Long term benefits of acupuncture for chronic pain: what makes a difference?
|
|
- Luke Webb
- 6 years ago
- Views:
Transcription
1 Long term benefits of acupuncture for chronic pain: what makes a difference? Hugh MacPherson 1
2 Outline 1. Acupuncture for chronic pain the Acupuncture Trialists Collaboration, and long-term effects 2. Longer-term effects of acupuncture from trials conducted in the UK 3. Exploring explanation of longer term effects in the ATLAS chronic neck pain trial 2
3 J.-S. Han, Y.-S. Ho / Neuroscience and Biobehavioral Reviews 35 (2011)
4 1.1. Members of the Acupuncture Trialists Collaboration 4
5 Methods: We combined 29 high quality acupuncture trials in a single database with 17,922 patients with chronic pain: Aims: Acupuncture trialists collaboration Osteoarthritis Headache/migraine Low back and neck pain 1. Establish effect of acupuncture vs. usual/standard care 2. Establish effect of acupuncture vs. sham 3. Establish long term trajectory of benefit 5
6 Individual patient data meta-analysis Single database with raw data obtained from 29 trials with 17,922 patients: 20 trials with sham controls (5,230 patients) 18 trials with usual/standard care controls (14,597 patients) NB: some trials had three arms
7 Is acupuncture better than sham Acupuncture, varies across trials Sham acupuncture controls vary: Non-needle sham (e.g. inactive TENS) Needle-based sham Penetrating needles Non-penetrating needle At acupuncture points At non-acupuncture points
8 Individual patient data meta-analysis Acupuncture vs. Sham controls (n= 5,230) Indication Effect size (Fixed effects) Acupuncture vs. Sham controls (excluding outliers) Migraine/headache (-0.24, -0.07) P<0.001 Osteoarthritis (-0.25, -0.07) P<0.001 LBP & Neck Pain (-0.33, -0.13) P<0.001 Interpretation of effect sizes: 0.8 = LARGE 0.5 = MODERATE 0.3 = SMALL Negative values represent better outcomes Values in parentheses are 95% confidence intervals
9 Is acupuncture better than nonacupuncture controls Acupuncture, varies across trials Non-acupuncture controls vary: No treatment Wait list Attention control Rescue medication Usual care Other standard treatment
10 Individual patient data meta-analysis Acupuncture vs. Sham controls, and Acupuncture vs. Non-acupuncture controls (n= 14,597 ) Indication Effect size (Fixed effects) Acupuncture vs. Sham controls (excluding outliers) Migraine/headache (-0.24, -0.07) P<0.001 Osteoarthritis (-0.25, -0.07) P<0.001 Back & Neck Pain (-0.33, -0.13) P<0.001 Acupuncture vs. Non-acupuncture controls Migraine/headache (-0.46, -0.37) P<0.001 Osteoarthritis (-0.64, -0.50) P<0.001 Back & Neck Pain (-0.58, -0.51) P<0.001 Negative values represent better outcomes Values in parentheses are 95% confidence intervals Effect sizes: 0.8 = LARGE 0.5 = MODERATE 0.3 = SMALL
11 Summary of findings: Effect size of acupuncture vs. usual care = 0.5 Effect size of acupuncture vs. sham acupuncture = 0.2 Effect size of sham acupuncture plus context vs. usual care = 0.3 Effect sizes: LARGE = 0.8 MODERATE = 0.5 SMALL = 0.3 All statistically significant : P<0.001
12 Acupuncture provides an additional 40% benefit over and above sham (placebo) Effect size 0.6 Effect sizes: 0.8 = Large 0.5 = Moderate = Small Acup vs. usual care 40% 60% Effect size Acupuncture vs. sham Sham acupuncture plus context effects vs. usual care
13 Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.. (a result) that can be distinguished from bias. Vickers et al. Archives of Internal Medicine. 2012, 172 (19): pp
14 ATC trials: Acupuncture vs. usual care Trajectory: ~10% of the benefit of acupuncture relative to usual care is lost at 12 months Thicker line = 5 trials or more MacPherson et al. PAIN. In press 2016
15 ATC trials: Acupuncture vs. sham ATC trials: Acupuncture vs. usual care Trajectory: ~50% of the benefit of acupuncture vs. sham controls is lost at 12 months Thicker line = 10 trials or more MacPherson et al. PAIN. In press 2016
16 Why inconsistency with other reviews? What at sample sizes? Estimated effect size Approx sample size* for a twoarm trial Medium Small Effect sizes: 0.8 = Large 0.5 = Moderate 0.3 = Small *Number needed to show a difference, if one existed, based on 90% power and 0.05 significance
17 Why inconsistency with other reviews? Sample sizes too small Estimated effect size Approx sample size* for a twoarm trial Medium Small True vs. sham acupuncture 0.2 1,052 Effect sizes: 0.8 = Large 0.5 = Moderate 0.3 = Small *Number needed to show a difference, if one existed, based on 90% power and 0.05 significance
18 Researching acupuncture Acupuncture as simple or complex? Acupuncture can be defined in two contrasting ways Simple intervention: Insertion of needles Complex intervention: A package of care Different mechanisms
