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What is Moxibustion?

Mugwort

Artemesia Vulgaris

Moxibustion is an ancient traditional Chinese treatment (TCM) that involves the burning of Mugwort near the surface of the skin. Mugwort is a common name for several species of aromatic plants belonging to the genus Artemisia. Other names include wormwood and green ginger. Moxibustion is frequently used in conjunction with acupuncture treatments. The main aim is to boost the flow of qi (vital energy) through the meridians (body’s energy pathways), whilst eliminating any unwanted pathological qi concentrations along the meridians. Mugwort is commonly referred to as Moxa and made from the dried-up plant materials. Typically, this process involves shaping the Moxa into a cylindrical cigar-shaped stick or small cones. They can be used directly and indirectly on the skin. Direct moxibustion involves a small amount of Moxa being placed directly on the skin, but it can cause scarring and therefore is less popular. Indirect Moxa involves fixing and burning the Moxa on the top end of the acupuncture needle, or hovering a moxa stick over the skin. This burning edge is then held within approx. 2-inch distance and made to smoulder gently diffusing the heat into the tissue. Other techniques may be burning it on a layer of sliced ginger, garlic or salt on the patient’s skin.

Acupuncturists target specific acupuncture points or meridian pathways corresponding to the condition being treated. Patients often report a flood of warmth at the treatment site which can radiate and along the meridian pathways.

The Moxibustion mechanism

In line with traditional Chinese medicine, Moxibustion functions by delivering a therapeutic effect using a mix of thermal and chemical stimulation. This is reported to lead to a tonification and purgation effect. Experiments have shown that the thermal effects of Moxibustion have proven to be very effective in stimulating not just the superficial, but also the deeper tissues of the skin. Investigations have shown that the burning moxa radiation lies within the infrared portion of the heat spectrum.

Ingredients identified from mugwort leaves and moxa smoke have a variety of biological properties, thus are at the root of Moxibustion effects. It is this dual effect that works along the meridians thereby regulating qi, and helping with disease treatment and prevention. Unlike acupuncture that generally facilitates the elimination of pathogenic qi, moxibustion helps to introduce heat, warming up the meridians and consolidates the body’s qi. Some preclinical studies suggest that moxibustion boosts the immune system and enhances the physiological functions of the body.

In TCM, mental and physical health problems are believed to develop as a result of unexpected blockages in the qi flow pathways. The thermal effect of moxibustion generated along the meridians helps to release these pathways while increasing the flow of vital energy. While arguments could be made either in favour or against its efficacy, preliminary evidence from several studies has shown that moxibustion does indeed provide relief when used in the treatment of a wide range of health issues.

In a 2009 study involving 51 postmenopausal women, the results indicated that 14 sessions of moxibustion were effective in keeping hot flashes at bay. While the actual mechanism and treatment pathway is well-studied, the specific cases where moxibustion can work are still much under speculation. However, this does not mean that moxibustion is ineffective. In fact, as a result of the attention generated from personal reports of people who have experienced acclaimed benefits, there are several studies currently being conducted to investigate the possible efficacy of Moxibustion for a variety of health issues.

 

Benefits of Moxibustion

Common health problems that can benefit from moxibustion includes;

  • Hot flashes – reduced frequency and severity of hot flashes.
  • Ulcerative Colitis – some benefit to symptom relief.
  • Breech birth
  • Arthritis– relieves pain and improves muscle function
  • Irritable bowel syndrome (IBS)- benefits symptoms relief
  • Other conditions include insomnia, diarrhoea and chronic pain.

Needless to say, there is a wide range of reported benefits of moxibustion and while studies are still being conducted on the exact range of effectiveness, moxibustion remains a safe treatment and can deliver therapeutic effects that can help heal the body.

