Acupuncture In The Management Of Migraine - Literature review Example

Literature Review on the Clinical Application and Evaluation of Acupuncture Name: University: Date: Literature Review on the Clinical Application and Evaluation of Acupuncture Introduction In acupuncture migraine research, evaluation of techniques of needling, treatment duration, acupuncturists’ background as well as suitable control interventions are seldom. Besides that, lack of standardized methodologies to acupuncture treatments has frustrated reproducibility of data. Basically, acupuncture was introduced over 25 centuries ago and is still the ancient medicinal practices performed across the globe. Generally, acupuncture connotes a set of procedures, which includes anatomical points’ stimulation on the body through various techniques. This technique has been studied scientifically and involves using needles (metallic, solid and thin) to penetrate the skin with stimulation by electrical devices or hands. For centuries, acupuncture has traditionally been used to treat a number of pain conditions such as migraine. A number of studies as it will be evidenced in the literature review have studied acupuncture effectiveness for headaches, especially for tension-type headache (TTH) as well as migraine. In view of this, existing controlled studies about other primary headaches such as cluster headache are very few. In this paper, a literature review of contemporary research findings on the clinical application and evaluation of acupuncture. Literature Review In migraines treatment, Plank and Goodard (2009) assert that acupuncture is one of the widely accepted as well as universally researched complementary and alternative medicine (CAM) remedies. Acupuncture is currently utilised extensively in the health care of soldiers, marines and sailors. Presently, acupuncture as mentioned by Plank and Goodard (2009) is utilised for management of pain as well as other conditions in various medical treatment facilities, particularly in the military. Plank and Goodard (2009) pilot study utilised a uniform set of recognized acupuncture points for a certain time interval on 26 patients that were experiencing chronic headache every day, most being migraineurs. They established a reduction in the intensity as well as frequency and of the patients’ headaches. That is to say, there was decrease in the use of pain medication between the end of treatment and baseline measures, wherein acupuncture failed to generate a common efficacy drug curve subsequent to the termination of the treatment. A migraine as indicated by Wang, Xue, Helme, Costa, and Zheng (2015) is a primary headache that is exceedingly prevalent, afetcing11 per cent to 16 per cent of the total population. Migraine is ranked 19th in the world amongst the most prevalent disease which bring about disability, and it is more prevalent to people aged between 25 and 55 years. For this reason, migraine has an effect on a large number of adults, especially those in the productive stage. According to Wang, Xue, Helme, Costa, and Zheng (2015), more than 90 per cent of migraineurs become functional impaired. Therefore, acupuncture is considered to be a safe and effective treatment for temporary relief for common migraine. Wang, Xue, Helme, Costa, and Zheng (2015) argue that, acupuncture may be utilised as safe as well as alternative prophylaxis for daily migraine, and they recommend that migraine sufferers should be treated twice every week for a minimum eight weeks. Besides that, use of medication should be reduced at the time of acupuncture treatment. In spite of the continuous advancement in the pharmacologic treatment as well as diagnosis of migraine, Liguori et al. (2008) argue that the outcome achieved is unreliable. For this reason, other non-pharmacologic treatments such as acupuncture have gradually been supported and utilised in different countries, especially in the Western World. Liguori et al. (2008) argued that a closer relationship between patient and physician generated by the Traditional Chinese medicine (TCM) approach can impact the treatment positively, by means of an iatroplacebogenesis instead of a mere placebo. Liguori et al. (2008) study results indicate that migraine prophylaxis can be managed effectively by the traditional acupuncture. Acupuncture, as argued by Deng et al. (2012) with its unique advantages as well as features is currently utilised for treating different types of neurological disorders. Still, acupuncture benefits are yet to be discerned from the health economics perspective. Essentially, health economics is concerned with the optimisation of healthcare resources allocation. In, China due to the inadequate health resources, more