Feeds:
Posts
Comments

Archive for the ‘OB / GYN’ Category

Our clinical trial protocol has been published recently in Journal of Integrative Medicine, the PDF of whole article is available based on request.

Effectiveness of two different acupuncture strategies in patients with vulvodynia: Study protocol for a pilot pragmatic controlled trial.

Fan AY, Alemi SF, Zhu YH, Rahimi S, Wei H, Tian H, He D, Gong C, Yang G, He C, Ouyang H.  J Integr Med. 2018 Oct 10. pii: S2095-4964(18)30103-1. doi: 10.1016/j.joim.2018.10.004. [Epub ahead of print]

Abstract

BACKGROUND:

Vulvodynia, or vulvar pain, is a common condition in women; however, there are few evidence-based clinical trials evaluating nonpharmacological therapies for this condition. Acupuncture is one complementary and integrative medicine therapy used by some patients with vulvodynia. This study evaluates two different acupuncture strategies for the treatment of vulvodynia and aims to evaluate whether either of the acupuncture protocols reduces vulvar pain, pain duration or pain with intercourse. The study also examines how long the effect of acupuncture lasts in women with vulvodynia.

METHODS/DESIGN:

The study is designed as a randomized controlled trial, focused on two acupuncture protocols. Fifty-one patients who have had vulvodynia for more than 3 months will be recruited. Among them, 34 patients will be randomized into Groups 1a and 1b; those who are unwilling to receive acupuncture will be recruited into the standard care group (Group 2). Patients in Group 1a will have acupuncture focused on the points in the pudendal nerve distribution area, while patients in Group 1b will receive acupuncture focused on traditional (distal) meridian points. Patients in Group 2 will receive routine conventional treatments, such as using pain medications, local injections and physical therapies or other nonsurgical procedures. Acupuncture will last 45 min per session, once or twice a week for 6 weeks. The primary outcome measurement will be objective pain intensity, using the cotton swab test. The secondary outcome measurement will be subjective patient self-reported pain intensity, which will be conducted before cotton swab test. Pain intensities will be measured by an 11-point Numeric Pain Rating Scale. Pain duration and pain score during intercourse are recorded. Local muscle tension, tenderness and trigger points (Ashi points) are also recorded. All measurements will be recorded at baseline (before the treatment), at the end of each week during treatment and at the end of the 6 weeks. Follow-up will be done 6 weeks following the last treatment.

DISCUSSION:

Results of this trial will provide preliminary data on whether acupuncture provides better outcomes than nonacupuncture treatments, i.e., standard care, and whether acupuncture focused on the points in pudendal nerve distribution, near the pain area, has better results than traditional acupuncture focused on distal meridian points for vulvodynia.

TRIAL REGISTRATION:

Clinicaltrials.gov: NCT03481621. Register: March 29, 2018.

Advertisements

Read Full Post »

In their recent report in the Annals of Internal Medicine, Ee et al1 state that Chinese medical acupuncture was no better than non-insertive sham acupuncture for women with moderately severe menopausal hot flashes in a randomised controlled trial. The authors conclude that they “cannot recommend skin-penetrating acupuncture as an efficacious treatment of this indication”.1 In my opinion, the authors might have misinterpreted the results.

The ‘sham acupuncture’ used in this clinical trial was the Park sham device, which is supposed to serve as a placebo treatment. It uses a 0.35×40 mm blunt needle supported by a plastic ring and guide tube (base unit) attached to the skin with a double-sided adhesive ring. The needle telescopes into itself and shortens on manipulation, giving the visual and physical impression of insertion into the skin.1 Although the blunt needle does not insert into the skin, it does cause considerable pressure and thereby mechanical stimulation, especially given the small diameter at its tip. This Park sham device should arguably be relabelled as an acupressure device, instead of a form of sham acupuncture treatment. Indeed, this type of device and needling method is historically recognised as an active form of treatment; it is otherwise known as a Di needle (鍉针 or Di Zhen, a style of pressing needle that does not penetrate the skin), as documented in The Spiritual Pivot: Nine Needles and Twelve Source Points (Ling Shu: Jiu Zhen Shi Er Yuan) in the second part of the Yellow Emperor’s Inner Classics, which was published 2000 years ago.2 For this reason, the trial design contained an obvious weakness; it compared acupuncture with acupressure, rather than acupuncture with truly inert sham acupuncture.

According to the trial’s results, hot flash scores decreased after both interventions by about 40% between baseline and the end of treatment (10 sessions, ending after 8 weeks) and these effects were sustained for 6 months. Statistically, there is no evidence that acupuncture was better than acupressure (called ‘sham acupuncture’ in the paper) in its impact on quality of life, anxiety or depression.1 This can equally be interpreted as evidence that both acupuncture and acupressure effectively decrease hot flashes and related symptoms, as well as quality of life, if we compare the results immediately after treatment (8 weeks) and at the 3- and 6-month follow-up, with baseline in the same group (self-control) or comparator group (as a waiting list-like control).

As regards the placebo effect, evidence from the literature3 and a review of multiple trials4 shows that patients receiving placebo interventions exhibit an average decrease of 21–25% in hot flash frequency and intensity. Therefore, a 40% decrease in hot flash symptom scores with either acupuncture or acupressure treatment is notably higher than that expected with a placebo and likely to be clinically significant. Further research with a more appropriate control group is needed. Meanwhile, however, if a patient declines or cannot tolerate conventional drug treatment, then it would not be unreasonable to offer either acupuncture or acupressure as an alternative treatment for this condition.