References:

  1. Deng H, Shen X. The mechanism of moxibustion: ancient theory and modern research. Evid Based Complement Alternat Med. 2013; 2013:379291. doi:10.1155/2013/379291
  2. Song-Yi Kim, Younbyoung Chae, Seung Min Lee, Hyejung Lee, Hi-Joon Park. The effectiveness of moxibustion: An overview during 10 years. Evid Based Complement Alternat Med. 2011; 2011:306515. org/10.1093/ecam/nep163.
  3. Park Ji-Eun, Lee MS, Jung S, Kim A, Kang K, Choi  J, Park J, Choi Sun-Mi. Moxibustion for treating menopausal hot flashes: a randomized clinical trial. 2009, 16; 4:660-665

In medicine we regard pain as a symptom associated with an injury or some type of pathological process. However this excludes a large proportion of sufferers with psychological pain where there is no obvious physical cause. Unlike acute pain which usually has an organic cause, patients with psychological ailments have no obvious cause of the pain. In the same way, chronic pain is also not a benign entity; the pain is continuous, can be disabling, lead to depression and overall the patients have a very poor quality of life. Often it is not just physical but also related to emotional and psychological reasons. Currently, it is estimated that anywhere from 3-7% of the population may have chronic or psychological pain.

psychological pain

Over the years many treatments have evolved for the treatment of psychological pain but none has proven to be effective in all patients. The traditional analgesics do not appear to work and with the current opiate crisis, these agents are no longer recommended. Most other drug therapies that include antidepressants and anticonvulsants do not reliably provide any significant pain relief in all patients. Plus, these drug therapies often have potent adverse effects, are costly and may be addictive.

Because of the failure of conventional therapies to manage psychological pain, many patients have been turning to acupuncture. This old Chinese treatment has been used to treat pain from a variety of causes with good success. Most of the literature on the benefits of acupuncture has looked at acute causes of pain but its role in the management of psychological pain has not been fully evaluated. The few studies published on the benefits of acupuncture for psychological pain appear confusing, with some reports indicating that the treatment works and others claiming that acupuncture does not work for psychological pain. Most of the older acupuncture studies with large numbers of participants were not randomized and the outcomes of pain relief were not always quantified, hence data from these studies are difficult to assess. Overall, these older studies have indicated that about 50% of patients with chronic or psychological pain do obtain some pain relief over time. Unfortunately, the studies did not indicate which patient would benefit from the treatment.

So what is the present status of acupuncture for psychological pain?

Recently researchers analyzed 6 studies involving 462 patients who had chronic pain. The patients were between 52-63 years of age and received treatment for a minimum of 8 weeks.

Unfortunately, the quality of evidence from these studies was low because the treatment was not compared to sham acupuncture and the participants were not blinded. The number of participants in some studies was small. Overall, the researchers stated that they simply did not have evidence to refute or support the use of acupuncture for chronic or psychological pain.

However, since the treatment is relatively safe when done by an experienced practitioner, it may be an option for an individual who has failed to respond to other conventional pain treatments.

Dr. Lucy Chen, a specialist in pain medicine and a practicing acupuncturist who works at the Harvard affiliated Massachusetts General Hospital states, “I think the benefit of acupuncture is clear, and the complications and potential adverse effects of acupuncture are low compared with medication.” More important acupuncture is not as costly as drug therapy nor does it cause physical or psychological dependence. So for patients with psychological pain, it may be worth a try.

 

References

  1. Research Finds Acupuncture Effective for Chronic Pain.(2018, May 21) https://www.aafp.org/news/health-of-the-public/20180521acupuncture.html
  2. Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955–956. doi:10.1001/jama.2013.285478
  3. Yang Z, Zhao L, Xie X, et al. The effectiveness of acupuncture for chronic pain with depression: A systematic review protocol. Medicine (Baltimore). 2017;96(47):e8800. doi:10.1097/MD.0000000000008800
  4. Vickers AJ, Vertosick EA, Lewith G et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018; 19(5): 455-474.
  5. Ingraham P. Does Acupuncture work for pain. (2018, Jun 13). https://www.painscience.com/articles/acupuncture-for-pain.php
  6. Ju ZY, Wang K, Cui HS, et al. Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;12(12):CD012057. Published 2017 Dec 2. doi:10.1002/14651858.CD012057.pub2
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Endometriosis is a painful chronic condition that occurs when tissue similar to the endometrium (the tissue that lines the walls of the uterus) begins to grow outside of it e.g. ovaries and fallopian tubes. There is painful inflammation in the surrounding tissue which results in the formation of scar tissue. Typically this leads to pain in the abdomen and lower back, usually worse during menstruation. It is particularly common in women who are well within their reproductive ages (15-49) and reportedly affects about 10% of women worldwide. In women experiencing infertility it can be as high as 30-50%1Uterus- Endometriosis

