopaths or herbalists to improve their wellbeing, yet little is known about the associations between these consultations and the patients’ health behaviours. This cross-sectional study aimed to examine the relationship between health behaviour and consultations with naturopaths or herbalists in three age cohorts of Australian women. Methods Women aged 19–25 years, 31–36 years, and 62–67 years from the Australian Longitudinal Study on Women’s Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behaviour; and whether they consulted with naturopath/herbalists in the last 12 months. Associations were analysed using multivariable logistic regression. Results A total of 9151 (19–25 years), 8200 (31–36 years) and 11,344 (62–67 years) women were included in the analysis. Between 7.3 and 11.9% of women reported to have consulted with naturopaths/herbalists in the last 12 months. Women of all cohorts consulting with naturopath/herbalist were less likely to smoke (19-25 yrs.: Odds Ratio [OR] 0.61; 31–36 years: OR 0.58; 62–67 years: OR 0.29), more likely to report at least moderate levels of physical activity (19-25 yrs.: OR 1.41; 31–36 years: OR 1.34; 62–67 years: OR 1.34), and the use of vegetarian diets(19-25 yrs.: OR 1.40; 31–36 years: OR 1.77; 62–67 years: OR 2.28), compared to women not consulting with naturopaths/herbalists. Women consulting with naturopaths/herbalists however were also more likely to have used marijuana (19-25 yrs.: OR 1.18; 31–36 years: OR 1.42), or illicit drugs in the last 12 months (19-25 yrs.: OR 1.24; 31–36 years: OR 1.40). Conclusions Consultations with a naturopath or herbalist are associated with positive health behaviours that are protective of internationally important non-communicable diseases. Psychoactive drug use is also reported among women visiting a naturopath or herbalist. Further research is needed to understand the role naturopaths play in advising patients with regards to health and non-healthy behaviours.
... The high prevalence of the lifetime use of acupuncture (7.7%) and CHM (4.8%) in Australian women was investigated in the previous study [5]. In the United States, the prevalence of the lifetime use of acupuncture was 4.1% in 2002 and increased to 6.8% in 2007 among adults aged 18 years and over [6,7]. An internet-based survey showed that the one-year prevalence of TCM use was as high as 39.7% in 2018 in Taiwan [8]. ...
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Background and aims Purchasing Chinese herbal medicine (CHM) without a physician’s prescription may have adverse effects on health. However, the recent status of purchasing non-prescribed CHM and the associated factors are not completely understood. We aimed to report the prevalence of purchasing CHM and associated factors. Methods Using data from the 2017 Taiwan Survey of Family Income and Expenditure, we identified 16,528 individuals (householders) aged 18 years and older. Sociodemographic factors, expenditures on medical services and health behaviours were compared between people with and without a history of purchasing non-prescribed CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis. Results The one-year prevalence of purchasing non-prescribed CHM was 74.8% in Taiwan. In addition to sociodemographics, marital status (OR 2.14, 95% CI 1.88–2.44), the use of traditional Chinese medicine (OR 3.62, 95% CI 3.30–3.97), the purchasing of non-prescribed biochemical medications (OR 3.09, 95% CI 2.75–3.48), the purchasing of health foods (OR 2.59, 95% CI 2.33–2.86), the use of folk therapy (OR 2.27, 95% CI 1.95–2.64), and a high level of expenditure on alcohol (OR 3.79, 95% CI 3.29–4.36) were strongly correlated with purchasing non-prescribed CHM. Conclusion The one-year prevalence of purchasing non-prescribed CHM is very high in Taiwan and is correlated with sociodemographics, health behaviours, and the utilization of medical care. The interaction of non-prescribed CHM with physician-prescribed herbal medicine and biomedical medications requires more attention.
... Based on data from a plenty of clinical trials, acupuncture effectively treats pain and may be a reasonable option for the treatment of chronic pain, and side effects of acupuncture intervention have been well-defined. In recent years, acupuncture has rapidly developed and gradually become part of mainstream medicine worldwide (Burke et al., 2006;MacPherson et al., 2006; P. M. Barnes and M. P. A. Bloom, 2008;Xue et al., 2007), although the minor and rare serious adverse events can occur during the treatment (Chan et al., 2017a;Wu et al., 2015). ...
Article
Background And Objective Critical clinical questions regarding how soon and how long the analgesic effect will be achieved by acupuncture, as well as who will responsive to acupuncture, need further address. This study is aim to investigate response‐time relationship and covariate effects of acupuncture. Databases And Data Treatment PubMed and EMBASE were searched up to December 2018 for randomised controlled trials that involved sham acupuncture, true acupuncture and conventional therapy. We used model‐based meta‐analysis to characterize the response‐time profile of these treatments. Results Seventy‐seven randomized clinical trials involved chronic shoulder, neck, knee and low back pain were included. The response‐time analysis suggested that the treatment duration of acupuncture will be 5 weeks or more to achieve 80% of maximum analgesic effect. Moreover, a lower baseline pain intensity and the location of low back pain resulted in a lower pain relief of acupuncture intervention. The absolute maximum analgesic effects of sham acupuncture and conventional therapy were 22.6 and 15.8 points at a 0‐100 NRS scale. The absolute effect of true acupuncture was 26.1 points for low back pain (relative effect of 3.5 and 9.4 points to sham and conventional therapy), 34.9 points for other pain body locations (relative effect of 12.3 and 19.1 points to sham and conventional therapy), in patients with a baseline pain intensity of 60 points. Conclusion The treatment duration of acupuncture will not be less than 5 weeks. Higher analgesic effect was related to higher baseline pain intensity and pain location of neck, shoulder and knee.
... An American survey found that 8 million Americans have been accepted acupuncture therapy in their lifetime and the most common used is for low back pain. [34,35] According to recent studies, acupuncture can not only bring immediate pain relief but also improve the functional recovery of the whole body. Silver acupuncture is based on acupuncture which the material and shape is different from traditional acupuncture needle. ...
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Background: This systematic review aims to evaluate the effectiveness and safety of silver acupuncture in treatment of myofascitis. Methods: Electronic databases of all silver acupuncture for myofascitis will be searched at PubMed, Cochrane Library, Springer, Embase, China National Knowledge Infrastructure, Wanfang, and Chinese Biological Medical disc from inception to March 31, 2020, with language restricted in Chinese and English. The primary outcome is visual analog scale, a short pain scale with sensitivity and comparability. Secondary outcomes included Clinical Assessment Scale for Cervical Spondylosis, Japanese Orthopaedic Association Scores, Oswestry dysfunction index, American Orthopaedic Foot and Ankle Society-Ankle Hindfoot scale, Foot and Ankle Ability Measure, The Cumberland ankle instability tool, Pittsburgh sleep quality index, self-rating anxiety scale, self-depression rating scale, and follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for myofascitis. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference, standard mean deviation, and binary data will be used to represent continuous results. Results: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of myofascitis with this therapy. Conclusion: This study will provide new evidence to evaluate the effectiveness and side effects of silver acupuncture for myofascitis. Due to the data are not personalized, no formal ethical approval is required. Ethics and dissemination: There is no requirement of ethical approval and it will be in print or disseminated by electronic copies. Prospero registration number: CRD42020151476.
... An American survey found that 8 million Americans have been accepted acupuncture therapy in their lifetime and the most common used is for low back pain. [31][32] According to recent studies, acupuncture can relieve not only pain but also the other symptoms including improving the functional recovery of the whole body. Electroacupuncture is based on acupuncture where a kind of chosen small current passed between pairs of acupuncture needles. ...
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Background: This systematic review aims to evaluate the effectiveness of electroacupuncture in treatment of lumbar disc herniation (LDH). Methods: Electronic databases of all electroacupuncture for LDH will be searched at PubMed, Cochrane Library, Springer, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang, and Chinese Biological Medical disc, (CBM) from inception to February 29, 2020, with language restricted in Chinese and English. The primary outcome is Japanese Orthopedic Association Scores, a quantification scale for a comprehensive assessment according to patients' subjects feeling and objective function. Secondary outcomes included visual analogue scale (VAS), Oswestry dysfunction index (ODI), Pittsburgh sleep quality index (PSQI), Self-rating anxiety scale (SAS), self-depression rating scale (SDS), follow-up relapse rate. The systematic review and searches for randomized controlled trials of this therapy for LDH. The Cochrane RevMan V5.3 bias assessment tool is implemented to assess bias risk, data integration risk, meta-analysis risk, and subgroup analysis risk (if conditions are met). Mean difference (MD), standard mean deviation (SMD) and binary data will be used to represent continuous results. Results: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of LDH with this therapy. Conclusion: This study will provide new evidence to evaluate the effectiveness and side effects of electroacupuncture for LDH. Due to the data is not personalized, no formal ethical approval is required.
