Acupuncture for Curing Tension-Type Headache - Research Proposal Example

Acupuncture in patients with tension- type headache Everyday, physicians are faced with disease, illness, suffering, and death. Ever since the early days, the medical profession has aimed to help cure, treat, comfort, and save the lives of those who seek help. The goals of medicine are geared towards the prevention of disease and injury and promotion and maintenance of health, the relief of pain and suffering caused by maladies, the care and cure of those with a malady, and the avoidance of premature death and the pursuit of a peaceful death. It is toward these goals that all medical education, research, practice and health care delivery should be aimed. There are varied modes of treatment in the world today, and one of these emerging disciplines is Complementary and Alternative Medicine. Many CAM practices have value for the way their practitioners manage health and disease. However, most of what is known about these practices comes from small clinical trials. As credible research continues on CAM, expanded options for managing clinical conditions will soon arise. Among the CAM practices, the use of acupuncture in treating pain is now becoming widely studied. Thus this paper aims to examine a wide range of literature regarding the effect of acupuncture on tension-type headache. Specifically, it seeks to define and review the basics of acupuncture; it will attempt to review a few clinical trials regarding the effect of acupuncture on tension-type headache and then, it will provide recommendations related to the use of acupuncture in tension-type headache. Review of Related Literature: Medical acupuncture is acupuncture that has been adapted for medical or allied health practices in Western countries. Acupuncture is derived from Asian and European sources and is practiced in both pure and hybrid forms. The foundation of medical acupuncture is the therapeutic insertion of solid needles in various combinations and patterns. The choice of needle patterns can be based on: Traditional principles, such as encouraging the flow of Qi (a subtle vivifying energy) through classically described acupuncture channels Modern concepts, such as recruiting neuroanatomical activities in segmental distributions A combination of traditional and modern concepts In the United States, acupuncture has been increasingly embraced by practitioners and patients since the landmark 1971 New York Times article by James Reston describing his successful postappendectomy pain management with acupuncture. (Reston, 1971) Before that time, acupuncture had been practiced only in urban Asian communities, discreetly and primarily by and for Asians. In the early 1970s, widespread enthusiasm for acupuncture was fueled by reports from physician visitors to China who witnessed surgical analgesia using only acupuncture needles. Respect for the technique grew in the medical and scientific communities in the late 1970s, when acupuncture analgesia demonstrated a link to the central nervous system activities of endogenous opioid peptides and biogenic amines. Since the 1970s, guidelines for education, practice, and regulation in acupuncture have been established and implemented. Also, state, regional, national, and international societies have evolved to represent the interests of groups of practitioners. Acupuncture is one discipline extracted from a complex heritage of Chinese medicine, a tradition that also includes massage and manipulation, stretching and breathing exercises, herbal formulae, and exorcism of demons and magical correspondences. Acupuncture has evolved over two millennia, both through refinements based on treatment responses and through adaptations to changing social situations. The language in classical acupuncture texts reflects nature and agrarian village metaphors and describes a philosophy of humans functioning harmoniously within an orderly universe. The models of health, disease, and treatment are presented in terms of a patients harmony or disharmony within this larger order; and these models involve the patients responses to external extremes of wind, heat, damp, dryness, and cold and to internal extremes of anger, excitement, worry, sadness, and fear. Likewise, illnesses are described and defined poetically: by divisions of the Yin and Yang polar opposites, by descriptors attached to elemental qualities (e.g., wood, fire, earth, metal, and water), and by the functional influences traditionally attached to each of the internal organs. The classical anatomy of acupuncture consists of energy channels traversing the body. The principal energy pathways are named for organs whose realms of influence are expanded from their conventional biomedical physiology to include functional, energetic, and metaphoric qualities. For example, the