19 Pragmatic trials for complex interventions. Randomised, controlled Typically usual/standard care is comparator Assessing comparative effectiveness Routine care context Practitioners can provide treatments that reflect their everyday practice Results are more generalisable Relevant for cost- effectiveness Decision making 19
20 2. Pragmatic trials from the UK n date Headache and migraine Chronic back pain Irritable bowel syndrome Depression Chronic neck pain
21 40 Headache and migraine (n=401) Acupuncture for chronic headache/migraine Acupuncture Usual care 20 Diff = 3.9 pts P=0.001 Diff = 4.6 pts P= Baseline 3 months 12 months Vickers et al BMJ 2004
22 Acupuncture for low back pain vs. usual care 100= no pain Low back pain (n=241) Thomas et al BMJ 2006; 333:
23 Irritable bowel syndrome (n=233) Acupuncture for irritable bowel syndrome 23 MacPherson et al. BMC Gastroenterology 2012, 12:150
24 Depression (n=755) MacPherson et al. PLoS Medicine, 2013, 10 (9): e
25 Headache /migraine Long-term effects Low back pain Irritable bowel Depression 25
26 Components of routine acupuncture Specific components integral to treatment include: Acupuncture-related diagnosis Explanations of the diagnosis Needling of points Diagnosis-related lifestyle advice given Patient take-up of lifestyle advice NB: Specific because theory-related and designed to impact on outcome 26
27 3. Case study: Acupuncture for chronic neck pain (ATLAS trial) 1. Is acupuncture clinically effective compared to usual care? 2. Is Alexander technique clinically effective compared to usual care? Secondary research questions: Life-style advice given? Why? Is it acted upon? Does self-efficacy increase with treatment? Do changes in self-efficacy reduce pain? 27
28 Trial Flow Chart Assessed 1,144 patients Randomly allocated 517 Acupuncture 173 (33%) Alexander 172 (33%) Usual GP Care 172 (33%) 3 month 3 month 3 month 20 SMS follow ups 6 month 6 month 6 month Questionnaire follow ups Practitioner focus group 12 month 12 month Analysis 12 month Patient interviews at 3 and 12 months 28
29 Design Patient eligibility criteria: 18 years of age and over Diagnosed with neck pain by GP Baseline score 28 or above on NPQ (Northwick Park neck pain & disability Questionnaire) Exclusion criteria: currently receiving acupuncture/alexander terminal illness, transmissible blood disorder serious underlying pathology 29
30 The acupuncture Acupuncture Up to 12 sessions, mostly weekly, approx 50 minutes Individualised needling and acupuncture diagnosisrelated lifestyle and self-care advice Active engagement of patient if possible Members of British Acupuncture Council (BAcC) 3 years post qualification experience
31 Outcomes Questionnaire data collected from patients at baseline, 3, 6 and 12 months Primary outcome measure: Northwick Park neck pain and disability Questionnaire (NPQ) Primary end-point at 12 months Secondary outcome measures include: Lifestyle advice Chronic Pain Self-Efficacy Scale 31
32 Recruitment: Participants Recruitment from 33 general medical practices in York, Manchester, Leeds and Sheffield, UK Baseline characteristics: Predominantly female (70%) Mean age 53 In paid employment (61%) Duration of neck pain (6 years) Taking prescription medication (76%) 32
33 Acupuncture provided Characteristics of the acupuncture 18 acupuncturists, average 15 years in practice Average 7 patients per practitioner Average 11 treatments per patient Practitioners completed logbooks documenting: Diagnosis and treatment Lifestyle advice & rationale 33
34 Raw outcome data (n=517) Acupuncture or Alexander lessons vs. usual care Unadjusted neck pain (NPQ) scores over 12 months MacPherson et al. Annals of Internal Medicine,
35 Acupuncture log-book data Lifestyle advice: 134 patients (84%) received advice Advised lifestyle change No. patients given advice % no. patients use on who received advice (n=134) Exercise 72 54% Relaxation 59 44% Diet 54 40% Rest 47 35% Work 31 23% Other 29 22% 35
36 Acupuncture log-book data Relationship between advice and diagnosis Advice given Rationale for patients with Liver-related diagnosis Rationale for patients with Spleen diagnosis Exercise To move Liver Qi N=67 (93%) To tonify Spleen Qi N=2 (3%) Relaxation To soothe Liver N=33 (56%) To conserve Qi N=12 (20%) Diet To reduce Liver Heat N=17 (31%) To tonify Spleen Qi clear Damp N=34 (63%) Rest To relax Liver N=8 (17%) To conserve Qi N=24 (51%) Work To sedate Liver N=16 (52%) To conserve Qi N=3 (10%) 36