With over 176 million women affected worldwide, endometriosis is not only an alarming issue, it is also a major cause of infertility. This has led to extensive studies focused on solving and alleviating the root causes. While there are a few courses of treatment that can help resolve the symptoms successfully and boost fertility, they include several types of hormones therapies with varying degrees of side effects, combined with pain relief but even that may only be temporary. Laproscopic surgery (seldom used now) is a definitive way to diagnose endometriosis, but can also be used to remove endometriosis2. In the event where either of these treatments are unsuccessful or only partially successful, there are limited options left to consider.

Being an oestrogen dependent condition, most of the available treatments and medication used to treat endometriosis are oestrogen–gestagen combinations; a potent hormone combination that tends to have side effects, such as menopausal symptoms. This conundrum adds to the already problematic pain symptoms. Additionally, there are the longer term effects of using analgesics also to be considered.  It is vital therefore to try to opt for treatment regimes that are advantageous to the body but also that may be of greater benefit.

Acupuncture is one treatment that could provide not just pain control but reducing inflammation. While there is a lot of anecdotal evidence regarding its efficacy, there have been substantial research studies concluding that regular and consistent acupuncture treatments can help to relieve the pain of this condition.

How acupuncture helps with endometriosis?

A systematic review in 2017 on the effects of acupuncture on endometriosis and the pain it brings suggests that acupuncture does in fact have a significant effect on alleviating endometriosis symptoms. This review featured 10 separate studies involving 589 patients. The main outcome to be assessed was changes in pain levels, blood CA-125 levels (a biomarker usually elevated in endometriosis), and the rate of clinical effectiveness.  Interestingly, the study revealed a unique correlation between the pain-reducing effect of acupuncture and the reduction of CA-125. While the result from this research may not be entirely conclusive, evidence points to the notion that acupuncture reduces the serum levels of CA-125 alongside the pain that comes with the condition3.

Another research conducted at Tongji University hospital indicated that acupuncture was a lot more effective than hormone drug therapy (mifepristone) in the treatment of endometriosis. As one of the more widely used medication in the treatment of the unusual growth of endometrial tissues, mifepristone helps to prevent the growth of new endometrium on pelvic organs while slowing down its general growth and reducing pain. Overall in both groups there was less pain, smaller masses and improvement in CA-125 levels.  However the effectiveness rate was higher in the acupuncture group 92%, compared to 52% in the mifepristone group. This difference was also proportionate for the recurrence rate as patients treated with acupuncture reported a 20% recurrence rate as opposed to the 36% associated with drug use. It is important to note that this comparative study was conducted using 12.5mg of mifepristone orally ingested daily for 6 months and an acupuncture treatment applied to the acupoints over the same period of time. These acupoints include; CV6 (Qihai), CV4 (Guanyuan), CV3 (Zhongji), Zigong (Extra), SP10 (Xuehai), SP6 (Sanyinjiao), LV2 (Xingjian) and LV3 (Taichong).

While there may still be a lot of research required to conclusively support the use of acupuncture as a stand-alone treatment for endometriosis, evidence has shown that patients experiencing this condition may be best served with acupuncture in the long run.

