Acupuncture for Pain: artigo e informação para o doente da revista American Family Physician

Acupuncture for Pain Relief

ROBERT B. KELLY, MD, MS, Fairview Hospital/Cleveland Clinic Family Medicine Residency, Cleveland, Ohio

Am Fam Physician.,2009 Sep 1;80(5):481-484.

http://www.aafp.org/afp/2009/0901/p481.html

Acupuncture is increasingly used as an alternative or complementary therapy for the treatment of pain. It is well tolerated, with a low risk of serious adverse effects. Traditional and modern acupuncture techniques may result in reported improvement in pain patterns. Research on acupuncture has had a number of limitations, including: incomplete understanding of the physiologic effects of acupuncture; ineffective blinding of participants; unclear adequacy of acupuncture “dose;” difficulty in identification of suitable sham or placebo treatments; and the use of standardized treatment regimens rather than the individualized approach that characterizes most acupuncture practice. Controlled trials have been published regarding acupuncture for lumbar, shoulder, and neck pain; headache; arthritis; fibromyalgia; temporomandibular joint pain; and other pain syndromes. Enough data are available for some conditions to allow systematic evaluations or meta-analyses. Based on published evidence, acupuncture is most likely to benefit patients with low back pain, neck pain, chronic idiopathic or tension headache, migraine, and knee osteoarthritis. Promising but less definitive data exist for shoulder pain, fibromyalgia, temporomandibular joint pain, and postoperative pain. Acupuncture has not been proven to improve pain from rheumatoid arthritis. For other pain conditions, there is not enough evidence to draw conclusions.

Information from Your Family Doctor

Acupuncture for Pain Relief

Am Fam Physician. 2009, Sep 1;80(5):506.

What is acupuncture?

Acupuncture is when thin needles are put into certain places on the body. Acupuncture has been an important part of traditional Chinese medicine for thousands of years. In modern times, other acupuncture methods have been discovered. The most common of these is “electroacupuncture,” which is when mild electrical pulses are passed through the acupuncture needles into the body. Doctors who treat patients with acupuncture are more likely to use electroacupuncture than acupuncturists who are not doctors.

How does it work?

Doctors aren't sure how acupuncture works. The traditional explanation is that acupuncture restores the normal flow of energy in the body.

Why do people have acupuncture?

Acupuncture is most often used to treat low back pain, neck and shoulder pain, headaches, osteoarthritis, fibromyalgia, and nerve pain.

Does it work?

Many people with a painful condition will feel somewhat or even completely better after acupuncture. Some people do not respond to acupuncture at all, and others do not respond well enough to make it worth the time and expense.

You may need several treatments before you know whether acupuncture will help. If it does help, you will have more treatments until the pain is better. At that point, treatments can be spaced further and further apart. You may need treatments every so often to keep the pain from coming back.

Is acupuncture painful? Is it safe?

Acupuncture needles are very thin and have no cutting edge. This makes them much less painful than needles used to give shots. Once acupuncture needles are in place, you may not feel them, or you might feel only a mild ache.

Acupuncture is safe. Complications are very rare. Some people have minor side effects, such as a headache or feeling tired. Sometimes symptoms get worse before they get better.

Where can I get more information?

Your doctor

American Academy of Medical Acupuncture

Web site: http://www.medicalacupuncture.org/

National Certification Commission for Acupuncture and Oriental Medicine

Web site: http://www.nccaom.org/find/index.html

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Cumprimentos!

Acupunctura tão eficaz quanto o tratamento farmacológico para a dor aguda do herpes zoster

Um estudo randomizado controlado italiano demonstrou que a acupunctura é tão eficaz como o tratamento farmacológico para a dor aguda em doentes com herpes zoster. Cento e dois doentes foram randomizados para receber acupunctura (AC) ou tratamento farmacológico (F) por um período de quatro semanas. AC consistiu em oito sessões de acupunctura tradicional chinesa administrada duas vezes por semana utilizando pontos que incluiram REN-12, REN-4, LI-11, LI-4, ST-44, SP-10, LIV-2, P-6. Ambas as intervenções foram consideradas eficazes, sem diferenças significativas entre os grupos relativamente à resposta  terapêutica e nas escalas de dor. A incidência de nevralgia pós-herpética após um ano foi considerada semelhante em ambos os grupos. (Acupuncture for the treatment of severe acute pain in Herpes Zoster: results of a nested, open-label, randomized trial in the VZV Pain Study. BMC Complement Altern Med. 2011 Jun 5;11(1):46).