... Traditional Chinese Medicine (TCM) is increasingly accepted as an effective treatment for cardiovascular diseases [6]. Acupuncture, which derives from ancient China, is an important component of TCM. is alternative therapy can prevent and treat many diseases, including AMI [7,8]. Clinical studies [9,10] have indicated that acupuncture can improve cardiac function and promote recovery from myocardial ischemia. ...
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The locus coeruleus (LC) is closely linked with cardiovascular disease. However, whether it mediates the alleviating effect of electroacupuncture (EA) on acute myocardial ischemia (AMI) remains unclear. A rat model of myocardial ischemia was established through occlusion of the left anterior descending coronary artery. Multichannel in vivo recording and other techniques were used to assess neurons in the LC, norepinephrine (NE) and dopamine (DA) levels in central and myocardial tissue, serum levels of inflammatory factors, and cardiac function. After induction of AMI, LC neuron activity increased and the central NE concentrations increased, while those of DA decreased. Moreover, the serum levels of high-sensitivity C-reactive protein (hs-CRP) increased, whereas those of interleukin-10 (IL-10) decreased. However, these effects were reversed by EA. Additionally, LC lesioning affected NE and DA levels in myocardial tissue and weakened the antimyocardial ischemic effect of EA. Collectively, our results indicated that LC is closely related to AMI and plays an important role in the antimyocardial ischemic effect of EA. This mechanism may be related to inhibition of LC neuron activity by EA, which inhibits the release of large amounts of hs-CRP and promotes that of IL-10 in the serum. Besides, after LC lesioning, EA may improve cardiac function by inhibiting the release of large amounts of NE and promoting the release of DA in myocardial tissue.
... Acupuncture therapy has been used in China for more than 2000 years [44] and has been generally practiced in Western countries in recent years [45] . Recently, despite some evidence of acupuncture for aMCI emerging, methodological quality is generally not high enough to produce convincing and suggestive results. ...
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Background: Patients with amnesic mild cognitive impairment (aMCI) are more likely to develop Alzheimer's disease (AD) than corresponding age normal population. Because AD is irreversible, early intervention for aMCI patients seems important and urgent. We have designed a pilot multicenter, randomized, parallel controlled trial to assess the efficacy and safety of acupuncture on aMCI, and explore the feasibility of acupuncture in the treatment of aMCI, so as to provide a reference for large-sample clinical trials in the next stage. Method: We designed a pilot multicenter, randomized, parallel controlled trial. This trial aims to test the feasibility of carrying out a large-sample clinical trial. In this trial, 50 eligible patients with aMCI will be included and allocated to acupuncture group (n = 25) or sham acupuncture group (n = 25) at random. Subjects will accept treatment 2 times a week for 12 weeks continuously, with a total of 24 treatment sessions. We will select six acupoints (GV20, GV14, bilateral BL18 , bilateral BL23). For the clinical outcomes, the primary outcome is Montreal cognitive assessment (MoCA), which will be assessed from baseline to the end of this trial. And the secondary outcomes are Mini-mental State Examination (MMSE), Delayed Story Recall (DSR), Clinical Dementia Rating scale (CDR), Global Deterioration Scale (GDS), Activity of Daily Life (ADL), Alzheimer's Disease Assessment Scale-Cognitive Section (ADAS-cog), brain Magnetic Resonance Imaging (MRI) , brain functional Magnetic Resonance Imaging (fMRI) and Event-related potential (ERP) P300, which will be assessed before and after treatment. In addition, we will asses the safety outcomes from baseline to the end of this trial and feasibility outcome after treatment. We will evaluate neuropsychological assessment scale (MoCA, MMSE, ADAS-cog) at 3 months and 6months after treatment. Discussion: This pilot trial aims to explore the feasibility of the trial, and verify essential information of its efficacy and safety. This pilot study will provide a preliminary basis for carrying out a larger clinical trial of acupuncture on aMCI in near future. Trial registration: Chinese Clinical Trial Registry , ChiCTR1900021557. Registered on 27 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35460. Keywords: amnestic Mild Cognitive Impairment , Acupuncture, Clinical trial
... It is a painful burden to many people; time spent in the ictal state is exhausting, making migraine the leading cause of disability in patients with neurological diseases [45]. Although conventional treatment options are widely available, acupuncture is often additionally used to relieve symptoms [46]. A Cochrane review published in 2016 comparing acupuncture therapy to a non-interventional control group, showed moderate evidence for its usage in the reduction of migraine frequency. ...
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Traditional Chinese Medicine (TCM) consists of a plethora of therapeutic approaches aiming to both characterize and treat diseases. Its utilization has gained significant popularity in the western world and is even backed by the World Health Organization’s decision to include TCM diagnostic patterns into the new revision of the International Classification of Diseases code, the global standard for diagnostic health information. As these developments and potentially far-reaching decisions can affect modern healthcare systems and daily clinical work as well as wildlife conservation, its underlying factual basis must be critically examined. This article therefore provides an overview of the evidence underlying the basic TCM concepts, such as Qi, meridians, acupuncture, pulse and tongue diagnostics as well as traditional herbal treatments. Moreover, it discusses whether scientific literature on TCM reflects the current standard for evidence-based research, as described in good scientific practice and good clinical practice guidelines. Importantly, misinformation regarding the therapeutic efficacy of animal-derived substances has lead and currently leads to problems with wildlife preservation and animal ethics. Nevertheless, the (re-)discovery of artemisinin more than 50 years ago introduced a novel development in TCM: the commingling of Eastern and Western medicine, the appreciation of both systems. The need for more rigorous approaches, fulfilment of and agreement to current guidelines to achieve high-quality research are of utmost relevance. Thereby, ancient knowledge of herbal species and concoctions may serve as a possible treasure box rather than Pandora’s box.
... A national survey of the general population of the United States (US) conducted in 2002 found that 3.4 % of participants who had used acupuncture within the past twelve months used it to treat anxiety and/or depression. 5 Similarly, a study that analyzed data collected between 2012 and 2013 from a population-based cohort of women in Australia found that, within the last twelve months, 19.3 % of the young women and 16.8 % of the middle-aged women who consulted for acupuncture had depression. 6 Clinical Practice Guidelines (CPGs) provide recommendations based on the best and most up to date evidence available to improve the quality of patient care. ...
... Traditional East Asian therapeutic approaches such as acupuncture, herbal decoctions, dietary therapies, massage (tui na) and mind-body exercises (qi gong, tai chi) were developed over a period of centuries in China, Korea, and Japan and are still used widely there. These traditional East Asian medicine (TEAM) therapies are used at lower rates in Western countries such as the US, the UK, and Europe, however this usage has increased over the last 10-15 years [1][2][3][4][5]. There is worldwide interest in a range of traditional medicine therapies, and the World Health Organization has stated that it seeks to integrate safe and effective TEAM therapies into health care globally [6]. ...
Article
Introduction: Traditional East Asian medicine (TEAM) is widely used in Asia and increasingly in the West. Systematic reviews (SRs) are the best summaries of the potential benefits or harms of interventions, and Cochrane is a leading international SR organization. Cochrane perspectives on the barriers to the initiation and completion of Cochrane SRs of TEAM therapies were solicited. Methods: Cochrane Review Groups (CRGs) were identified from the online listing of CRGs at cochrane.org and a link to an online survey was e-mailed to the primary contact for each CRG. Results: Forty-eight responses were received on behalf of 49/53 (92%) CRGs. Most CRGs had experience producing TEAM reviews, primarily in acupuncture or herbal medicine. The main barriers to taking on a new TEAM review were difficulty in understanding and assessing the intervention, and the low priority of TEAM topics. Problems with the quality and accessibility of randomized trials in TEAM were cited as a major concern. CRGs suggested that the quality and accessibility of randomized trials should be improved, that the methodological and language expertise of authors should be enhanced, and that further peer review expertise should be made available to CRGs. Conclusions: TEAM topics are covered in Cochrane reviews but are often considered low-priority. This survey highlights Cochrane concerns about the quality of the underlying evidence base and the training of the author teams as barriers to successful SR completion. Specific approaches are proposed to increase the number of TEAM reviews and address the limitations of TEAM research processes within Cochrane.
... According to a US-based survey, 9.9% of patients who underwent treatment for migraine or other headaches used acupuncture to help alleviate symptoms. 12 In recent years, controlled clinical trials on acute or chronic migraine have increased in number and experimental breadth. [13][14][15][16] Furthermore, several Cochrane systematic reviews have confirmed the effectiveness and safety of acupuncture. ...