 

References

  1. Endometriosis. (2019, Jan 18) https://www.nhs.uk/conditions/endometriosis/
  2. org. (2015, March 26) http://endometriosis.org/treatments/
  3. Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S. Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017;12(10):e0186616. Published 2017 Oct 27. doi:10.1371/journal.pone.0186616
  4. Health CMi. Acupuncture beats drug for endometriosis. (2017, July 11) https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1770-acupuncture-beats-drug-for-endometriosis-relief
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Chronic pain affects a significant number of people worldwide. The exact number of people with chronic pain is not known but the numbers are not minuscule. For decades, acupuncture has been used to manage several types of acute and chronic pain disorders.  The therapy utilities very fine needles that are inserted at specific anatomical sites in the body for pain relief. When performed by a qualified acupuncturist, the treatment is said to provide pain relief and has a very good safety profile. Over the years, this old Chinese remedy has been used to manage a variety of pain disorders including joint pain, migraine, sciatica, neck pain, and even headaches. 

Recently a meta-analysis of dozens of high-quality clinical trials that involved nearly 18,000 participants showed that acupuncture is an effective treatment for individuals with neck and back pain, chronic headache, osteoarthritis, and shoulder pain. In addition, one large randomized control study revealed that acupuncture significantly lowered symptoms of depression at 12-weeks compared with traditional therapies. Finally there are other studies showing that acupuncture can also lower the depression associated with cancer and enhance the quality of life.

However, to put things into perspective, there are just as many studies showing that acupuncture has none or only mild pain-relieving effects.

Today, the effectiveness of acupuncture for the treatment of pain continues to be debated. The reason why some patients benefit from acupuncture and others do not has not been well explained. So what is the issue? Does the technique work for pain or not?

Acupuncture is one of the oldest complementary therapies to manage pain and there is evidence from clinical trials that the technique can help lower pain. While many factors that influence acupuncture have been studied in the past, the patient’s psyche, his or her relationship with the acupuncturist and beliefs have not been thoroughly studied, until this recent study.

Now a study by researchers from the University of Southampton sheds more light into this controversy. The lead investigator, Dr. Felicity Bishop from the University conducted this study to determine why some individuals with low back pain gained more pain relief from acupuncture and others did not. What the researchers observed is that individuals with low back pain who have apriori low expectations of acupuncture before the start of the treatment generally gain less benefit than those individuals who believe it will work. Overall the study revealed that individuals who have a positive view of their pain and who feel in control of their health condition had led back-related disability over the course of acupuncture treatment. The findings of this study were just published in the Journal of Clinical Pain.

In this study, it was shown that psychological factors were consistently associated with back pain-related disability. Patients who started out with very low expectations of acupuncture and thought that the treatment would not help them, in fact, had the least benefit. Further, the same patients who changed their psyche and started to develop positive feelings about their pain, then went on to experience less back-related disability; and as their desire to understand why they were having pain increased, they experienced less pain. In summary, patients who were less emotional conflicts and fewer negative feelings about acupuncture and their pain had more benefits.

What this study shows is that perhaps clinicians need to start motivating or help change patient perceptions about their pain and the potential benefits of acupuncture. Improving the psyche is the key and this may be the reason why there is such a great variance in past acupuncture studies and pain control.

Dr. Bishop has stated that to improve the outcomes after acupuncture, acupuncturists should now consider improving the patient’s psyche and positivity about their pain as part of the initial consultation.

Dr Stephen Simpson, director of research at Arthritis Research UK, said: “This study emphasizes the influence of the placebo effect on pain. The process whereby the brain’s processing of different emotions in relation to their treatment can influence outcome is a really important area for research.” He went on to add,

“Factors such as the relationship between practitioner and patient can inform this and we should be able to understand the biological pathways by which this happens. This understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximize patient benefit.”

 

References

  1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19): 1444-53.
  2. University of Southampton. Psychological factors play a part in acupuncture treatment of back pain. (2015, Feb 12) https://www.sciencedaily.com/releases/2015/02/150212065036.htm
  3. Felicity L. Bishop, Lucy Yardley, Philip Prescott, Cyrus Cooper, Paul Little, George T. Lewith. Psychological Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture. The Clinical Journal of Pain, 2015; 31 (3): 254
  4. Fields, Rd. Acupuncture Works–Sort of Acupuncture: Physiology, Psychology, or Placebo? Psychology Today. (2010, Sep 27) https://www.psychologytoday.com/intl/blog/the-new-brain/201009/acupuncture-works-sort
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St John’s Wort (SJW) also known as Hypericum perforatum is a shrub that has star shaped yellow flowers, leaves and stem commonly found in Europe and the US. Historically, it has been extensively used medicinal herb. The flowers and leaves contain active ingredients ‘hyperforin’ and ‘hypericin’ and new research suggests that taking the whole preparation (rather than just the two ingredients) is more beneficial.  Described as a nervous system balancer and restorer it helps to ease anxiety, tension, seasonal affective disorder, mild to moderate depression and menopause. Beyond its emotional effects, SJW is also used to bring relief from physical pain and tension.