37 Patient reported variables Better outcomes for acupuncture compared to usual care at 6 months associated with: Changes made in exercise, relaxation, diet or rest Number of lifestyle changes made Extent advice was put into practice Ability to make improvements in self-care Extent changes perceived as helpful [All P<0.005]
38 Chronic Pain Self-Efficacy Scale 38
39 Patient reported self-efficacy In the acupuncture group (and Alexander group) compared to the usual care group, we found: Change in self efficacy at 6 months greater in the acupuncture group (P<0.0002) Better self-efficacy associated with: Reduced pain scores at 6 months (P<0.0004) Reduced pain scores at 12 months (P<0.0004) 39
40 Implications for acupuncture and research Acupuncture is beneficial in reducing chronic pain effect size is moderate (~0.5) 90% of effect sustained at 12 months Acupuncture is more than a placebo effect size is small (~0.2) a result that is not due to bias Trials need a large enough sample size to have sufficient power 40
41 Implications for acupuncture and research Pragmatic trials are relevant for the evaluation of routine care Trials need to document life-style advice and measure long-term outcomes Lifestyle advice related to diagnosis can improve self-efficacy related to pain Improved self-efficacy can reduce pain over the longer term 41
42 ATC publications to date: 1. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Victor N, et al. Individual patient data meta-analysis of acupuncture for chronic pain: protocol of the Acupuncture Trialists Collaboration. Trials. 2010;11: Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. ArchInternMed Sep 10;172(19): Vickers AJ, Maschino AC, Lewith G, MacPherson H, Sherman KJ, Witt CM, et al. Responses to the Acupuncture Trialists Collaboration individual patient data metaanalysis. Acupunct Med Mar;31(1): MacPherson H, Maschino AC, Lewith G, Foster NE, Witt C, Vickers AJ, et al. Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials. PLoS ONE. 2013;8(10):e MacPherson H, Vertosick E, Lewith G, Linde K, Sherman KJ, Witt CM, et al. Influence of Control Group on Effect Size in Trials of Acupuncture for Chronic Pain: A Secondary Analysis of an Individual Patient Data Meta-Analysis. PLoS ONE Apr 4;9 (4):e Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA Mar 5;311(9): MacPherson H, Vertosick E, Foster N, Lewith G, Linde, K, Sherman K, Witt C, Vickers A. The persistence of the effects of acupuncture after a course of treatment. In Press with PAIN.
43 Pragmatic trials with long-term outcomes 1. Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004;328( ): Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell MJ, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ Sep 23;333: MacPherson H, Tilbrook H, Bland JM, Bloor K, Brabyn S, Cox H, et al. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterol. 2012;12: MacPherson H, Richmond S, Bland M, Brealey S, Gabe R, Hopton A, et al. Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial. PLoS Medicine Sep 24;10(9):e MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, et al. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann. Intern. Med Nov 3;163(9):
Acupuncture for chronic pain when combined with depression. Hugh MacPherson
Acupuncture for chronic pain when combined with depression Hugh MacPherson 1 Back history of research at York into acupuncture for depression: Two successful feasibility studies Five large grant applications
More informationAcupuncture, Counselling and Usual care for Depression (ACUDep trial): Dr Stewart Richmond
Acupuncture, Counselling and Usual care for Depression (ACUDep trial): findings for effectiveness and cost-effectiveness Dr Stewart Richmond Research Fellow and Trial Manager stewart.richmond@york.ac.uk
More informationRecent Progress in Clinical Research of Acupuncture
23 28 2009 1 Recent Progress in Clinical Research of Acupuncture Adrian WHITE Clinical Research Fellow, General practice and Primary Care, Institute of Health and Social Care, Peninsula Medical School,
More informationClinical Policy: Acupuncture Reference Number: PA.CP.MP.92
Clinical Policy: Reference Number: PA.CP.MP.92 Effective Date: 01/18 Last Review Date: 11/18 Coding Implications Revision Log Description involves the manual and/or electrical stimulation of thin, solid,
More informationIntegrative Medicine on Pain Management Is There Any
Integrative Medicine on Pain Management Is There Any Evidence? Lixing LAO, MB, PhD Professor and Director of School of Chinese Medicine, The University of Hong Kong Overview Acupuncture Trials on Pain
More informationMigraine and Acupuncture
