Contemporary Evidence-Based research pertaining to Integrative and Mind-Body Therapies.
Acupuncture’s efficacy in treating chronic pain conditions:
A systematic review of over 17,000 randomly controlled trials found acupuncture effective for chronic pain and therefore a reasonable referral option.
In the case of osteoarthritis the use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life…Current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.
Acupuncture was given an evidence rating of “A”, the same rating given to analgesics, such as acetaminophen and Ultram, and non-steroidal anti-inflammatory medications (NSAIDs).
Acupuncture’s efficacy the treatment of depression:
Standard acupuncture as well as auricular acupuncture has often been prescribed for mental and emotional disorders, such as depression. In this particular study researchers demonstrated that 3 particular auricular acupuncture points stimulated with an active electrical current, over the course of 3 days, can improve various aspects of quality of life significantly and also increased HRV, a potential indicator for state of health.
Acupuncture’s efficacy in treating gastrointestinal disturbances:
A review of studies from both Chinese and Western Medicine literature suggests acupuncture at ST-36 suppresses hyperfunction (as in diarrhea), and stimulates hypofunction (as in constipation) of the gut motility.
Acupuncture’s efficacy in treating gynecological disorders:
In regards to dysmenorrhea woman who were experiencing painful menstruation were instructed to follow a once a week acupuncture treatment for one year. In this controlled trial, 10 of the 11 woman (90.9%) showed improvement and there was a reduction of 41% analgesic medication used.
Acupuncture’s efficacy in treating hypertension and lowering blood pressure:
Acupuncture stimulation at meridian points pericardium 5-6 and Large Intestines 10-11 are effective at reducing reflex-induced hypertension, a visceral reflex of the sympathetic nervous system. Researchers in this study found that acupuncture elicits specific modulation effects in the endocrine system as well as in inhibiting the rostral ventrolateral medulla(rVLM). Overall researchers have uncovered several mechanisms that might be involved in the long-lasting inhibitory action of acupuncture in hypertension.
In a study of 65 patients with both stage I and II hypertension acupuncture resulted in a hypoaldosteronemic effect, which showed statistical correlation with a decrease in blood pressure. These results suggest that acupuncture has a therapeutic role in the treatment of hypertension.
Acupuncture administered in the auricle as well as standard points administered on 360 patients produced a hypotensive effect on patients with essential hypertension. The effect was noted on 82% of patients to reduce excretion of adrenaline, inhibit plasma renin, and normalize lipid metabolism. The hypotensive effect in the majority of patients persisted for 12 months.
Acupuncture’s efficacy in treating migraine headaches:
The results of this study showed a clinically relevant decrease in MMP-2 activity in patients with migraine treated with acupuncture. The mechanism underlying the effect of acupuncture in alleviating pain may be associated with a decrease in MMP-2 activity.
A study found that acupuncture was equipotent to that of the pharmaceutical metoprolol in the reduction of frequency and duration of migraine attacks, and had fewer negative side-effects.
Acupuncture’s efficacy in treating multiple sclerosis:
A demyelinating disease such as multiple sclerosis is a condition where the protective and conductive sheath that wraps around a nerve bundle is damaged. In a experimental Japanese study on rats researchers investigated whether EA(Electro Acupuncture) performed on the governing meridian could efficiently promote increase in cell number of OPCs or Oligodendrocyte precursor cells. OPCs are one of the potential treatment tools for dealing with multiple sclerosis. After 15 days of treatment with EA, NT-3 a neutrotrophic factor in NGF(Nerve Growth Factor) as well as NG-2 positive OPCs were significantly increased suggesting that EA treatment can promote remyelenation in a demyelinated spinal cord.
Acupuncture’s efficacy in treating post-stroke disorders:
Meta-analysis results showed that twelve studies reported significant effects of Baihui (GV20)-based scalp acupuncture for improving infarct volume compared with middle cerebral artery occlusion group (P < 0.01), and thirty-two studies reported significant effects of Baihui (GV20)-based scalp acupuncture for improving the neurological function score when compared with the control group (P < 0.01). In conclusion, Baihui (GV20)-based scalp acupuncture could improve infarct volume and neurological function score and exert potential neuroprotective role in experimental ischemic stroke.