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Introduction Migraine is a primary cause of disability worldwide, particularly affecting young adults and middle-aged women. Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating acute migraine attacks, the methodologies in academic studies and commonly applied practices vary greatly. This study protocol outlines a plan to assess and rank the effectiveness of the different acupuncture methods in order to develop a prioritised acupuncture-based treatment regimen for acute migraine attacks. Objective To compare the efficacy of different acupuncture methods and conventional medicinal methods in the treatment of acute migraine attacks. Methods and analysis Six databases will be searched, including MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang Database from inception to 31 August 2019. The primary outcomes will be assessed using metrics for intensity and duration (in hours) of pain post-treatment. Bayesian network meta-analysis will be conducted using WinBUGS V.1.4.3. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System to assess the quality of evidence. Ethics and dissemination The results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol. PROSPERO registration number CRD42019126472.
... Acupuncture is an important therapeutic modality in Traditional East-Asian Medicine and recently gaining popularity in Western countries [27,28]. As research on acupuncture rapidly increases over time [29], there is concerning voice that outcome reporting biases in acupuncture randomized controlled trials (RCTs) may hamper the reliability of the evidence. ...
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Background and objective Trial registration is widely endorsed as it is considered not only to enhance transparency and quality of reporting but also to help safeguard against outcome reporting bias and probably spin, known as specific reporting that could distort the interpretation of results thus mislead readers. We planned to investigate the current registration status of recently published randomized controlled trials (RCTs) of acupuncture, outcome reporting bias in the prospectively registered trials, and the association between trial registration and presence of spin and methodological factors in acupuncture RCTs. Methods Acupuncture RCTs published in English in recent 5 years (January 2013 to December 2017) were searched in PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Trial registration records identified in the publications and trial registries were classified into prospectively registered, retrospectively registered, or unregistered. Primary outcomes were identified and the direction of the results was judged as statistically significant (positive) or statistically nonsignificant (negative). We compared registered and published primary outcomes to assess outcome reporting bias and assessed whether discrepancies favored statistically significant outcomes. Frequency and strategies of spin in published reports with statistically nonsignificant results for primary outcomes were then identified. We also analyzed whether the trial registration status was associated with spin and quality of methodological factors. Results Of the 322 included RCTs, 41.9% (n = 135) were prospectively registered. Among 64 studies that were prospectively registered and specified primary outcomes, 25 trials had the discrepancies between the registered and published primary outcomes and 60% of them (15 trials) favored the statistically significant findings. Among 169 studies that specified primary outcomes, trial registration status was not associated with the direction of results, i.e., statistically significant or not. Spin was identified in 56.4% out of 78 studies with statistically nonsignificant primary outcomes and claiming efficacy with no consideration of statistically nonsignificant primary outcomes was the most common strategy for spin. Trial registration status was not statistically different between studies with and without spin. Conclusion While trial registration seemed to have improved over time, primary outcomes in registered records and publications were often inconsistent, tending to favor statistically significant findings and spin was common in studies with statistically nonsignificant primary outcomes. Journal editors and researchers in this field should be alerted to still prevalent reporting bias and spin.
... Acupuncture treatment has been practiced in China for more than two millennia [31] and in recent years has been widely used in Western countries [32]. Recent studies have found that acupuncture can be used to relieve vasomotor symptoms during the MT [23], but have not yet established the effects of acupuncture on insomnia during the MT. ...
Article
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Background: The National Institutes of Health estimates the prevalence of insomnia in menopausal women at 40-50%. Some studies have shown that acupuncture might be effective in treating primary insomnia and insomnia related to depression and stroke. Although there are some programs supporting insomnia during the menopausal transition, there are few randomized controlled trials (RCT) to provide evidence regarding their effectiveness. We design a RCT of suitable sample size to verify the effectiveness of acupuncture in patients with insomnia during the menopausal transition and to form an optimized acupuncture treatment protocol. Method/design: In this randomized, single-site, single-blind, placebo-controlled trial, 84 eligible patients will be recruited and randomly assigned to either the acupuncture group (n = 42) or the sham control group (n = 42) in a 1:1 ratio. Participants will receive a total of 18 treatment sessions for eight consecutive weeks. Treatments will be given three times per week in the first four weeks, twice a week for the next two weeks, and finally once weekly for the final two weeks. Treatment will utilize eight main acupoints (GV20, GV24, GV29, RN6, RN4, SP6, HT7, EX-HN22) and extra two acupoints based on syndrome differentiation. The primary outcome will be assessed using the Pittsburgh Sleep Quality Index (PSQI). The secondary outcomes will be measured by sleep parameters recorded in the Actigraphy (SE, TST, SA), Insomnia Severity Index (ISI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Menopause Quality of Life (Men-QOL). The primary outcomes will be assessed at baseline, week 4, week 8, and the first and third month after the end of treatment. Discussion: If the results confirm that acupuncture is effective and safe for the treatment on insomnia in menopausal women, this positive outcome could provide evidence for clinical application. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800018645 . Registered on 10 January 2018.
... Non-steroidal antiinflammatory drugs (NSAIDs) are widely used as first-line therapy in women with primary dysmenorrhea. On the other hand complementary and alternative medicine is an increasingly popular therapeutic mode all over the world [15][16][17][18]. Alternative medicines have a long history indicating the efficacy of spices in the management of dysmenorrhea. ...
Article
Background: Dysmenorrhea is the most common gynecologic complaint among adolescent and adult females. Some dysmenorrheic females do not respond to treatment with NSAIDs or oral contraceptives and exhibit contraindications to such medications. Therefore, alternative medication gained importance in management of dysmenorrhea. Methods: A comparative clinical trial was conducted on thirty-one dysmenorrheic subjects, who were randomly assigned to three groups. The dosage was 1gr/day, 3gr/day and 3gr/day for Ginger, Dill seeds, and Cumin, respectively. The girls in respective group consumed the spice for three days during each cycle for three consecutive cycles. Results: Dill seed was effective in reducing pain, followed by ginger wherein Cumin did not exhibit any effect. Cumin exhibited significant reduction in systemic responses like cold sweats, backache, fatigue and cramps. Conclusion: Dill seeds were more effective in reducing pain. It was obvious from our study that reducing symptoms is also important in the overall management of dysmenorrhea.
... Acupuncture is the needling of specific points of the body and is an intervention that is often used for the relief of headache (Burke, Upchurch, Dye & Chyu, 2006). Studies have illustrated that acupuncture in the short term effects a range of various physiological variables similar to analgesia (Endres, Diener & Molsberger, 2007). ...
... Up till now, the exact pathophysiology of this misperception condition has not been identified, and efficacious treatments have not been established. Acupuncture, a component of complementary and alternative medicine (CAM), has been widely used for the treatment of insomnia in Chinese clinics, even in some western countries [3]. Since acupuncture may be effective for primary insomnia [4], we considered paradoxicalinsomnia might be responsive to it. ...
... These findings have been substanti- ated in both national 4,7,11 and international literature regarding CAM utilisation. [13][14][15][16] Communication in the therapeutic relationship was also identified as a reason for seeking TCM treatment, a finding substantiated in previous New Zealand research. 1 The patient-health care practitioner relationship is considered reciprocal in Chinese medicine, as patients have an active role in their healing. ...
... These findings have been substanti- ated in both national 4,7,11 and international literature regarding CAM utilisation. [13][14][15][16] Communication in the therapeutic relationship was also identified as a reason for seeking TCM treatment, a finding substantiated in previous New Zealand research. 1 The patient-health care practitioner relationship is considered reciprocal in Chinese medicine, as patients have an active role in their healing. ...
Article
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INTRODUCTION Acupuncture is one of the most well-known and utilised forms of traditional Chinese medicine (TCM). Very little is known about the factors that influence individuals to seek this type of treatment. The aim of this study was to identify and examine patients’ reasons for seeking TCM treatment, which was mainly in the form of acupuncture. METHODS Participants were 15 Auckland-based patients who attended a student acupuncture clinic. Participants were individually interviewed. An inductive thematic approach was used to analyse data. RESULTS Three main themes were identified regarding factors that influenced individuals to seek TCM: the perceived limitations of pharmaceutical treatment for certain conditions; a previous positive experience of acupuncture; and word-of-mouth regarding the perceived effectiveness of acupuncture in the treatment of certain conditions. DISCUSSION Users perceive TCM-based acupuncture to be an effective form of treatment for their condition, especially after having previously received conventional medical treatment. Past and present users of TCM appear to have an advocate-based role with family and friends regarding the promotion of TCM-based acupuncture.
