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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

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The evidence for acupuncture in Irish health system

Dr Clare Thornley writes that the traditional Chinese practice of acupuncture has a place in modern Western medicine, especially when it comes to providing pain relief for patients.

Like it or not, acupuncture is growing ever more popular in Ireland. Many of those in the mainstream medical profession still view this ancient discipline and its scientifically implausible concepts of yin, yang and energy meridians with suspicion.
Fewer realise that over the past two decades, a modern, ‘Western’ approach to acupuncture has evolved that largely ignores the ancient ideas or else reinterprets them in the context of current medical knowledge.

So, what is the state of acupuncture in Ireland today? Who precisely are the practitioners of acupuncture? Is it safe? Is there any real evidence that it is effective, and if so, what for? This article aims to provide some of the answers, thereby encouraging doctors to explore adding acupuncture to their practice’s therapeutic options, and assisting them in informing and advising patients.

Acupuncture past and present

Acupuncture originated over 3,000 ago in China, probably using primitive sharp stones or bamboo as precursors of modern ultra-fine needles. Acupuncture is still used in China within the traditional Chinese medicine (TCM) system.

According to TCM, acupuncture unblocks the body’s channels of energy that have become interrupted by disease. This theory predates current knowledge of anatomy and physiology and is difficult to reconcile with Western medicine. However, China trains both conventional and TCM medical doctors and the Chinese seem happy to live with a mixture of both disciplines.

As a result of Western scientific research, it is now possible to explain many of acupuncture’s effects. There is now experimental evidence that inserting needles in certain areas of the body not only stimulates the release of endorphins, serotonin and other neurotransmitters, but also deactivates the limbic system, which governs pain perception.

Research in this area is ongoing and we are still a long way from a definitive understanding of how acupuncture works.

Who practices acupuncture in Ireland?

There are four main categories of acupuncture practitioners in Ireland: doctors, other health professionals, and registered and unregistered lay acupuncturists.

Doctors who practice acupuncture here are primarily GPs or have a background in general practice, though a small number work in pain clinics, palliative care or sports medicine. The other main group of health professionals using acupuncture are chartered physiotherapists — soon to be State regulated — as well as a smaller number of osteopaths (members of the Irish Osteopathic Association are registered with the UK’s regulatory body).

Many of these two groups will have undertaken postgraduate training with the British Medical Acupuncture Society (BMAS), which has well-established education, accreditation (DipMedAc) and five-yearly re-accreditation procedures for registered health professionals. Others will have taken TCM courses alongside lay practitioners and a few learn the technique while working abroad. A recent development is the postgraduate Diploma/MSc acupuncture course at UCD for doctors and physiotherapists.

While the statutory regulation of lay acupuncturists is imminent in the UK, there are no immediate plans for compulsory registration in Ireland. In 2006, at the instigation of the HSE, three separate organisations came together to form the Acupuncture Council of Ireland – otherwise known as the TCMCI — with a view to overseeing voluntary self-regulation.

TCMCI members must have completed approved training and carry professional indemnity and public liability insurance. There are a number of acupuncture courses taught in Ireland that hope to be TCMCI accredited eventually, although this scheme is still a work in progress.

Most of these courses last three or four years part-time and while they do include anatomy and physiology in their syllabus, all have a strong emphasis on the theories of traditional Chinese medicine. It would seem that there is, as yet, no compulsory requirement for continuing medical education for TCMCI members.

Oddly, while TCMCI members are approved by VHI and other health insurers, for historic reasons most medical acupuncturists in Ireland are not. Instead our patients must recoup our fees by claiming for GP, physiotherapy or hospital visits. By contrast, Northern Ireland’s accredited BMAS members are automatically approved by bodies such as BUPA.

The remainder of acupuncturists in Ireland are unregistered and unregulated. Whilst the TCMCI claims 500 members, the number of unregistered acupuncturists practising in Ireland is unknown.

These include respectable practitioners who have opted not to join the TCMCI, as well as some who would fail to qualify for registration. One enigmatic group of acupuncturists are the ‘doctors’ who are not listed on the Medical Council register.
Some may have qualified from TCM medical schools in China, a number presumably use their PhD entitlement, whilst others probably believe that the title will inspire confidence in their clients.

As for the acupuncture ‘shops’ that have sprung up on our high streets and shopping precincts, I believe that the practice of pressing customers to purchase as many as ten sessions in advance after (sometimes even before) the first consultation is as disquieting for the customer as it is damaging for the profession as a whole.