Herbal history has shown SJW to widely treat low mood, anxiety and depression. SJW’s mood elevating properties comes from its ability to increase levels of serotonin, a chemical found in the brain. Often serotonin levels are low in people with depression. Studies also show that it improves quality of sleep, which is a significant problem in people with depression. They also exhibited less sadness, helplessness, exhaustion and headache.

Unknown to many SJW has many uses beyond mental health benefits. SJW also has antibacterial, antiviral, anti-inflammatory, anti-spasmodic and pain relief properties. In herbal medicine specific indications include trauma and damage to the nervous system either via an injury or viral infection e.g. neuralgias, sciatica, Bell’s palsy, pinched nerves or trauma to head and spine. With its antiviral and analgesic effects it is ideal for conditions like, shingles or herpes infections.

Several scientific studies have described SJW ‘s analgesic and antinociceptive properties for use in pain conditions.  Animal studies have shown low dose SJW to block pain stimuli in acute and chronic pain conditions. In another study comparing SJW to morphine in rats showed that SJW has notable antinonciceptive activity for neuropathic pain but could also be useful in enhancing the effects of morphine.  There are however legitimate concerns for drug-herb interactions such as; anti-anxiety, antidepressants, barbiturates, contraceptives, certain chemotherapy, immune suppressive drugs and statins. Therefore SJW’s ability to manage pain at low doses greatly reduces this risk.

SJW can be very effective in the treatment of mild to moderate depression, but particularly helpful if there are additional pain symptoms e.g. fibromygia where both anti-anxiety, anti-inflammatory and analgesic properties can offer added support to the condition.  Dosage is 900 mg a day. Its use is generally safe if you are not taking any prescription medicine. If you are then you may need professional health advice to guide you.

 

 

Rheumatoid arthritis (RA) is a chronic autoimmune disorder that causes pain, stiffness, inflammation of the joints, joint deformity and reduced physical function. Autoimmune disorders are characterised by the body’s immune system attacking healthy body tissue. Both T- and B- immune cells are implicated in the underlying pathology due to overproduction of pro-inflammatory cytokines.  Inevitably, it affects quality of life and life expectancy. Unfortunately, the cause of RA is still unknown. Patients often receive strong medication and may require surgical treatment. However, frequently patients will seek non-medical alternatives to try and alleviate their symptoms.

Acupuncture is often sought by patients for pain. Through its ability to modulate pain signals and release of neuro-chemicals e.g. serotonin and endorphins that influence biochemical changes within the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.

A new systematic review of the clinical efficacy of acupuncture on RA was published which included 43 studies. The study concluded that acupuncture alone or in combination with other treatment modalities is beneficial to treating RA, by improving physical function and quality of life. Possible mechanisms included anti-inflammatory effect, anti-oxidative effect and regulation of immune system function.

Acupuncture is believed to stimulate the circulatory and nervous system causing the release of

  • Release body chemicals and changes the way the brain and spinal cord processes the pain signals. These chemicals include; endorphins and other neurohumoral factors e.g. neuropeptide Y, serotonin.
  • Increases local release of  nitrous oxide(NO) known to play an important physiological role in skin local microcirculation, neurotransmission, immunity and wound healing.
  • Reduces inflammation by regulating the immune system, thus normalising immune function.
  • Increases the release of adenosine, which reduces the sensitivity to pain
  • Modulates parts of the brain network (limbic and paralimbic system), responsible for anti-pain, anti-anxiety, and other therapeutic effects
  • Improves muscle stiffness and joint mobility by increasing local microcirculation, and therefore blood circulation.
  • Benefits depression by acting through other pathways involving dopamine, noradrenaline, cortisol and neuropeptide Y. Stress-induced behavioural and biochemical changes may also be reversed. Acupuncture can generally be safely used in combination with medical treatments.

