January 2001

The Cochrane Database of Systematic Reviews
Quality Assessed Systematic Reviews
The Cochrane Controlled Trials Register
References which have been added to Acubriefs database since the December edition

The January 2001 edition of the newsletter will depart from its usual format. Rather than review recent citations, the Cochrane Library (Issue Jan 2001) is reviewed with regard to acupuncture research. For those of you unfamiliar with the Cochrane Collaboration, the following introduction is lifted from their home page:

http://www.update-software.com/cochrane/help/

"The Cochrane Collaboration is an international organization that began in 1993 as a response to Archie Cochrane's call for systematic, up-to-date reviews in healthcare. Cochrane was an epidemiologist who observed that:
Healthcare practice is not always based on good evidence. There is too much information for any individual to access and use.
Resources are always limited, so it is all the more important to know which interventions work.

The Collaboration now comprises centers in 15 countries, 50 topic-based Review groups, and about 6,000 members. The collaboration members hand-search journals in 19 countries, produce Cochrane reviews, moderate the feedback system, and ensure that methodology, statistics, and software used in the writing of reviews is state-of-the-art and that consumer and other groups are represented.

The main output of The Cochrane Collaboration is systematic reviews of the effects of healthcare interventions. These systematic reviews are published electronically in successive issues of The Cochrane Library."

Editor's Note: This edition of "Acubriefs" reflects the importance I place on our readers being familiar with the Cochrane Library, and particularly their reviews pertinent to acupuncture. The Cochrane Library approaches acupuncture from an analytical/objective/statistical viewpoint. With the clear emphasis on evidence-based recommendations, it has been hailed by academicians and governmental agencies as the standard approach upon which to base all recommendations. An issue with many practitioners, and even some researchers, is that by using standard evidence-based approaches, one can never fully and fairly evaluate acupuncture; certainly, as practiced from an Oriental medical perspective. The subjective nature of Oriental medical diagnoses alone limits the value of objectively evaluating outcomes based on Oriental medical models. In simple words: if we cannot fully agree on what the problem is, can we ever objectively determine which treatment is best? There are also such mundane problems as clearly defining acupuncture, and determining appropriate acupuncture interventions for a particular Western diagnosis. Almost inevitably, the reviews of interventions skirt these important but relevant issues.

In my opinion, the case series approach to evaluating interventions from an evidence-based format demonstrates the greatest hope of evaluating acupuncture from a Western perspective. The only other viable alternative is outcome studies evaluating interventions from a context rather than a Western diagnostic standpoint. Otherwise, we will continue to see studies designed to meet Western criteria for properly randomized controlled trials that fail miserably to reflect the reality of clinical acupuncture practice.

SEIRIN-America, along with Oriental Medical Supplies (OMS), suppliers of acupuncture needles and accessories, are financial sponsors of Acubrief's Newsletter.

The Cochrane Library has several categories. The first and most important is "The Cochrane Database of Systematic Reviews." (Total of 59 hits using "acupuncture" as the search item.) This section is divided into Complete Reviews (38 hits) and Protocols (21). The most pertinent reviews, along with their findings, are briefly discussed herein by James K. Rotchford, MD, MPH, editor.

1. Acupuncture for Chronic Asthma. (Cochrane Review)

Linde K, Jobst K, Panton J.; Cochrane Database Syst Rev; 2000; Vol.(2):CD000008
In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

2.Acupuncture for Idiopathic Headache. (Cochrane Review)

Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, Allais G.; Cochrane Database Syst Rev; 2001 Vol.(1):CD001218; In: The Cochrane Library, Issue 1, 2001.Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

3.Acupuncture for Induction of Labor. (Cochrane Review)

Smith CA, Crowther CA.; Cochrane Database Syst Rev; 2001; Vol.(1):CD002962; In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

4. Acupuncture for Low Back Pain. (Cochrane Review)

Tulder MW van, Cherkin DC, Berman B, Lao L, Koes BW.; Cochrane Database Syst Rev; 2000; Vol.(2):CD001351; In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

5. Acupuncture for Smoking Cessation. (Cochrane Review)

White AR, Rampes H, Ernst E.; Cochrane Database Syst Rev; 2002; Vol.(2):CD000009; In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

6. Transcutaneous Electrical Nerve Stimulation for Knee Osteoarthritis. (Cochrane Review)

Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G.; Cochrane Database Syst Rev; 2000; Vol.(4):CD002823 ; In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. PubMed Abstract

Reviewed by James K. Rotchford, MD, MPH

Click here to read the review

The following are pertinent Protocols which have been developed for future systematic reviews:

1. He L, Zhou D, Wu B, Li N. Acupuncture for Bell's palsy (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

2. Richardson MA, Allen C, Ezzo J, Lao L, Ramirez G, Ramirez T, Zhang G. Acupuncture for chemotherapy-induced nausea or vomiting among cancer patients (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

3.Green S, Buchbinder R, Hall S, Barnsley L, Forbes A, Smidt N, Assendelft W. Acupuncture for lateral elbow pain in adults (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

4. Ezzo J, Hadhazy V, Berman B, Birch S, Kaplan G, Hochberg M. Acupuncture for osteoarthritis (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

5. Wilson M, Farquhar C, Kennedy S, Jin X. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

The next major section of the Cochrane Library is: Database of Abstracts of Review of Effectiveness (35 hits with search term "acupuncture"; 9 major ones herein reviewed.)

