This article by de Almeida et al, 2013 reminds us that previous studies have shown acupuncture to increase the synthesis and reorganisation of collagen molecules in rat tendons after injury. Clinical studies have also shown that acupuncture improves pain and functional activity in patients with tendinopathy. This may be due to acupuncture having been shown to modulate both anti-inflammatory and mechanotransduction molecular pathways resulting in an increase in type 1 collagen synthesis.

The authors present a hypothesis that acupuncture increases synthesis and subsequent reorganisation of type I collagen during tendon healing by concomitant modulation of the Toll-like receptor-nuclear factor-κB AI pathway, the mitogen-activated protein kinases pathway and the Rho/Rac-F-actin MT pathway. All sounds a bit complicated for my clinical brain, so lets move on.

In practice the authors state that increased collagen synthesis and reorganisation requires the use of at least one acupuncture point that is anatomically ‘connected’ with the site of the injury because of the local tenoblast mechanotransduction mechanism. This may support the use of more local needling when treating tendon injuries which I have discussed in a previous blog.

Given the fact that using Medical Acupuncture in clinical practice is viewed by some as being somewhat controversial, wouldn't it be nice to know exactly where we stand from an evidence point of view?

There is a growing body of compelling evidence to support its use. We need to know about this evidence as well as aspects of basic pain science which makes interpreting the evidence more meaningful.

Thankfully, we all have the good fortune of being able to access an up to date review of the evidence, supporting the use of Acupuncture in the treatment of a variety of conditions - found here... 

This review was compiled and is updated by Dr. Mike Cummings, the medical director at the British Medical Acupuncture Society

Armed with this information, we are able to take on the Acupuncture cynic we may encounter (usually someone who does not actually use the technique) and challenge them with a sound evidence base for the use of a technique which, when used correctly, can be so very effective.

Another year has passed and I have become even more convinced of the enhanced clinical effectiveness which can be achieved by integrating the use of Medical Acupuncture (MA).

Could this be partly due to the effects of patient self selection - in other words I have more and more patients seeking me out with the specific intention of receiving MA as part of their treatment. I seem to have become known as the therapist who does the 'hands on' physiotherapy with the 'Acupuncture needling'. To what extent does this positive sense of expectation influence clinical outcomes? I would suggest this non specific effect has a potent impact, even more so if the patient arrives having also been referred by his or her GP. I trust my doctor so this therapist must be good (so they might be thinking). Of course I then have to deliver on this expectation, not always easy but I seem to be successful in the majority of cases.

Looking back over the year I have found writing these blogs very interesting and insightful. There has certainly been some interesting research on which to comment. I also hope some of my clinical discussions may have been of use to some of you. It's also certainly been a good exercise in keeping up to date with what's going on in the field of MA.

Baldry (2005) reports good empirical results with superficial needling i.e. needling to 5-10mm depth for 30 secs, then up to 1-2 mins if no change in tissue sensitivity.

A study by Ceccherelli et al (2002) found superficial needling to be as effective as deep needling in lumbar myofascial pain immediately after treatment but those who received deep needling were better at 3 month follow up. Which poses the question ‘Does superficial needling only result in short term relief?’

Itoh et al (2004) found deep needling at trigger point sites to be more effective than superficial needling as well as using ‘standard Acupuncture’ at ‘standard Acupuncture points’ for elderly patients with chronic low back pain. However there was no statistically significant difference between the results of each group. Again superficial needling does seem to be effective but no longer term follow up was performed.

Migraine is one of the most common types of headache as we know. Prophylactic drugs are often used to prevent migraine headaches but are not always effective in reducing the frequency of migraine attacks. New research has shown that Acupuncture may be very useful in supplementing the effect of prophylactic drugs.

The objective of a recent study from the Beijing University of Chinese Medicine by Foroughipour et al (2013)  was to assess the effects of adding acupuncture to conventional migraine prophylaxis.

One hundred patients with migraine (41 male, 59 female), in whom prophylactic drugs had not produced a fall of at least 50% in the number of attacks, entered the study. The patients were randomised into two groups, sham and true acupuncture. The patients in both groups continued their prophylactic treatment and received 12 sessions of either true or sham acupuncture.

Patients in the true acupuncture group received Acupuncture according to their involved meridians (Shaoyang, Yangming,Taiyang or Jueyin) and their Chinese medicine syndrome differentiation, thus adding individualised acupuncture to the semi-standardised protocol based on meridian diagnosis, while patients in the sham acupuncture group were needled superficially, not in ‘real’ Acupuncture points. The traditional Chinese medicine diagnosis was made by the acupuncturist in the same way for both groups.