Alongside acupuncture dietary changes to avoid anti-inflammatory foods e.g. consider reducing consumption of meat, avoid gluten and eliminate dairy products, avoid citrus foods and consume sugars and in small amouts only.  In addition supplements  can help to support the immune system;

  • Essential fatty acids (EFA) like fish or fish oil, flax seed and borage seed oil.
  • Probiotics
  • Turmeric or ginger for its anti-inflammatory action.

 

One would have thought that anatomist would have discovered everything there was to discover in the human body. Au Contraire!  Hidden in plain sight researchers discovered the “Interstitium”; a mesh network of fluid filled spaces that lies along the web of collagen and elastin tissues throughout the body. It is estimated to be 20% of the total body volume. In the past it was simply labelled as dense connective tissue. Dr Neil Theise (co-senior study author) describes it as an “open, fluid-filled highway”. This was an accidental finding during studies on the bile duct. These spaces were never identified because the fluid filled spaces are only visible in living tissue, in dead tissue the fluid is lost and the compartments collapse and flatten losing their structure. Researchers used probing techniques on living tissue to see them in their full form. The spaces appear to be pre-lymphatic and appear to drain into lymph nodes.

In the human body around 70% of the water is found in cells. This finding helps to answer questions about where the remaining extracelluar fluid resides. Various theories for the function of the Interstitium have been put forward including being a source of lymphatic fluid. Consequently, it has a role in the body’s immune system and could be involved is the process of spread of cancer cells.

Researchers have speculated that in Acupuncture the tip of the needle goes into these spaces and may explain how it works. Traditional Chinese Medicine (TCM) practitioners (including acupuncturists) learn about how the healthy and balanced movement of qi is vital to maintaining health and that blockages or stagnation results in health problems. Results from this study support this understanding. Past articles have discussed the existence of interstitial fluid network along fascia lines. These fluid-filled matrix correspond very closely to the acupuncture meridian channels where Qi (vital energy) flows. We can therefore postulate that the flow of interstitial fluid is crucial and any impediment would compromise the interstitium’s ability to fully function.

The use of cupping in acupuncture, where the skin is sucked up has the effect of raising tissue and loosening these spaces therefore allowing the flow of interstitial fluid. The Interstitium spaces are supported and organised by collagen lattice and thus described as a dynamic compression and distension shock absorber to protect tissue during daily functions. Data on keloid scars shows that they appear on skin under high tension, and so the effects of forceful mechanical forces of these spaces and the fluid flow within can be considerable. Similarly massage and acupressure techniques include compression and lifting actions that would act on these spaces and therefore the interstitial flow. Further, the process of wet cupping where through a small incision blood is sucked into cups is understood to remove toxins or ‘stagnant blood’ can be directly linked to clearing these interstitium spaces and encourage the flow.

Future studies on the Interstitium could give much more detailed answers on how acupuncture works and finally confirm ancient TCM theories around 5,000 yrs old.

 

References:

Benias, P.C., Wells, R.G., Sackey-Aboagye, B., Klavan, H., Reidy, J., Buonocore, D., Miranda, M., Kornacki, S., Wayne, M., Carr-Locke, D.L., Theise, N.D. Structure and distribution of an unrecognized interstitium in human tissues. Sci Rep. 2018;8:4947. Link

 

