The Maternity Acupuncture service in Plymouth has been established for over 23 years. Three midwives who are also TCM Acupuncturists treat a wide range of mostly ante-natal conditions as well as a few post-natal problems on one day per week each. The service is extremely popular, and sadly there is a long waiting list to be seen. Referrals come from midwives, physios, GPs and hospital obstetric staff as well as self-referral.

This presentation will look at data collected using the MYMOP outcome tool: a standardized health status questionnaire, which asks patients to identify and then rate the first and second priority symptoms, an activity affected by those symptoms and overall wellbeing on a scale of 0 to 6. An improvement of one point or more is considered clinically significant. (see www.pms.ac.uk/mymop)

We found this method easy to use, as did our patients, and we were pleased with our results. Our percentage of patients improved was over 90% , and our average number of points of improvement on the scale was at least two. Our intention is to start a new audit, and we hope our data may be used to inspire further research.

Many randomised trials of acupuncture for chronic pain have been conducted but most are of low methodological quality. The international Acupuncture Trialists Collaboration pooled individual patient data of available trials with adequate allocation concealment, in a meta-analysis. Raw data from 29 trials and 17,892 patients were reanalyzed. Acupuncture was found to be superior to both sham and no acupuncture control for all analyses. The effect size for acupuncture was consistent across pain conditions. Patients receiving acupuncture had less pain, with scores 0.23 (95% C.I. 0.13, 0.33), 0.16 (95% C.I. 0.07, 0.25) and 0.15 (95% C.I. 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache respectively; the effect sizes in comparison to no acupuncture controls were 0.55 (95% C.I. 0.51, 0.58), 0.57 (95% C.I. 0.50, 0.64) and 0.42 (95% C.I. 0.37, 0.46). In conclusion, acupuncture is effective for the treatment of chronic pain. Differences between acupuncture and sham are however relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

Note: The Acupuncture Trialists' Collaboration is funded by an R21 (AT004189I from the National Center for Complementary and Alternative Medicine at the National Institutes of Health to Dr Vickers) and by a grant from the Samueli Institute. Dr MacPherson's work has been supported in part by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10186). The presentation is based on a paper by Andrew J. Vickers, Angel M. Cronin, Alexandra C. Maschino, George Lewith, Hugh MacPherson, Norbert Victor, Karen J. Sherman, Nadine E. Foster, Claudia M. Witt, Klaus Linde on behalf of the Acupuncture Trialists' Collaboration

TCM for TMD: A test of Whole Systems Research

The challenge for research in acupuncture and Oriental medicine (AOM) is to design clinical trials that reflect and inform clinical practice. Examples will be presented of trials that tailored pre-defined treatments to a pre-selected set of pattern differentiations, as well as trials that allowed partially or completely individualized care. As a further exploration of clinically relevant designs, a dual-site, phase-2 NCCAM/NIH-funded trial assessed the appropriate role of TCM (acupuncture, herbal therapy and tuina) for the treatment of Temporomandibular Disorder (TMD)-related chronic facial pain. Whole system TCM was compared to psychosocial self care (SC) in a manner that allowed re-randomization at pre-selected times of patients who did not adequately improve on SC. Overall, TCM provided significantly greater short-term (8-week) relief than SC and greater reduction in interference with social activities. The study also identified longer-term outcomes, and beneficial trajectories and combinations of care. Lessons learned from this Whole Systems Research trial will be discussed.

Biofield Physiology: Exploring Interfaces between Biofield Healing and Conventional Physiology

Biofield therapies (eg, External Qigong, Healing Touch, Johrei, Reiki, and Therapeutic Touch) are a family of health care practices that use a combination of hands-on (physical touch) and hands-off (non-physical contact) procedures to stimulate healing. Such healing is considered possible since, in this view, living systems co-contribute to a biofield, which comprises a confluence of electro-magnetic as well as other conventional and non-conventional phenomena. This presentation will examine the RCT evidence base for non-physical contact biofield healing and the evidence for biofield therapy-related changes in biochemistry and physiology. It will also present examples of transduction and amplification mechanisms that mediate responses to extremely low levels of conventional sensory stimuli; such mechanisms may provide explanatory models for biofield therapy-initiated physiological responses. Discussion will also include newly-described mechanisms (and implications) involving the whole-body system of fascia (Oschman's 'living matrix'). A framework will be considered for defining Biofield Physiology as an emerging area of research.