Sedentarismo com más consequências para o coração

Prolongados períodos de sedentarismo levam a maior perimetro abdominal e níveis mais elevados de triglicéridos no sangue, mesmo em indivíduos que fazem exercicio regularmente, de acordo com pesquisadores australianos. Estes examinaram as consequencias cardiovasculares de estar sentado de forma prolongada de 4757 participantes que fizeram parte de um estudo de coorte sobre saúde e nutricao nos EUA. Os indivíduos usavam acelerômetros que medem a intensidade da sua atividade física durante sete dias. Os pesquisadores mediram o perimetro abdominal, pressão arterial, os níveis de colesterol e as concentrações de proteína C-reativa para determinar a saúde do coração. Em um subconjunto do grupo, eles também mediram marcadores de diabetes - glicose no sangue, a insulina e triglicéridos. Associações prejudiciais foram observadas entre o tempo de sedentarismo e o perimetro abdominal, HDL-colesterol, proteína C-reativa, triglicéridos, insulina e resistência à insulina. Os autores sugerem que mesmo curtos intervalos no tempo que se esta sentado, que poderiam ser tão pouco como estar de pé por um minuto, podem ajudar a reduzir este risco para a saude.

Link para o artigo "Prolonged sitting is bad for the heart"

Novo consultório a partir de Outubro/2011

A partir de Outubro passamos a fazer consultas no Centro Medico Dr. Paz Ferreira na Rotunda de Sao Goncalo.

Contactos:
Centro Medico Dr. Paz Ferreira
Rua de Sao Goncalo, 203  5º andar
Telefones: 296285903 / 911897759

Acupunctura para a dor menstrual

Uma revisão sistemática da Cochrane de autores australianos concluiu que a evidência actual apoia a utilização da acupunctura para reduzir a dor menstrual. Dez estudos, com dados de 944 participantes, foram incluidos nesta revisão. Os resultados mostraram haver melhoria da dor menstrual com a acupunctura comparando com placebo ou fitoterapia chinesa. Em dois estudos a acupunctura levou a redução de sintomas menstruais (como por exemplo naúseas e lombalgia) comparada com medicação; em um estudo a acupunctura reduziu os sintomas menstruais em comparação com fitoterapia chinesa; e em um estudo a acupunctura levou a  melhoria da qualidade de vida em comparação com o tratamento médico. Houve melhoria no alívio da dor  e nos outros sintomas menstruais em doentes tratados com acupressão comparativamente ao placebo em um estudo. O risco de viés foi considerado baixo em 50% dos estudos e os autores sugerem haver necessidade de mais estudos bem desenhados.
(Acupunctura para a dismenorreia primária, Cochrane database systematic review 2011, Jan 19;1:. CD007854).

Probióticos podem aliviar as cólicas do lactente

Probiotics relieve infant colic

A probiotic supplement has been shown to significantly relieve the symptoms of infantile colic, compared to placebo. Forty-six breastfed colicky infants, who cried for at least three hours per day at the beginning of the study, were randomly assigned to receive either supplementation with Lactobacillus reuteri or a placebo daily for 21 days. Those receiving the probiotic supplement showed at least a 50% improvement in crying time. The treatment group also showed an increase in Lactobacilli in their stools and a decrease in Escherichia coli, a bacterium associated with colic. (Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010 Sep;126(3):e526-33).