Smoking is a significant risk factor for many diseases including cancer, cardiovascular, chronic lung diseases and gastric ulcers. According to The WHO  smoking kills nearly 6 million people each year i.e. approximately one death every six seconds. 5 million of these results directly from smoking, while more than 600,000 are due to passive smoking. Due to the lag of many years, smoking is a slow gradual killer and people don’t realise its impact on their health until much later.  By then they have already developed an addiction.  A survey in China revealed that only 38% were aware it caused coronary heart disease.  Amongst smokers who are aware of its dangers, most want to quit however worldwide national smoking cessation services are only available in 21 countries. Smokers wanting to give up have tried, but most attempts are unsuccessful. E-cigarettes have become the new alternative to smoking but its safety is yet to be evidenced, and in my opinion there is a need to be cautious before giving it the green light. Getting help through cessation advice services using nicotine replacement therapy and counselling may be helpful but don’t always work for everyone. Complementary therapy studies have been done on acupuncture, hypnotherapy, yoga, mindfulness meditation herbal remedies and dietary supplements with some encouraging preliminary results.

Acupuncture is an ancient traditional Chinese therapy involving the insertion of fine needles at specific points in the body. It aims to affect symptoms of withdrawal, and studies show that it reduces the taste of tobacco and the intensity of the desire to smoke. A review of of 38 acupuncture and related randomised studies found inconsistent evidence of benefit, however there is enough to support the possibility of a positive effect that is greater than placebo. When used in combination with education it is found to have greater benefit. Studies on  smoking longer term effects show that it helps to keep smokers motivated to reduce or even quit smoking, with the effects lasting up to 5 yrs.

Hypnotherapy is a therapeutic tool used to affect patterns of behaviour. A Cochrane review found the evidence to be unclear, and not more successful than other therapist contact interventions. Any encouraging results were attributed to the individual’s strong motivation.

Yoga, breathing exercises and meditation-based therapies demonstrate some positive results to stop smoking in a small number of studies. Yoga compared to a psychologist led wellness group showed greater rates of abstinence in the longer term, but also improvements in anxiety levels and perceived health and well-being.

Dietary supplements and herbal remedies, S-adenosyl-L-methionine (SaMe), silver acetate, lobeline (Lobelia inflate) and St. John’s Wort have not shown to be effective, and should only be tried with the advice and guidance of an appropriately qualified health professional.

There has been an ongoing interest in the use of complementary therapies to stop smoking. Regularly, I get smokers who express a need (for all the right health and economic reasons) to give up smoking and inquire about the effectiveness of complementary therapies.  My answer has always been the importance of a <b>strong inner desire (rather than just need) to give up, without which nothing works completely. Therapies like acupuncture can help to alleviate stress, aid relaxation, reduce withdrawal symptoms and the urge to smoke thus easing the journey to becoming smoke free somewhat soother, but in my experience the reason for smoking is the key influencing factor which needs to be addressed. Issues of life style choices, work, family, relationships and childhood can all form part of the picture. Finally, what determines which way it swings is a willingness to make real life changes, which is the ultimate ‘Crunch Factor’.

 

Fibromyalgia  is a chronic conditions that causes widespread pain in the body. It is accompanied by increased pain sensitivity, extreme tiredness, muscle stiffness, sleep difficulties, headaches, functional impairment e.g. memory and concentration (known as “fibro-fog”) and irritable bowel syndrome (IBS).

The cause of fibromyalgia is not well understood, but genetic, automimmune factors,  traumatic events and stress are contributory. Treatment is limited to improving function using pain medication, antidepressants and antiepileptic, supported by physical and talk therapy.

Although there is no cure for fibromyalgia, acupuncture can provide respite from symptoms.  One study found that 1 in 5 people suffering with fibromyalgia use acupuncture within a period of 2 years after diagnosis. The WHO recommend acupuncture for treating fibromyalgia but conclude that more research is needed.

Pain intensity was noticeably reduced after 10 weeks using tailored acupuncture treatments at weekly intervals in a multicentre trial conducted in three primary care centres. Participants were randomly assigned to real acupuncture or placebo, whilst continuing their medical management.  A total of 153 participants completed the study. The acupuncture group reported a 41% reduction in pain, compared to 27% in the placebo group. The effects were still apparent at the end of 12 months, reporting 20% and 6% reduction respectively. Other measures of anxiety, fatigue and depression were also significantly reduced at 10 weeks.