evaluations on health economics are required so as to offer evidence for best healthcare resources allocation. Therefore, Deng et al. (2012) study was the first Chinese acupuncture treatment economic evaluation for migraine. In Shaoyang meridians, amongst the studied groups, Deng et al. (2012) established that acupuncture utilising certain acupoints was economical and the most effective. They further established that migraines were managed effectively through acupoints rather than non-acupoints. TCM theory as explained by Deng et al. (2012) treatment through genuine acupoints is more efficient as compared to non-acupoints treatment rooted in certain physiological effects associated with meridians as well as meridian (Qi) collections. Foroughipour et al. (2014) asserts that migraine treatment can be either abortive (rescue) or prophylactic (preventive), and treating attacks involves utilisation of intravenous analgesics, triptans (subcutaneous, nasal or oral) as well as common oral analgesics. Migraine as stated by Foroughipour et al. (2014) is a multifaceted condition wherein the causes vary amongst persons; therefore, preventive techniques must target the force resulting in the attack. Foroughipour et al. (2014) clinical trial exhibited a noteworthy drop in migraine headache attacks subsequent to the addition of the acupuncture to traditional prophylactic drugs. After 30 days, in comparison to the baseline, Foroughipour et al. (2014) noted a considerable reduction in the number of migraine headache attacks. Migraine headache attacks as observed by Evans (2012) can be managed by acupuncture, cognitive behavioural therapy, biofeedback as well relaxation therapy. Even though, surgical treatments such as deactivating trigger points bariatric are becoming prevalent, Evans (2012) believes that they are not suitable for the majority of migraine sufferers. Still, Evans (2012) established that acupuncture point injection using safflower seed was more efficient in subjects having migraine. A key indication for acupuncture therapy according to Yang et al. (2012) is migraine, and that randomized controlled trials (RCTs) proves that acupuncture in contrast to other therapies, is effective for managing migraine through reduction of medication use. Citing a number of studies Yang et al. (2012) posits that genuine acupoints stimulation is more effective as compared to non-acupoints stimulation in preventing aggravation or relapse of migraine and in relieving pain. Still, acupuncture as exhibited by evaluation of clinical trials is an efficient treatment alternative for migraine prophylaxis. Yang et al. (2012) in their study used persons with migraine as subjects so as to examine specificity of the acupoints. They established that integral to the acupuncture effect on people with migraines is the limbic system. Therefore, Yang et al. (2012) believe that traditional acupoints stimulation commonly utilised clinically for treatment of migraine, can deactivate brain regions related to pain or migraine. Molsberger et al. (2006) in their study reviewed verum acupuncture as conducted in the national German Acupuncture Trials (GERAC), which was examined against sham acupuncture for people with TTH or Migraine. As observed by Molsberger et al. (2006), there exist no recognized guidelines for carrying out a steady sham or verum treatment. For this reason, in GERAC the intention was developing a semi-standardized protocol for verum acupuncture therapy that is accepted extensively, which closely look like Chinese acupuncture therapy, so as to be conducted in a real-life setting even under RCT environment limitation. Acupuncture as asserted by Zheng et al. (2010) is an economical treatment for primary headache patients in line with global cost- effectiveness threshold values; still, a number of acupuncture protocols can be utilised in migraine treatment. According to Zheng et al. (2010) acupuncture treatment course as well as point selection in the acupuncture therapy trials lacks standardisation. For that reason, even though several acupuncture therapy trials performed for primary headache with the intention of addressing whether there is dissimilarity between sham acupuncture as well as verum acupuncture, Zheng et al. (2010) posit that it is hard to discern due to the results’ heterogeneity. Therefore, unavailability of standardised acupuncture protocol relatively illuminates the results’ heterogeneity amongst the acupuncture treatment trials. In view of this, Zheng et al. (2010) suggest that there is urgent need for an optimal as well as standardized acupuncture protocol for treating primary headache, regardless of the clinical studies. According to White (2005), auricular acupuncture (AA) is an