Um suplemento probiótico mostrou aliviar significativamente a cólica do lactente, em comparação com o placebo. Quarenta e seis crianças a fazer aleitamento materno e com cólicas, que choravam pelo menos três horas por dia no início do estudo, foram randomizados para receber suplementação com Lactobacillus reuteri ou um placebo diariamente durante 21 dias. Aqueles que receberam o suplemento probiótico apresentaram pelo menos uma melhoria de 50% no tempo de choro. O grupo de tratamento também mostrou um aumento de lactobacilos nas suas fezes e uma diminuição de Escherichia coli, uma bactéria associada com as cólicas.

Benefícios da canela em algumas doenças

Cinnamon beneficial in many diseases

Cinnamon bark (Cinnamomi Cortex [Rou Gui]) has a potential role in the prevention of many diseases, according to a review by American authors. Recent studies carried out in vitro and in vivo have shown that cinnamon can improve many of the factors associated with development of metabolic syndrome and type 2 diabetes, including insulin resistance, elevated glucose and lipids, inflammation, decreased antioxidant activity, weight gain and increased glycation of proteins. In addition, cinnamon has been shown to alleviate factors associated with Alzheimer's disease and ischaemic stroke. In vitro studies have also shown that components of cinnamon inhibit angiogenesis associated with cancer cell proliferation. Human studies involving subjects with metabolic syndrome, type 2 diabetes and polycystic ovary syndrome have all show beneficial effects of whole cinnamon and/or aqueous extracts of cinnamon on glucose and lipid levels, insulin sensitivity, antioxidant status, blood pressure, lean body mass and gastric emptying. (Cinnamon: potential role in the prevention of insulin resistance, metabolic syndrome, and type 2 diabetes. J Diabetes Sci Technol. 2010 May 1;4(3):685-93).

A casca de canela tem um papel potencial na prevenção de muitas doenças, de acordo com uma revisão por autores americanos. Estudos recentes realizados in vitro e in vivo têm mostrado que a canela pode melhorar muitos dos factores associados ao desenvolvimento da síndrome metabólica e diabetes tipo 2, incluindo a resistência à insulina, elevação da glicose e dos lípidos, inflamação, diminuição da actividade antioxidante e ganho de peso. Além disso, a canela mostrou aliviar os factores associados à doença de Alzheimer e AVC isquémico. In vitro os estudos mostraram também que os componentes de canela inibem a angiogénese associada à proliferação de células cancerosas. Estudos em humanos envolvendo indivíduos com síndrome metabólica, diabetes tipo 2 e síndrome do ovário poliquístico têm mostrado efeitos benéficos da canela em seu todo e/ou extracto aquoso sobre os níveis de glicose e lípidos, sensibilidade à insulina, a capacidade antioxidante, pressão arterial, massa corporal e esvaziamento gástrico.

Acupunctura beneficia doentes com cancro

Acupuncture benefits cancer patients

Acupuncture treatment produces measurable benefits in symptom reduction and quality of life (QOL) for patients with advanced ovarian and breast cancer, according to US researchers. In a pilot, single-armed prospective trial, 40 patients with advanced cancer were enrolled to receive 12 acupuncture sessions over eight weeks, with follow-up at weeks 9 and 12. Among all 32 assessed patients, there was self-reported improvement immediately post-treatment in anxiety, fatigue, pain, and depression and significant improvement over time for patients with anxiety and depression. QOL measures of pain severity and interference, physical and psychological distress, life satisfaction, and mood states showed improved scores during treatment, with sustained benefit at 12 weeks. (Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients. Integr Cancer Ther. 2010 Jun;9(2):158-67).

O tratamento com acupunctura produz benefícios mensuráveis ​​na redução dos sintomas e da qualidade de vida (QV) para doentes com cancro do ovário avançado e cancro da mama, segundo pesquisadores dos EUA. Num estudo piloto prospectivo e com apenas um braço, 40 doentes com cancro avançado foram inscritos para receber 12 sessões de acupunctura ao longo de oito semanas, com avaliação nas semanas 9 e 12. Entre os 32 pacientes avaliados, houve melhoria auto-relatada logo após o tratamento na ansiedade, fadiga, dor e depressão; houve também melhoria significativa ao longo do tempo para nos doentes com ansiedade e depressão. As medidas de QV da severidade da dor, sofrimento físico e psicológico, satisfação de vida e estados de humor apresentaram melhoria nos scores respectivos durante o tratamento, que se mantiveram durante 12 semanas.