BRIEFING PAPER No 1 Migraine and Acupuncture The evidence for effectiveness Edited and produced by the Acupuncture Research Resource Centre Published by the British Acupuncture Council June 1998 The Evidence
More informationEast Meets West: Treating Pain with Acupuncture
East Meets West: Treating Pain with Acupuncture Lixing Lao, Ph.D., L.Ac. Professor and Director TCM Research Program, Center for Integrative Medicine University of Maryland School of Medicine Center for
More informationAllinaHealthSystems 1
Acupuncture and Integrative Medicine for Neck and Back Pain Michael Egan, LAc, MaOM, DiplOM The Penny George Institute for Health and Healing 11/9/18 Disclosures I have no relevant financial interests
More informationPragmatic clinical trials
Complementary Therapies in Medicine (2004) 12, 136 140 Pragmatic clinical trials Hugh MacPherson a,b, a Foundation for Traditional Chinese Medicine, York, UK b Department of Health Sciences, University
More informationAcupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial
MacPherson et al. BMC Gastroenterology 2012, 12:150 RESEARCH ARTICLE Open Access Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial Hugh MacPherson 1*, Helen
More informationResponse to Blue Cross Blue Shield of Vermont s Report to the Vermont General Assembly: Insurance Coverage for Acupuncture
Response to Blue Cross Blue Shield of Vermont s Report to the Vermont General Assembly: Insurance Coverage for Acupuncture In January of 2017 Blue Cross Blue Shield of Vermont (BCBSVT) filed a report to
More informationThe effectiveness of an acupuncturist working in general practice an audit
The effectiveness of an acupuncturist working in general practice an audit Patrick W Harborow, Jane Ogden Patrick W Harborow general practitioner Jane Ogden reader in health psychology Department of General
More informationEVIDENCE SUMMARY - PAIN
EVIDENCE SUMMARY - PAIN info@evidencebasedacupuncture.org ACUPUNCTURE FOR PAIN Russell, D. L.Ac,CMT, DNBAO & Hopper Koppelman, M. MSc, MSc PAIN IS A GLOBAL PROBLEM Over 1.5 billion people worldwide suffer
More informationCost-Effectiveness Analysis of Acupuncture, Counselling and Usual Care in Treating Patients with Depression: The Results of the ACUDep Trial
RESEARCH ARTICLE Cost-Effectiveness Analysis of Acupuncture, Counselling and Usual Care in Treating Patients with Depression: The Results of the ACUDep Trial Eldon Spackman 1 *, Stewart Richmond 2, Mark
More information3. Treatment guidelines: Initial treatment: A total of 3-4 visits over 2 weeks may be considered medically necessary
HCT Medical Policy Acupuncture for the Treatment of Pain Policy # HCT112 Current Effective Date: 2/21/2015 Medical Policies are developed by HealthyCT to assist in administering plan benefits and constitute
More informationPain is one of the most common medical conditions that people
DOI: 10.1089/act.2008.14202 Complementary Therapies for Chronic Pain Management Jane Hart, M.D. Pain is one of the most common medical conditions that people report in visits to physicians. Conditions
More informationEfficacy and Effectiveness in Interventions: The Case of Acupuncture
Efficacy and Effectiveness in Interventions: The Case of Acupuncture Claudia M. Witt, MD, MBA Vice Dean Interprofessionalism University of Zurich Professor and Chair Institute for Complementary and Integrative
More informationACUPUNCTURE THE EVIDENCE
SUMMARY OF THE CURRENT EVIDENCE ON ACUPUNCTURE FOR MUSCULOSKELETAL CONDITIONS Summary In this Summary we present an overview that includes the most recent evidence on acupuncture for musculo-skeletal conditions
More informationClinical Policy: Acupuncture Reference Number: CP.MP.92
Clinical Policy: Reference Number: CP.MP.92 Effective Date: 12/13 Last Review Date: 11/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory and
More informationLearning Objectives. What are Medical Group Visits?
2:30-3:15pm Medical Group Visits: Moving into Primary Care, Are You Ready? Disclosures The following relationships exist related to this presentation: Paula M. Gardiner, MD, MPH: No financial relationships
More informationAcupuncture Reduces Pain, Alleviates Depression
Acupuncture Reduces Pain, Alleviates Depression 25 APRIL 2017 Memorial Sloan Kettering Cancer Center (New York, USA) and University of York (York, UK) researchers conclude that acupuncture is more effective
More informationCite this article as: BMJ, doi: /bmj c (published 15 September 2006)
Cite this article as: BMJ, doi:10.1136/bmj.38932.806134.7c (published 15 September 2006) BMJ A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis
More informationAcupuncture for low back pain: a survey of clinical practice in the UK. Authors: Felicity L Bishop PhD, Shipu Zaman, George T Lewith DM.