... According to a survey in USA, 9.9% of patients who received acupuncture treatment did so in search of relief from migraine and other headaches. 13 A 2016 Cochrane Review from Germany concluded that acupuncture is safe and effective for episodic migraine prophylaxis compared with prophylactic drug treatment. 14 How the intervention might work While enhanced calcitonin gene-related peptide (CGRP) and spontaneous cortical spreading depression are regarded as causative in triggering migraine, 15 the pathophysiology of migraine is attributed to multiple factors, many of which remain unclear. ...
Article
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Introduction Although the effectiveness of acupuncture for episodic migraine has been confirmed by multiple clinical trials and Cochrane systematic reviews, the mechanisms underlying the specific effect of acupuncture for migraine remain controversial. We aim to evaluate the effectiveness and safety of acupuncture for both episodic migraine and chronic migraine by meta-analysis and explore the possible factors influencing the specific effect of acupuncture for migraine by meta-regression. Methods and analysis We will search for randomised control trials of acupuncture for migraine in the following eight databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED (via OVID) and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database and Wanfang Database) from inception to 31 December 2017. We will also search OpenSIGLE (opensigle.inist.fr) for conference abstracts. No language restriction will be applied. The selection of studies, data extraction and coding and assessment of risk of bias of the included studies will be conducted independently by two reviewers. Standard meta-analysis and, if appropriate, meta-regression will be performed using the R packages Meta and Metafor. Ethics and dissemination The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal and presented at a relevant conference. The data used in this meta-analysis will not contain individual patient data; therefore, ethical approval is not required. PROSPERO registration number CRD42018087270.
... It has been well understood that acupuncture is effective in analgesia and blood flow regulation [10]. According to research, women are more likely to use acupuncture as an adjunct treatment compared to men [11,12]. With increased recognition of effect of acupuncture in many field of studies, its effects on gynecological and reproductive issues were raised among people. ...
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Background: It has been known that acupuncture treatment relieves gynecological disorders such as menopause, ovarian dysfunction, and dysmenorrhea. Sex hormones, including estrogen, progesterone, and gonadotropins, are related to the women disease. However, regulative effect of acupuncture on sex hormones has not been fully identified. Methods: Acupuncture articles including analysis of sex hormones were searched in electronic databases from inception to June 2018. The methodological quality was assessed using modified CAMRADES tool. A total of 23 articles were selected and analyzed. Results: In the results, overall studies showed that acupuncture increases estrogen, especially estradiol, progesterone, prolactin, and other hormones. Estradiol level was increased in most of studies except 3 studies which resulted in decreased level or not meaningful change. Two studies showed increase of FSH and LH whereas it was decreased in other studies. Other hormones were mostly increased by acupuncture. Conclusion: This study possibly indicates that acupuncture changes sex hormone in various gynecological conditions in women.
... Musculoskeletal and neurologic disorders were the major symptoms prompting people to seek out acupuncture treatment. Similar findings were also recorded in the general public in the United States (Burke, Upchurch, Dye, & Chyu, 2006). Kemper and her colleagues (2000) surveyed pediatric pain patients as well as their families and found that most parents considered acupuncture helpful as they could see the health of their children improve. ...
... However, those drugs have limited efficacy in relieving headache or reducing the frequency of attacks and are often accompanied by adverse effects (Cranz, 1990;Lipton et al., 1994;Silberstein and Young, 1995;Silberstein et al., 2012b). Acupuncture has become a widely used complementary therapy in many countries (Hartel and Volger, 2004;Bodeker et al., 2005;Burke et al., 2006). Due to its stable effects, acupuncture has been increasingly used in migraine prevention. ...
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Background: Acupuncture is frequently used as an efficient method to prevent and treat migraines. However, its effect on the quality of life remains controversial. Methods: Seven databases, such as PubMed and Cochrane Library were searched to retrieve reference lists of eligible trials and related reviews. Randomized controlled trials that were published in Chinese and English were included. Results: Acupuncture resulted in lower Visual Analog Scale scores than the medication group at 1 month after treatment (MD −1.22, 95%CI −1.57 to −0.87; low quality) and 1–3 months after treatment (MD −1.81, 95%CI −3.42 to −0.20; low quality). Compared with sham acupuncture, acupuncture resulted in lower Visual Analog Scale scores at 1 month after treatment (MD −1.56, 95%CI −2.21 to −0.92; low quality). Conclusion: Acupuncture exhibits certain efficacy both in the treatment and prevention of migraines, which is superior to no treatment, sham acupuncture and medication. Further, acupuncture enhanced the quality of life more than did medication.
Article
Background Korean acupuncture comes from the far-eastern tradition and has unique approaches to acupuncture point selection. Objectives There are several types of acupuncture methods. Among these, Tae-Geuk acupuncture and Saam acupuncture adopt five phase characteristics, using five vital points. Cho-sun acupuncture regulates Qi using acupunctures and meridians according to the flow of Qi. In this project, the effects of Korean Tae-Geuk acupuncture on chronic tension-type headache (TTH) were examined. Methods This study is a randomized controlled study involving sham acupuncture (placebo acupuncture), and everything is clear except for the data processing phase. The purpose of the study; was to measure the safety and efficacy of Korean Tae-Geuk acupuncture in patients with chronic TTH. Groups used; acupunture + traditional pharmacological therapy, traditional pharmacological therapy only and placebo korean acupuncture + traditional pharmacological therapy groups. Seven treatment sessions were applied over a four-week period. Changes in pain and quality of life and side effects were examined during treatment and within 3 months after the completion of treatment. Results were evaluated by using the visual analog scale for pain and pain log records. Results Korean Tae-Geuk acupuncture is a more effective treatment than placebo and traditional pharmacological treatment in chronic TTH. Korea Tae-Geuk acupuncture showed significant improvement in clinically chronic TTH during treatment and in 3 months follow-up after treatment. Conclusion Tae-Geuk acupuncture is a treatment branch of Sasang Constitution Medicine. Acupuncture points do not change according to acupuncture practitioner or disease.
Article
Resumen Introducción La migraña es un trastorno común que aqueja a gran parte de la población mundial, por este motivo se han buscado diversas formas de combatirla, entre ellas, la acupuntura como alternativa o complemento para el tratamiento farmacológico. Objetivo Evaluar la eficacia y seguridad de la acupuntura en el manejo de la migraña. Material y métodos Se realizó una búsqueda de la literatura médica actual, se incluyeron únicamente ensayos clínicos y estudios de cohorte a través de PubMed. Simultáneamente, se revisaron 18 bases de datos de la Organización Mundial de la Salud en busca de registros de futuros ensayos clínicos que evalúen la acupuntura en el manejo de la migraña. Resultados Se incluyeron documentos (n = 21), estudios de cohorte retrospectivos (n = 2) y ensayos clínicos (n = 19), todos escritos en inglés; además, 11 ensayos clínicos registrados Chinese Clinical Trial Registry (n = 7), U.S. National Library of Medicine (n = 3) e Iranian Registry of Clinical Trials (n = 1). Conclusión La acupuntura es una técnica eficaz y segura según se reporta en los ensayos clínicos y estudios observacionales incluidos; sin embargo, se requiere de estudios que cuenten con un mayor número de tiempo de observación y número de pacientes para generar una mayor validez a la actual evidencia.
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Introduction: Endometriosis is an inflammatory estrogen-dependent gynecological disease, which is one of the common reasons for infertility. The current treatments of endometriosis-associated infertility often involve laparoscopic surgery, medical therapy and in vitro fertilization (IVF) therapy, which are expensive, and the therapeutic effects are far from the expectation. Acupuncture and Yangjing Zhongyu Decoction (YZD) which have the advantages of effective and inexpensive, have been used clinically for the infertile female in China for many years. However, a comprehensive evaluation of the current clinical evidence of their efficacy is lacking. Our study intends to evaluate the efficacy of acupuncture and YZD on endometriosis-associated infertility (EAI). Methods/design: This study is a multi-center, controlled and randomized clinical trial. A total of 224 eligible patients with endometriosis-associated infertility will be randomly assigned into two groups, in a 1:1 ratio as the treatment group or the control group. All participants will receive pregnancy guidance. The participants assigned to the treatment group will be treated with acupuncture and YZD while the control group will receive the GnRH-a therapy. The trial will include three menstrual cycles of treatment and twelve menstrual cycles of follow-up. The primary outcome is pregnancy rate that will be verified by human chorionic gonadotropin (HCG) tests and secondary outcomes include the result of ultrasound, cancer antigen 125 (CA125), anti-Müllerian hormone (AMH), sex hormones, alanine aminotransferase (ALT) and the Endometriosis Health Profile-5 (EHP-5). Outcome will be collected at baseline, the end of treatments and follow-up visits at 3, 6 and 12 menstrual cycles. All the data including the major adverse events will be recorded in electronic case report forms and analysed by SPSS V.25.0. Discussion: This study protocol will help to evaluate whether acupuncture and Chinese herb medicine Yangjing Zhongyu Decoction are effective in increasing pregnancy rate of the infertile female with endometriosis. Trial registration: ChiCTR2100042830; Registered on 29 January 2021.
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Objective: Existing systematic reviews and meta-analyses indicate that acupuncture has similar clinical effectiveness in the prevention of headache disorders (HDs) as drug therapy, but with fewer side effects. As such, examining acupuncture’s use in a pragmatic, real-world setting would be valuable. The purpose of this study was to compare the effects of acupuncture and prophylactic drug treatment (PDT) on headache frequency in patients with HDs, under real-world clinical conditions. Methods: Retrospective cohort study of patients with HDs referred to a pain clinic, using electronic health record data. Patients continued with tertiary care (treatment of acute headache attacks and lifestyle, meditation, exercise and dietary instructions) with PDT, or received 12 sessions of acupuncture over 3months, instead of PDT under conditions of tertiary care. The primary outcome data were the number of days with headache per month, and groups were compared at baseline and at the end of the third month of treatment. Results: Data were analysed for 482 patients with HDs. The number of headache days per month decreased by 3.7 (standard deviation (SD)=2.9) days in the acupuncture group versus 2.9 (SD=2.3) in the PDT group (p=0.007). The proportion of responders was 39.5% versus 16.3% (p<0.001). The number needed to treat was 4 (95% confidence interval=3–7). Conclusion: Our study has shown that patients with HDs in tertiary care who opted for treatment with acupuncture appeared to receive similar clinical benefits to those that chose PDT, suggesting these treatments may be similarly effective of the prevention of headache in a real-world clinical setting
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Background In India, the use of traditional medicine for health problems is a part of the cultural discourse on treatment, but the introduction of Western medicines has adversely affected their popularity. However, with the rapid spread of chronic diseases like coronary artery disease (CAD), many Indians are reverting to complementary and alternative medicine (CAM) treatments. Although previous literature has identified several motivational factors underlying CAM usage, we know little from the perspective of its practitioners. Aim The aim of the present study was to investigate the motivations behind the use of CAM treatments among Indian patients with CAD. Method Using semi‐structured interviews, we collected data from 15 CAM practitioners and 14 CAD patients utilising CAM treatments alongside conventional biomedical (BM) treatment. We used the Clarke and Braun (2006) method of thematic analysis. Result and Conclusion Our findings suggest that the use of CAM treatments depends on various factors working at multiple levels viz., personal factors, disease’ characteristics, perceived treatment characteristics (positive attributes of CAM and negative attributes of BM) and external facilitators. Furthermore, our analysis also identifies the role of two underlining forces—push and pull—in motivating CAD patients to choose CAM treatments. The push force comprises factors that participants found to have a repelling nature, whereas pull forces were regarded as advantageous for CAM usage. Although some reasons behind the usage of CAM treatments according to patients and practitioners were overlapping, both groups also provided many distinct insights into the studied health behaviour.
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Male reproductive fitness has faced significant challenges in the current scenario. Derangement in the fertility spectrum has been associated with a host of modifiable and non-modifiable lifestyle factors and affected by equally contributing holistic, complementary and alternative therapies for their management. Infertility has stepped up the ladder to be considered among the complex chronic lifestyle conditions. Infertile men not only face challenges in reproductive potential but deranged seminal parameters are also a gateway to the overall health since infertility in men may pose as a harbinger of various medical conditions later in life. This chapter intends to portray an outline of various complementary therapies being adopted as an adjunct to modern medicine for the management of male infertility because male reproductive health and general health are largely intertwined.
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Clinically informed efforts to curb inappropriate opioid prescribing seek to reduce prescribing to adults with lower pain levels that are potentially manageable with alternative therapies. According to the Medical Expenditure Panel Survey, the annual share of US adults who were prescribed opioids decreased from 12.9 percent in 2014 to 10.3 percent in 2016, and the decrease was concentrated among adults with shorter-term rather than longer-term prescriptions. The decrease was also larger for adults who reported moderate or more severe pain (from 32.8 percent to 25.5 percent) than for those who reported less-than-moderate pain (from 8.0 percent to 6.6 percent). In the same period opioids were prescribed to 3.75 million fewer adults reporting moderate or more severe pain and 2.20 million fewer adults reporting less-than-moderate pain. Because the decline in prescribing primarily involved adults who reported moderate or more severe pain, these trends raise questions about whether efforts to decrease opioid prescribing have successfully focused on adults who report less severe pain.
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Objective: Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilisation of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery. Methods: The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis. Results: The acupuncture and control groups included 50 171 and 128 556 neck pain patients, respectively. A total of 50 161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group. Conclusions: A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.
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Application of acupuncture and Electro-acupuncture technique for enhancement of semen quality during heat stress period
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Acupuncture is one of the oldest forms of medical treatment in the world and is commonly used to treat pain. There is some evidence to suggest that acupuncture is more efficacious than sham acupuncture and placebo in the treatment of pain. Despite the lack of definitive evidence, acupuncture is often used to treat cancer-related pain. Common uses of acupuncture include treatment of aromatase inhibitor-induced musculoskeletal pain, chemotherapy-induced peripheral neuropathy, and cancer-induced bone pain. Complications of acupuncture are rare and usually minor, making it a safe method for the treatment of pain in cancer patients.
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This study explored the use of mental health services by Asian Americans and other ethnic populations (N=104,773) in California. The authors used linear regression analyses to assess the role of ethnicity and diagnosis in predicting six-month use of services. East Asians used more services than Southeast Asians, Filipinos, other Asians, Caucasians, African Americans, Latinos, and Native Americans, even when severity of illness was taken into account. The findings suggest that aggregating Asian subpopulations into a single group in services research is no longer appropriate. Attention needs to be placed on the needs of Southeast Asians and other Asians, whose service use patterns approximate those of the traditionally most underserved groups, African Americans and Latinos.
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A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
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Nonphysician clinicians (NPCs) are becoming increasingly prominent as health care providers. This study examines 10 such disciplines: nurse practitioners (NPs), physician assistants (PAs), nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse specialists. The aggregate number of NPCs graduating annually in these 10 disciplines doubled between 1992 and 1997, and a further increment of 20% is projected for 2001. Assuming that enrollments remain at the levels attained in 2001, NPC supply will grow from 228000 in 1995 to 384000 in 2005, and it will continue to expand at a similar rate thereafter. The greatest growth is projected among those NPCs who provide primary care services. Moreover, the greatest concentrations of both practicing NPCs and NPC training programs are in those states that already have the greatest abundance of physicians. On a per capita basis, the projected growth in NPC supply between 1995 and 2005 will be double that of physicians. Because of the existing training pipeline, it is probable that most of the growth projected for 2005 will occur. The further expansion of both NPC and physician supply thereafter warrants careful reconsideration.
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Despite recent findings that patients who use complementary and alternative medicine (CAM) typically choose not to mention this to their physicians, little is known about the reasons for this lack of communication. Understanding the reasons for nondisclosure of CAM use is critical to improving physician-patient communication and patient care. We are conducting a 5-year prospective cohort study consisting of 4 interview cycles. The multiethnic, population-based sample consists of 86 San Francisco residents with recently diagnosed breast cancer (response rate = 87%). Findings are determined using qualitative analysis of transcribed interviews. At initial contact, 72% of the participants were using at least 1 CAM therapy for breast cancer. Six months later, 65% of participants were using CAM. Of the women being treated by an alternative practitioner, 54% disclosed their CAM use to their physicians. Conversely, 94% discussed details of their biomedical treatments with their alternative practitioner. Reasons for not disclosing CAM use included anticipating the physician's disinterest, negative response, or unwillingness or inability to contribute useful information; the perception that the CAM therapies used were irrelevant to the biomedical treatment course; and the patients' views regarding the appropriate coordination of disparate healing strategies. Discussions of patients' CAM use are more poorly integrated into the medical encounter than discussions of biomedical treatment are with alternative practitioners. Patients' disclosure is often cautiously modulated, even by those who would welcome an open discussion with their physicians. Specific suggestions for discussing CAM use with patients are presented.
