COMBINATION OF MANUAL THERAPY AND ACUPUNCTURE FOR PAIN MANAGEMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS. Acupuncture in Manual Therapy is a comprehensive overview of manual therapy interventions combined with acupuncture management of musculoskeletal. Two acupuncture points were selected by the manual technique, together Keywords: Acupuncture, Amitriptyline, Earache, Therapy with acupuncture, Touch.
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This retrospective study investigated the effects of combining manual therapy and acupuncture on the pain and maximal mouth opening (MMO), which were. value of acupuncture and electroacupuncture as a treatment for 1Department of Physical Therapy, Communication Science & Disorders. International Association of Acupuncture of Physical Therapists (IAAPT). Standards of media/cms/File/lagemahgunste.ml>; [Accessed 1 Jul ]. Brady S.
References Chin J Integr Med ;—9. Nichols HW. Ancient pain-killing method works, while US scientists don't know why. Albany Democrat-Herald Albany , March 21, Accessed October 3, Google Scholar Increased trapezius pain sensitivity is not associated with increased tissue hardness. J Pain ;— Trigger points and acupuncture points for pain: correlations and implications.
Pain ;— Birch S. Trigger point—acupuncture point correlations revisited. J Altern Complem Med ;— CrossRef Google Scholar Dorsher PT, Fleckenstein J. Trigger points and classical acupuncture points: Part 1. Qualitative and quantitative anatomic correspondences. Ger J Acupunct Relat Tech ;— Trigger points and classical acupuncture points: Part 2.
Clinical correspondences in treating pain and somatovisceral disorders. Dorsher PT. Can classical acupuncture points and trigger points be compared in the treatment of pain disorders?
Birch's analysis revisited. J Altern Complement Med ;— Response to Dommerholt and Stanborough re: ''Evidence that dry needling is the intent to bypass regulation to practice acupuncture in the United States''.
J Altern Complem Med DOI: Hong CZ. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupunct Med ;— Traditional Chinese medicine acupuncture and myofascial trigger needling: the same stimulation points? Complement Ther Med ;— Hao JK, ed. Atlas of Extro-meridian acupuncture points.
Revised Ed. Beijing: People's Military Medicine Press; Risk of bias within studies Most of the studies were rated as low ROB, except for four studies. Nine studies performed blinding of participants and outcome assessment.
Figure 2 Risk of bias summary.
Effects of interventions Real acupuncture vs sham acupuncture Pain changes after treatment The data regarding pain changes were reported in all studies. The quality of evidence was downgraded because of inconsistency and evaluated as moderate Table 2. Figure 3 Forest plot comparing real acupuncture vs sham acupuncture.
C Outcome: FIQ changes after treatment. D Outcome: long-term effect of pain changes VAS, 0—10 cm scale. E Outcome: long-term effect of FIQ changes.
The quality of evidence was evaluated as low downgraded because of imprecision and publication bias, Table 2 Quality of life: FIQ changes after treatment Four studies evaluated quality of life by using the FIQ score. The quality of evidence was evaluated as low downgraded because of inconsistency and imprecision, Table 2. Long-term effect of acupuncture There were three studies that followed-up long-term more than three months after treatment to assess the effect of acupuncture, and the data can be obtained.
Because of inconsistency and imprecision, the quality of evidence was downgraded and evaluated as low Table 2. Adverse events Six studies reported no serious adverse events, 14 , 18 — 20 , 30 , 33 of which four studies observed mild adverse events, such as bruising, soreness, nausea, discomfort of needle insertion, and aggravation of symptoms.
The other four studies did not provide any details about adverse events. However, the quality of evidence was downgraded because of ROB, imprecision and publication bias and was evaluated as very low Table 2.
Figure 4 Forest plot comparing real acupuncture vs conventional medication. B Outcome: long-term effect of pain changes VAS, 0—10 cm scale. Long-term effect of acupuncture Two studies 28 , 31 included follow-up observations at 6 months after treatment, but only one study provided data on pain changes VAS, 0—10 cm scale. Adverse events There were no details about any adverse events reported. We conducted sensitivity analyses by omitting potential heterogeneous studies to observe their influence on the pooled effect size.
Two studies were omitted because their ROB was high. Sensitivity analyses indicated that the pooled effect was not changed when omitting either of the four mentioned studies. The result of sensitivity analyses on studies with low ROB was consistent with the result of all studies Table S2. However, the heterogeneity was not resolved and may be caused by various acupoints, different measurement time points, and sham acupuncture methods.
The sensitivity analyses of other outcomes were not conducted due to the low number of corresponding included studies. Publication bias The funnel plot for pain changes after treatment demonstrated that visual inspection of the funnel plot was symmetric and no clear publication bias was detected Figure 5. Figure 5 Funnel plot comparing real acupuncture vs sham acupuncture.
Note: Outcome: pain changes after treatment VAS, 0—10 cm scale.