Background: Although acupuncture has been investigated using functional magnetic resonance imaging (fMRI) since 1998, and electroencephalography (EEG) since at least 1961, the effects of different EA/TEAS stimulation frequencies have not been so well researched. Heart rate variability (HRV) has also been used as a tool to investigate the effects of acupuncture, but only two HRV studies have been found that explore the effects of different stimulation frequencies. Few such studies have used both EEG and HRV, and none have explored the effects of 10 Hz stimulation.

Objectives: (1) To detect changes in the EEG and subjective state following EA/TEAS with a variety of parameters at different acupoints; (2) In particular, to determine whether an EEG 'frequency following response' (FFR) occurs in different regions of the cortex from peripheral electrical stimulation, and whether this occurs preferentially at particular frequencies (2.5 or 10 Hz) or acupoints; (3) To develop and investigate the characteristics of an 'expectation of feelings' questionnaire (EXP) and assess whether subjective changes experienced in response to stimulation are in line with those expected.

Methodology: Following completion of a set of online questionnaires, in the initial pilot seven participants attended for either one or two visits (12 in total), during each of which they completed further questionnaires before and after six brief 'sessions' of stimulation and monitoring. A follow-up questionnaire was administered online. The EXP questionnaire is also being piloted as an aid to the teaching of EA (N=35, ongoing).

Presentation: Preliminary results will be presented on data extracted from EEG and HRV recording, and from the various questionnaires used.

Conclusions: Implications for the practice of EA/TEAS will be discussed, as well as for the next pilot within this study.

The German acupuncture trials ART and GERAC have shown that acupuncture as well as a so called sham- or minimal acupuncture were likewise effective in the reduction of chronic pain symptoms and superior to conventional treatment. As a consequence of these results there is an ongoing discussion whether acupuncture exerts its effects through a placebo response.

The lecture examines the question, whether the pain relief experienced by patients, who have received acupuncture for the treatment of chronic pain, is mainly due to a placebo effect or whether other mechanisms, specific to acupuncture, may play a role. One possible mechanism is the analgesia-inducing physiological phenomenon of diffuse noxious inhibitory control, or DNIC, which likely plays a role in acupuncture and is specific to that type of treatment. In addition acupuncture analgesia shows neurobiological characteristics similar to those of placebo-induced analgesia, especially expectation-induced analgesia, both apparently utilizing the same neuro-chemical pathway. It seems likely that the relief of pain by acupuncture involves both, specific neurobiological mechanisms elicited only by acupuncture, and less specific mechanisms similar to those of an expectation-induced placebo effect.

Traditional acupuncturists and researchers carried out a qualitative study nested within a co-operative enquiry. A convenience sample of 27 consultations by 7 practitioners was audio-recorded, and 15 patients were telephone interviewed afterwards.   These were transcribed and analysed by two researchers, using a constant comparative method.

The analysis explored each consultation as a trajectory of eight interwoven categories of talk. We identified how ‘self-care talk’ was situated within these trajectories. The consultations contained 130 sequences of self-care talk, often by interactive discussion.

A number of consultations demonstrated a co-construction of self-care talk that was woven throughout the consultation and through other categories of talk, namely ‘symptom’, ‘life-world’ and ‘acupuncture’ talk, thus individualising the self-care advice and, in many instances, linking it with the Chinese medicine diagnosis.

Our findings demonstrate the importance of self-care talk within acupuncture consultations and indicate the close links with discussions of the patient’s everyday life (‘lifeworld’) and the explanatory theory base. Detailed analysis of the structure of the talk may inform professional development in this area.

This talk will be an abridged version of my undergraduate dissertation carried out while studying at the College of Integrated Chinese Medicine.

It is my assertion that the response to grief and loss is a human condition that most of us – and our patients – are undergoing at some level most of the time. Should this process be interrupted or get stuck, the effects on the human body, mind, and deeper levels can become pathological and symptoms of dis-ease may occur.

After an introduction, the talk will outline the research methodology used. The findings of my research will then briefly be discussed. Some useful point combinations, especially using translations from the ancient names of acupoints, and other uses of points commonly used in grieving patients will be presented.

The purpose of this talk is to illustrate to the audience how traditional acupuncture can be used, not just as a physical therapy, but to nurture patients through their individual grieving process therefore treating and preventing dis-ease.