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Little is known about perceptions of complementary and alternative medical (CAM) therapy relative to conventional therapy among patients who use both. To document perceptions about CAM therapies among persons who use CAM and conventional therapies. Nationally representative, random-household telephone survey. The 48 contiguous U.S. states. 831 adults who saw a medical doctor and used CAM therapies in 1997. Perceptions about helpfulness and patterns of CAM therapy use relative to conventional therapy use and reasons for nondisclosure of CAM therapies. Of 831 respondents who saw a medical doctor and used CAM therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone. Of 411 respondents who reported seeing both a medical doctor and a CAM provider, 70% typically saw a medical doctor before or concurrent with their visits to a CAM provider; 15% typically saw a CAM provider before seeing a medical doctor. Perceived confidence in CAM providers was not substantially different from confidence in medical doctors. Among the 831 respondents who in the past year had used a CAM therapy and seen a medical doctor, 63% to 72% did not disclose at least one type of CAM therapy to the medical doctor. Among 507 respondents who reported their reasons for nondisclosure of use of 726 alternative therapies, common reasons for nondisclosure were "It wasn't important for the doctor to know" (61%), "The doctor never asked" (60%), "It was none of the doctor's business" (31%), and "The doctor would not understand" (20%). Fewer respondents (14%) thought their doctor would disapprove of or discourage CAM use, and 2% thought their doctor might not continue as their provider. Respondents judged CAM therapies to be more helpful than conventional care for the treatment of headache and neck and back conditions but considered conventional care to be more helpful than CAM therapy for treatment of hypertension. National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care. Adults who use both appear to value both and tend to be less concerned about their medical doctor's disapproval than about their doctor's inability to understand or incorporate CAM therapy use within the context of their medical management.
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Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations. The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies.
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Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal. To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. Randomized, controlled trial. Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. 570 patients with osteoarthritis of the knee (mean age [+/-SD], 65.5 +/- 8.4 years). 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks. Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02). At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis. Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.
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Efforts to build a complementary and alternative medicine (CAM) education and research infrastructure have been productive. Development has focused largely on graduate, postgraduate, and professional level training. This paper examines baccalaureate programs, looking at the prevalence and characteristics of CAM and holistic health training in the United States. A comprehensive literature and web site search was conducted to find educational institutions offering baccalaureate programs in CAM or holistic health. Search criteria included accredited undergraduate programs terminating in a minor, an AA, or a BA/BS degree. A search of health and education databases produced marginal results. Internet searches, by contrast, were very productive in locating CAM or holistic health-related programs generally and baccalaureate programs specifically. The most effective search strings included terms such as "holistic health," "minor," "certificate," and "undergraduate." Using these terms, 5 programs were found in the United States that met the inclusion criteria: Arizona State University East, Bastyr University, San Francisco State University, Metropolitan State College of Denver, and Georgian Court College. Preparing tomorrow's scholars and clinicians to contribute meaningfully to this emerging healthcare paradigm will require a plan that integrates all elements of higher education. The creation of a truly effective workforce of CAM-competent M.D.s, nurses, health educators, pharmacists, and other allied health professionals will increasingly necessitate baccalaureate preparation. Curriculum discussions at the campus, state, and national levels are needed.
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Little is known about policies governing the integration of complementary and alternative medical (CAM) therapies and providers. To document emerging approaches in 19 US hospitals regarding credentialing, malpractice liability, and pharmacy policies governing integration of CAM therapies and providers into conventional medical settings, we surveyed 21 academic medical centers and 13 non-academically affiliated hospitals that are nationally visible and are integrating CAM therapies into conventional medical settings. Of the 19 respondents, 11 were tertiary care hospitals, 6 were community hospitals, 1 was a freestanding center associated with a community-based hospital, and 1 was a university-based rehabilitation hospital. Institutions had no consistent approach to provider mix and authority within the integrative care team, and minimum requirements for professional liability insurance, informed consent disclosure, and hiring status. Less than a third had a formal (stated) policy concerning dietary supplements; those selling supplements in their pharmacy lacked consistent, evidence-based rationales regarding which products and brands to include or exclude. Although many hospitals confiscated patient supplements on admission, institutions had inconsistent criteria regarding allowance of home supply. Hospitals are using heterogeneous approaches to address licensure, credentialing, scope of practice, malpractice liability, and dietary supplement use in developing models of integrative care. The environment creates significant impediments to the delivery of consistent clinical care and multisite evaluations of the safety, efficacy, and cost-effectiveness (or lack thereof) of CAM therapies (or integrative models) as applied to management of common medical conditions. Consensus policies need to be developed.
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Complementary and alternative medicine (CAM) use among ethnic minority populations is poorly understood. We sought to examine CAM use in Hispanics, non-Hispanic blacks and non-Hispanic whites. We analyzed data from the Alternative Health Supplement to the 2002 National Health Interview Survey (NHIS), including information on 19 different CAM therapies used in the past 12 months. An estimated 34% of Hispanic, non-Hispanic black and non-Hispanic white adults in the United States used at least one CAM therapy (excluding prayer) during the prior 12 months (2002). CAM use was highest for non-Hispanic whites (36%), followed by Hispanics (27%) and non-Hispanic blacks (26%). Non-Hispanic whites were more likely to use herbal medicine, relaxation techniques and chiropractic more frequently than Hispanics and non-Hispanic blacks. After controlling for other sociodemographic factors, Hispanic and non-Hispanic black races/ethnicities were associated with less CAM use, with adjusted odds ratios (95% confidence intervals) of 0.78 (0.70, 0.87) and 0.71 (0.65, 0.78), respectively. Hispanics cited using CAM because conventional medical treatments were too expensive more frequently than non-Hispanic blacks or whites. Hispanics had the highest provider nondisclosure rates (68.5%), followed by non-Hispanic blacks (65.1%) and non-Hispanic whites (58.1%). Excluding prayer, Hispanics and non-Hispanic blacks used CAM less frequently than non-Hispanic whites and were less likely to disclose their use to their healthcare provider. Further research is needed to improve our understanding of the disparities in CAM use.
Article
Objective. To measure utilization of complementary and alternative medicine (CAM) by US adults. Methods. We analyzed data from the 1999 National Health Interview Survey (NHIS), which covers the noninstitutionalized civilian US population. Information on 12 types of CAM use in the past 12 months was obtained from 30,801 respondents aged 18 years and older. Statistical analyses were performed using the SUDAAN software package to account for the complex sample design of the NHIS. Results. An estimated 28.9% of US adults used at least one CAM therapy in the past year. The three most commonly used therapies were spiritual healing or prayer (13.7%), herbal medicine (9.6%), and chiropractic therapies (7.6%). The use of CAM was most prevalent among women, persons aged 35 to 54 years, and persons with an educational attainment of ≥16 years. The overall CAM use was higher for white non-Hispanic persons (30.8%) than for Hispanic (19.9%) and black non-Hispanic persons (24.1%). Although the use was higher for persons who had health insurance than for those who did not, the difference was not statistically significant after adjusting for age, gender and educational attainment. Compared with nonusers, CAM users were more likely to use conventional medical services. Conclusions. Estimates of CAM use in this nationally representative sample were considerably lower than have been reported in previous surveys. Most CAM therapies are used by US adults in conjunction with conventional medical services.
Article
BACKGROUND Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic.METHODSA series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer.RESULTSA total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%.CONCLUSIONS This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely. Cancer 1998;83:777-782. © 1998 American Cancer Society.
Article
Objective To determine the prevalence of complementary and alternative medicine (CAM) use and to identify factors associated with its use in older patients with arthritis.MethodsA population-based telephone survey of 480 elderly patients with arthritis was conducted to determine demographics, comorbidities, health status, arthritis symptoms, and the use of CAM and traditional providers and treatments for arthritis.ResultsCAM provider use was reported by 28% of respondents, and 66% reported using one or more CAM treatments. Factors independently related to CAM provider use (P < 0.05) included podiatrist or orthotist use, physician visits for arthritis, and fair or poor self-reported health. For CAM treatments, independent associations were found with physical or occupational therapist use, physician visits for arthritis, chronic obstructive pulmonary disease, and alcohol abstinence. Rural residence, age, income, education, and health insurance type were unrelated to CAM use.Conclusion Many older patients with arthritis reported seeing CAM providers, and most used CAM treatments. The use of CAM for arthritis was most common among those with poorer self-assessed health and higher use of traditional health care resources.
Article
Chinese medicine is growing in popularity and offers an important alternative or complement to biomedical care, but little is known of who uses it or why they purchase it. This article reports the first in-depth, large-scale (n = 575) survey of United States acupuncture users. An anonymous mixed quantitative-qualitative survey questionnaire assessed user demographics, Chinese medicine modalities used, complaints, response to care, other health-care used, and satisfaction with care in six general-service clinics in five states. The user demographic picture was of mid-age, well-educated, employed, mid-income patients. They sought care for a wide variety of conditions; top uses were for relief of musculoskeletal dysfunction, mood care, and wellness care. A large majority reported "disappearance" or "improvement" of symptoms, improved quality of life, and reduced use of selected measures including prescription drugs and surgery. Respondents reported utilizing a wide array of practices in addition to Chinese medicine, while also expressing extremely high satisfaction with Chinese medicine care. The evidence indicates that these respondents behave as astute consumers within a plural health care system. Part II (in press) details reasons given for satisfaction and situates respondent attitudes within a larger sociocultural framework.