NOTICE: this is the author s version of a work that was accepted for publication in Complementary Therapies in Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections,
More informationACUPUNCTURE AND BACK PAIN
ACUPUNCTURE AND BACK PAIN About back pain Back pain can affect anyone at any age and most people will suffer from it at some point in their lives. It is the UK s leading cause of disability and one of
More informationEditor: Yu-Kang Tu, National Taiwan University, Taiwan. Received: November 13, 2013; Accepted: March 6, 2014; Published: April 4, 2014
Hugh MacPherson, Emily Vertosick, George Lewith, Klaus Linde, Karen J. Sherman, Claudia M. Witt, Andrew J. Vickers, on behalf of the Acupuncture Trialists' Collaboration Published: April 4, 2014 DOI: 10.1371/journal.pone.0093739
More informationNoninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review
Leaders in Multidisciplinary Care Since 1988 Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review Supplemental comments submitted to the Agency for Healthcare Research and Quality
More informationChronic knee pain caused by osteoarthritis (OA) is
MEDICAL ACUPUNCTURE Volume 27, Number 5, 2015 # Mary Ann Liebert, Inc. DOI: 10.1089/acu.2015.1105 REVIEW ARTICLE Acupuncture for Chronic Knee Pain: A Critical Appraisal of an Australian Randomized Controlled
More informationCommissioning Policy. The use of Acupuncture in the Management of Musculoskeletal Pain. July 2013
Commissioning Policy The use of Acupuncture in the Management of Musculoskeletal Pain July 2013 This commissioning policy applies to patients within: South Worcestershire Clinical Commissioning Group (CCG)
More informationCite this article as: BMJ, doi: /bmj eb (published 15 March 2004)
Cite this article as: BMJ, doi:10.1136/bmj.38033.896505.eb (published 15 March 2004) Primary care Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care David
More informationACUPUNCTURE AND NECK PAIN
ACUPUNCTURE AND NECK PAIN About neck pain Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Twenty-six to 71% of the adult population can recall experiencing
More informationEditor: Sam Eldabe, The James Cook University Hospital, United Kingdom
Hugh MacPherson, Alexandra C. Maschino, George Lewith, Nadine E. Foster, Claudia Witt, Andrew J. Vickers, on behalf of the Acupuncture Trialists' Collaboration Published: October 11, 2013 DOI: 10.1371/journal.pone.0077438
More informationAcupuncture Immune System Discovery
Acupuncture Immune System Discovery Published by HealthCMi on November 2017 Researchers conclude that acupuncture benefits the immune system. In a controlled laboratory experiment, Hubei University of
More informationThere is good evidence (Level 1a) to support the use of relaxation therapy for children and adolescents with headaches.
1 There is good evidence (Level 1a) to support the use of relaxation therapy for children and adolescents with headaches. Prepared by: Belinda Swain and Margaret Wallen The Children s Hospital at Westmead
More informationEffectiveness of True Acupuncture as an Adjunct to Standard Care or Electro-Physiotherapy in Osteoarthritis of the Knee
Cronicon OPEN ACCESS ORTHOPAEDICS Research article Effectiveness of True Acupuncture as an Adjunct to Standard Care or Electro-Physiotherapy in Osteoarthritis of Dimitar Tonev 1 *, Stoyka Radeva 2 and
More informationBiofeedback as a Treatment of Headache
Biofeedback as a Treatment of Headache Policy Number: 2.01.29 Last Review: 7/2018 Origination: 7/2008 Next Review: 7/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) may provide coverage
More informationCost-Effectiveness of Complementary Therapies in the United Kingdom A Systematic Review
Advance Access Publication 26 July 2006 ecam 2006;3(4)425 432 doi:10.1093/ecam/nel044 Review Cost-Effectiveness of Complementary Therapies in the United Kingdom A Systematic Review Peter H. Canter, Joanna
More informationComments from the Acupuncture Now Foundation to the AHRQ draft report: Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review
December 26, 2017 Comments from the Acupuncture Now Foundation to the AHRQ draft report: Noninvasive, Nonpharmacological Treatment for Chronic Pain: A Systematic Review By Matthew Bauer, L.Ac. and John
More informationGynaecology and Acupuncture The evidence for effectiveness
BRIEFING PAPER No 4 Gynaecology and Acupuncture The evidence for effectiveness Edited and produced by the Acupuncture Research Resource Centre Published by the British Acupuncture Council September 1999
More informationAcupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial
To cite: Hopton A, MacPherson H, Keding A, et al. Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. BMJ Open 2014;4:e004964.
More informationThe latest evidence for acupuncture updated Feb 2015
The latest evidence for acupuncture updated Feb 2015 Compiled by Mike Cummings, Medical Director of the British Medical Acupuncture Society Contact: Allyson Brown, Support Manager to MD BMAS, 02077139437,
More informationAcupuncture , The Patient Education Institute, Inc. amf00102 Last reviewed: 06/23/2017 1
Acupuncture Introduction Acupuncture is the practice of inserting thin needles into specific body points to improve health and well-being. It originated in China more than 2,000 years ago. Research has
More informationOutline. Understanding Placebo Response in Psychiatry: The Good, The Bad, and The Ugly. Definitions
Outline Understanding Placebo Response in Psychiatry: The Good, The Bad, and The Ugly Michael E. Thase, MD Professor of Psychiatry Perelman School of Medicine University of Pennsylvania and Philadelphia
More informationmain/1103_new 01/11/06
Search date May 2006 Allan Binder QUESTIONS What are the effects of treatments for people with uncomplicated neck pain without severe neurological deficit?...3 What are the effects of treatments for acute
More informationCopyright Ó 2017 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
Research Paper The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain H. MacPherson a, *, E.A. Vertosick b, N.E. Foster c, G. Lewith d,
More informationLonger term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain
Health Technology Assessment 2005; Vol. 9: No. 32 Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain KJ Thomas, H MacPherson, J Ratcliffe, L
More informationACUPUNCTURE AND TOUCH PROTOCOL