Acupuncture and safety

We know that adverse events tend to be under-reported in all areas of medicine. However, it would seem that in properly trained hands, acupuncture is a very safe practice and that serious complications are uncommon. Indeed, this was confirmed in a recent report from the British Medical Association (BMA).

Significant adverse reactions fall into three main areas:
* Physical injuries, such as pneumothorax, cardiovascular traumas or nerve injury. These should be avoided by ensuring acupuncturists are adequately trained in anatomy and physiology.
* Infections through improper sterilisation or improper handling of needles. Sterile disposable acupuncture needles are now standard in the West, so infections should be a rarity.
* Diverse reactions such as local dermatitis or fainting.

For more common minor transient adverse reactions such as local pain, bleeding or symptom aggravation, explanation and reassurance are usually all that are required.
Besides the physical adverse effects of acupuncture, a more serious concern for many doctors will be that a non-medically qualified practitioner may misdiagnose or fail to recognise a serious condition.

The Blood Transfusion Service appears to acknowledge the safety profile of doctors and physiotherapists using acupuncture. Their patients can be issued with a signed certificate that allows them to donate blood immediately after treatment, rather than wait six months before donation, as is otherwise the BTS rule.

The evidence for acupuncture

A key finding of the BMA report already mentioned was that research into complementary medicine in general is hampered by a combination of inadequate funding, research skills and academic infrastructure — as well as by a lack of patients.

A further consideration is that many acupuncture trials use so-called ‘sham’ acupuncture as a control. In the past, this often involved either needling non-traditional points or else using superficial – as opposed to deep – needle insertion.
A number of these trials showed positive results from both active and ‘sham’ treatments, which led observers to conclude that any benefits were probably due to patient expectation.

In fact, some Western medical acupuncturists do not believe in the existence of specific acupuncture ‘points’ at all and others have observed beneficial effects from shallow needle insertion. So maybe the ‘sham’ treatments used in these trial are not necessarily sham after all, suggesting that the trial results are actually more positive than first thought.

Despite this issue, a significant body of supportive acupuncture research has been published in recent years. The conditions for which most research evidence is now available are low back pain, chronic headache, osteoarthritis of the knee, neck pain, postoperative nausea and vomiting, and fibromyalgia.

The effectiveness and cost-utility of acupuncture for low back pain and chronic headache or migraine seems now well established.

A 2006 British Medical Journal (BMJ) editorial observed that acupuncture for persistent low back pain had been clinically researched more thoroughly than many orthodox medical treatments.

The BMJ also recommended that healthcare decision makers should consider acupuncture for patients with persistent low back pain or migraine. The results of a more recent trial have convinced the German health authorities to reimburse acupuncture for low back pain from national health insurance funds.

Several large sham-controlled trials and a large meta-analysis have shown consistently positive results for pain, clinical improvement and cost-effectiveness in osteoarthritis of the knee. And while a 2006 Cochrane review found moderate evidence that acupuncture relieves pain in chronic mechanical neck disorders, a subsequent study on neck pain clearly demonstrated efficacy and cost-effectiveness.
A complete list of references to the trials, papers and reviews mentioned above – as well as others — may be found in Clinical Evidence for Acupuncture, an article by Dr Mike Cummings, Medical Director of the British Medical Acupuncture Society, at the following URL: www.medical-acupunc ture.co.uk/members/hot_topics.html.

It is also worth pointing out that, although the current focus of acupuncture in the West is principally on pain relief, the Chinese use it to treat a myriad of diverse health problems.

The fact that acupuncture anaesthesia is widely used in China in a variety of operations from minor procedures to open heart surgery makes Western medical acupuncture appear positively cautious in its approach.

One in ten patients in Ireland will attend an acupuncturist at some point and many will seek advice from their GP or hospital specialist. An informed and evidence-based approach to this subject will hopefully empower and reassure both practitioner and patient. Doctors interested in learning more about training in acupuncture may wish to visit the BMAS website: www.medical-acupuncture.co.uk.

Dr Clare Thornley,
MRCGP DipMedAc.

• The Irish Medical Acupuncture Society is holding a meeting at the City North Hotel, Dublin, on Saturday, March 28, for all interested doctors and registered health professionals. Advance booking is essential.

• For further information visit the IMAS Meeting blog http://irishmedicalacupuncture.blogspot.com or contact Clare Thornley at 053 9147671 or drclare@medical-acupuncture.ie

Posted in Mental Health & CNS on 03 February 2009
Tags: accupuncture

Tagcloud

abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

The evidence for acupuncture in Irish health system

Dr Clare Thornley writes that the traditional Chinese practice of acupuncture has a place in modern Western medicine, especially when it comes to providing pain relief for patients.