efficient way of treating different pain conditions; still, there are no RCTs on using AA for acute postoperative pain treatment. For complementary pain relievers (analgesics), White (2005) evaluated wether auricular acupuncture of particular points is more effective than sham acupuncture. In the study, people with migraine were allocated randomly so as to get true auricular acupuncture or sham procedure, and it was established that AA is effective for reducing requirement of postoperative pain relievers. Linde et al. (2003) in their study designed a sham acupuncture intervention with the intention of minimising the possible physiological effects of migraine by superficially needling at points far from the ‘true’ treatment points segments as well as by utilising fewer needles as compared to the acupuncture group. They noted a strong reaction to the sham acupuncture; therefore, the results are evidently clinically appropriate. The intervention according to Linde et al. (2003) reduced the migraine attacks frequency by half, and the achieved improvement lasted for a number of months. This rate of response as observed by Linde et al. (2003) when compared to that witnessed during treatment by analgesics demonstrated to be the efficacious migraine prophylaxis. Headache as indicated in Sun and Gan (2008) study is a main neurobiological disorder, which affects almost 70% of the population in the world. In the United States alone, almost 10 million persons go to hospital for chronic headache. Sun and Gan (2008) argue that even though pharmacological alternatives are still the backbone of headache management strategy, scores of patients are still suffering, and this in turn, affects their normal day-to-day activities. Sun and Gan (2008) systematic review proves the effectiveness of acupuncture in treating chronic headache. They argue that acupuncture when compared to sham; it is somewhat superior with a response rate that is considerably higher for people with tension-type headache and migraine. Acupuncture reduced the intensity of headache. Fascinatingly, Sun and Gan (2008) in their subgroup analysis established that acupuncture was more efficient in lessening the intensity of headache as compared to sham in TTH, but failed to yield the same results for migraine. In comparison to waiting list and pharmacological options, Sun and Gan (2008) noted that acupuncture was successful in reduction of headache frequency and intensity. These sentiments are echoed by Rezvani et al. (2014) who posit that Traditional Chinese acupuncture (TCA) is a suitable treatment technique for primary headache such as migraine. In their study, resentence compares the therapeutic effect of TCA with the Yamamoto new scalp acupuncture (YNSA) for the treatment as well as prophylaxis of migraine. The study results indicated that both TCA as well as YNSA could effectively reduce migraine attacks’ severity as well as frequency. As observed by Rezvani et al. (2014), both TCA and YNSA techniques reduced equally the necessity for medications and improved the patient day-to-day activities. Concerning the effectiveness as well as low acupuncture techniques’ complication rate, Rezvani et al. (2014) believe that this treatment is a suitable substitute for medication for migraine patients. Their study results prove that acupuncture technique has almost no effect on the outcome; thus, indicating that effects that are specific to point play an insignificant part in the entire response. Rezvani et al. (2014) conclude by saying YNSA is more feasible and efficacious modality because it needs less needling as compared to TCA.A human body as mentioned by Göksel (2013) has over 12 meridians as well as 324 acupuncture points. Even though, the Chinese medicine believed that the meridians cannot be expounded by contemporary research tools, Göksel (2013) posits that there are a number of theories concerning how acupuncture works. Practically, acupuncture needle insertion stimulates C fibres as well as A-delta and when the brain perceives the stimulation it produces the opioid peptides (enkephaline, endorphin, dynorphin). Prophylaxis and acupuncture meta-analysis study for primary headaches was examined in Göksel (2013) study, which involved 4,419 patients in 22 RCTs. in this case, six RCTs contrasted conventional acupuncture with standard or no prophylactic treatment; while fourteen RCTs compared sham acupuncture with real acupuncture. The study results exhibited that more benefit is offered by acupuncture as compared to acute treatment or routine care. But there was no prove exhibiting that true acupuncture is more efficacious as compared to sham acupuncture. Schiapparelli et al. (2011) in their study conducted two large trials