Article
Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.
Article
China is the only country in the world where Western medicine and traditional medicine are practised alongside each other at every level of the healthcare system. Traditional Chinese medicine has a unique theoretical and practical approach to the treatment of disease, which has developed over thousands of years. Traditional treatments include herbal remedies, acupuncture, acupressure and massage, and moxibustion. They account for around 40% of all health care delivered in China. The current government policy of expansion of traditional facilities and manpower is being questioned because many hospitals using traditional Chinese medicine are already underutilized and depend on government subsidies for survival. Research priorities include randomised controlled trials of common treatments and analysis of the active agents in herbal remedies. As more studies show the clinical effectiveness of traditional Chinese medicine, an integrated approach to disease using a combination of Western medicine and traditional approaches becomes a possibility for the future.
Article
Patient use of complementary and alternative medicine (CAM) is on the rise. With millions of Americans using CAM, it has become imperative from the public health point of view to undertake a coordinated research effort that will thoroughly evaluate the role and effectiveness of CAM modalities. We developed a prospective data-collection system to capture presenting complaints, patient health histories, and demographic information on the patients of a hospital-based alternative medicine clinic. Of 760 patients in the present cohort, 248 different complaints or complaint combinations were entered. Of 16 major categories, the largest was musculoskeletal, followed by the addictions, psychiatric, and nonspecific categories. Slightly more than one in five patients requested treatment on the recommendation of their physician. Over two-thirds of patients in this study group were female. Given the growing interest and use of complementary and alternative therapies, a system such as described can demonstrate the types of patients presenting for treatment, a more detailed picture of their complaints, and, over time, measurable outcomes.
Article
Complementary/alternative cancer treatments are believed to be prevalent. However, reliable prevalence rates do not exist. The aim of this review was to summarize the existing data on this topic. A series of computerized literature searches was performed to locate all published studies documenting the prevalence of complementary and/or alternative therapy (CAM) use among patients with cancer. A total of 26 surveys from 13 countries, including 4 studies of pediatric patients, was retrieved. The use of CAM therapies in adult populations ranged from 7-64%. The average prevalence across all adult studies was 31.4%. This large degree of variability most likely is due to different understandings of "complementary/alternative medicine" on the part of both investigators and patients. It is likely that the results of the current study reflect the primarily adjunctive use of CAM treatments. Future studies should use a standardized protocol to determine the true prevalence of these therapies more closely.
Article
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.
Article
Use of complementary and alternative medicine (CAM) is common among persons with chronic conditions. To identify correlates of and describe patients' perspective on use of CAM for rheumatologic conditions. Telephone survey. Three university practices and three private rheumatology practices. 232 of 428 eligible consecutive patients (54%) with scheduled appointments. Patients answered questions on CAM use, functional status, pain, provider satisfaction, and health services utilization. Chart reviews provided demographic information and rheumatologic diagnoses. Bivariate analyses identified correlates of four CAM outcomes (history, magnitude, and frequency of CAM use and communication about CAM use with a physician), and multiple logistic regression identified independent correlates of regular CAM use. Approximately two thirds of the respondents (n = 146) had used CAM. Of these 146 respondents, 82 (56%) currently used CAM and 132 (90%) regularly used CAM or had done so in the past. Fifty-five respondents (24%) had used three or more types of CAM. In multivariate analyses, persons who used CAM regularly were more likely to have osteoarthritis (odds ratio, 5.6 [95% CI, 1.9 to 16.8]), severe pain (odds ratio, 2.5 [CI, 1.4 to 4.8]), and a college degree (odds ratio, 2.6 [CI, 1.3 to 5.4]) than patients who had never used CAM. Nearly half of the respondents discussed CAM use with their physicians. The most common reasons for not disclosing CAM use were that the physician had not asked about it and that the patient forgot to tell the physician; fear of disapproval was rarely cited. Discussions about CAM use between patient and physician occurred more frequently among patients with fibromyalgia and persons who regularly used CAM or used several types of CAM. Patients with rheumatologic conditions frequently use CAM. Severe pain and osteoarthritis predict regular use of CAM but do not predict a greater likelihood of discussing CAM use with physicians. Routine inquiry by physicians will probably detect CAM use.
Article
Between 1995 and 1997, 1,675 HIV-positive men and women using complementary and alternative medicine (CAM) were enrolled into the Bastyr University AIDS Research Center's Alternative Medicine Care Outcomes in AIDS (AMCOA) study. Funded by the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) and National Institute of Allergy and Infectious Diseases (NIAID), the AMCOA study collected information on participant demographics, health status and use of conventional and CAM therapies. Participants from 46 states completed a baseline questionnaire, while additional clinical information (such as CD4 count and HIV-RNA viral load) was obtained from laboratory records. AMCOA participants reported using more than 1,600 different types of CAM therapies (1,210 CAM substances, 282 CAM therapeutic activities and 119 CAM provider types) for treating HIV/AIDS. Approximately two-thirds (63% n = 1,054) of the AMCOA cohort reported using antiretroviral drug therapy (ART) during the six-months previous to completing the baseline questionnaire, while 37% (n = 621) indicated they were not using ART. Of those not using ART, 104 subjects reported never having used any conventional medications for their HIV and 12 subjects used only non-prescription diarrhoea medications. The most frequently reported CAM substances were vitamin C (63%), multiple vitamin and mineral supplements (54%), vitamin E (53%) and garlic (53%). CAM provider types most commonly consulted by the AMCOA cohort were massage therapists (49%), acupuncturists (45%), nutritionists (37%) and psychotherapists (35%). CAM activities most commonly used were aerobic exercise (63%), prayer (58%), massage (53%) and meditation (46%). The choice of CAM therapies among the AMCOA cohort does not appear to be solely based on scientific evidence of efficacy of individual therapies. The majority of AMCOA subjects could be characterized as using integrated medicine, since an overwhelming proportion of the cohort consult with both conventional and CAM providers and use both conventional and CAM medications, yet few subjects reported that their conventional and CAM providers work as a team. These data and this cohort set the stage for conducting studies of health status changes associated with specific CAM therapies.
Article
A series of 16 independent studies of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) community and their use of alternative and complementary therapies over the past 10 years helps document the changes that have occurred. The earlier studies are characterized by political activism, lack of confidence in conventional therapies, and widespread use of alternative pharmacological therapies and unapproved drug use. The improvement of conventional treatment since the mid-1990s has been accompanied by a greater emphasis on complementary therapies used in conjunction with conventional drug therapy. Mind-body or psycho-spiritual therapies that help the patient cope with stress and adjust to life-threatening illness are the most popular.
Article
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.
Article
To measure utilization of complementary and alternative medicine (CAM) by US adults. We analyzed data from the 1999 National Health Interview Survey (NHIS), which covers the noninstitutionalized civilian US population. Information on 12 types of CAM use in the past 12 months was obtained from 30,801 respondents aged 18 years and older. Statistical analyses were performed using the SUDAAN software package to account for the complex sample design of the NHIS. An estimated 28.9% of US adults used at least one CAM therapy in the past year. The three most commonly used therapies were spiritual healing or prayer (13.7%), herbal medicine (9.6%), and chiropractic therapies (7.6%). The use of CAM was most prevalent among women, persons aged 35 to 54 years, and persons with an educational attainment of > or =16 years. The overall CAM use was higher for white non-Hispanic persons (30.8%) than for Hispanic (19.9%) and black non-Hispanic persons (24.1%). Although the use was higher for persons who had health insurance than for those who did not, the difference was not statistically significant after adjusting for age, gender and educational attainment. Compared with nonusers, CAM users were more likely to use conventional medical services. Estimates of CAM use in this nationally representative sample were considerably lower than have been reported in previous surveys. Most CAM therapies are used by US adults in conjunction with conventional medical services.
Article
The number of U.S. medical schools offering courses in complementary and alternative medicine (CAM) has risen sharply in recent years. This study gauged the current state of CAM instruction by gathering details about the specific topics being taught and the objectives behind the instruction. Data were collected from questionnaires mailed to 123 CAM course directors at 74 U.S. medical schools. Questionnaires were returned by 73 course directors at 53 schools. The topics most often being taught were acupuncture (76.7%), herbs and botanicals (69.9%), meditation and relaxation (65.8%), spirituality/faith/prayer (64.4%), chiropractic (60.3%), homeopathy (57.5%), and nutrition and diets (50.7%). The amounts of instructional time devoted to individual CAM topics varied widely, but most received about two contact hours. The "typical" CAM course was sponsored by a clinical department as an elective, was most likely to be taught in the first or fourth year of medical school, and had fewer than 20 contact hours of instruction. Most of the courses (78.1%) were taught by individuals identified as being CAM practitioners or prescribes of CAM therapies. Few of the courses (17.8%) emphasized a scientific approach to the evaluation of CAM effectiveness. A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.