Tai chi e chá verde - benefícios ósseos para a mulher pós-menopáusica

Tai chi and green tea benefit women’s bone health

A study by an American research team has demonstrated that tai chi exercise (TC) and supplementation with green tea polyphenols (GTP) can benefit bone remodeling and muscle strength in postmenopausal women by reducing oxidative stress damage. One hundred and seventy-one postmenopausal women with osteopaenia (low bone mineral density) were divided into 4 groups: placebo - placebo pill plus no tai chi; GTP - green tea polyphenols (500 mg/day) plus no tai chi; placebo+TC - placebo pill plus tai chi (three times per week); GTP+TC - green tea polyphenols plus tai chi. The treatment phase of the study lasted for six months. The results showed that consumption of GTP (at a level equivalent to about four to six cups of steeped green tea daily) and TC independently enhanced markers of bone health. Both GTP and tai chi were also found to reduce levels of biological markers of oxidative stress, suggesting that they have anti-inflammatory activity. TC participants also reported significant beneficial effects in quality of life in terms of improved emotional and mental health. (Effect of green tea polyphenols and Tai Chi exercise on bone health in postmenopausal women with low bone mass: a 24-week placebo-controlled randomized trial.  HYPERLINK "http://www.fasebj.org/" FASEB Journal. 2011;25.

Um estudo realizado por uma equipa norte-americana demonstrou que a prática de Tai Chi (TC) e suplementação com os polifenóis do chá verde (GTP) podem beneficiar a remodelação óssea e a força muscular em mulheres no período pós-menopausa, reduzindo danos causados ​​pelo stress oxidativo. Cento e setenta e uma mulheres pós-menopáusicas com osteopenia (baixa densidade mineral óssea) foram divididas em 4 grupos: placebo - comprimido placebo adicionalmente à ausência de tai chi; GTP - os polifenóis do chá verde (500 mg/dia) e ausência de tai chi; placebo+TC - comprimido placebo mais tai chi (três vezes por semana); GTP + TC - os polifenóis do chá verde e tai chi. A fase de tratamento do estudo durou seis meses. Os resultados mostraram que o consumo de GTP (a um nível equivalente a cerca de 4-6 chávenas de chá verde por dia) e TC independentes melhoraram os marcadores ósseos. Ambos GTP e tai chi  também reduziram os níveis de marcadores biológicos de stress oxidativo, sugerindo que ambos têm uma actividade anti-inflamatória. As participantes que fizeram TC também relataram efeitos benéficos significativos na qualidade de vida em termos de saúde emocional e mental.

A acupunctura melhora a marcha em pacientes geriátricos

Acupuncture improves walking gait in elderly


A single acupuncture treatment at Yanglingquan GB-34 has been shown to significantly improve walking gait in geriatric patients. Sixty German patients receiving rehabilitation treatment on a geriatric ward were randomised to receive a one-time needle stimulation at Yanglingquan GB-34 or a technically identical needle stimulation at a non-acupoint. Gait performance was objectively measured on an electronic walkway before and after needling. All gait parameters showed statistically significant improvement after verum acupuncture compared with control treatment. (Stimulation of acupoint ST-34 acutely improves gait performance in geriatric patients during rehabilitation: A randomized controlled trial. Arch Phys Med Rehabil. 2011 Jan;92(1):7-14).


Neste estudo, um único tratamento com acupunctura em GB-34 mostrou melhorar significativamente a marcha em pacientes geriátricos. Sessenta pacientes alemães a fazer tratamento de reabilitação numa enfermaria geriátrica foram randomizados para receber um estímulo da agulha em GB-34 (acupunctura "verum") ou um estímulo da agulha tecnicamente idêntico noutro local do corpo que não seja ponto de acupunctura (acupunctura "sham"). O desempenho da marcha foi medido objectivamente numa passadeira eléctrica antes e depois da inserção. Todos os parâmetros da marcha apresentaram melhoria significativa após a acupunctura "verum" comparada com o tratamento controle (acupunctura "sham").


Apesar de se tratar de uma amostra pequena (sessenta pacientes), o resultado é promissor.

Acupunctura para a cervicalgia

Acupunctura para alívio da dor no trabalho de parto

Electroacupuncture at Sanyinjiao Sp-6 helps with labour pain

A Chinese study has concluded that electroacupuncture (EA) at Sanyinjiao SP-6 is an effective way of decreasing labour pain. A total of 350 women in labour were randomised to either electroacupuncture at Sanyinjiao SP-6, sham electroacupuncture at Sanyinjiao SP-6 or a control group. Self-rated labour pain scores from women in the verum electroacupuncture group were significantly less than in the control group after 30 minutes of needle retention and at two and four hours after needle withdrawal. Other evaluated outcomes did not show significant differences among the three groups. (Effects of Sanyinjiao (SP6) with electroacupuncture on labour pain in women during labour. Complement Ther Med. 2011 Jan;19 Suppl 1:S13-8).

Este estudo chinês concluiu que a eletroacupunctura (EA) em SP-6 é uma forma eficaz de diminuir a dor do parto. Um total de 350 mulheres em trabalho de parto foram randomizadas para eletroacupunctura em SP-6 (verum - verdadeira), eletroacupuntura sham (controlo) em SP-6 ou um grupo de controle. Os scores de auto-avaliação da dor no trabalho de parto das mulheres no grupo de eletroacupunctura verum foram significativamente menores do que no grupo controle após 30 minutos de retenção de agulha e em duas e quatro horas após a retirada da agulha (menor score corresponde a menos dor). Os outros parâmetros avaliados neste estudo não apresentaram diferenças significativas entre os três grupos.

The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial -- Sunay et al. 29 (1): 27 -- Acupuncture in Medicine

Abstract

Background Acupuncture is commonly used to treat menopausal symptoms and other gynaecological conditions. In this study, the authors aimed to investigate whether acupuncture has an effect on menopausal symptoms and to explore whether this effect is related to changes in hormone levels.

Materials and methods A total of 53 postmenopausal women were alternately assigned into two treatment groups: acupuncture (n=27) and sham acupuncture (n=26). Menopausal symptoms were assessed using the Menopause Rating Scale (MRS). The serum oestradiol, follicular stimulating hormone (FSH) and luteinising hormone (LH) levels were measured at baseline and again after the first and last sessions. The Student t test was used for normally distributed data and the Wilcoxon signed rank test for not normally distributed data. The group differences in MRS scores were assessed using non-parametric Mann–Whitney U test.

Results After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels.

Conclusion Acupuncture was effective in reducing menopausal complaints when compared to sham acupuncture and can be considered as an alternative therapy in the treatment of menopausal symptoms.

Immediate effect of acupuncture on the sleep pattern of patients with obstructive sleep apnoea

Abstract

Background Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG).

Objectives To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA.

Methods 40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00.

Results The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group.

Conclusion A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

Efeitos e mecanismos da Acupunctura no aparelho reprodutor

Effects and mechanisms of acupuncture in the reproductive system

The use of acupuncture to treat reproductive dysfunction has not been well  investigated. Only a few clinical studies have been reported, most of which are flawed by poor design and a lack of valid outcome measures and diagnostic criteria, making the results difficult to interpret. Experimental studies, however, show that acupuncture has substantial effects on reproductive function. Here we review the possible mechanisms of action of acupuncture on the reproductive system and its effects on reproductive dysfunction, focusing in particular on polycystic ovary syndrome, the most common endocrine and metabolic disorder in women.

Clinical and experimental evidence demonstrates that acupuncture is a suitable alternative or complement to pharmacological induction of ovulation, without adverse side effects. Clearly, acupuncture modulates endogenous regulatory systems, including the sympathetic nervous system, the endocrine system, and the neuroendocrine system. Randomized clinical trials are warranted to further evaluate the clinical effects of acupuncture in reproductive disorders.