ACUPUNCTURE AND TOUCH PROTOCOL The Role of Acupuncture Treatment with the Management of Threatened Miscarriage: An exploratory study Acupuncture treatment This involves receiving an acupuncture treatment
More informationCite this article as: BMJ, doi: /bmj eb (published 16 March 2004)
Cite this article as: BMJ, doi:10.1136/bmj.38029.421863.eb (published 16 March 2004) Primary care Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial Andrew J Vickers,
More informationCite this article as: BMJ, doi: /bmj eb (published 16 March 2004)
Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial Andrew J Vickers, Rebecca W Rees, Catherine E Zollman, Rob McCarney, Claire Smith, Nadia Ellis, Peter Fisher, Robbert
More informationEugena Stamuli *, Karen Bloor, Hugh MacPherson, Helen Tilbrook, Tracy Stuardi, Sally Brabyn and David Torgerson
Stamuli et al. BMC Gastroenterology 2012, 12:149 RESEARCH ARTICLE Open Access Cost-effectiveness of acupuncture for irritable bowel syndrome: findings from an economic evaluation conducted alongside a
More informationShared Decision Making Osteoarthritis of the Knee Next clinical review date March 2018
Shared Decision Making Osteoarthritis of the Knee Next clinical review date March 2018 Deciding what to do about Osteoarthritis of the Knee This short decision aid is to help you decide what to do about
More informationAcupuncture for Depression?: A Systematic Review of Systematic Reviews
Acupuncture for Depression?: A Systematic Review of Systematic Reviews Evaluation & the Health Professions 34(4) 403-412 ª The Author(s) 2011 Reprints and permission: sagepub.com/journalspermissions.nav
More informationAcupuncture trials before the 1980s were haphazard. Developing a Research Strategy for Acupuncture REVIEW ARTICLE
REVIEW ARTICLE Developing a Research Strategy for Acupuncture George T. Lewith, MA, DM, FRCP, MRCGP,* Peter J. White, PhD,w and Ted J. Kaptchukz Abstract: This strategic overview revisits some of the basic
More informationAppendix Studies of the Efficacy of Acupuncture *
Appendix Studies of the Efficacy of Acupuncture * Study Study Description Main Results Researchers Conclusions Lee A, Fan LT. Stimulation of wrist acupuncture point P6 for preventing nausea and vomiting.
More informationSummaries and commentaries by editor Adrian White on a selection of recent acupuncture research studies
Summaries and commentaries by editor Adrian White on a selection of recent acupuncture research studies Clinical studies Chronic shoulder pain c Lathia AT, Jung SM, Chen LX. Efficacy of acupuncture as
More information3. Research Institute for Primary Care and Health Sciences, Keele University, UK
PAIN Publish Ahead of Print DOI: 10.1097/j.pain.0000000000000747 version 10thAug2016 The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic
More informationMedical Affairs Policy
Service: Acupuncture Therapy PUM 250-0002-1803 Medical Affairs Policy Medical Policy Committee Approval 03/16/18 Effective Date 07/01/18 Prior Authorization Needed Yes-if not an exclusion of the health
More informationMethods for network meta-analysis of continuous outcomes using individual patient data: a case study in acupuncture for chronic pain
Saramago et al. BMC Medical Research Methodology (2016) 16:131 DOI 10.1186/s12874-016-0224-1 RESEARCH ARTICLE Open Access Methods for network meta-analysis of continuous outcomes using individual patient
More informationShort term reactions to acupuncture a cross-sectional survey of patient reports
Short term reactions to acupuncture a cross-sectional survey of patient reports Hugh MacPherson, Kate Thomas Hugh MacPherson senior research fellow Department of Health Sciences University of York Kate
More informationREVIEW ARTICLE. and stimulation of needles at specific points on the body to facilitate recovery
ONLINE FIRST REVIEW ARTICLE Acupuncture for Chronic Pain Individual Patient Data Meta-analysis Andrew J. Vickers, DPhil; Angel M. Cronin, MS; Alexandra C. Maschino, BS; George Lewith, MD; Hugh MacPherson,
More informationEvidence for acupuncture updated Aug 2016
Evidence for acupuncture updated Aug 2016 Compiled by Mike Cummings, Medical Director of the British Medical Acupuncture Society Contact: Allyson Brown, Support Manager to MD BMAS, 02077139437, allyson@thebmas.com
More informationBetter Outcomes for Older People with Spinal Trouble (BOOST) Research Programme
Better Outcomes for Older People with Spinal Trouble (BOOST) Research Programme Background Low back pain (LBP) is now recognised as the leading disabling condition in the world. LBP is a highly variable
More informationCONSORT 2010 checklist of information to include when reporting a randomised trial*
CONSORT 2010 checklist of information to include when reporting a randomised trial* Section/Topic Title and abstract Introduction Background and objectives Item No Checklist item 1a Identification as a
More informationRESEARCH. Patients preferences within randomised trials: systematic review and patient level meta-analysis. Preference Collaborative Review Group
Correspondence to: H Tilbrook, Research Fellow, York Trials Unit, Department of Health Sciences, University ofyork, YorkYO105DD het2@york.ac.uk Cite this as: BMJ 2008;337:a1864 doi:10.1136/bmj.a1864 Patients
More informationAcupuncture compared to other physical therapies for osteoarthritis of the knee: a network meta-analysis. Hugh MacPherson University of York
Acupuncture compared to other physical therapies for osteoarthritis of the knee: a network meta-analysis Hugh MacPherson University of York Acupuncture for osteoarthritis 1. Clinical guidance on acupuncture
More informationCONSORT 2010 Statement Annals Internal Medicine, 24 March History of CONSORT. CONSORT-Statement. Ji-Qian Fang. Inadequate reporting damages RCT
CONSORT-Statement Guideline for Reporting Clinical Trial Ji-Qian Fang School of Public Health Sun Yat-Sen University Inadequate reporting damages RCT The whole of medicine depends on the transparent reporting
More informationREVIEW ARTICLE. and stimulation of needles at specific points on the body to facilitate recovery
REVIEW ARTICLE Acupuncture for Chronic Pain Individual Patient Data Meta-analysis Andrew J. Vickers, DPhil; Angel M. Cronin, MS; Alexandra C. Maschino, BS; George Lewith, MD; Hugh MacPherson, PhD; Nadine
More informationWhat Is Known About the Cost- Effectiveness of Nonpharmacological and Nonsurgical Treatments for Pain?