A review of multiple small studies concluded that acupuncture was safe to use for fibromylgia. Electro acupuncture was more effective than manual acupuncture for pain and stiffness, well-being, sleep and fatigue. Effects lasted up to one month.

Acupuncture is well knows to be effective in reducing many types of chronic pain, including arthritic, rheumatic, headaches. It releases feel-good natural pain killers in our body called endorphins. These same chemicals are also released after orgasm, thus leave us with a relaxed warm afterglow.  Its ability to modify pain, reduce stress and enhance well being is ideal to tackle these fibromyalgia symptoms.  The insertion and twisting needle action also release adenosine, an anti-inflammatory chemical that lingers for up to an hour after the treatment.

It is unsurprising therefore that many people with fibromyalgia would be interested in trying acupuncture.  A  Personal story  from  one sufferer shows how acupuncture  can help change lives.  Despite the mixed results from studies, most suggest that it may have a beneficial role in treating fibromyalgia, which can be used without anxiety about its safety. It can be used on its own for symptom management, but often advocated in addition to other exercise or physical program.

 

Acupuncture has a long history of use to treat many conditions, including pain, depression, fatigue and addictions.  It is known to effect local responses as well as distal changes through neurological and endocrine systems. When used together with heat treatment it can cause multiple biological responses, seen both in animals and humans.  However, the mechanism and biochemical changes responsible for these effects are still unclear.  Chinese concepts refer to the flow of Qi, five element theory and yin and yang. Anatomical studies show that most acupoints located along the meridian lines (also known as channels) are located closely to nerve fibre distribution and blood vessels. Interestingly, there is also an increase in hair follicles and sweat glands at these points.

Nitrous Oxide (NO) is known to play an important physiological role in skin local microcirculation, neurotransmission, immunity and wound healing. It produces relaxation of blood vessels via an increase in NO synthase acitivty, but also utilizes the nitrate-nitrite-NO pathway in the human skin. Studies in rats have also shown that NO content and NO synthase protein levels are in the skin tissue at acupoints and meridian lines. Repeated thermal application also increases immunoreactivity and NO synthase in hamsters. NO also mediates noradrenergic function on skin sympathetic nerve activation, which contributes to low resistance characteristics of acupoints and meridians.

One crossover study conducted on 20 volunteers who underwent a real acupuncture and then non-invasive sham acupuncture in the hand or forearm with 1 week interval between treatments. The blood plasma concentration of NO in the acupunctured arm and hand was significantly increased, which was not observed in the sham acupuncture.

A more recent published study at the Harbor-UCLA Medical Center examined the effect of manual acupuncture and electrical heat to the release of nitric oxide (NO) over the human skin. Participants included 25 volunteers (men and women) aged 18-60 yrs. Participants were randomly asked to undergo manual acupuncture over the pericardium meridian, or heat treatment over the lung meridian. NO was monitored using a Biocapture device with a collecting solution taped to the skin along the meridians. Results found that manual acupuncture and electrical heat cause release of NO from the local skin, which was almost doubled at acupuncture points.

Initial pilot studies also show that the extent of NO production can vary depending on the person’s age and gender due to the differences in sympathetic acitivity, body weight, hormones, sweat rates and skin thickness. There was no noticeable difference between different ethnic groups.

The importance of a rich blood circulation is an evident necessary part of tissue healing, and suggests the rationale for subsequent pain relief or sensitising substances. These studies determined that acupuncture elevates the local level of NO in the treated areas, thus increasing blood flow and warmth. There is vasodilation accompanied neurochemical changes which may further contribute to generation of NO. Thus suggesting that acupuncture treatment using a reinforced technique and the addition of electrical heat will improve local circulation.

Clinical experience has shown that the use of acupuncture for pain relief is an excellent alternative to the use of medicinal pain killers.  However we must not ignore the benefits of increase blood circulation for other conditions, therefore improving the overall body functions.  My own clinical practice regularly incorporates the use heat in the form of direct or indirect moxa or electrical heat. We have always found that the addition of heat enhances the needle effects, thus confirming the above research findings. It should be a treatment choice for those experiencing pain but in particular where there is chronic pain.

 

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