A meta analysis of 24 systemic reviews concluded that acupuncture may be effective for post-stroke dysphagia, or trouble swallowing. Performance on the video-fluoroscopic swallowing study test often reported that acupuncture was superior to the control treatment.
Acupuncture’s efficacy in treating sleep disorders:
The aim of this study was to examine the subjective self-reported sleep quality of post-menopausal women and cardiac sympathovagal activity after receiving auricular acupressure therapy. A group of 45 women having had insomnia for several years were treated with a course of 5 auricular points every night before going to sleep for 4 weeks. The study concluded that after 4 weeks, total sleep duration and efficiency were increased as well as the length of time it takes to accomplish the transition from full wakefulness to sleep. The research team suggested that the auricular acupressure intervention lead to more cardiac parasympathetic and less cardiac sympathetic activity, which contributed to an overall improvement in post-menopausal insomnia.
Acupuncture’s efficacy in treating tinnitus:
This controlled study aimed to assess how acupuncture, stretching, and posture training could benefit somatically related tinnitus. The researchers found a significant reduction in the severity of tinnitus in the treatment group, both after treatment and on a follow-up after 3 months. The team gathered that this method may be a useful alternative to somatosensory tinnitus.
Acupuncure and adenosine release:
Adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.
Acupuncture and the biochemical importance of needle manipulation:
The interstitial adenosine concentration increased significantly during acupuncture and remained elevated for 30 minutes after the acupuncture. Acupuncture-mediated adenosine release was not observed if acupuncture was not delivered in the Zusanli point or if the acupuncture needle was inserted, but not rotated.
Acupuncture and neuronal specificity:
This study investigated the specific brain regions that were activated with fMRI(functional magnetic resonance imaging) while the researchers stimulated specific [EA] electroacupuncture points. The study illustrated that different areas of the brain were activated based on point specificity as well as needle depth and sensitivity applied. Specifically, they concluded that EA at analgesic acupoints of same meridian maybe involved the pain-related neuromatrix especially the hypothalamus-limbic system; deep EA at meridian points could elicit stronger needling sensation and modulate the pain-related neuromatrix more effectively than EA at nonmeridian points or shallow EA at meridian points.
Few have investigated how acupuncture stimulated brain regions interacted at the whole brain level. A team of researchers with the help of brain scan technology divided the whole brain into 90 regions and analyzed functional connectivity following acupuncture at specific points. Their findings demonstrated that acupuncture at different acupoints may exert different modulatory effects on the post-stimulus resting brain, providing new evidences for the relatively function-oriented specificity of acupuncture effects.
Many studies have attempted to demonstrate specific acupuncture effects vs non-specific acupuncture effects, such as those that generate effects based solely on expectation, context, and conditioning. This study illustrates that real acupuncture has a specific physiological effect and additionally that patients’ expectation and belief regarding a potentially beneficial treatment modulate activity in component areas of the reward system.
Acupuncture meridian-network research:
One of the most important concepts in Chinese Medical Theory is that of the meridians or organ-channel system. These channels are believed to be functional networks that course over the body into specific regions, organs, and bodily systems. Meridians are said to represent or reflect the health of various organ systems and it is understood that when these networks become compromised, disease may arise. Although the meridian system has never been proven by modern scientific methods there have been several interesting studies determined to find evidence for there existence.
Researchers from the China Academy of Medical Sciences performed a controlled experiment on pigs by injecting a gel into acupuncture points that were situated along the stomach channel. The experiment was intended to block the flow of information or energy in this meridian, and over the course of several weeks, examine any changes in the animal and especially to the stomach organ. The researchers concluded that the pigs with the gel injected had numerous pathologies, such as bloated stomach/intestines when compared to the control group, which only had saline injected. The team believed that the results of this experiment demonstrates that obstruction along the stomach channel pathway can influence the state of the stomach and intestine, specifically to distention of these organs.