References 1. Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes: a randomized trial. Ann Intern Med 2016;164:146–54. doi:10.7326/M15-1380 [Medline] 2. Wu JN (translator). Ling Shu or The Spiritual Pivot. University of Hawaii Press, 2002. 3. Loprinzi CL, Michalak JC, Quella SK, et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med 1994;331:347–52. doi:10.1056/NEJM199408113310602 [CrossRef][Medline][Web of Science] 4. Sloan JA, Loprinzi CL, Novotny PJ, et al. Methodologic lessons learned from hot flash studies. J Clin Oncol 2001;19:4280–90. [Abstract/FREE Full text]

Fan AY. Trial suggests both acupuncture and acupressure are effective at reducing menopausal hot flashes. Acupunct Med doi:10.1136/acupmed-2016-011119.

http://aim.bmj.com/content/early/2016/04/19/acupmed-2016-011119.full

Read Full Post »

Today a patient called me–She said she labored this morning and gets a baby girl after our 2 session acupuncture treatments.

Her labor was over-due at 42 weeks and 2 days pregnancy, her OB doctor suggested her using medication to induce the labor. But she liked to try acupuncture first. It was worked! She got two days’ treatments in our center for “acupuncture labor induction”.

However, another patient (with 40 weeks pregnancy) got two acupuncture treatments during this week in our center, she did not start the labor yet, only got more intermittent cramping, she did not resume our acupuncture treatment. She said she likes to wait and see what will happen.

Acupuncture does help some of the patients whose labor is over-due. Based on our experience, two to three session acupuncture is needed–once a day, each for 45 to 60 minutes. We had 7 cases for “acupuncture labor induction”– 4 were successful, 2 were not (did not have enough cramping with 36 hours after the second acupuncture treatment) , one stopped only after one acupuncture(too hurry to start the medication).

I find there are more and more needs in natural way to accelerate/ induce the labor. Some video are online:

http://www.youtube.com/results?search_query=acupuncture+baby+induction&oq=acupuncture+baby+induction&gs_l=youtube.3…1381.10887.0.11469.26.26.0.0.0.0.68.1296.26.26.0…0.0…1ac.1.11.youtube.Fe9nmJ7IzJk

For more information is at: http://www.ncbi.nlm.nih.gov/pubmed/19922252

J Altern Complement Med. 2009 Nov;15(11):1209-14. doi: 10.1089/acm.2009.0100.

Effect of acupuncture on induction of labor.

Source

Division of Chinese Medicine, Royal Melbourne Institute of Technology University, Bundoora Campus, Victoria, Australia celim@unswalumni.com

Abstract

OBJECTIVE:

The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy.

DESIGN:

The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008.

INCLUSION CRITERIA:

These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor.

EXCLUSION CRITERIA:

These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies.

RESULTS:

Ten (10) studies on labor induction were identified. The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F(2alpha) (PGF(2alpha)), and beta-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, beta-endorphin, and PGF(2alpha) were not found to be significantly influenced by acupuncture.

CONCLUSIONS:

Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. Further randomized clinical trials are needed to investigate this further.

PMID:

 

19922252

 

[PubMed – indexed for MEDLINE]

Read Full Post »

Recently, a patient came to see me for urination difficult, the former doctors’ diagnosis was “neurological bladder”(which means the patient is too nervous to urine).

After a detail inquiring and examination, the urination difficult actually is secondary to the uterus and rectum prolapse. She had three natural labors before, and had weakness of pelvic bottom. She had to use the catheter to drain the urine out of bladder in most of time, esp. before the sleep.

Dr.Fan suggested her to consult other related specialists to see if this need an operation. Patient was very hesitate to do the operation. Anyway, she still booked appointments with ob/gyn surgeon and rectum surgeon.

So, during the gap to see other doctors, we started acupuncture, twice a week. To our surprise, the result of acupuncture is very impressive–after three or four acupuncture, her urination is much much easier, and almost does not need the catheter.

Read Full Post »

Yesterday, a 44 years old lady came and hugged me very tightly for three minutes. And then told me she got pregnant naturally after my acupuncture treatment.

She said she should be my no.76 clients got pregnant–because she had seen there was a notes on the office board-75 pregnancy since 2007.

Read Full Post »

Acupuncture helped the mother overcome the migraine and hypertension during pregnancy

Read Full Post »

This morning, a lady reported her pregnancy test strong positive–got pregnant. This is no.65 patient got pregnant, since 2007, by our acupuncture treatments.

She is 33 years old, married for 6 years, and tried seriously to get conceive for over one years. According to her, her husband is healthy and the sperm test was good. She also has a lot acne, so she hope we could adjust her hormones for both acne and fertility.

When she first saw me, she was in day 14 of her period cycle (she had  28-days-cycles before). I gave her acupuncture according to our protocol, and herb pills. after 8 sessions acupuncture, she felt her cervical mucus is slippery and very stretchable, better than before. after another two weeks, her period didn’t come. Then her pregnancy test became positive.

 

Read Full Post »

Older Posts »