Kidney supervises bones, marrow, joints, hearing, head hair, and will and motivation; and the Spleen oversees digestion, blood production, blood-related functions (e.g., menstruation), and nurturing and introspection. Acupuncture anatomy is a multilayered interconnecting network of channels that establishes an interface between an individuals internal and external environments and permits energy to move through the muscles and the various organs. The most superficial of these pathways are the tendinomuscular meridians, which are an interface between the organism and its external environment. These meridians provide the first defense for the bodys response to climatic conditions and external traumas. The principal meridians travel through the muscles and provide nourishment to all tissues and vitality for animation and physical activity. The distinct meridians go directly from the surface of the body deep to the organs, and they allow the nourishment and the energy produced by the organs to circulate throughout the body. Finally, a system of pathways called the curious meridians creates connections among the principal acupuncture channels and serves as energy reservoirs for extreme conditions of emptiness or fullness. These meridians and their connections form a network of energy circulation that is organized into three bilaterally symmetric plates that divide the body into six sagittal territories of influence. Each plate manifests the energy derived from four organs as it circulates in their anatomic territory of influence. Methodology This is a descriptive study which utilized various qualitative data from the journals in electronic databases which describe quantitative studies This study has compiled 3 studies related to the use of acupuncture in patients with tension type headache. Whereas previous reviews have been descriptive, the aim of this review is to quantify the evidence in as unbiased a manner as possible. At the same time, the review also aims to analyze qualitative research and consider how findings from this literature complement the quantitative literature Discussion of Findings There were three studies which were reviewed in this paper. The study of Melchart et al in 2005 will be compared with two other literatures concerning the use of acupuncture in tension type headache: A study by Loh et al (1986) and that done by Vickers et al (2001). The results of these trials will be compared as to effective reduction of days with tension headache and health status. The study of Melchart et al (2005) showed that the number of days with headache decreased by 7.2 (SD 6.5) days in the acupuncture group compared with 6.6 (SD 6.0) days in the minimal acupuncture group and 1.5 (SD 3.7) days in the waiting list. The proportion of responders (at least 50% reduction in days with headache) was 46% in the acupuncture group, 35% in the minimal acupuncture group, and 4% in the waiting list group. This study concluded that acupuncture in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache. The study of Vickers et al in 2000 also revealed similar results. This randomized control trial in UK utilized 401 patients with chronic headache. Patients were randomly allocated to receive up to 12 acupuncture treatments over three months or to a control intervention offering usual care. Main outcome measures were headache score, SF-36 health status, and use of medication were assessed at baseline, three, and 12 months. It was found out that headache score at 12 months, the primary end point, was lower in the acupuncture group (16.2, SD 13.7, n = 161, 34% reduction from baseline) than in controls (22.3, SD 17.0, n = 140, 16% reduction from baseline). Patients in the acupuncture group experienced the equivalent of 22 fewer days of headache per year (8 to 38). SF-36 data favoured acupuncture, although differences reached significance only for physical role functioning, energy, and change in health. Compared with controls, patients randomised to acupuncture used 15% less medication (P = 0.02), made 25% fewer visits to general practitioners (P = 0.10), and took 15% fewer days off sick (P = 0.2). Thus this study concluded that acupuncture leads to persisting, clinically relevant benefits for primary care patients with chronic headache, particularly migraine. A study made by Loh in compared a prophylactic course of acupuncture with medical treatment for muscle tension headaches. It was intended that all patients should have 3 months with both forms of treatment, but 19 were unwilling to change from one form of prophylaxis to the other. Twenty-four of 41 patients improved on acupuncture, the improvement being very marked in nine; nine of 36 patients improved on medical treatment, the improvement being marked in three. Of the 29 patients who changed from one form of treatment to the