to compare acupuncture to routine care or acute headaches treatment. In both trials, statistical results indicated substantial and clinically valuable temporary benefits (nearly three months) of acupuncture in reducing the pain intensity as well as the number of headache per day. Citing previous RCTs that had examined addition of acupuncture to basic care, Schiapparelli et al. (2011) posit that results from these trials indicate a drop in the number of migraine days for patients using acupuncture treatment. Besides that, RCTs comparing sham acupuncture with true acupuncture, noted a little improved effects in patients having true acupuncture. In sum, Schiapparelli et al. (2011) study akin to other studies provides evidence that acupuncture is a valuable and helpful alternative for patients having migraine or TTH.Li et al. (2012) in their study established that the difference for patients of migraine after four weeks was minimal when sham acupuncture is used, but after 16 weeks, there was a clinically slight effect. According to Li et al. (2012), acupuncture therapy effect on migraine prophylaxis is clinically minor than that of sham acupuncture. Therefore, acupuncture style as observed by Li et al. (2012) has small significance on the outcome. For instance, Shaoyang point-specific acupuncture failed to yield improved outcomes as compared to other acupuncture points, and this according to Li et al. (2012) indicate that effects that are specific to points play a negligible part to the whole effect. Li et al. (2012) study results indicated that non-specific effects (such as interaction between patient and practitioner as well as expectations) play a crucial role and is heightened by utilization of electro-stimulation. Fofi et al. (2014) study proposes an acupuncture protocol and another integrated with verapamil for Cluster headache (CH) patients. In the study, four patients are reviewed; one having chronic Cluster headache while the other three had episodic Cluster headache. In this case, every patient has to adhere to the same protocol (fourteen treatments) as well as a set of standardized acupuncture points. The study results indicated that acupuncture was an effective treatment option for the four patients (Fofi et al., 2014). The patients responded well to Sumatriptan injection for acute treatment, but failed to react well to normal pharmacological preventive treatment. Harrison and Hilmi (2014) in their study focus on a 53-year-old woman isolated unilateral hypoglossal nerve injury brought about by ipsilateral acupuncture while treating migraines. According to Harrison and Hilmi (2014), the palsy was partial without transient as well as the related dysarthria while further imaging and examination was negative. Evidently, injuries on , cranial nerve caused as a result of acupuncture treatment have not been studies, but in theory are risky considering the cranial nerves location in the neck. Harrison and Hilmi (2014) think that, anatomical understanding is crucial for practitioners who administer the treatment as well as those who review patients for probable complications. Basically, acupuncture can result in transient isolated nerve palsy, which may be an indication of a malady. Therefore, examinations must be done to establish the cause and reassurance as well as observation can be employed as a suitable management strategy if the cause is not found. Harrison and Hilmi (2014) suggest that if the main cause is not established, the practitioners should offer repeat imaging for some yeas so as to make sure the underlying demyelinating condition does not progress. In their study, Wallasch et al. (2012) compares vasotonus pre- and post-acupuncture transcranial Doppler sonography (f-TCD) measurements with their results exhibiting no substantial dissimilarity between the parameters studied. As indicated by Wallasch et al. (2012), migraine is a neurovascular headache syndrome. A number of studies carried out though TCD has exhibited hemodynamic abnormalities in people having migraines at the time of migraine attack. Besides that, augmented flow velocities of the baseline were noted in the basal cerebral arteries on patients with migraine. Even though, acupuncture as mentioned by Cabýoglu, Ergene, and Tan (2006) has been used to treat different symptoms and diseases, the acupuncture’s effects mechanisms are yet to be comprehended fully. Still, due to the research efforts made by a number of scientists, it is now evident that acupuncture application increases the the levels of neurotransmitters like serotonin, encephalin, beta endorphin as well as endomorphin- 1 increase in brain and plasma tissue. Besides that, acupuncture in metabolism has lipolithic effects while on the