Acupuncture therapy and childbirth:
The aim of this study was to determine the extent of acupuncture’s influence on the duration of labor. This controlled study determined that women who received acupuncture had 70% more Oxytocin during the first stage of labor, and 44% more during the second stage. Oxytocin is an important hormone that is released in large amounts during labor and helps facilitate child birth. Researchers concluded acupuncture is a recommended form of childbirth preparation due to its positive effect on the duration of labor, namely shortening the first stage.
Acupuncture treatment during labor significantly reduced the need of epidural analgesia. Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group. The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.
Acupuncture therapy and heart rate variability(HRV):
Heart rate variability (HRV) is a way to measure beat-to-beat fluctuations in the heart rhythm. A low HRV score has been associated with an increased risk to mortality and a broad range disease marker, whereas a high HRV score seems to suggest increased synchronization between the two branches of the autonomic nervous system and entrainment between multiple body systems. There is strong evidence from randomized placebo controlled studies that acupuncture therapy modulates HRV, which can be used to monitor future treatment efficacy and research methods.
Researchers conducted a study based upon the concept that vagal withdrawal and an overactive sympathetic nervous system can be potentially dangerous to the human body. They chose Sishencong points located around the apex of the skull to conduct a controlled study vs sham points around the periphery. Researchers concluded that manual acupuncture at the Sishencong points enhanced cardiac vagal activity and suppressed sympathetic activities in humans. They believe the underlying mechanisms and potential applications warrant further study.
Real acupuncture at LI4 acupoint lead to a specific change in EEG frequency and in HRV parameters. This relationship was greater in real acupuncture 80% vs 45% and suggests a linear relationship between EEG frequency and HRV.
A branch of the vagus nerve forms a bridge between a circumscribed area of the auricle, the external auditory meatus and an internal organs. These vagal reflexes have shown activity in autonomic functions of cardiovascular, respiratory, and gastrointestinal systems . Further studies have suggested projections from the auricular branch of the vagus nerve (ABVN) form the anatomical basis for vagal regulation in auricular acupuncture.
Stimulation at auricular heart point regulates cardiovascular function by activation of baroreceptor sensitive neurons.
Chronic psychological stress appears to accelerate biological aging, and oxidative damage is an important potential mediator of this process. This study supports the emerging model that chronic stress exposure promotes oxidative damage through frequent and sustained activation of the hypothalamic-pituitary-adrenal axis. It also supports the less studied model of ‘eustress’ – that manageable levels of life stress may enhance psychobiological resilience to oxidative damage.
The authors of this study investigated the effects of cross-group friendships and propose that friendly contact with members of different religious, cultural, ethnic, and racial groups reduce prejudices. The mechanism established for this seems to be self-disclosure, a type of transparent openness, via empathy, contact, and intergroup trust.
Heart Rate Variability:
Heart rate variability(HRV) measures autonomic modulation of the heart. A coherent HRV pattern is associated with an increased synchronization between the two branches of the ANS. It is postulated that a high HRV scores reflect a healthy coherence pattern within sympathetic and parasympathetic systems and may be a marker for healthy and resilient autonomic function.
Decreased HRV has shown a predictive value of certain disease patterns among healthy adults. It has been a well-established risk factor for arrhythmic events and mortality among post-myocardial-infarction patients. Decreased HRV identifies diabetic patients with autonomic neuropathy.
Meditation is a popular arena of research as there have been many claims for health and mood improvements associated with its use. The scope of meditation practice is vast and encompasses many different forms, styles, and techniques; however, experienced meditators often have a particular intention, focus, or goal such as increasing attention, relaxation, or clarity during a given meditation. Still, many styles advice the practitioner to just be aware of their surroundings and not to have any specific goal or desire, perhaps just simply sitting or standing quietly aware of their surroundings. Research seems to suggest that even brief periods of meditation can improve memory, mood, and cognitive abilities.
Researchers examined whether brief meditation training affected cognition and mood compared to a control group. Meditation improved mood and reduced fatigue and anxiety as well as significantly improved visuo-spatial processing, working memory, and executive functioning. Additionally 4 days of meditation training can enhance the ability to sustain attention.
Researchers studied a basic form of concentration meditation in which sustained attention is focused on a small stimulus such as the breath while the brain was examined with the help of fMRI. Researchers found that a region of the brain that is typically involved in sustained attention was activated in advanced meditators more so than novice ones. Additionally, in response to distractor sounds advanced meditators had more activation in regions related to response inhibition and attention.