Hand Acupuncture Therapy
Discussion Summary of the main findings We included 12 RCTs that compared acupuncture therapy to sham acupuncture or conventional medication. With respect to reducing pain VAS 0—10 cm scale , there was moderate-quality evidence showing that real acupuncture was more effective than sham acupuncture in the short term, and similar results were obtained with low-quality evidence in the long term.
With respect to improving the quality of life, there was low-quality evidence showing that real acupuncture was more effective than sham acupuncture in both the short and long term.
In the comparison of acupuncture vs conventional medication, we found very low-quality evidence showing that acupuncture was more effective in relieving pain in both the short and long term. Subgroup analyses demonstrated that real MA was superior to sham MA in reducing pain VAS, 0—10 cm scale and improving the quality of life, with moderate-quality evidence in the short term and low- to very low-quality evidence in the long term.
There were two studies that compared real EA with sham EA. The results indicated real EA was superior to sham EA in reducing pain in the short term with low-quality evidence, but no significant difference was observed in the long term with low-quality evidence.
Only one study compared real EA with sham EA and reported the effect on improving the quality of life.
The results demonstrated no significant difference between real EA and sham EA in both the short and long term with low-quality evidence. A modern medical study indicated that acupuncture can significantly increase blood flow in the skin and muscles of patients with FM, 35 which is very important for reducing pain symptoms.
As a primary mechanism of FM, the central sensitization of nervous system can decrease the pressure pain threshold, elicit hyperalgesia, and as a result, a noxious stimulus can cause more severe pain than in normal individuals.
EA at the bilateral Zusanli ST36 acupoints can reverse the upregulation of these receptors and reduce mechanical hyperalgesia significantly.
These substances are essential to decrease the hypersensitivity of pain and reduce pain symptoms. Therefore, more studies are needed in the future. Comparison with previous systematic reviews Previous meta-analyses have drawn various conclusions depending on the inclusion criteria and the number of included studies.
However, sensitivity analysis indicated that this small analgesic effect of acupuncture was only present in studies with ROB. Therefore, this review concluded that acupuncture cannot be recommended for the management of FM.
In , one systematic review 16 included 16 RCTs that compared acupuncture alone or combined with other interventions cupping therapy, point injection, point catgut embedding, or moxibustion to no treatment, sham, or conventional medication.
The conclusion indicated that acupuncture alone or combined with cupping therapy was superior to conventional medications. However, acupuncture had no better effect than sham acupuncture on pain reduction.
Therefore, the available systematic reviews demonstrated controversial conclusions about whether acupuncture was more effective than sham acupuncture in relieving pain. Compared with previous systematic reviews, our review focused mainly on observing the efficacy of acupuncture alone, so we did not involve studies with mixed therapies. Therefore, we extracted the results of the same tool as much as possible.
Because one study data of the meta-analysis were transformed from NRS, we conducted sensitivity analyses by excluding this study and found that the pooled effect was not changed. This new conclusion of our review was completely different from that of previous research and can provide a better reference for clinical decisions because we analyzed direct VAS results.
Evidence and expert opinions: Dry needling versus acupuncture (II)
Limitations and implications This systematic review has several limitations. First, a low number of studies were included in our review, and most of the studies had a relatively small sample size.
This limitation may lead to imprecise evidence. Second, there was considerable heterogeneity in our meta-analysis. We attempted to decrease the heterogeneity by subgroup and sensitivity analyses, but it was not completely resolved.
We considered that this heterogeneity possibly derived from methodological bias and differences in acupoint selection, sham acupuncture method, and the frequency and duration of treatment. Third, only a few studies followed-up the patients after treatment and reported adverse events; thus, studies with more details about follow-up and adverse events would better evaluate the long-term effect and safety of acupuncture. Given the above limitations, more rigorous larger-scale and well-designed RCTs are needed to provide higher-quality evidence and evaluate the efficacy of acupuncture for FM.
First, future RCTs should correctly conduct random sequence generation, allocation concealment, and blinding to avoid ROB.The study protocol was approved by the institutional review boards at these hospitals and written informed consent was obtained from all study participants. Non-penetrating acupuncture The Streitberger non-penetrating needle was used in the control group. A meta-analysis was performed according to the Cochrane systematic review method by using RevMan 5.
Acupuncture Physical Medicine
The other four studies did not provide any details about adverse events. Methods This was a randomized, double-blind, controlled trial at 3 physical therapy centers in Philadelphia, PA. Nine acupuncture points for each knee were chosen to be consistent with the traditional Chinese Bi syndrome therapy for knee pain and to be consistent with a previously positive acupuncture study[ 19 ].
Conclusion Puncturing acupuncture needles did not perform any better than non-puncturing needles integrated with EPT.
Because acupuncture was given immediately following EPT, it was not always possible to associate the event with acupuncture or EPT separately.
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