Like it or not, acupuncture is growing ever more popular in Ireland. Many of those in the mainstream medical profession still view this ancient discipline and its scientifically implausible concepts of yin, yang and energy meridians with suspicion.
Fewer realise that over the past two decades, a modern, ‘Western’ approach to acupuncture has evolved that largely ignores the ancient ideas or else reinterprets them in the context of current medical knowledge.

So, what is the state of acupuncture in Ireland today? Who precisely are the practitioners of acupuncture? Is it safe? Is there any real evidence that it is effective, and if so, what for? This article aims to provide some of the answers, thereby encouraging doctors to explore adding acupuncture to their practice’s therapeutic options, and assisting them in informing and advising patients.

Acupuncture past and present

Acupuncture originated over 3,000 ago in China, probably using primitive sharp stones or bamboo as precursors of modern ultra-fine needles. Acupuncture is still used in China within the traditional Chinese medicine (TCM) system.

According to TCM, acupuncture unblocks the body’s channels of energy that have become interrupted by disease. This theory predates current knowledge of anatomy and physiology and is difficult to reconcile with Western medicine. However, China trains both conventional and TCM medical doctors and the Chinese seem happy to live with a mixture of both disciplines.

As a result of Western scientific research, it is now possible to explain many of acupuncture’s effects. There is now experimental evidence that inserting needles in certain areas of the body not only stimulates the release of endorphins, serotonin and other neurotransmitters, but also deactivates the limbic system, which governs pain perception.

Research in this area is ongoing and we are still a long way from a definitive understanding of how acupuncture works.

Who practices acupuncture in Ireland?

There are four main categories of acupuncture practitioners in Ireland: doctors, other health professionals, and registered and unregistered lay acupuncturists.

Doctors who practice acupuncture here are primarily GPs or have a background in general practice, though a small number work in pain clinics, palliative care or sports medicine. The other main group of health professionals using acupuncture are chartered physiotherapists — soon to be State regulated — as well as a smaller number of osteopaths (members of the Irish Osteopathic Association are registered with the UK’s regulatory body).

Many of these two groups will have undertaken postgraduate training with the British Medical Acupuncture Society (BMAS), which has well-established education, accreditation (DipMedAc) and five-yearly re-accreditation procedures for registered health professionals. Others will have taken TCM courses alongside lay practitioners and a few learn the technique while working abroad. A recent development is the postgraduate Diploma/MSc acupuncture course at UCD for doctors and physiotherapists.

While the statutory regulation of lay acupuncturists is imminent in the UK, there are no immediate plans for compulsory registration in Ireland. In 2006, at the instigation of the HSE, three separate organisations came together to form the Acupuncture Council of Ireland – otherwise known as the TCMCI — with a view to overseeing voluntary self-regulation.

TCMCI members must have completed approved training and carry professional indemnity and public liability insurance. There are a number of acupuncture courses taught in Ireland that hope to be TCMCI accredited eventually, although this scheme is still a work in progress.

Most of these courses last three or four years part-time and while they do include anatomy and physiology in their syllabus, all have a strong emphasis on the theories of traditional Chinese medicine. It would seem that there is, as yet, no compulsory requirement for continuing medical education for TCMCI members.

Oddly, while TCMCI members are approved by VHI and other health insurers, for historic reasons most medical acupuncturists in Ireland are not. Instead our patients must recoup our fees by claiming for GP, physiotherapy or hospital visits. By contrast, Northern Ireland’s accredited BMAS members are automatically approved by bodies such as BUPA.

The remainder of acupuncturists in Ireland are unregistered and unregulated. Whilst the TCMCI claims 500 members, the number of unregistered acupuncturists practising in Ireland is unknown.

These include respectable practitioners who have opted not to join the TCMCI, as well as some who would fail to qualify for registration. One enigmatic group of acupuncturists are the ‘doctors’ who are not listed on the Medical Council register.
Some may have qualified from TCM medical schools in China, a number presumably use their PhD entitlement, whilst others probably believe that the title will inspire confidence in their clients.

As for the acupuncture ‘shops’ that have sprung up on our high streets and shopping precincts, I believe that the practice of pressing customers to purchase as many as ten sessions in advance after (sometimes even before) the first consultation is as disquieting for the customer as it is damaging for the profession as a whole.