Quality Assessed Systematic Reviews:

1. A Meta_Analysis of the Effectiveness of Acupuncture in Smoking Cessation.

Ashenden R, Silagy C A, Lodge M, Fowler G. A meta-analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review, 1997; 16, 33-40.

Note: The authors' conclusions and those echoed by the CRD reviewer are that while acupuncture appears promising, there is insufficient evidence at present to recommend it as an effective form of therapy. More direct comparative trials with larger numbers of subjects are required before the effectiveness of acupuncture can be reliably compared against other therapies.

2. A Review of Randomized Clinical Trials in Tinnitus.

Dobie R A. A review of randomized clinical trials in tinnitus. Laryngoscope 1999, 109(8), 1202-1211.

Note: 6 RCT's for acupuncture showed no statistically significant difference; however, there is no discussion of size of studies or the possibility of sham acupuncture being used as comparison. Only database searched was MEDLINE up to 1998.

3. A Systematic Review of Randomized Controlled Trials of Acupuncture for Neck Pain.

White A R, Ernst E. A systematic review of randomized controlled trials of acupuncture for neck pain. Rheumatology, 1999; 83(2); 143-147.

Note: The authors believe that better designed trials of acupuncture are required before its place in the management of neck pain can be defined.

4.Acupuncture and Addiction Treatment.

Moner S E. Acupuncture and addiction treatment. Journal of Addictive Diseases, 1996; 15(3); 79-100.

Note: Although the author concluded that the evidence is very encouraging for the use of acupuncture in addictive disorders, the CRD reviewer's belief is that there was inadequate evidence to support a pro or con position.

5. Acupuncture as a Symptomatic Treatment of Osteoarthritis: A Systematic Review.

Ernst E. Acupuncture as a symptomatic treatment of osteoarthritis: a systematic review. Scandinavian Journal of Rheumatology, 1997; 26(6); 444-447.

Note: The author, well-respected in the area of evidence-based evaluation of acupuncture, concluded that the evidence does not support the position that acupuncture is superior to sham needling in alleviating pain of axial and peripheral joint osteoarthritis. CRD commentary was supportive of this conclusion, but noted that inclusion of all pertinent studies was perhaps limited because certain databases were not included.

6. Acupuncture as a Treatment for Temporomandibular Joint Dysfunction: A Systematic Review of Randomized Trials.

Ernst E, White A R. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Archives of Otolaryngology Head and Neck Surgery, 1999; 125(3); 269-272.

Note: Basically, all studies were supportive of acupuncture's effectiveness in TMJ, but the quality of the studies was such, it was felt that more rigorous studies involving other locations besides Scandinavian sites were necessary before concluding that the evidence supported acupuncture's use in TMJ.

7. Acupuncture as an Adjuvant Therapy in Stroke Rehabilitation?

Ernst E, White A R. Acupuncture as an adjuvant therapy in stroke rehabilitation? Wiener Medizinische Wochenschrift 1996; 146, 556-558.

Note: Similar to the last review, the author concludes that several trials suggest that acupuncture is a useful adjunct for stroke rehabilitation; however, methodological flaws in the studies indicate that current data is not conclusive and that further trials should be initiated.

8. Acupuncture/Acupressure for Weight Reduction? A Systematic Review. Ernst E. Acupuncture/acupressure for weight reduction? A systematic review. Wiener Klinische Wochenschrift 1997; 109(2); 60-62.

Note: Again, the author concludes that no clear picture emerged and that further well-designed clinical trials are required.

9.The Use of Acupuncture in Dentistry: A Systematic Review.

Rosted P. The use of acupuncture in dentistry: a systematic review. Acupuncture in Medicine 1998, 16(1), 43-48.

Note: The author found that 11 out of 15 papers were in favor of standard (traditional) acupuncture, having been shown to be more effective than non-standard (sham) acupuncture, or to have a similar effect to conventional treatments. The value as an analgesic for surgery is questioned, but the beneficial effect in treatments involving TMJ dysfunction and facial pain appears real; in this area, acupuncture could be a valuable alternative to orthodox treatment. However, the number of good quality randomized trials are few and more studies are required. CRD commentary basically felt the above conclusions were justifiable.

The next major section of the Cochrane Library is:

The Cochrane Controlled Trials Register:

(1,189 hits for the term "acupuncture;" only year 2000 references are listed below.)

1. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy.

AU:Wedenberg K; Moen B; Norling A

SO:Acta Obstetricia et Gynecologica Scandinavia;

May 2000; Vol 79; Pp 331-5.

2.A randomized controlled trial of auricular acupuncture for cocaine dependence.

AU: Avants SK; Margolin A; Holford TR; Kosten TR

SO: Archives of Internal Medicine; Aug 2000,14-28;

Vol 160; Pp 2305-12.

3. Acupressure for nausea: results of a pilot study.

AU:Dibble SL; Chapman J; Mack KA; Shih AS.

SO:Oncology Nursing Forum,Jan-Feb 2000; Vol 27; Pp 41-7.

4. Acupuncture for symptom relief in HIV-positive adults: lessons learned from a pilot study.

AU:Beal MW; Nield_Anderson L.

SO: Alternative Therapies in Health & Medicine; Sep 2000; Vol 6; Pp 33-42.

5. Acupuncture treatment of bulbar palsy: a report of 54 cases.

AU: Liu L.

SO: Journal of Traditional Chinese Medicine;

Mar 2000; Vol 20; Pp 30-2.

6. Effect of acupuncture on pain management in patients before and after lumbar disc protrusion surgery: a randomized control study.

AU:Wang RR; Tronnier V.

SO: American Journal of Chinese Medicine; Yr 2000; Vol 28; Pp 25-33.

7. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects.

AU:Haker E; Egekvist H; Bjerring P.

SO: Journal of the Autonomic Nervous System; Feb 14 2000; Vol 79; Pp 52-9.

8. Effects of electro_acupuncture on anovulation in women with polycystic ovary syndrome.

AU: Stener_Victorin, E., Waldenstrom, U., Tagnfors, U., Lundeberg, T., Lindstedt, G., and Janson, P. O.

SO: Acta Obstetricia et Gynecologica Scandinavica;

Yr 2000; Pp 180-8.

9. Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery.

AU:Schlager A; Boehler M; Puhringer F.

SO: British Journal of Anaesthesia; Aug 2000; Vol 85; Pp 267-70.

10. The benefit from whole body acupuncture in major depression.

AU: Roschke J; Wolf C; Muller MJ; Wagner P; Mann K; Grozinger M; Bech S. SO: Journal of Affective Disorders;

Jan-Mar 2000; Vol 57.

11. Treatment of 86 cases of facial spasm by acupuncture and pressure on otopoints.

AU: Li Y; Peng C.

SO: Journal of Traditional Chinese Medicine; Mar 2000; Vol 20; Pp 33-5.

12. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. (German)

AU: Eich H; Agelink MW; Lehmann E; Lemmer W; Klieser E .

SO: Fortschritte der Neurologie_Psychiatrie; Mar 2000; Vol 68; Pp 137-44.

13. Effect of needle acupuncture on pain perception and functional impairment of patients with coxarthrosis. (German)

AU: Fink MG; Kunsebeck HW; Wippermann B.

SO: Zeitschrift fur Rheumatologie; Jun 2000; 59(3):191-9; Jun 2000; Vol 59; Pp 191-9.

14. The use of low_frequency magnetotherapy and EHF puncture in the combined treatment of arterial hypertension in vibration_induced disease. (Russian)

AU: Drobyshev VA, Filippova GN, Loseva M, Shpagina LA, Shelepova NV, Zhelezniak MS. SO: Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury; May-Jun 2000; Pp 9-11.

The next section follows with pertinent references:

Health Technology Assessment Database (5 hits, 1999 total)

1. Acupuncture for migraine and headache in primary care: a pragmatic, randomized trial: primary research (project).

Acupuncture for migraine and headache in primary care: a pragmatic, randomized trial/primary research (project). UK NHS National Coordinating Centre for Health Technology Assessment (NCCHTA).

2. Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain: primary research (project).

Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain: primary research (project). UK NHS National Coordinating Centre for Health Technology Assessment(NCCHTA).

NHS Economic Evaluation Database (2 hits, 6113 total)

1. Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: an open, prospective study.

Ballegaard M D, Johannessen A, Karpatschof B, Nyboe J. Addition of acupuncture and self-care education in the treatment of patients with severe angina pectoris may be cost beneficial: an open, prospective study. Journal of Alternative and Complementary Medicine, 1999, 5(5), 405-413.

2.Cost-benefit of combined use of acupuncture, shiatsu, and lifestyle adjustment for treatment of patients with severe angina pectoris.

Ballegaard S, Norrelund S, Smith D F. Cost-benefit of combined use of acupuncture, shiatsu, and lifestyle adjustment for treatment of patients with severe angina pectoris. Acupuncture & Electro-Therapeutics Research, 1996; 21(3-4), 187-197.

Following are some of the references which have been added to Acubriefs database since the December edition which are not Cochrane references: