Evidence Search on Acupuncture and Headaches in a Primary Care Setting




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Evidence Search on Acupuncture and Headaches in a Primary Care Setting



Evidence Search on Acupuncture and Headaches in a Primary Care Setting


Search conducted by: Kieran Lamb


Sources


Sources searched included:


  • NHS Evidence

  • Cochrane Library

  • Health Database Advanced Search

  • Google (nhs.uk, ac.uk, org.uk filters applied)

  • Trip Database


Links to the relevant material and live web searched are embedded within this document.


Coding of Quality of Evidence


Best Evidence

Clinical Q&A Evidence

Core primary research

Extended primary research

Articles/Good Practice



ID: CD001218

AU: Linde Klaus

AU: Allais Gianni

AU: Brinkhaus Benno

AU: Manheimer Eric

AU: Vickers Andrew

AU: White Adrian R

TI: Acupuncture for migraine prophylaxis

SO: Linde Klaus, Allais Gianni, Brinkhaus Benno, Manheimer Eric, Vickers Andrew, White Adrian R. Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews: Reviews 2009 Issue 1 John Wiley & Sons, Ltd Chichester, UK DOI: 10.1002/14651858.CD001218.pub2

YR: 2009

NO: 1

PB: John Wiley & Sons, Ltd

US: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001218/frame.html

KY: Humans [checkword]; Acupuncture Therapy; Migraine Disorders [prevention & control]; Randomized Controlled Trials as Topic

CC: HM-SYMPT

DOI: 10.1002/14651858.CD001218.pub2

AB: BACKGROUND: Acupuncture is often used for migraine prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for tension-type headache') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. OBJECTIVES: To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with migraine. SEARCH STRATEGY: The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. SELECTION CRITERIA: We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (no prophylactic treatment or routine care only), a sham acupuncture intervention or another intervention in patients with migraine. DATA COLLECTION AND ANALYSIS: Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (outcome of primary interest), migraine attacks, migraine days, headache days and analgesic use. Pooled effect size estimates were calculated using a random-effects model. MAIN RESULTS: Twenty-two trials with 4419 participants (mean 201, median 42, range 27 to 1715) met the inclusion criteria. Six trials (including two large trials with 401 and 1715 patients) compared acupuncture to no prophylactic treatment or routine care only. After 3 to 4 months patients receiving acupuncture had higher response rates and fewer headaches. The only study with long-term follow up saw no evidence that effects dissipated up to 9 months after cessation of treatment. Fourteen trials compared a 'true' acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably. Four trials compared acupuncture to proven prophylactic drug treatment. Overall in these trials acupuncture was associated with slightly better outcomes and fewer adverse effects than prophylactic drug treatment. Two small low-quality trials comparing acupuncture with relaxation (alone or in combination with massage) could not be interpreted reliably. AUTHORS' CONCLUSIONS: In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment. ACUPUNCTURE FOR MIGRAINE PROPHYLAXIS: Migraine patients suffer from recurrent attacks of mostly one-sided, severe headache. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for migraine prophylaxis - that is, to reduce the frequency and intensity of migraine attacks.We reviewed 22 trials which investigated whether acupuncture is effective in the prophylaxis of migraine. Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.


Source: Cochrane Library




Record #2 of 6

ID: CD007587

AU: Linde Klaus

AU: Allais Gianni

AU: Brinkhaus Benno

AU: Manheimer Eric

AU: Vickers Andrew

AU: White Adrian R

TI: Acupuncture for tension-type headache

SO: Linde Klaus, Allais Gianni, Brinkhaus Benno, Manheimer Eric, Vickers Andrew, White Adrian R. Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews: Reviews 2009 Issue 1 John Wiley & Sons, Ltd Chichester, UK DOI: 10.1002/14651858.CD007587

YR: 2009

NO: 1

PB: John Wiley & Sons, Ltd

US: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007587/frame.html

KY: Humans [checkword]; Acupuncture Therapy [methods]; Randomized Controlled Trials as Topic; Tension-Type Headache [prevention & control]

CC: HM-SYMPT

DOI: 10.1002/14651858.CD007587

AB: BACKGROUND: Acupuncture is often used for tension-type headache prophylaxis but its effectiveness is still controversial. This review (along with a companion review on 'Acupuncture for migraine prophylaxis') represents an updated version of a Cochrane review originally published in Issue 1, 2001, of The Cochrane Library. OBJECTIVES: To investigate whether acupuncture is a) more effective than no prophylactic treatment/routine care only; b) more effective than 'sham' (placebo) acupuncture; and c) as effective as other interventions in reducing headache frequency in patients with episodic or chronic tension-type headache. SEARCH STRATEGY: The Cochrane Pain, Palliative & Supportive Care Trials Register, CENTRAL, MEDLINE, EMBASE and the Cochrane Complementary Medicine Field Trials Register were searched to January 2008. SELECTION CRITERIA: We included randomized trials with a post-randomization observation period of at least 8 weeks that compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another intervention in patients with episodic or chronic tension-type headache. DATA COLLECTION AND ANALYSIS: Two reviewers checked eligibility; extracted information on patients, interventions, methods and results; and assessed risk of bias and quality of the acupuncture intervention. Outcomes extracted included response (at least 50% reduction of headache frequency; outcome of primary interest), headache days, pain intensity and analgesic use. MAIN RESULTS: Eleven trials with 2317 participants (median 62, range 10 to 1265) met the inclusion criteria. Two large trials compared acupuncture to treatment of acute headaches or routine care only. Both found statistically significant and clinically relevant short-term (up to 3 months) benefits of acupuncture over control for response, number of headache days and pain intensity. Long-term effects (beyond 3 months) were not investigated. Six trials compared acupuncture with a sham acupuncture intervention, and five of the six provided data for meta-analyses. Small but statistically significant benefits of acupuncture over sham were found for response as well as for several other outcomes. Three of the four trials comparing acupuncture with physiotherapy, massage or relaxation had important methodological or reporting shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes in the control groups. AUTHORS' CONCLUSIONS: In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches. ACUPUNCTURE FOR TENSION-TYPE HEADACHE: Patients with tension-type headache suffer from episodes of pain which is typically bilateral (affects both sides of the head), pressing or tightening in quality, mild to moderate in intensity, and which does not worsen with routine physical activity. In most patients tension-type headache occurs infrequently and there is no need for further treatment beyond over-the-counter pain killers. In some patients, however, tension-type headache occurs on several days per month or even daily. Acupuncture is a therapy in which thin needles are inserted into the skin at defined points; it originates from China. Acupuncture is used in many countries for tension-type headache prophylaxis - that is, to reduce the frequency and intensity of tension-type headaches.We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or 'fake' acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or 'fake' acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.


Source: Cochrane Library




Title: Physician characteristics and variation in treatment outcomes: Are better qualified and experienced physicians more successful in treating patients with chronic pain with acupuncture?


Citation: The Journal of Pain, May 2010, vol./is. 11/5(431-435), 1526-5900 (May 2010)


Author(s): Witt, Claudia M, Ludtke, Rainer, Wegscheider, Karl, Willich, Stefan N


Language: English


Abstract: The aim of this paper was to quantify the influence of the physician's training and experience in the field of acupuncture on the outcome in patients with chronic pain. Patients visiting their physician because of chronic low back pain, headache, pain due to osteoarthritis of the knee or hip, or neck pain, were included in 4 multicenter, randomized, controlled studies. All patients received routine care; patients in the acupuncture groups received additional acupuncture treatment (on average 10 sessions). The data was pooled, and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined. A total of 9,990 patients (mean age 49.6 13.6 years, 68% female) treated by 2,781 physicians (mean age 46.3 7 years, 37% female) were analyzed. The physicians had 7.3 5.2 (mean sd) years of experience in acupuncture and their mean duration of formal acupuncture training had been 287 321 hours. The outcome was markedly improved in the acupuncture group. We identified only 1 physician characteristic with a significant influence on the outcome: Internists performed better (odds ratio OR = 1.49, confidence interval CI: 1.01;2.18; P = .043); orthopedists worse (OR = .79, CI: .62;1; P = .043) than the average physician. Neither the duration of training nor the duration of experience had any impact on the extent of the acupuncture effect. Perspective: In this analysis, physician characteristics such as training did not influence patients' outcome after acupuncture, suggesting that formal training parameters have only a limited influence on treatment effect. Other skills such as the therapeutic relationship, which are difficult to measure, may probably play a more important role and should be taken into consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)


Publication Type: Journal, Peer Reviewed Journal


Source: PsycINFO



Title: Acupuncture in primary care.


Citation: Primary Care; Clinics in Office Practice, March 2010, vol./is. 37/1(105-17), 0095-4543;1558-299X (2010 Mar)


Author(s): Mao JJ, Kapur R


Language: English


Abstract: Acupuncture, an ancient traditional Chinese medical therapy, is used widely around the world. When practiced by a certified provider, it is safe and patients often find it calming and relaxing. Animal and human studies have found a physiologic basis for acupuncture needling in that it affects the complex central and peripheral neurohormonal network. Although it is unclear whether acupuncture is beneficial over sham/placebo acupuncture, acupuncture care yields clinically relevant short- and long-term benefits for low back pain, knee osteoarthritis, chronic neck pain, and headache. The integration of acupuncture into a primary care setting also appears to be cost-effective. The practice of acupuncture in primary care requires rigorous training, financial discipline, and good communication skills. When done correctly, acupuncture is beneficial for both patients and providers. Copyright 2010 Elsevier Inc. All rights reserved.


Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review


Source: MEDLINE

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