immune system has immunomodulator effects (Cabýoglu, Ergene, & Tan, 2006). Due to such effects, acupuncture application has increased tremendously across the globe in the treating migraine, metabolic diseases, psychological illnesses, gastrointestinal disorders as well as motor function disorder and other forms of pain. The traditional techniques of acupuncture according to Sierpina and Frenkel (2005) have achieved substantial acceptance in the contemporary society, especially amongst non-Asian communities. Due to its lengthy history of application, efficacy and safety, Sierpina and Frenkel (2005) posit that more patients with migraine prefer acupuncture. Even though in-depth clinical trials of acupuncture benefits in addition to the comprehension of its action mechanism are far behind its extensive application, physicians should understand how they can use it to treat their patients with migraine. According to Lee and Zaslawski (2009), acupuncture can be used to treat brought about by substance withdrawal, as widely utilized in the West. The connection between acupuncture as well as substance abuse was studied extensively by the protagonists of acupuncture who argued that a traditional, ancient medicine may be utilized to treat ‘contemporary diseases’. Most literature in this area was stirred by Smith’s revolutionary work with patients of drug abuse, primarily heroin in the 1970s. In view of this, Lee and Zaslawski (2009) posit that Smith’s work attracted a number of acupuncture practitioners who started using acupuncture to solve intractable social as well as public health concern such as drug abuse. Acupuncture is widely used in Australia to treat substance abusers by means of acute detox phase. This proves that, does not only help in treating medical conditions, but also has a noteworthy psychic and social dimension to the health care. Nearly 14 per cent of female with migraines experience it during their menstruation cycle while a staggering 60 per cent have migraine both during their menses as well as other times in what Zhang et al. (2013) terms as menstrual-related migraine (MRM)). Most of the studies that focus on this topic have noted that MRM results in limitations of day-to-day as well as the migraine attacks are normally more severe, longer as well as less responsive to drugs as compared to non-menstrual migraines. In considering the clinical picture epitomizing MRM, Lay and Payne (2007) posit that MRM attacks cannot be handled easily. However, acupuncture treatment has been underlined as the safer and most effective way of treating MRM as compared to topirmarate. Citing a number of studies, Zhang et al. (2013) argue that acupuncture is the most effective of reducing the frequency of migraine attacks than flunarizine; for this reason, acupuncture should be utilized to treat MRM. Scott and Deare (2006) argue that research should focus more on the maximization of acupuncture therapeutic effects. Besides that, migraine patients should be advised to utilize the acupuncture treatment so as to reduce migraine severity, both alone and together with medication. Scott and Deare (2006)further state that the optimum acupuncture protocol is yet to be established through clinical trials; still, both deep as well as shallow needling methods at different points have proved to considerably improve the clinical outcomes Summary In summary, this paper has provided a literature review of contemporary research findings on the clinical application and evaluation of acupuncture. As argued by a number of studies reviewed in the paper, acupuncture is an effective option for treating migraine. As indicated in the literature review, treatment by utilizing specific meridians acupoints is more effective and economical as compared to non-acupoints. In consequence, this represents a significant progress in the life quality for patients with migraine as well as a considerable drop in cost of treatment. References Cabýoglu, M. T., Ergene, N., & Tan, U. (2006). The mechanism of acupuncture and clinical applications. 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Liang, F. (2012). A PET-CT study on the specificity of acupoints through acupuncture treatment in migraine patients. Complementary and Alternative Medicine, 12, 123-129. Zhang, X.-Z., Zhang, L., Guo, J., Zeng, L., Yang, Y., Zhang, T., . . . Wang, L.-P. (2013). Acupuncture as prophylaxis for menstrual-related migraine: study protocol for a multicenter randomized controlled trial. Trials, 14, 374-380. Zheng, H., Chen, M., Wu, X., Li, Y., & Liang, F.-R. (2010). Manage Migraine with Acupuncture: A Review of Acupuncture Protocols in Randomized Controlled Trials. The American Journal of Chinese Medicine, 38(4), 639–650. Read More