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