What Is Known About the Cost- Effectiveness of Nonpharmacological and Nonsurgical Treatments for Pain? Role of Nonpharmacologic Approaches to Pain Management: A National Academies Workshop HEALTH Patricia
More informationChiropractic : Opioid Reduction & Avoidance
Chiropractic : Opioid Reduction & Avoidance O Jeff King DC, MS O Wisconsin Chiropractic Association Alliance Opioid Epidemic Summit Avoidance is paramount 11 O 5% of patients given opioids will go on to
More informationThis is a legal requirement and will be discussed with you. All LJMC services are offered free of charge to NHS. Vernon Cancer Centre.
Ear acupuncture This leaflet should be given out with either: PI18a Ear acupuncture service for women or PI18b Ear acupuncture service for men Patient Information Series PI18 East and North Hertfordshire
More informationPriorities Forum Statement
Priorities Forum Statement Number 48 Subject Complementary and Alternative Medicine (CAM) Date of decision August 2016 Date refreshed March 2017 Date of review August 2018 Recommendations GUIDANCE Interventions
More informationGynaecology and Acupuncture The evidence for effectiveness
BRIEFING PAPER No 4 Gynaecology and Acupuncture The evidence for effectiveness Edited and produced by the Acupuncture Research Resource Centre Published by the British Acupuncture Council September 1999
More informationCluster Randomised Trials: Sources of Bias. Ada Keding Professor David Torgerson
Cluster Randomised Trials: Sources of Bias Ada Keding Professor David Torgerson Problems with Cluster Randomisation Possible Selection Bias; Inadequate uptake of intervention by either group reduces study
More informationAuthor's response to reviews
Author's response to reviews Title:A Randomised Multicentre Trial of Acupuncture in Patients with Seasonal Allergic Rhinitis - Study Intervention including Physician and Treatment Characteristics Authors:
More informationACR OA Guideline Development Process Knee and Hip
ACR OA Guideline Development Process Knee and Hip 1. Literature searching frame work Literature searches were developed based on the scenarios. A comprehensive search strategy was used to guide the process
More informationPragmatic Evidence Based Review The efficacy of acupuncture in the management of musculoskeletal pain
Pragmatic Evidence Based Review The efficacy of acupuncture in the management of musculoskeletal pain Reviewer Natalie Hardaker and Mark Ayson Date Report Completed August 2011 Important Note: This report
More informationAn audit of self acupuncture for chronic musculoskeletal pain
An audit of self acupuncture for chronic musculoskeletal pain Silje Teig, Sue Peacock, Lorraine Stevens, Kimberley Tordoff, Edwina Maguire, Paul Watson Silje Hilmo Teig research student Sue M Peacock research
More informationRandomised Controlled Trial for Low Back Pain
INSPIRING THE WORLD TO MOVE WELL Randomised Controlled Trial for Low Back Pain A T 10 WEEKS, ViMove PATIENTS SHOWED SIGNIFICANT IMPROVEMENT IN ALL KEY MEASURES. IMPROVEMENTS WERE SUSTAINED OR IMPROVED
More informationDCEM2 Purpan. Reading skills Skimming & Scanning. Abstracts. Guidelines for authors. Research article structure. Journals
Reading skills Skimming & Scanning DCEM2 Purpan Abstracts Skimming: going through the reading material to know how it is organized Scanning: trying to locate specific information by letting eyes wander
More informationTREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING
TREATMENT OF CHRONIC MECHANICAL NECK PAIN IN AN OUTPATIENT ORTHOPEDIC SETTING Clinical Problem Solving II Allison Walsh PATIENT OVERVIEW Age: 22 years Gender: Female Chief Complaint: Cervical pain, cervicogenic
More informationQuit Rates of New York State Smokers
Quit Rates of New York State Smokers Sara M. Abrams, MPH Data Manager NYS Smokers Quitline Sara.Abrams@roswellpark.org September 6, 20 Presentation Outline Basic Quitline Service How Quit Rates are defined
More informationManual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain A Randomized, Controlled Trial
Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain A Randomized, Controlled Trial Annals of Internal Medicine,, Vol. 136 No. 10, Pages 713-722 May
More informationA Chiropractic Approach to Managing Migraine
www.migraine.org.uk A Chiropractic Approach to Managing Migraine What is chiropractic? Chiropractic is a primary healthcare profession that specialises in the diagnosis, treatment and overall management
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Centre for Clinical Practice Surveillance Programme
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Centre for Clinical Practice Surveillance Programme Clinical guideline CG28: Depression in children and young people: identification and management in
More informationSystematic reviews and meta-analyses of observational studies (MOOSE): Checklist.
Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. MOOSE Checklist Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease:
More informationAcupuncture for migraine prophylaxis (Review)
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009,
More informationStandardised Data Collection Questionnaire Patient Information Version 2.0 SDC
Standardised Data Collection Questionnaire Patient Information Version 2.0 SDC Part 1: Initial consultation for new episode To be completed by the osteopath Practitioner ID code 1. Date of first appointment
More informationCADET: Clinical & Cost Effectiveness of Collaborative Care for Depression in UK Primary Care: A Cluster Randomized Controlled Trial
CADET: Clinical & Cost Effectiveness of Collaborative Care for Depression in UK Primary Care: A Cluster Randomized Controlled Trial David Richards, PhD "This presentation reports independent research funded
More informationThis leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.
Information for patients This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request. This leaflet tells you about acupuncture
More informationimpact report April March 2013
impact report April 2012 - March 2013 introduction BigLifeCentres manages 5 health and community centres across Greater Manchester. Our centres deliver, facilitate and host services which improve the quality
More informationSpecific question: Does acupuncture improve pain, function and quality of life for adults with fibromyalgia?
Specific question: Does acupuncture improve pain, function and quality of life for adults with fibromyalgia? Clinical bottom line There is low to moderate level evidence that western and electro acupuncture
More informationAcupuncture for chronic pelvic inflammatory disease: a qualitative study of patients insistence on treatment
Liang and Gong BMC Complementary and Alternative Medicine 2014, 14:345 RESEARCH ARTICLE Open Access Acupuncture for chronic pelvic inflammatory disease: a qualitative study of patients insistence on treatment
More informationMacclesfield Physio Pilates Health Questionnaire
General Client Details Title:... Name:... Date Of Birth:... Address:... Postcode:... Phone:... Email:... GP s Name:... GP Address:... How did you hear of us? Pilates Aims Why have you decided to commence
More informationResearch Methodology Guidelines for Acupuncture Randomized Controlled Trial
Research Methodology Guidelines for Acupuncture Randomized Controlled Trial Last updated on 30.03.2017 Contents 1. Purpose... 3 2. Background... 3 3. Guidelines for designing scientific RCT on acupuncture...
More informationUseful sources of information Pharmacy Medicines Helpline British Acupuncture Council British Medical Acupuncture Society Your comments and concerns
Seated acupuncture What is seated acupuncture? Acupuncture is the insertion of very fine needles in specific points on the body, to stimulate or relax. Seated acupuncture is based on Traditional Chinese
More informationEvidence-Based Integrative Therapies for Common Problems in Family Medicine. Pamela Wiseman MD Associate Professor of Family Medicine
Evidence-Based Integrative Therapies for Common Problems in Family Medicine Pamela Wiseman MD Associate Professor of Family Medicine Learning Objectives As a result of this session, the participant will
More informationPhysical Activity: Family-Based Interventions
Physical Activity: Family-Based Interventions Community Preventive Services Task Force Finding and Rationale Statement Ratified October 2016 Table of Contents Context... 2 Intervention Definition... 2
More informationAttention-Deficit/Hyperactivity Disorder Nathan J. Blum, M.D.
ADHD in Preschool Children Preschool ADHD: When Should We Diagnose it & How Should We Treat it? Professor of Pediatrics Diagnosis of ADHD in Preschool Children: Impact of DSM-IV Is Preschool ADHD Associated
More informationA research report of the therapeutic effects of yoga for health and wellbeing Prepared at ScHARR for the British Wheel of Yoga
A research report of the therapeutic effects of yoga for health and wellbeing Prepared at ScHARR for the British Wheel of Yoga About The British Wheel of Yoga The British Wheel of Yoga The British Wheel
More informationContents. Chapter 1: Complementary medicine. Chapter 2: Questions and issues
Contents Complementary and alternative medicine 1 Evolving use of alternative medicines 5 The difference between complementary and alternative therapies 6 How to choose a CAM practitioner 8 Complementary
More information