Acupuncture and safety

We know that adverse events tend to be under-reported in all areas of medicine. However, it would seem that in properly trained hands, acupuncture is a very safe practice and that serious complications are uncommon. Indeed, this was confirmed in a recent report from the British Medical Association (BMA).

Significant adverse reactions fall into three main areas:
* Physical injuries, such as pneumothorax, cardiovascular traumas or nerve injury. These should be avoided by ensuring acupuncturists are adequately trained in anatomy and physiology.
* Infections through improper sterilisation or improper handling of needles. Sterile disposable acupuncture needles are now standard in the West, so infections should be a rarity.
* Diverse reactions such as local dermatitis or fainting.

For more common minor transient adverse reactions such as local pain, bleeding or symptom aggravation, explanation and reassurance are usually all that are required.
Besides the physical adverse effects of acupuncture, a more serious concern for many doctors will be that a non-medically qualified practitioner may misdiagnose or fail to recognise a serious condition.

The Blood Transfusion Service appears to acknowledge the safety profile of doctors and physiotherapists using acupuncture. Their patients can be issued with a signed certificate that allows them to donate blood immediately after treatment, rather than wait six months before donation, as is otherwise the BTS rule.

The evidence for acupuncture

A key finding of the BMA report already mentioned was that research into complementary medicine in general is hampered by a combination of inadequate funding, research skills and academic infrastructure — as well as by a lack of patients.

A further consideration is that many acupuncture trials use so-called ‘sham’ acupuncture as a control. In the past, this often involved either needling non-traditional points or else using superficial – as opposed to deep – needle insertion.
A number of these trials showed positive results from both active and ‘sham’ treatments, which led observers to conclude that any benefits were probably due to patient expectation.

In fact, some Western medical acupuncturists do not believe in the existence of specific acupuncture ‘points’ at all and others have observed beneficial effects from shallow needle insertion. So maybe the ‘sham’ treatments used in these trial are not necessarily sham after all, suggesting that the trial results are actually more positive than first thought.

Despite this issue, a significant body of supportive acupuncture research has been published in recent years. The conditions for which most research evidence is now available are low back pain, chronic headache, osteoarthritis of the knee, neck pain, postoperative nausea and vomiting, and fibromyalgia.

The effectiveness and cost-utility of acupuncture for low back pain and chronic headache or migraine seems now well established.

A 2006 British Medical Journal (BMJ) editorial observed that acupuncture for persistent low back pain had been clinically researched more thoroughly than many orthodox medical treatments.

The BMJ also recommended that healthcare decision makers should consider acupuncture for patients with persistent low back pain or migraine. The results of a more recent trial have convinced the German health authorities to reimburse acupuncture for low back pain from national health insurance funds.

Several large sham-controlled trials and a large meta-analysis have shown consistently positive results for pain, clinical improvement and cost-effectiveness in osteoarthritis of the knee. And while a 2006 Cochrane review found moderate evidence that acupuncture relieves pain in chronic mechanical neck disorders, a subsequent study on neck pain clearly demonstrated efficacy and cost-effectiveness.
A complete list of references to the trials, papers and reviews mentioned above – as well as others — may be found in Clinical Evidence for Acupuncture, an article by Dr Mike Cummings, Medical Director of the British Medical Acupuncture Society, at the following URL: www.medical-acupunc ture.co.uk/members/hot_topics.html.

It is also worth pointing out that, although the current focus of acupuncture in the West is principally on pain relief, the Chinese use it to treat a myriad of diverse health problems.

The fact that acupuncture anaesthesia is widely used in China in a variety of operations from minor procedures to open heart surgery makes Western medical acupuncture appear positively cautious in its approach.

One in ten patients in Ireland will attend an acupuncturist at some point and many will seek advice from their GP or hospital specialist. An informed and evidence-based approach to this subject will hopefully empower and reassure both practitioner and patient. Doctors interested in learning more about training in acupuncture may wish to visit the BMAS website: www.medical-acupuncture.co.uk.

Dr Clare Thornley,
MRCGP DipMedAc.

• The Irish Medical Acupuncture Society is holding a meeting at the City North Hotel, Dublin, on Saturday, March 28, for all interested doctors and registered health professionals. Advance booking is essential.

• For further information visit the IMAS Meeting blog http://irishmedicalacupuncture.blogspot.com or contact Clare Thornley at 053 9147671 or drclare@medical-acupuncture.ie

Posted in Mental Health & CNS on 03 February 2009
Tags: accupuncture