Its Not Only 'What' But 'How' You Do It - Clinical Outcomes

I mention this in relation to Acupuncture, however this concept has implications across all disciplines of medicine. Like it or not, the non specific effects of treatment, sometimes referred to as the placebo effects are real and account for a fairly large proportion of the overall effectiveness of a given treatment, up to 70% so I have heard some experts report.

In the era of evidence based medicine (EBM), I am concerned a fundamental element of medical care is being diluted in an effort to prove efficacy and work in an EBM manner.

Studies seem to show that given the same treatment, fully interactive and empathic verbal communication only makes a small difference in terms of outcome versus limited verbal interactions.

What makes greater difference to the outcome is ‘something else’, something we may as yet not be able to fully quantify, something primitive, limbic driven maybe? a subconscious assessment of practitioner by the patient which may then influence expectancy of a therapeutic benefit.

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There Is More To Medical Acupuncture Than Simply Dry Needling Trigger Points

Dry needling is a term which is used to describe the practice of medical acupuncture in a myofascial pain context - in other words its one technique which falls under the ‘umbrella’ of medical acupuncture.

Sometimes the terms are used interchangeably which I feel detracts from a true understanding of medical acupuncture and the fact that it can be used not just in the treatment of myofascial pain, but for other pain conditions as well.

Medical acupuncture, as we know is the more western medical approach to the practice of acupuncture and is based on an understanding of the neurophysiological mechanisms, both specific and nonspecific (placebo) which underpin the the technique. Lets not fool ourselves, the placebo effect plays a part (as it does in everything we do as clinicians), but there is compelling evidence to suggest that needling has specific physiological effects over and above placebo, regardless of where the needle is placed.

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Is Acupuncture Nothing More Than a ‘Theatrical Placebo’?

TCM did acupuncture a disservice by suggesting that there was such a thing as an acupuncture ‘point’, a concept which has been taken too literally in western medicine and its obsession with proving efficacy.

If, as rational intelligent beings we can all agree that there is no such thing as a physically or otherwise definable acupuncture point, then we can stop trying to prove that missing the point i.e sham acupuncture, has any better or worse clinical effect.

With this understanding we can stop comparing like with like in an effort to prove efficacy. Surely the suggestion that inserting a needle into the tissues, regardless of where, is likely to have a physiological effect over and above placebo? These proposed mechanisms have been well described in the scientific acupuncture literature, with further evidence of specific physiological effects emerging regularly.

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Further Applications For Medical Acupuncture During Pregnancy

I have already discussed how Acupuncture may be of benefit for those women suffering from low back and pelvic pain, as well as discussing aspects relating to safety in a previous post. In quick summary, its safe, its effective, we should be using it more to help those suffering in this way.

But what of the other applications?

It would seem, according to three trials summarized by Lee & Ernst (2004) that Acupuncture may be useful in reducing labour pain. Furthermore, those who receive this treatment during labour have been found to be less likely to require epidural analgesia (Nesheim & Kinge, 2006). Of course the delivery of Acupuncture during labour may be challenging and would probably be dependant on a midwifery team who have not only been trained to deliver this form of treatment but who have the time, inclination and support to do so. Given the strain on resources in public healthcare environments this could be a barrier.

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De qi or not De Qi?

The de qi, or needling sensation as we refer to it in medical Acupuncture is not a single, but rather a combined sensory response which occurs when a variety of sensory receptors are stimulated.

These would include small fibre innervated nociceptors and myelinated fibre innervated mechanoreceptors (Leung et al, 2006).

Zhang et al (2012) hypothesise that the numbness, heaviness and distension felt as part of the needle sensation may be due to the stimulation of sites rich in muscle spindles and tendon organs (proprioceptors) and the soreness and aching in the deep tissues is likely to be due to the activation of intramuscular nociceptors (type II/III).

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