Posts Tagged ‘headache’

Research Headache

February 22nd, 2012 4 comments

Greetings all! I know it’s been a while since I’ve blogged, so here we go – merry christmas, happy hanukah, happy new year, happy chinese new year happy valentine’s day yada yada been there done that.

What I wish to write about to day is a sharing of a personal experience with some research I’m involved with in the Philippine General Hospital, teaching hospital of the University of the Philippines College of Medicine.

Yes, skeptics, there IS research being done in reputable state universities.  Then again the skeptics have already ignored the research done at the University of Vermont and the University of  Munich (click the links!) so why won’t they ignore this one?

Anyway, the research is supposed to be a cross-sectional study comparing the preventive effects of acupuncture versus propranolol in the treatment of migraine.  What I would like to comment on is the initial procedure that the residents wanted to do.

Initially, the idea of the other researchers was to pick a set of points and use that same set of points on EVERY PATIENT.  Following the principles of traditional chinese medicine, I said that that shouldn’t be the case.  I understand that their objective was to standardize the treatment.  I pointed out that chinese medicine emphasizes the root cause of the headache/migraine and address those causes.  The points to be used depend on those factors, as well as the location and nature of the pain.

wei shengchu 60 displays acupuncture needles in hi 2172839354 300x200 Research Headache

This is NOT how to treat headache using acupuncture.

In the end, what the protocol we submitted (which was subsequently approved by the appropriate committees) was that we would come up with a POOL of points to choose from.  Other factors would be there would only be ONE acupuncturist to diagnose, select from the pool and insert/manipulate the needles.  That will try to eliminate skill variation in practitioners.

When that study gets published, you guys will be the first to know about it!


P.S. – Gotta love this study

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How to Research Acupuncture?

March 30th, 2010 4 comments

A problem with acupuncture is not so much the lack of research – there are kaboodles of it – but the way these researches are conducted.  A recent online conversation I had with a fellow Xavier high school alumnus made this obvious to me.  Here is a quote from an email I wrote which I think summarizes my thoughts on this.

research 300x156 How to Research Acupuncture?

Is there a "proper" way to do acupuncture research?

Anyway here is the text:

(A) major misunderstanding (is) that the idea that acupuncture is like a pill – that can be single blinded (meaning that recipient doesn’t know that they’re getting the real thing or not) or double blinded (pill giver doesn’t know either.)  Obviously, using fake needles or sham treatments would necessitate that the “treatment” giver NOt be blinded.

However, the first difficulty comes in designing an adequate “sham”

First objection: sometimes inserting needles anywhere seem to stimulate an effect as well.

Second objection: even just pretending to insert needles seems to have an effect.  this is the “placebo” being indicated here.

The conclusion skeptics derive from these observations is thus: since inserting a needle into specific “points” doesn’t seem to be much different than inserting anywhere or simulating points without insertion, acupuncture is thus “useless”.

A closer examination of how acupuncture works biophysically (and yes, I do explain this to patients who ask) reveals that it works by simulation of the immune and nervous system.  Chris Kresser’s blog elaborates on this quite well.  Now is this the only way to stimulate the nervous and immune system? No.  Acupuncture evolved from touch/massage.  The question thus begged is, why not just touch?  My answer is that inserting needles saves time and effort.  Imagine if I had to stimulate ten points on a patient with my fingers?  By inserting needles to achieve the same stimulation, I can then leave the patient and attend to another one.

doctoroctopus 300x195 How to Research Acupuncture?

I'll bet Doctor Octopus would make a great masseuse...

So what is my proposal for an appropriate acupuncture “sham” procedure: it must involve NOT triggering the a-delta fibers.  A-delta fibers are the key to the “qi-sensation” or heavy feeling accompanying acupuncture (as opposed to sharp).  Research has shown that acupuncture analgesia is obliterated by blocking the transmission of a-delta fibers.  The best way to do that that i know of is through naloxone.  Hypothetically, a control group would have no treatment, another with conventional treatment, and two experimental groups – both with real acupuncture given by the SAME practitioner (more on this later) but with one blocked by naloxone.  The latter is the “sham”.  ”fake” needles that touch the skin also won’t work because the mere touching of the skin sets off similar reactions in the patient’s central nervous system, albeit to a lesser intensity as with acupuncture.

Now for the importance of the practitioner.  I once gave a lecture in a geriatrics convention and a participant commented to me that he used to practice acupuncture but his practice died out.  He then asked me “what are the points to use for migraine?”  I then said to myself, “kaya pala. (so that’s why…)” What does this incident tell us? Let me illustrate – it also explains to me why it is difficult to formulate studies for acupuncture.

acupucture chinese medicine cartoon 229x300 How to Research Acupuncture?

It's not the size that counts. It's how you use it!

Acupuncture is not just inserting a needle and plugging it into a machine.  Acupuncture involves selecting points (although Chris Kresser disagrees with me there) , choosing how thick the needles are, determining how deep the insertion will be, and trying to control the sensations the patient feels through manipulation of the handle.  About manipulations, there are many which I shan’t specify now.  Suffice it to say that I have personally discovered that errors in any of the above will lead to treatment failure.  It is like surgery, the procedure itself is standard, but a lot also depends on how well the surgeon handles things.  i would normally not be so heretical as to compare something like acupuncture skills to the taxing physical and mental requirements required of a surgeon, but I hope the reader grasps my point (pun intended.)

Another problem is something I have been trying to get to with my earlier comments on different culture and world view.  Chinese medicine diagnoses things in a method somewhat different from western medicine.  I’m not just talking about differences in terminology.  I did touch on this with the example of dyspepsia.  I will try to elaborate more using headache, which is the disease condition that got me into acupuncture in the first place.

