V. Hopwood

... 69 Maureen Lovesey SECTION 2 SOME SPECIALIZED TECHNIQUES 77 6. Introduction to acupressure 79 Sara Mokone, Val Hopwood 7. Myofascial pain syndromes, trigger point therapy and dry needling acupuncture 89 Charles Liggins 8. Moxibustion and cupping 101 Kim ...

... Before using acupuncture outside the hospital, the community physician should be informed, local infection control contacted and a check made on local licensing laws. ... When acupuncture is used in the community there have been interesting results. ...

In favour of self-acupuncture, this is a useful way to prolong the effects of acupuncture when the response is only brief or patients cannot attend frequently. If the patient is capable and the condition is suitable for self-acupuncture, patients can be taught how to do it and then seen for review. Patients should be provided with complete information sheets, and one example is presented. Against self-acupuncture, patient safety is paramount and would be compromised by teaching them how to do acupuncture. In addition, serious accidents have happened with self-acupuncture, including a death. Other arguments against it are that it is less effective than standard acupuncture, the patient misses out on the therapeutic relationship, and safer alternative methods exist.

The issue of what constitutes an effective and realistic acupuncture placebo control has been a continuing problem for acupuncture research. In order to provide an effective placebo, the control procedure must be convincing, visible and should mimic, in all respects, apart from a physiological effect, the real active treatment. The 'Streitberger' needle might fulfil these criteria and this paper reports on a validation study. This was a single-blind, randomised, cross-over pilot study. Patients were drawn from the orthopaedic hip and knee, joint replacement waiting list. Intervention consisted of either 2 weeks of treatment with real acupuncture followed by 2 weeks on placebo, or vice versa. The prime outcome was a needle sensation questionnaire and there was a range of secondary outcomes. Thirty-seven patients were randomised and completed treatment. Groups were well balanced at baseline. No significant differences between groups or needle types were found for any of the sensations measured. Most patients were unable to discriminate between the needles by penetration; however, nearly 40% were able to detect a difference in treatment type between needles. No major differences in outcome between real and placebo needling could be found. The fact that nearly 40% of subjects did not find that the two interventions were similar, however, raises some concerns with regard to the wholesale adoption of this instrument as a standard acupuncture placebo. Further work on inter-tester reliability and standardisation of technique is highly recommended before we can be confident about using this needle in further studies.

To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo. Placebo-controlled, randomised, clinical trial. Post-stroke rehabilitation wards in five NHS hospitals in the UK. Patients between 4 and 10 days after their first stroke. The patients received 12 acupuncture or placebo treatments over four weeks. Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility. 92 patients completed data sets. Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure. While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p = 0.737, 95 % CI -2.00 to 2.81) and 52 weeks (p = 0.371, 95 % CI -3.48 to 1.32). An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks (p = 0.009, 95 % CI 1.55 to 10.77) is interesting. Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.

This short speculative report describes the outcome of three studies looking at the effect of acupuncture on stroke recovery and the subsequent place of residence of the subjects entered. It is not a systematic review and does not endeavor to provide comprehensive data on the effect of acupuncture on post-stroke recovery. Our observations demonstrate that patients may be more likely to remain independent and in their own homes one year post stroke if they receive acupuncture. This conclusion is supported by our study and two previous trials. It may be that acupuncture improves post-stroke perception, thereby enhancing independence.

ABSTRACT Introduction: The practice and philosophy of traditional (classical) acupuncture (TA), as opposed to Western acupuncture, remains a contentious issue within mainstream healthcare in the UK. In spite of the relative integration of acupuncture within orthodox medical practice, a lack of paradigm conformity continues to divide traditional from Western approaches. This study sought to explore the perceptions and attitudes of existing acupuncture clinicians in the UK, from a range of professional backgrounds and affiliations, towards traditional acupuncture philosophy and practice. In doing so, it attempted to determine the extent to which traditional approaches were both regarded as legitimate and utilised in practice within mainstream healthcare.Method: A postal questionnaire was deployed that incorporated an ‘attitudes to TA’ scale developed from a validated ‘attitude to alternative medicine’ scale. The questionnaire was distributed to 250 randomly selected subjects, drawn from the membership of three key professional acupuncture associations: 100 from the membership of the British Medical Acupuncture Society (BMAS), 100 from the British Acupuncture Council (BAcC) and 50 from the Acupuncture Association of Chartered Physiotherapists (AACP).Results: A response rate of 60.8% (n = 152) was obtained. Respondents held a broadly positive attitude towards TA (65 ± 12; 95% CI 62.9, 67.1), which included 39 BMAS respondents (54 ± 11; 95% CI 50.5, 57.5), 36 AACP respondents (63 ± 7; 95% CI 60.7, 65.3) and 53 BAcC respondents (75 ± 5; 95% CI 73.7, 76.3). No difference was found in attitude between 27 general practitioners and 13 hospital doctors (p > 0.1). More positive attitudes towards TA were found among younger BMAS respondents (Spearman’s rank correlation coefficient [rs] = -0.353; 0.01 < p < 0.05). Of BAcC respondents, 62% used ‘trigger point’ theory, whereas 59% and 72% of respondents in the BMAS and AACP groups respectively used ‘channels’ theory.Conclusions: These findings confirm broadly positive attitudes towards TA within each of the professional groups from which data were drawn, although they do reveal a range of disparate attitudes to TA among the groups, particularly between the BMAS and BAcC members.

Summary Patients have the right to be fully informed about the likely benefits and risks of any proposed examination or treatment, and practitioners are obliged to obtain informed consent beforehand. Accurate information about the risks of acupuncture is available following publication of the results of two prospective surveys. At a joint meeting on the safety of acupuncture, members of the