other, a larger proportion preferred acupuncture to medical treatment. A beneficial response to acupuncture was more likely when the patient had local tender muscular points. The presence of depressive features did not preclude satisfactory treatment with acupuncture. No major side effects were encountered with acupuncture. Since the late 1970s, acupuncture analgesia has been demonstrated to activate the endogenous opioid peptide system and thereby influence the bodys pain regulatory mechanism by changing the processing and perception of noxious information at various levels of the central nervous system. Two model systems of acupuncture analgesia have been advanced: the endorphin-dependent system, which involves low-frequency, high-intensity electrical stimulation of acupuncture needles (2 to 4 Hz) that is slow in onset, generalized throughout the body, and cumulative on subsequent stimulation. The other is the Monoamine-dependent system, which involves high-frequency, low-intensity electrical stimulation of acupuncture needles (70 Hz or greater) that is rapid in onset, segmental, and not cumulative. (Stux, 1987) By combining the neurohumoral models with other observations and speculations about the mechanism of acupunctures effect, a physiological model is created of an acupuncture needle simultaneously activating multiple systems in the bodys physiology. This model involves the nervous system, which includes peripheral afferent transmission, perivascular sympathetic fiber conduction, and the central neurohumoral and neuropeptide mechanisms. This also involves the blood circulation system, which transmits locally, and centrally biomolecular elements and the biochemical and cellular changes stimulated by acupuncture in the periphery. The lymphatic system is also involved because it serves as a medium for ionic flow along fascial planes and perivascular interstitial fluid circulation. Lastly, the electromagnetic bioinformation system is also involved, which consists of static electricity on the surface, ionic migration in the interstitial fluid between the needles and as currents of injury at the needled site, and fascial and perineural semiconduction throughout the body. (Stux, 1987) These considerations are of special importance in acupunctures application in pain management, in which knowledge of dermatomal, myotomal, sclerotomal, and autonomic innervation patterns is indispensable. Perhaps these are the reasons which can help explain why acupuncture is effective in managing tension type headache in these three separate trials. (Stux 1987) Conclusion: In summary, we have reviewed three literatures which dealt with the effectiveness of acupuncture in tension type headache. Thus, we can conclude that acupuncture is a safe and effective method in eliminating and controlling tension and migraine headaches in the population. Further studies should be done regarding this matter. The government should also fund studies such as these, considering that headache is a common disorder which causes people to spend thousands of dollars each year for pain relief. Thus with the discovery of alternative pain relief methods, our people will be able to shift to inexpensive yet effective means to get rid of tension and migraine headaches. References: 1. Arber, S. (1993) Designing samples. In Gilbert, N (ed) (1993) Researching social life. 3rd ed. London: Sage 2. Bell J.(1993) Doing your research project. Open University Press; 2nd edition 3. Bowling, Ann. (1997) Research methods in health: Investigating health and health services. Open University Press. 4. Boynton, M. (2005). The research companion: a practical guide for the social and health science. Psychology Press; 1st edition 5. Bryman, Alan. (2004) Social research methods. Oxford University Press, USA 6. Hart, Chris. (1998). Doing a Literature Review: releasing the social science research imagination. Sage Publications Ltd 7. Loh, P W Nathan, GD Schott, and K J Zilhha. Acupuncture versus medical treatment for migraine and muscle tension headaches. J Neurol Neurosurg Psychiatry. 1984 April; 47(4): 333–337 8. Macpherson, Hugh. (2007) Acupuncture Research: Strategies for Establishing an Evidence Base. Elsevier Publishers. pp 57-75 9. Melchart D et al. (2005). Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ. 2005 August 13; 331(7513): 376–382. doi: 10.1136/bmj.38512.405440.8F. 10. Reston J. Now about my operation in Peking. The New York Times 1971; July 26:1, 6. 11. Robson, Colin. (2002) Real World Research: A Resource for Social Scientists and Practitioner-Researchers, 2nd Edition. Wiley-Blackwell. 12. Stux G, Pomeranz B. Acupuncture: textbook and atlas. Berlin: Springer–Verlag, 1987:1–26. P.354 13. Vickers A et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004 March 27; 328(7442): 744. doi: 10.1136/bmj.38029.421863.EB. Read More