Point selection and manipulation in acupuncture depend on too many variables.  Ten people can have headaches.  One will have it in the front, another at the temples, another at the nape.  One will have headache associated with chronic sinusitis, another will have it due to migraines, yet another because he is a computer encoder always looking at CRT screens, another will have it after a flaring temper, yet another associated with menses.  Acupuncture treatment then, will seldom be the same for any two of these patients.

Hence, what would be my suggestion for a proper study?  In addition to the conditions above, we can also add something to make the patients even more homogenous (can never be totally homogenous though) – same race, same diet, same emotional pattern, same job, same associated factors for the headache.  Difficult yes, but necessary because of the nature of proper acupuncture point selection.

Clinical experience has shown that “cookbook” acupuncture, which means taking a western symptom “headache”, or “dysmenorrhea” CAN be effective, but I wouldn’t be surprised if it wouldn’t be AS effective.

What do you guys think?

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Migraine Madness: How I Truly Began to Believe in Acupuncture

March 29th, 2010 No comments

Acupuncture did wonders for my migraines.  I had it so bad before that i had status migranosus for a week.  Imagine a whole week of having most lights and sounds burn like soldering torches.  Imagine a whole week of misery and pain.  That was the worst, thankfully.  Typically my mood would be trashed, my eyes heavy, and my head pounding.

That was there for years, only mildly relieved by sumatriptan and once I even needed ergotamine given in hospital.  I thought I was doomed to a life of drugs.

Until acupuncture.

One treatment.

Since then, for five years, nothing.  They’ve only began to return mildly recently – time for a “booster treatment”.

Anyway, once can see why I am “biased” towards acupuncture – it worked for me.

It’s also quite nice to see it verified by western medicine:

Acupuncture Eases Migraine Headache Pain
Acupuncture May Be Cost-Effective Option for Treating Chronic Headache


Note the term “cost-effective option”.  This means basically that it’s an option that uses up less money in the long run.  Hence, the patient benefits from the same health effects but at less cost.

By Jennifer Warner

WebMD Health News

Reviewed by Brunilda Nazario, MD

March 15, 2004 — Acupuncture may provide lasting relief from the pain of chronic headaches, such as migraines, according to a new study.

Researchers found that compared with standard medical care, acupuncture offers substantial benefits in preventing headaches and improving the quality of life for people who suffer from frequent headaches, especially migraines.

Acupuncture is commonly used to treat other types of chronic pain, but researchers say this is the first large-scale study to examine the effectiveness of acupuncture under real-life conditions. They say the results indicate that health insurance coverage of acupuncture services should be expanded to include the treatment of chronic headaches and migraine.

Darned right it should.

Pins and Needles Ease Migraine Pain

In the study, published in the March 15 issue of the British Medical Journal, researchers randomly divided 401 adults aged 18-65 years old with chronic headache (at least two headaches a month) — into two treatment groups. Participants had a history of having mostly migraine headaches.

I just found it interesting that six years ago, the BMJ seemed to support articles on acupuncture.  Now it publishes an editorial (not even a news article!) totally biased against it (see previous post).

One group received up to 12 acupuncture sessions during a three-month period in addition to standard medical care, and the other group received standard care alone.

A year later, researchers found those who received acupuncture:

  • Experienced 22 fewer days with headaches
  • Used 15% less medication
  • Made 25% fewer visits to their doctor
  • Took 15% fewer days off sick from work than the control group
  • In my case it was no headaches, 100% less medication, 100% fewer visits and no sick days from work since the acupuncture.

    One session btw.

    Researchers say one limitation of their study is that the control group did not receive a sham acupuncture intervention. Therefore, some of the benefits found among the acupuncture group may have not been caused by the actual treatment but because of the “placebo effect,” which is based on the patient’s expectations of benefit from treatment rather than the effectiveness of the treatment itself.

    But researchers say previous placebo-controlled studies have already shown that acupuncture is superior to placebo in treating migraine.

    In a related study published in the same journal, British researchers found that acupuncture improves the quality of life for people with chronic headaches at a small additional cost. They say the findings show that acupuncture is a relatively cost-effective headache therapy compared with other treatments covered by the National Health Service of the United Kingdom.

    A recent study I found (not online but I have the PDF file) entitled “Efficacy of Acupuncture for the Prophylaxis of Migraine: A multicentre randomised controlled clinical trial” (Lancet Neurology 2006;5:310-16)

    The results were:

    Findings Of 1295 patients screened, 960 were randomly assigned to a treatment group. Immediately after randomisation, 125 patients (106 from the standard group) withdrew their consent to study participation. 794 patients were analysed in the intention-to-treat popoulation and 443 in the per-protocol population. The primary outcome showed a mean reduction of 2·3 days (95% CI 1·9–2·7) in the verum acupuncture group, 1·5 days (1·1–2·0) in the sham acupuncture group, and 2·1 days (1·5–2·7) in the standard therapy group. These differences were statistically significant compared with baseline (p<0·0001), but not across the treatment groups (p=0·09). The proportion of responders, defined as patients with a reduction of migraine days by at least 50%, 26 weeks after randomisation, was 47% in the verum group, 39% in the sham acupuncture group, and 40% in the standard group (p=0·133).

    The “verum” group was defined as receiving true acupuncture, the sham were placed in random points and standard as… standard western medical care.  Note that the condition for success was “reduction of migraine days”.  Personally I find that some patients can respond by having the same amount of headaches but less intensity and duration – they hurt much less and last shorter.

    Anyway the results still show that real acupuncture works better than either sham or standard treatment.  Not statistically significant, but significant to patients.

    And doctors like me.

    pixel Migraine Madness: How I Truly Began to Believe in Acupuncture
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