Article
This study examined the use of complementary and alternative medicine (CAM) therapies by breast cancer patients and the communication of their CAM use to their physicians relative to lymphedema symptoms and other factors. Breast cancer patients ( N = 148) in the State of Vermont were interviewed 2-3 years after their primary surgery using computer-aided telephone interviewing methods. Questionnaire items included demographic information, treatment, CAM use, lymphedema symptoms, and other measures. A large proportion (72.3%) reported using at least one CAM treatment after surgery. The most frequently used treatments were vitamins and nonfood supplements (72.3%), with herbal treatments, meditation, and traditional massage each being reported by about one-fifth of the women. Age, education, adjuvant chemotherapy, and extremity swelling were associated with use of more CAM treatments in a regression model. A large proportion (73.8%) of CAM users reported their CAM use to their physicians. Correlations between patients' income, adjuvant radiation therapy, and adjuvant tamoxifen use with communication of CAM use to their physicians were sought in a logistic regression model. CAM use is high among breast cancer patients in Vermont, and the number of CAM therapies used is related to demographic factors, adjuvant treatment, and lymphedema symptoms. Communication of CAM use to physicians appears to be multifaceted.
Article
In the United States, traditional Chinese medicine (TCM) is recognized by the National Institutes of Health as an effective complementary and alternative medicine modality, widely used by consumers and growing as a profession.1–3 Ironically, while TCM is expanding in the United States, it may be contracting in China as a result of dramatic health care reforms and changing cultural values. There is, however, little information in Western literature explicitly delineating the impacts of these forces on TCM. The purpose of this inquiry was to interview a sample of select respondents, particularly individuals from a major Chinese college of traditional medicine, regarding their perceptions of the field. The results provided insight into the survival and assimilation of indigenous health systems in a modern world. In the late 1970s, Deng Xiao Ping introduced elements of the market economy into China. During the 1990s, significant health care reforms were also initiated. These reforms placed a new emphasis on profitability, economic autonomy for health facilities, and decentralization of public health services and contributed to the demise of the rural cooperative medical system.4–6 These reforms also produced fundamental changes in health care financing, including replacing free universal health care with fee-for-service and private insurance strategies.4,7 This has contributed to increased medical care costs, higher out-of-pocket expenses, growing inequity in access, a reduction of prevention programs in poor areas, and pricing policies that encourage overprescribing drugs and high-tech services.4,7,8–10 As a significant percentage of all health care delivered in China is in the form of traditional treatments,11 such reforms will invariably affect this ancient healing system as well.
Article
Acupuncture is widely used by the American public, but little is known about its availability and use in academic medical settings. We performed a pilot study to compare acupuncture services provided by hospitals affiliated with a major academic teaching institution, and a parallel survey of services provided through an acupuncture school in one city in New England. Between December 2000 and July 2001, a telephone survey was conducted of the 13 hospitals affiliated with Harvard Medical School, and the clinics affiliated with the New England School of Acupuncture. Acupuncture was available in 8 of the 13 hospitals. Acupuncture was provided in ambulatory clinics in all eight hospitals, but was available to inpatients in only one hospital. Six hospitals delivered acupuncture through an outpatient pain treatment service, one through a women's health center, one through an HIV clinic, and one hospital delivered acupuncture through two services; a program in the anesthesia department and a multi-disciplinary holistic program in a primary care department. In contrast, the acupuncture school clinics provided services through an on-site clinic at the school, through acupuncture departments at two community-based hospitals, and through a network of 12 satellite acupuncture-dedicated clinics operating throughout the state. Acupuncture is available on a limited basis in a majority of the teaching hospitals in this city. At the acupuncture school clinics, there are few barriers to care. Future health care studies will need to examine the role of acupuncture in diverse geographic settings and to examine its impact on quality of care, teaching and its role in research in academic centers.
A growing number of women are being diagnosed and successfully treated for breast cancer. Therefore, many women are living with a history of breast cancer. The use of complementary and alternative therapies within this patient population has increased. To determine post breast cancer treatment health behaviors with regard to use of complementary and alternative therapies. Survey participants were asked about their use of 15 complementary and alternative medicine (CAM) therapies. In order to determine the relative importance of the hypothesized predictor variables, standard logistic regression was performed with CAM use as the dependent variable. 551 women who had been diagnosed with breast cancer and were post treatment. Telephone Survey. Telephone interviews were conducted with 551 females in the Portland, Oregon, metropolitan area who had been diagnosed with breast cancer an average of 3.5 years earlier. Two-thirds (66%) of the women used at least one CAM therapy during the previous 12 months, and the majority of them perceived that their CAM use was without the recommendation of their doctor. Relaxation/meditation, herbs, spiritual healing, and megavitamins were used most often. Significant predictors of CAM use included younger age, higher education, and private insurance. The majority of the CAM therapies were perceived by their users to be at least "moderately important" in remaining free of cancer. The reasons given for using CAM were to enhance overall quality of life, to feel more in control, to strengthen the immune system, and to reduce stress. Two-thirds of women in this study followed conventional treatment for breast cancer with one or more CAM therapies, which, they believed, could prevent cancer recurrence and/or improve their quality of life. CAM use did not reflect negative attitudes towards conventional medical care, but rather an orientation to self-care in the optimization of their health and well being.
Complementary and alternative medicine (CAM) is popular in Germany. In a consecutive survey the experiences with CAM and the need for a CAM consultation among inpatients of the departments of cardiology (CL), gastroenterology (GE), oncology (OL) and psychosomatics (PS) of the University Hospital Freiburg (FUH) were questionned. Exclusion criteria were inability to understand the questions or a Karnofsky Index < 30%. Four hundred thirty-five patients were included. Three hundred and fifty patients, 100 each in the departments of CL, GE and OL, and 50 in PS answered the questionnaires. Eighty-five patients (20%) refused. Among the 350 patients 26% had previously visited a CAM physician and 19% had visited a CAM therapist (Heilpraktiker). Information about CAM was obtained mainly by television, radio and family members. Frequently used therapies for the current disease were physical training (21%), diet (19%), massage (19%), vitamins/trace elements (19%), herbs (13%), acupuncture (10%) and homeopathy (7%). The highest frequency of CAM use had PS patients, followed by GE, OL and CL patients. High effectivity (> or = 70%) for the current disease, rated on a scale of 4 degrees, had for CL patients physical exercise and massage, for GE patients herbal treatment and for OL patients diet. Physical exercise, diet, massage and herbal treatment generally had better ratings than homeopathy, acupuncture and vitamins. 65% would welcome a CAM center and 53% asked for a consultation about CAM at FUH. OL and GE patients had the strongest (58%), PS patients a lower (52%) and patients with cardiovascular diseases the lowest (43%) interest in a CAM consultation. Twenty-five percent believed, that CAM can help to cope better with their disease. Predictors for a positive attitude towards CAM were young age, aversion to chemical medications (Spearman correlation r = 0.22), desire to participate in therapeutic decisions (r = 0.29), motivation to change, if recommended, the life style (r = 0.31) and desire for a holistic treatment (r = 0.37).
Article
Reflecting society's interest in complementary and alternative medicine (CAM), most allopathic medical schools in the United States offer instruction in CAM. Pertinent information about the teaching of CAM at osteopathic medical schools is lacking. The authors therefore sought to document the form and content of CAM instruction at osteopathic medical schools and compare their findings with those reported for allopathic medical schools in a recently published survey. Phone conversations with academic officials at each of the 19 colleges of osteopathic medicine revealed that only one school did not teach CAM. With the help of these officials, the authors identified 25 CAM instructors at 18 osteopathic medical schools and sent them questionnaires. All returned a completed form with details about CAM instruction at their schools. The authors found that CAM material was usually presented in required courses sponsored by clinical departments, was most likely taught in the first 2 years of medical school, and involved fewer than 20 contact hours of instruction. The topics most often taught were acupuncture (68%), herbs and botanicals (68%), spirituality (56%), dietary therapy (52%), and homeopathy (48%). Most (72%) CAM instructors were also practitioners of CAM modes of therapy. Few (12%) of the instructors taught CAM from an evidence-based perspective. The authors conclude that the form and content of CAM instruction at osteopathic medical schools is similar to that offered at allopathic medical schools and that both osteopathic and allopathic medical schools should strive to teach CAM with less advocacy and more reliance on evidence-based medicine.