Gamma waves are patterns of neural oscillations that occur in the brain and may be implicated in what we consciously perceive as “unity”. In this study, long-term Buddhist practitioners self-induce sustained high-amplitude gamma-band oscillations during meditation. Data suggests that mental training involves mechanisms that may induce short-term and long-term brain changes.
Researchers concluded that through mental training, increased control over the distribution of limited brain resources may be possible. Additionally the team confirms that individuals practicing advanced meditation have a greater ability to detect subtle changes, not only in themselves, but also in the environment.
Negative Emotional State:
It has long been suggested in medical literature that negative emotions may contribute to a wide range of disease patterns. Research is emerging that illustrates just how emotional states such as: anger, fear, and pessimism can contribute in the course of a disease.
This study discusses perspectives from psychoneuroimmunology on how negative emotions can intensify a variety of health threats. Negative emotions may have a course of onset starting from the immune system; inflammation has been linked to conditions such as aging, osteoporosis, arthritis, type 2 diabetes, certain cancers, Alzheimer’s disease, fraility and functional decline, and periodontal disease. Production of proinflammatory cytokines that influence these conditions can be stimulated by stress events and negative emotions.
There is a correlation between the expression of anger and hostility and lessened nocturnal blood pressure “dipping”, that is individuals will experience higher blood pressure over the course of a night. Additionally, these emotional traits increase the risk of developing cardiovascular and cerebrovascular disease.
The very act of listening to an angry speech, specifically its rhythm and intonation can illicit parts of the brain to mirror the content of the speaker.
Violent media consumption, the act of watching violence portrayed in the news make participants react slower to happiness and faster to depictions of anger. It is postulated that participants “consuming” this type of media will feel more aggressive, angry, negative, and powerless.
Negative emotions such as negative remarks and memories seem to have a stronger influence when compared to positive emotions in a wide range of cognitive domains. On the bright side of this study however are instances where positive emotions and motivational shifts are happening in older adults.
Oxytocin is a hormone secreted by the pituitary gland and modulates several functions within the human body including increasing positive behavior and social bonding. In a study that investigated relationships among married couples and wound healing researchers concluded that higher levels of oxytocin in the blood were associated with more positive communication and faster wound healing.
Pharmaceuticals in the treatment of depression:
In the last several years studies have been conducted to determine the efficacy of pharmaceutical preparations in the treatment of depression. 2,318 patients were grouped into a double-blind study and were randomly assigned either an anti-depressant or a placebo pill. The results of the study indicated a high correlation between the placebo effect and the drug effect, indicating perhaps that variation in drug effect was due to placebo characteristics of the studies. Researchers concluded that approximately one-quarter of the specific responses are from active-ingredients, half from placebo, and once-quarter from other “non-specific” factors.
Somatovisceral reflexes are nerve reflexes that carry a signal from a stimulated sensory organ, towards the central nervous system, and finally towards the stimulated effector organ. According to studies these phenomena have been demonstrated in sites such as the gastrointestinal tract, urinary bladder, adrenal medula, lymphatic tissues, heart and vessels of the brain and peripheral nerves. . Although the author of this study clearly makes no claim to extrapolate clinical situations from these findings, it is interesting to imagine future research studies that may demonstrate reflex mechanisms in the fields of osteopathic, chiropractic, and acupuncture therapies and perhaps reveal some of the diverse systemic effects attributed to these reflexive methods.
Vagal tone is the state of activity or passivity of the vagal nerve, a key component of our autonomic nervous system. Having high vagal tone is considered beneficial as it represents the dynamic functioning of the parasympathetic nervous system. Diminished activity of the vagas and its corresponding PNS functions is considered low vagal tone.
A team of researchers hypothesized that low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers. Vagal tone was initially measured by measuring heart rate variability in both test and control subjects and by later comparing the two groups after a stress test. The data suggests that low vagal tone was associated with impaired recovery of cardiovascular, endocrine, and immune markers in healthy males. Additionally they concluded resting HRV can be used as a marker for future cardiovascular and stress related disease.